• Investigative Magnetic Resonance Imaging
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• v.15 no.1
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• pp.22-31
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• 2011

Purpose : To compare free-breathing and respiratory-triggered diffusion-weighted imaging on 1.5-T MR system in the detection of hepatic lesions. Materials and Methods: This single-institution study was approved by our institutional review board. Forty-seven patients (mean 57.9 year; M:F = 25:22) underwent hepatic MR imaging on 1.5-T MR system using both free-breathing and respiratory-triggered diffusion-weighted imaging (DWI) at a single examination. Two radiologists retrospectively reviewed respiratory-triggered and free-breathing sets (B50, B400, B800 diffusion weighted images and ADC map) in random order with a time interval of 2 weeks. Liver SNR and lesion-to-liver CNR of DWI were calculated measuring ROI. Results : Total of 62 lesions (53 benign, 9 malignant) that included 32 cysts, 13 hemangiomas, 7 hepatocellular carcinomas (HCCs), 5 eosinophilic infiltration, 2 metastases, 1 eosinophilic abscess, focal nodular hyperplasia, and pseudolipoma of Glisson's capsule were reviewed by two reviewers. Though not reaching statistical significance, the overall lesion sensitivities were increased in respiratory-triggered DWI [reviewer1: reviewer2, 47/62(75.81%):45/62(72.58%)] than free-breathing DWI [44/62(70.97%):41/62(66.13%)]. Especially for smaller than 1 cm hepatic lesions, sensitivity of respiratory-triggered DWI [24/30(80%):21/30(70%)] was superior to free-breathing DWI [17/30(56.7%):15/30(50%)]. The diagnostic accuracy measuring the area under the ROC curve (Az value) of free-breathing and respiratory-triggered DWI was not statistically different. Liver SNR and lesion-to-liver CNR of respiratory-triggered DWI ($87.6{\pm}41.4$, $41.2{\pm}62.5$) were higher than free-breathing DWI ($38.8:{\pm}13.6$, $24.8{\pm}36.8$) (p value < 0.001, respectively). Conclusion: Respiratory-triggered diffusion-weighted MR imaging seemed to be better than free-breathing diffusion-weighted MR imaging on 1.5-T MR system for the detection of smaller than 1 cm lesions by providing high SNR and CNR.

• Journal of Veterinary Clinics
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• v.16 no.2
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• pp.339-351
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• 1999

Excess secretion of goblet cell stimulated by inhalation anesthetics have side effects during operation or postoperative care. Mucosubstances, which are almost secreted by goblet cells in the epithelium of the respiratory tract, are secreted by a direct irritation of inhalation anesthetics. This study was carried out to compare the differences of mucus secretion on lower respiratory tract stimulated by ethyl ether, halothane and isoflurane. Total of 24 rabbits were used as experimental animals. The trachea and the 1st bronchi were fixed in 10% neutral buffered formalin. After embedding in paraffin, the specimens were sectioned to a thickness of 6 ${\mu}{\textrm}{m}$, and PAS-H, Alcian blue pH 2.5 and Alcian blue pH 1.0 stains were performed for the observation of the composition and the quantity of the mucus. The results were as follows; Ethyl ether and isoflurane irritated the mucous membrane of the respiratory tract. Ethyl ether irritated more than isoflurane. Halothane irritated the mucous membrane, but its effect was minimal and had little influences during operation. In the specimens stained with PAS-H, Alcian blue pH 2.5 and Alcian blue pH 1.0, the mucosubstance lining the cilia and in the goblet cells of the trachea and 1st bronchi were the strongly PAS-H reactive mucosubstances, moderately Alcian blue pH 2.5 and Alcian blue pH 1.0. The PAS-H reactive mucosubstance were polysaccharides, neutral mucopolysaccharides, mucoproteins, glycoproteins and glycolipids. Trachea was easily affected than bronchi by inhalation anesthetics. Consequently, it is suggested that because halothane does not irritates respiratory mucosal secretion, its application may be efficient to the depressed respiratory system.

