Rabbit and pig lung damage comparison from exposure to continuous wave 30-kHz ultrasound

Ammonia-induced oxidative stress triggered proinflammatory response and apoptosis in pig lungs

Ammonia, a common toxic gas, is not only one of the main causes of haze, but also can enter respiratory tract and directly affect the health of humans and animals. Pig was used as an animal model for exploring the molecular mechanism and dose effect of ammonia toxicity to lung. In this study, the apoptosis of type II alveolar epithelial cells was observed in high ammonia exposure group using transmission electron microscopy. Gene and protein expression analysis using transcriptome sequencing and western blot showed that low ammonia exposure induced T-cell-involved proinflammatory response, but high ammonia exposure repressed the expression of DNA repair-related genes and affected ion transport. Moreover, high ammonia exposure significantly increased 8-hydroxy-2-deoxyguanosine (8-OHdG) level, meaning DNA oxidative damage occurred. In addition, both low and high ammonia exposure caused oxidative stress in pig lungs. Integrated analysis of transcriptome and metabolome revealed that the up-regulation of LDHB and ND2 took part in high ammonia exposure-affected pyruvate metabolism and oxidative phosphorylation progress, respectively. Inclusion, oxidative stress mediated ammonia-induced proinflammatory response and apoptosis of porcine lungs. These findings may provide new insights for understanding the ammonia toxicity to workers in livestock farms and chemical fertilizer plants.

State of the Art in Lung Ultrasound, Shifting from Qualitative to Quantitative Analyses

Lung ultrasound (LUS) has been increasingly expanding since the 1990s, when the clinical relevance of vertical artifacts was first reported. However, the massive spread of LUS is only recent and is associated with the coronavirus disease 2019 (COVID-19) pandemic, during which semi-quantitative computer-aided techniques were proposed to automatically classify LUS data. In this review, we discuss the state of the art in LUS, from semi-quantitative image analysis approaches to quantitative techniques involving the analysis of radiofrequency data. We also discuss recent in vitro and in silico studies, as well as research on LUS safety. Finally, conclusions are drawn highlighting the potential future of LUS.

A Model for Predicting Malignant Sub-pleural Solid Masses Using Grayscale Ultrasound and Ultrasound Elastography

This article aimed to establish a prediction model of grayscale sonography and ultrasound elastography for malignant sub-pleural solid masses and evaluate its diagnostic value. The study included 153 patients, including 89 patients with malignant tumors and 64 patients with benign diseases. Statistical differences between the malignant and benign groups were found in the factors of age, air bronchogram, borderline, shape and elasticity score (p < 0.05). Age, elasticity score and borderline were effective factors for predicting malignant sub-pleural solid masses, offering an area under the receiver operating characteristic curve (AUROC) value of 0.72 (95% confidence interval [CI] 0.64-0.80), 0.73 (95% CI 0.65-0.79) and 0.70 (95% CI 0.62-0.77), respectively. The AUROC value of the prediction model for malignant sub-pleural solid masses was 0.88 (95% CI 0.81-0.92), which indicates that the prediction model was able to improve the diagnostic accuracy and that it may prove a useful auxiliary diagnostic tool for malignant sub-pleural solid masses, especially in primary health care institutions in developing countries.

The effect of ultrasound with acoustic radiation force on rabbit lung tissue: a preliminary study

PURPOSE

Acoustic radiation force (ARF) elastography has recently become available. The previous animal studies have revealed lung injuries induced by diagnostic ultrasound, but the effects on the lung resulting from exposure to ultrasound with ARF are unknown. This study aimed to assess the risk of lung injury associated with ultrasound with ARF.

METHODS

A focused 2.5-MHz transducer that emits ultrasound with ARF was used. A rabbit was anesthetized, and the transducer was placed in the right subcostal region. Exposure settings of mechanical index (MI) 0.80, pulse duration 10 ms, pulse repetition time 5 s, and exposure time 150 s were applied.

RESULTS

One red spot (7 × 6 mm) was observed on the surface of the right lung corresponding to the area of exposure. Alveolar hemorrhage was observed microscopically. This lesion was visible across a range of 20-170 μm in depth from the pleural surface.

