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Keeling H, Williams EJ, Itasaki N. Consideration of the thoracic phenotype of cerebro-costo-mandibular syndrome. Clin Anat 2024; 37:254-269. [PMID: 37265362 DOI: 10.1002/ca.24054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/01/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023]
Abstract
Cerebro-costo-mandibular syndrome (CCMS) is a congenital condition with skeletal and orofacial abnormalities that often results in respiratory distress in neonates. The three main phenotypes in the thorax are posterior rib gaps, abnormal costovertebral articulation and absent ribs. Although the condition can be lethal, accurate diagnosis, and subsequent management help improve the survival rate. Mutations in the causative gene SNRPB have been identified, however, the mechanism whereby the skeletal phenotypes affect respiratory function is not well-studied due to the multiple skeletal phenotypes, lack of anatomy-based studies into the condition and rarity of CCMS cases. This review aims to clarify the extent to which the three main skeletal phenotypes in the thorax contribute to respiratory distress in neonates with CCMS. Despite the posterior rib gaps being unique to this condition and visually striking on radiographic images, anatomical consideration, and meta-analyses suggested that they might not be the significant factor in causing respiratory distress in neonates. Rather, the increase in chest wall compliance due to the rib gaps and the decrease in compliance at the costovertebral complex was considered to result in an equilibrium, minimizing the impact of these abnormalities. The absence of floating ribs is likely insignificant as seen in the general population; however, a further absence of ribs or vestigial rib formation is associated with respiratory distress and increased lethality. Based on these, we propose to evaluate the number of absent or vestigial ribs as a priority indicator to develop a personalized treatment plan based on the phenotypes exhibited.
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Affiliation(s)
- Holly Keeling
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | | | - Nobue Itasaki
- Faculty of Health Sciences, University of Bristol, Bristol, UK
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2
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Glau CL, Lin EE, Conlon TW, Himebauch AS, Keim GP, Nishisaki A. Ultrasound assessment of diaphragm thickness, contractility, and strain in healthy pediatric patients. Pediatr Pulmonol 2024; 59:433-441. [PMID: 38038168 DOI: 10.1002/ppul.26768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/12/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Ultrasound-based diaphragmatic assessments are becoming more common in pediatric acute care, but baseline pediatric diaphragm thickness and contractility values remain unknown. METHODS We conducted a prospective, observational study of healthy children aged <18 years undergoing elective surgery. Diaphragm thickness at end-expiration (Tdi-exp), thickening fraction (DTF) and excursion were measured by ultrasound during spontaneous breathing and during mechanical ventilation. Diaphragm strain and peak strain rate were ascertained post hoc. Measurements were compared across a priori specified age groups (<1 year, 1 to <3, 3 to <6, 6 to <12, and 12 to <18 years) and with versus without mechanical ventilation. RESULTS Fifty subjects were evaluated (n = 10 per age group). Baseline mean Tdi-exp was 0.19 ± 0.04 cm, DTF 0.19 ± 0.09, excursion 1.69 ± 0.97 cm, strain -10.3 ± 4.9, peak strain rate -0.48 ± 0.21 s-1 . No significant difference in Tdi-exp or DTF was observed across age groups (p > .05). Diaphragm excursion increased with age (p < .0001). Diaphragm strain was significantly greater in the 12-17-year age group (-14.3 ± 6.4), p = .048, but there were no age-related differences in peak strain rate (p = .08). During mechanical ventilation, there were significant decreases in DTF 0.12 ± 0.04 (p < .0001), excursion 1.08 ± 0.31 cm (p < .0001), strain -4.60 ± 1.93 (p < .0001), and peak strain rate -0.20 ± 0.10 s-1 (p < .0001) while there was no change in Tdi-exp 0.18 ± 0.03 cm (p = .25) when compared to baseline values. CONCLUSION Pediatric Tdi-exp, DTF, and diaphragm peak strain rate were similar across age groups. Diaphragm excursion and strain varied across age groups. All measures of diaphragm contractility were diminished during mechanical ventilation.