• Tuberculosis and Respiratory Diseases
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• v.69 no.2
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• pp.75-80
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• 2010

The year of 2009~2010 brought a number of concepts and new ideas were evaluated with promising results. However, some studies that challenged many beliefs. In acute respiratory distress syndrome (ARDS), recent clinical studies took into consideration of pathophysiologic changes of respiratory system compliance. Meta-analysis of positive end-expiratory pressure trials showed survival benefit of high positive end-expiratory pressure in ARDS. Until now, prone positioning did not show survival benefit in patients with ARDS. Extracorporeal membrane oxygenation (ECMO) based management improved survival in patients with severe ARDS. ECMO can be a management option in severe ARDS. Sedation is a standard practice in critically ill patients needing mechanical ventilation. However, Danish group reported less sedation of critically ill patients receiving mechanical ventilation was associated with an increase in days without ventilation. Although this single center study has some limitations, the overall results are promising. Use of maximal sterile barrier precautions (mask, sterile gown, sterile gloves, and large sterile drapes) with chlorhexidine-impregnated dressing reduced central venous catheter related infection. Selective oropharyngeal decontamination (application of topical antibiotics in the oropharynx) reduced the mortality rate of an intensive care unit (ICU) population. Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial reported intensive glucose control increased mortality among adults in the ICU. Some of the results of above papers are promising. However, some ideas may need for more frequent individual assessment and increase the workload of ICU staffs. Before implementation of new practice in ICU, we should take into consideration of individual hospital situation including human and material resources.

• Korean Journal of Veterinary Service
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• v.45 no.3
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• pp.145-153
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• 2022

Pathogens such as feline herpesvirus, feline calicivirus, Bordetella bronchiseptica, Chlamydia felis, Mycoplasma felis and Pasteurella multocida usually cause feline upper respiratory tract disease (URTD). Real-time PCR was used to analyze the detection and prevalence of the most common respiratory pathogens in cats with (n=69) and without respiratory signs (n=31). Pathogens were detected in 53 cats, divided into 37 (69.8%) with a single pathogen, 15 (28.3%) with two pathogens, and 1 (1.9%) with three pathogens. M. felis had the highest detection rate in 29 (42.0%) cats, P. multocida was detected in 18 (26.1%), FHV in 10 (14.5%), FCV in 7 (10.1%), B. bronchiseptica in 3 (4.3%), and C. felis in 2 (2.9%). M. felis was the most frequently detected pathogen in cats living outdoors without vaccination. Of the 37 cats infected with single pathogen, nasal discharge was observed in 13 (35.1%), ocular signs in 6 (16.2%), drooling in 5 (13.5%), dyspnea in 3 (8.1%), and asymptomatic in 10 (27.0%). In 51 outdoor and 49 indoor cats, pathogens were detected in 35 (68.6%) and 18 (36.7%) cats, respectively. Of the 29 cats infected with M. felis, 22 (75.9%) showed respiratory signs, and 7 (24.1%) were healthy. In the age of the 53 positive cats, 10 (18.9%) were under the age of 1 year, 26 (49.1%) were aged 1~3 years, and 17 (32.1%) were aged 3 years or older. Although the number of cats in the study was small, the results can provide valuable data on the prevalence of URTD in Korean cats.

• The Journal of Korean Physical Therapy
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• v.16 no.1
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• pp.1-13
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• 2004

Airway clearance technique are used to aid in mucus clearance in a variety of disease states. In this review I discuss airway physiology including airway mucus, action of airways, and airway resistance and review the literature and theory regarding forced expiratory technique, active cycle of breathing technique, and autogenic drainage. Also, I look at the appropriate device such as positive expiratory pressure mask(PEP mask), Flutter, and HFCWO(Vest system) which can be applied in the field of respiratory physical therapy. This study is provided as the basic resource regarding the application method of respiratory physical therapy.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.2
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• pp.107-113
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• 2013