CONCLUSION

The first example of lung hemorrhage induced by ultrasound with ARF was observed in this study. This observation suggests the possibility of lung injury in humans when ARF elastography is applied with the transducer directed toward the lung. Further studies are needed to determine the safety of this modality.

Application of analyzer based X-ray imaging technique for detection of ultrasound induced cavitation bubbles from a physical therapy unit

BACKGROUND

The observation of ultrasound generated cavitation bubbles deep in tissue is very difficult. The development of an imaging method capable of investigating cavitation bubbles in tissue would improve the efficiency and application of ultrasound in the clinic. Among the previous imaging modalities capable of detecting cavitation bubbles in vivo, the acoustic detection technique has the positive aspect of in vivo application. However the size of the initial cavitation bubble and the amplitude of the ultrasound that produced the cavitation bubbles, affect the timing and amplitude of the cavitation bubbles' emissions.

METHODS

The spatial distribution of cavitation bubbles, driven by 0.8835 MHz therapeutic ultrasound system at output power of 14 Watt, was studied in water using a synchrotron X-ray imaging technique, Analyzer Based Imaging (ABI). The cavitation bubble distribution was investigated by repeated application of the ultrasound and imaging the water tank. The spatial frequency of the cavitation bubble pattern was evaluated by Fourier analysis. Acoustic cavitation was imaged at four different locations through the acoustic beam in water at a fixed power level. The pattern of cavitation bubbles in water was detected by synchrotron X-ray ABI.

RESULTS

The spatial distribution of cavitation bubbles driven by the therapeutic ultrasound system was observed using ABI X-ray imaging technique. It was observed that the cavitation bubbles appeared in a periodic pattern. The calculated distance between intervals revealed that the distance of frequent cavitation lines (intervals) is one-half of the acoustic wave length consistent with standing waves.

CONCLUSION

This set of experiments demonstrates the utility of synchrotron ABI for visualizing cavitation bubbles formed in water by clinical ultrasound systems working at high frequency and output powers as low as a therapeutic system.

Bio-effects and safety of low-intensity, low-frequency ultrasonic exposure

Low-frequency (LF) ultrasound (20-100 kHz) has a diverse set of industrial and medical applications. In fact, high power industrial applications of ultrasound mainly occupy this frequency range. This range is also used for various therapeutic medical applications including sonophoresis (ultrasonic transdermal drug delivery), dentistry, eye surgery, body contouring, the breaking of kidney stones and eliminating blood clots. While emerging LF applications such as ultrasonic drug delivery continue to be developed and undergo translation for human use, significant gaps exist in the coverage of safety standards for this frequency range. Accordingly, the need to understand the biological effects of LF ultrasound is becoming more important. This paper presents a broad overview of bio-effects and safety of LF ultrasound as an aid to minimize and control the risk of these effects. Its particular focus is at low intensities where bio-effects are initially observed. To generate a clear perspective of hazards in LF exposure, the mechanisms of bio-effects and the main differences in action at low and high frequencies are investigated and a survey of harmful effects of LF ultrasound at low intensities is presented. Mechanical and thermal indices are widely used in high frequency diagnostic applications as a means of indicating safety of ultrasonic exposure. The direct application of these indices at low frequencies needs careful investigation. In this work, using numerical simulations based on the mathematical and physical rationale behind the indices at high frequencies, it is observed that while thermal index (TI) can be used directly in the LF range, mechanical index (MI) seems to become less reliable at lower frequencies. Accordingly, an improved formulation for the MI is proposed for frequencies below 500 kHz.

Low-frequency ultrasound increases non-viral gene transfer to the mouse lung

The aim of the study was to assess if low-frequency ultrasound (US), in the range of 30-35 kHz, increases non-viral gene transfer to the mouse lung. US is greatly attenuated in the lung due to large energy losses at the air/tissue interfaces. The advantages of low-frequency US, compared with high-frequency US are: (i) increased cavitation (responsible for the formation of transient pores in the cell membrane) and (ii) reduced energy losses during lung penetration. Cationic lipid GL67/plasmid DNA (pDNA), polyethylenimine (PEI)/pDNA and naked pDNA were delivered via intranasal instillation and the animals were then exposed to US (sonoporation) at 0.07 or 0.1 MPa for 10 min. Under these conditions, US did not enhance GL67 or PEI-mediated transfection. It did, however, increase naked pDNA gene transfer by approximately 4 folds. Importantly, this was achieved in the absence of microbubbles, which are crucial for the commonly used high-frequency (1 MHz) sonoporation but may not be able to withstand nebulization in a clinically relevant setup. Lung hemorrhage was also assessed and shown to increase with US pressure in a dose-dependent manner. We have thus, established that low-frequency US can enhance lung gene transfer with naked pDNA and this enhancement is more effective than the previously reported 1 MHz US.