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Affiliation(s)
- Christie L Glau
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elaina E Lin
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Garrett P Keim
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Müller S, Kluck R, Jagodzinski C, Brügelmann M, Hohenfellner K, Büscher A, Kemper MJ, Fröde K, Oh J, Billing H, Thumfart J, Weber LT, Acham-Roschitz B, Arbeiter K, Tönshoff B, Hagenberg M, Pavičić L, Haffner D, Zivicnjak M. Chest configuration in children and adolescents with infantile nephropathic cystinosis compared with other chronic kidney disease entities and its clinical determinants. Pediatr Nephrol 2023; 38:3989-3999. [PMID: 37415042 PMCID: PMC10584709 DOI: 10.1007/s00467-023-06058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Infantile nephropathic cystinosis (INC) is a systemic lysosomal storage disease causing intracellular cystine accumulation, resulting in renal Fanconi syndrome, progressive kidney disease (CKD), rickets, malnutrition, and myopathy. An INC-specific disproportionately diminished trunk length compared to leg length poses questions regarding the functionality of the trunk. METHODS Thus, we prospectively investigated thoracic dimensions and proportions, as well as their clinical determinants in 44 pediatric patients with INC with CKD stages 1-5 and 97 age-matched patients with CKD of other etiology between the ages of 2-17 years. A total of 92 and 221 annual measurements of patients with INC and CKD, respectively, were performed, and associations between anthropometric and clinical parameters were assessed using linear mixed-effects models. RESULTS Patients with INC exhibited altered chest dimensions that were distinct from CKD controls, characterized by markedly increased chest depth to height and chest depth to chest width ratio z-scores (> 1.0), while those of patients with CKD were only mildly affected (z-score within ± 1.0). Ratio z-scores differed significantly between both patient groups from 2-6 years of age onward. The degree of chest disproportion in INC patients was significantly associated with both the degree of CKD and tubular dysfunction (e.g., low serum phosphate and bicarbonate) across three different age groups (2-6, 7-12, and 13-17 years). CONCLUSION Our data show an INC-specific alteration in thoracic shape from early childhood onward, which is distinct from CKD of other etiologies, suggesting early childhood subclinical changes of the musculoskeletal unit of the thoracic cage, which are associated with kidney function. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Sophia Müller
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Rika Kluck
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Celina Jagodzinski
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Malina Brügelmann
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Anja Büscher
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | | | - Kerstin Fröde
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jun Oh
- Division of Pediatric Nephrology, University Children's Hospital Hamburg, Hamburg, Germany
| | - Heiko Billing
- Clinic for Pediatric and Adolescent Medicine, RHK Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Julia Thumfart
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | | | - Klaus Arbeiter
- Division of Pediatric Nephrology and Gastroenterology, Medical University Vienna, Vienna, Austria
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Martina Hagenberg
- Children's Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | | | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Miroslav Zivicnjak
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Brossier D, Flechelles O, Sauthier M, Engert C, Chahir Y, Emeriaud G, Cheriet F, Jouvet P, de Montigny S. Evaluation of the SIMULRESP: A simulation software of child and teenager cardiorespiratory physiology. Pediatr Pulmonol 2023; 58:2832-2840. [PMID: 37530484 DOI: 10.1002/ppul.26595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/16/2022] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Mathematical models based on the physiology when programmed as a software can be used to teach cardiorespiratory physiology and to forecast the effect of various ventilatory support strategies. We developed a cardiorespiratory simulator for children called "SimulResp." The purpose of this study was to evaluate the quality of SimulResp. METHODS SimulResp quality was evaluated on accuracy, robustness, repeatability, and reproducibility. Blood gas values (pH, PaCO2 , PaO2, and SaO2 ) were simulated for several subjects with different characteristics and in different situations and compared to expected values available as reference. The correlation between reference and simulated data was evaluated by the coefficient of determination and Intraclass correlation coefficient. The agreement was evaluated with the Bland & Altman analysis. RESULTS SimulResp produced healthy child physiological values within normal range (pH 7.40 ± 0.5; PaCO2 40 ± 5 mmHg; PaO2 90 ± 10 mmHg; SaO2 97 ± 3%) starting from a weight of 25-35 kg, regardless of ventilator support. SimulResp failed to simulate accurate values for subjects under 25 kg and/or affected with pulmonary disease and mechanically ventilated. Based on the repeatability was considered as excellent and the reproducibility as mild to good. SimulResp's prediction remains stable within time. CONCLUSIONS The cardiorespiratory simulator SimulResp requires further development before future integration into a clinical decision support system.