Purpose: To verify accuracy of respiratory gated proton therapy by measuring and analyzing proton beam delivered when respiratory gated proton therapy is being performed in our institute. Materials and Methods: The plan data of 3 patients who took respiratory gated proton therapy were used to deliver proton beam from proton therapy system. The manufactured moving phantom was used to apply respiratory gating system to reproduce proton beam which was partially irradiated. The key characteristics of proton beam, range, spreat-out Bragg peak (SOBP) and output factor were measured 5 times and the same categories were measured in the continuous proton beam which was not performed with respiratory gating system. Multi-layer ionization chamber was used to measure range and SOBP, and Scanditronix Wellhofer and farmer chamber was used to measure output factor. Results: The average ranges of 3 patients (A, B, C), who had taken respiratory gated proton therapy or not, were (A) 7.226, 7.230, (B) 12.216, 12.220 and (C) 19.918, 19.920 $g/cm^2$ and average SOBP were (A) 4.950, 4.940, (B) 6.496, 6.512 and (C) 8.486, 8.490 $g/cm^2$. And average output factor were (A) 0.985, 0.984 (B) 1.026, 1.027 and (C) 1.138, 1.136 cGy/MU. The differences of average range were -0.004, -0.004, -0.002 $g/cm^2$, that of SOBP were 0.010, -0.016, -0.004 $g/cm^2$ and that of output factor were 0.001, -0.001, 0.002 cGy/MU. Conclusion: It is observed that the range, SOBP and output factor of proton beam delivered when respiratory gated proton therapy is being performed have the same beam quality with no significant difference compared to the proton beam which was continuously irradiated. Therefore, this study verified the quality of proton beam delivered when respiratory gated proton therapy and confirmed the accuracy of proton therapy using this.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.73-78
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• 2015

Purpose : Under the assumption of change to the amplitude based sorting, the study will use four dimensional computed tomography imaging (4DCT) arrayed using the phase based sorting to analyze the respiratory phase difference. Materials and Methods : The study analyzed the 4DCT (4-dimensional computed tomography) images of 10 liver cancer patients that were treated with respiratory gated radiotherapy from 2015 February to March. Using RPM respiratory gating (RPM 1.7.5, Varian, USA) equipment, imaging according to respiratory cycle of phase based sorting was acquired and using a treatment planning system (Pinnacle 9.2, Philips, USA) the acquired imaging according to respiratory cycle was used to measure the abdominal movement value by respiratory cycle. The measuring point was the point where the center point of the Marker Block and the body surface met in the 50% phase image and here the coordinate values Lateral, Vertical, Longitudinal (X, Y, Z) were set as reference points, and on the X, Z plane identical to the reference point, using the identical method the Y axis coordinate value of each 0%, 30%, 40%, 50%, 60%, 80% phase images were acquired to quantitatively measure the variation of distance to the Y axis. The abdominal movement value according to respiration was applied to the theoretical model that the value decreases linearly from maximum inhalation to maximum exhalation to divide the variation of my value to predict as amplitude value by respiratory cycle and conversely the variation in amplitude was recalculated with the phase variation deviation value to analyze. Results : The deviation value between expected value and actual location was the largest in the 30% phase with 0.24 cm, and standard deviation was also the largest in 30% phase with 0.13 cm. The effective value of the deviation value derived from the average of the deviation squared value of each patient appeared as minimum 0.7 cm, maximum 0.18 cm, average 0.12 cm, and standard deviation 0.4 cm. Also by dividing the actual movement distance value with the peak expiration value then converting it into %Phase, the deviation value with actual phase 16.5% in 30% phase, 10.0% and 40% phase, 10.0% and 60% phase, 15.4% and 80% phase, and overall average about 13%, and arraying based on amplitude, phase shift occurred and further it was from peak expiration the chance of deviation occurrence was increasingly measured. Conclusion : Based on the results of the study there were differences between value acquired based on theoretical model and actual value. Therefore in respiratory gated radiotherapy using external surrogates, there needs to be establishment of respiration gated radiation system that avoids the combination of two Sorting methods considering that there will be occurrence of treatment and corresponding clinical differences due to the phase difference that occur due to the Amplitude based Phase Sorting.

• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.683-693
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• 1993

Background: During movement the major inputs to nervous system come from firstly the muscle and joint to maintain posture and motion and secondly the chemoreceptors and baroreceptors to adjust the cardiovascular and respiratory function. Their complex relationships are generally studied for many years but the direct relation between the joint and respiratory system is not studied thoroughly until now. So this experiment was performed to determine whether the natural movement of knee joint can cause the enhancement of respiratory function by observation of the changes of respiratory rate, phrenic nerve activity and inspiratory neuron activity during the stimulation of knee joint in cat anesthetized with $\alpha$-chloralose. Method: Twenty six male adult cats were used and the extracelluar recording using bipolar platinum electrode and carbon filament electrode was done to record the changes in the activities of phrenic nerve and inspiratory neuron movement of knee joint, injection of chemicals into the joint cavity and electrical stimulation of articular nerve were done. Results: The 60 Hz. could not but 120 Hz. flexion-extension movement of knee joint increased respiratory rate(R.R.), tidal neural activity(TNA) and minute neural activity(MNA). Intra-articular injection of lactate could not increase R.R. but significantly increase TNA and MNA which represented the enhanced respiratory function. Injection of potassium chloride showed similar effects with the case of lactate but the duration of effect was shorter. The electrical stimulation of medial articular nerve with IV strength which could activate only group I and II afferents showed increased TNA and MNA during stimulation but 20 V stimulation which could activate all the afferents increased all the respiratory parameters. The changes of inspiratory neuron activity by knee joint stimulation was similar to that of phrenic nerve. Conclusion: The respiratory center could be directly stimulated by the activation of group I and II articular afferents and it seemed that the magnitude of the respiratory center enhancement is proportional to the amount of sensory information from the knee joint. These facts might suggest that the respiratory function could be enhanced even by the normal movement of knee joint.

• Journal of Radiation Protection and Research
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• v.34 no.3
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• pp.137-143
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• 2009

This study was conducted to evaluate the accuracy of CyberKnife $Synchrony^{TM}$ respiratory tracking system which was applied to Stereotactic Radiosurgery (SRS) for moving tumors in chest and abdomen with breathing motion. For accurate evaluation, gold fiducial marks were implanted into a moving phantom. The moving phantom was a cube imbedding an acryl ball as a target. The acryl ball was prescribed to 20 Gy at 70% of isodose curve in a virtual treatment and radiochromic films were inserted into the acryl ball for dose verification and tracking accuracy evaluation. The evaluation of position tracking consists of two parts: fiducial mark tracking in a stationary phantom and $Synchrony^{TM}$ respiratory tracking in a moving phantom. Each measurement was done in three directions and was repeated to 5 times. Range of position error was 0.1957 mm to 0.6520 mm in the stationary phantom and 0.4405 mm to 0.7665 mm in the moving phantom. Average position error was 0.3926 mm and 0.5673 mm in the stationary phantom and the moving phantom respectively. This study evaluates the accuracy of CyberKnife $Synchrony^{TM}$ Respiratory tracking system, and confirms the usefulness when it's used for Stereotactic Radiosurgery of body organs.

• The Journal of Korean Physical Therapy
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• v.15 no.2
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• pp.111-122
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• 2003

The purpose of this study was to investigate the influence on sympathetic nerve system of interferential current therapy(ICT). The subjects were consisted of 20 senile patients, 10 males and 10 females with an average age of 71 years old. And systolic and diastolic blood pressure, temperature, heart rate, and respiratory were tested. The results were as follows: 1) Systolic and diastolic blood pressure were observed a statistical significance between before and during stimulation(p < .05). 2) Temperature was observed a statistical significance between before and during, and before and after 10 minutes stimulation(p < .05). 3) Heart rate and respiratory were not statistical significance(p > .05). These results are imply that electrical stimulation is directly or indirectly influence on sympathetic nerve system.