An animal model for ultrasound lung imaging

In the past decade, a number of clinical investigators have used ultrasound (US) to image the lung during video-assisted thoracoscopic surgery (VATS). In contrast, animal studies have shown prohibitively high attenuation levels in the lung, incompatible with the ability to image the lung. We hypothesized that the use of anesthesia during VATS augments lung collapse upon exposure to atmospheric pressure; thus, making US lung imaging possible. To test this hypothesis, we compared the effect of two commonly used anesthetic protocols on our ability to image 200 microL of US gel injected in rabbit lungs using a pulse echo transducer at 13 MHz. The anesthetic protocol, using acepromazine, ketamine and isoflurane, allowed US lung imaging in rabbits. It is concluded that US at 13 MHz can detect 200 microL of US gel injected into the lung parenchyma in a rabbit model.

High-frequency sound transmissions under water and risk of decompression sickness

We tested the possible occurrence of a neurological insult secondary to high-frequency sound exposure. Immersed, anesthetized rats were subjected to a simulated diving profile designed to induce decompression sickness, while exposed to the transmission of an acoustic beacon. Intermittent sound at a pressure level of 184.5 dB re 1 microPa at 1 m (1.7 kPa), a frequency of 37 kHz, and with a duration of 4 ms, was transmitted in a duty cycle of 0.26%. Four groups, each containing nine animals, were included in the study as follows: group 1, immersion only, no sound exposure; group 2, immersion with sound exposure; group 3, diving simulation when immersed, no sound exposure; group 4, diving simulation when immersed, with sound exposure. Somatosensory evoked potentials (SSEPs) were recorded the day before the study, and a second recording was made 30 min after immersion. Some of the SSEP components disappeared after the dive in 3 rats from group 3 and 2 rats from group 4. SSEP components could not be identified in a significantly larger number of animals from groups 3 and 4, compared with groups 1 and 2. No differences were found in wave latency, amplitude or conduction time. Our data show that the high-frequency sound exposure employed did not contribute to the development of the neurological insult.

A one-dimensional model for the propagation of transient pressure waves through the lung

The propagation of pressure waves in the lung has been investigated by many authors concerned with respiratory physiology, ultrasound medical techniques or thoracic impact injuries. In most of the theoretical studies, the lung has been modeled as an isotropic and homogeneous medium, and by using Hooke's constitutive law (see e.g. Ganesan et al. Respir. Physiol. 110 (1997) 19; Jahed et al. J. Appl. Physiol. 66 (1989) 2675; Grimal et al. C.R. Acad. Sci., Paris 329 (IIb) (2001) 655-662), or more elaborated material laws (see, e.g. Bush and Challener (Proceedings of the International Research Council on Biokinetics Impacts (IRCOBI), Bergish-gladbach, 1988); Stuhmiller et al. J. Trauma 28 (1988) S132; Yang and Wang, Finite element modeling of the human thorax. Web page: http://wwwils.nlm.nih.gov/research/visible/vhpconf98/AUTHORS/YANG/YANG.HTM.). The hypothesis of homogeneous medium may be inappropriate for certain problems. Because of its foam-like structure, the behavior of the lung-even if the air and the soft tissue are assumed to behave like linearly elastic materials-is susceptible to be frequency dependent. In the present study, the lung is viewed as a one-dimensional stack of air and soft tissue layers; wave propagation in such a stack can be investigated in an equivalent mass-spring chain (El-Raheb (J. Acoust. Soc. Am. 94 (1993) 172; Int. J. Solids Struct. 34 (1997) 2969), where the masses and springs, respectively, represent the alveolar walls and alveolar gas. Results are presented in the time and frequency domains. The frequency dependence (cutoff frequency, variations in phase velocity) of the lung model is found to be highly dependent on the mean alveolar size. We found that short pulses induced by high velocity impacts (bullet stopped by a bulletproof jacket) can be highly distorted during the propagation. The pressure differential between two alveoli is discussed as a possible injury criterion.