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Affiliation(s)
- David Brossier
- CHU Sainte Justine Research Center, Université de Montreal, Montreal, Canada
- Pediatric Intensive Care Unit, CHU de Caen, Caen, France
- School of Medicine, Université Caen Normandie, Caen, France
- Université de Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- Université Caen Normandie, GREYC, Caen, France
| | - Olivier Flechelles
- Pediatric and Neonatal Intensive Care Unit, CHU de Martinique, Fort de France, France
| | - Michael Sauthier
- CHU Sainte Justine Research Center, Université de Montreal, Montreal, Canada
- Pediatric Intensive Care Unit, CHU Sainte Justine, Montreal, Canada
| | - Catherine Engert
- CHU Sainte Justine Research Center, Université de Montreal, Montreal, Canada
| | | | - Guillaume Emeriaud
- CHU Sainte Justine Research Center, Université de Montreal, Montreal, Canada
- Pediatric Intensive Care Unit, CHU Sainte Justine, Montreal, Canada
| | - Farida Cheriet
- CHU Sainte Justine Research Center, Université de Montreal, Montreal, Canada
- École Polytechnique de Montréal, Montréal, Canada
| | - Philippe Jouvet
- CHU Sainte Justine Research Center, Université de Montreal, Montreal, Canada
- Pediatric Intensive Care Unit, CHU Sainte Justine, Montreal, Canada
| | - Simon de Montigny
- CHU Sainte Justine Research Center, Université de Montreal, Montreal, Canada
- École de santé publique, Université de Montréal, Montréal, Canada
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Gao Q, Ji H, Wu Z, Zhao P. Effect of ultrasound-guided lung recruitment manoeuvre on perioperative atelectasis during laparoscopy in young infants: A randomised controlled trial. J Clin Anesth 2023; 86:111075. [PMID: 36796214 DOI: 10.1016/j.jclinane.2023.111075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Pneumoperitoneum is a risk factor for perioperative atelectasis in infants. This research aimed to investigate whether lung recruitment manoeuvres guided by ultrasound are more effective for young infants (<3 months) during laparoscopy under general anaesthesia. METHODS Young infants (<3 months) undergoing general anaesthesia during laparoscopic surgery (>2 h) were randomised to either conventional lung recruitment (control group) or ultrasound-guided lung recruitment (ultrasound group) once per hour. Mechanical ventilation was started with a tidal volume of 8 mL·kg-1, positive end-expiratory pressure of 6 cm H2O and 40% inspired oxygen fraction. Lung ultrasound (LUS) was performed four times (T1 was performed 5 min after intubation and before pneumoperitoneum set, T2 was performed after pneumoperitoneum, T3 was performed 1 min after surgery, and T4 was performed before being discharged from post-anaesthesia care unit [PACU]) in each infant. The primary outcome was the incidence of significant atelectasis at T3 and T4 (defined by LUS consolidation score ≥ 2 in any region). RESULTS 62 babies were enrolled in the experiment and 60 infants were included in the analysis. Before the recruitment, atelectasis was similar between infants randomised to the control or ultrasound group at T1 (83.3% vs 80.0%; P = 0.500) and T2 (83,3% vs 76.7%; P = 0.519). The incidence of atelectasis at T3 and T4 were lower in the ultrasound group (26.7% and 33.3%), compared with infants randomised to conventional lung recruitment (66.7% and 70%) (P = 0.002; P = 0.004; respectively). CONCLUSIONS Ultrasound-guided alveolar recruitment reduced the perioperative incidence of atelectasis in infants <3 months during laparoscopy under general anaesthesia.