High-frequency sound field and bubble formation in a rat decompression model

High-frequency sound might cause bubble enlargement by rectified diffusion. The purpose of the present study was to investigate gas bubble formation in the immersed diving animal during exposure to high-frequency sound. Anaesthetised rats were subjected to a simulated diving profile while immersed inside a hyperbaric chamber. An acoustic beacon (pinger) was placed ventral to the animal's abdomen, transmitting at an intensity of 208.9 dB re 1 micro Pa and a frequency of 37 kHz. Six groups of eight animals were included in the study as in Table 1, breathing air (n = 4) or Nitrox 72/28 (n = 2), at a depth of 0 m, 30 m or 40 m. Immediately after decompression, the intestinal mesenterium was imaged, and frames were acquired digitally. The number of bubbles and their radii were analysed and compared among the groups. The mean bubble density for group 1 was 1.35 +/- 0.18 bubbles/mm(2), significantly higher when compared with the other groups (p < 0.0001). The average bubble radius for groups 1 and 2 was similar (12.57 +/- 4.1 and 10.63 +/- 1.8 microm, respectively), but significantly larger than in the other groups (p < 0.0002). The percentage of bubbles with a radius greater than 50 microm was significantly higher in group 1 (p < 0.0001). The results suggest that commercially available underwater pingers might enhance bubble growth during deep air diving.

The effect of low-frequency ultrasound on immersed pig lungs

Acoustic models suggest that high-intensity, low-frequency ultrasound (US) at 21-31 kHz, could cause damage to divers' lungs. The purpose of the study was to investigate lung tissue changes secondary to water-borne low-frequency US produced by commonly used underwater acoustic beacons (pingers). Explanted pig lungs were immersed and exposed to four different modes of low-frequency US pinger transmission. In each trial, 5 pairs of lungs were exposed to sound and 5 pairs served as controls. One central and one peripheral section were taken from each lung and evaluated microscopically for location and extent of damage. When present, microhaemorrhages were primarily found in a patchy alveolar distribution, as well as in the septal and subpleural regions. Only rare focal microhaemorrhages could be found in the Control Group. The results demonstrate a potential hazard to the immersed lungs of large mammals on exposure to prolonged transmission by commercially available underwater pingers. The relevance of these findings to human exposure should be further evaluated.

Lung damage assessment from exposure to pulsed-wave ultrasound in the rabbit, mouse, and pig

The principal motivation of the study was to assess experimentally the question: "Is the MI (Mechanical Index) an equivalent or better indicator of nonthermal bioeffect risk than I(SPPA.3) (derated spatial peak, pulse average intensity)?" To evaluate this question, the experimental design consisted of a reproducible biological effect in order to provide a quantitative assessment of the effect. The specific biological effect used was lung damage and the species chosen was the rabbit. This work was initiated, in part, by a study in which lung hemorrhage was observed in 7-week old C3H mice for diagnostic-type, pulsed-wave ultrasound exposures, and, therefore, 6- to 7-week old C3H mice were used in this study as positive controls. Forty-seven adult New Zealand White male rabbits were exposed to a wide range of ultrasound amplitude conditions at center frequencies of 3 and 6 MHz with all temporal exposure variables held constant. A calibrated, commercial diagnostic ultrasound system was used as the ultrasound source with output levels exceeding, in some cases, permissible FDA levels. The MI was shown to be at least an equivalent, and in some cases, a better indicator of rabbit lung damage than either the I(SPPA.3) or p(r.3) (derated peak rarefactional pressure), thus answering the posed question positively. Further, in situ exposure conditions were estimated at the lung pleural surface (PS); the estimated in situ I(SPPA.PS) and p(r.PS) exposure conditions tracked lung damage no better than I(SPPA.3) and p(r.3), respectively, whereas the estimated in situ MI(PS) exposure condition was a slightly poorer predictor of lung damage than MI. Finally, the lungs of six adult crossbred pigs were exposed at the highest amplitude exposure levels permitted by a diagnostic ultrasound system (to prevent probe damage) at both frequencies; no lung damage was observed which suggests the possibility of a species dependency biological effect.