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Affiliation(s)
- Qiushi Gao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haiyin Ji
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ziyi Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
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Seifnaraghi N, de Gelidi S, Frerichs I, Kallio M, Sorantin E, Tizzard A, Demosthenous A, Bayford RH. Cross-sectional chest circumference and shape development in infants. BMC Res Notes 2022; 15:206. [PMID: 35705999 PMCID: PMC9202117 DOI: 10.1186/s13104-022-06087-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study investigates the development of the thoracic cross-section at the nipple line level during the early stages of life. Unlike the descriptive awareness regarding chest development course, there exist no quantitative references concerning shape, circumference and possible dependencies to age, gender or body weight. The proposed mathematical relations are expected to help create guidelines for more realistic modelling and potential detection of abnormalities. One potential application is lung electrical impedance tomography (EIT) monitoring where accurate chest models are crucial in both extracting reliable parameters for regional ventilation function and design of EIT belts. Despite their importance, such reference data is not readily available for the younger age range due to insufficient data amid the regulations of neonatal imaging. RESULTS Chest circumference shows the highest correlation to body weight following the relation [Formula: see text] where x is the body weight in grams and f(x) is the chest circumference in cm at the nipple line level. No statistically significant difference in chest circumference between genders was detected. However, the shape indicated signs of both age and gender dependencies with on average boys developing a more rectangular shape than girls from the age of 1 years and 9 months.
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Affiliation(s)
- Nima Seifnaraghi
- Department of Natural Sciences, Middlesex University, London, UK.
| | - Serena de Gelidi
- Department of Natural Sciences, Middlesex University, London, UK
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Merja Kallio
- PEDEGO Research Unit, Medical Research Center, Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Erich Sorantin
- Department of Radiology, Medical University of Graz, Graz, Austria
| | - Andrew Tizzard
- Department of Natural Sciences, Middlesex University, London, UK
| | - Andreas Demosthenous
- Department of Electronic and Electrical Engineering, University College London, London, UK
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Generative Adversarial Network (GAN) for Automatic Reconstruction of the 3D Spine Structure by Using Simulated Bi-Planar X-ray Images. Diagnostics (Basel) 2022; 12:diagnostics12051121. [PMID: 35626277 PMCID: PMC9139385 DOI: 10.3390/diagnostics12051121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
In this study, we modified the previously proposed X2CT-GAN to build a 2Dto3D-GAN of the spine. This study also incorporated the radiologist’s perspective in the adjustment of input signals to prove the feasibility of the automatic production of three-dimensional (3D) structures of the spine from simulated bi-planar two-dimensional (2D) X-ray images. Data from 1012 computed tomography (CT) studies of 984 patients were retrospectively collected. We tested this model under different dataset sizes (333, 666, and 1012) with different bone signal conditions to observe the training performance. A 10-fold cross-validation and five metrics—Dice similarity coefficient (DSC) value, Jaccard similarity coefficient (JSC), overlap volume (OV), and structural similarity index (SSIM)—were applied for model evaluation. The optimal mean values for DSC, JSC, OV, SSIM_anteroposterior (AP), and SSIM_Lateral (Lat) were 0.8192, 0.6984, 0.8624, 0.9261, and 0.9242, respectively. There was a significant improvement in the training performance under empirically enhanced bone signal conditions and with increasing training dataset sizes. These results demonstrate the potential of the clinical implantation of GAN for automatic production of 3D spine images from 2D images. This prototype model can serve as a foundation in future studies applying transfer learning for the development of advanced medical diagnostic techniques.
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Bruins S, Sommerfield D, Powers N, von Ungern-Sternberg BS. Atelectasis and lung recruitment in pediatric anesthesia: An educational review. Paediatr Anaesth 2022; 32:321-329. [PMID: 34797011 DOI: 10.1111/pan.14335] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022]
Abstract
General anesthesia is associated with development of pulmonary atelectasis. Children are more vulnerable to the development and adverse effects of atelectasis. We review the physiology and risk factors for the development of atelectasis in pediatric patients under general anesthesia. We discuss the clinical significance of atelectasis, the use and value of recruitment maneuvers, and other techniques available to minimize lung collapse. This review demonstrates the value of a recruitment maneuver, maintaining positive end-expiratory pressure (PEEP) until extubation and lowering FiO2 where possible in the daily practice of the pediatric anesthetist.
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Affiliation(s)
- Suze Bruins
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Crawley, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia
| | - Neil Powers
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Crawley, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia
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Trachsel D, Erb TO, Hammer J, von Ungern‐Sternberg BS. Developmental respiratory physiology. Paediatr Anaesth 2022; 32:108-117. [PMID: 34877744 PMCID: PMC9135024 DOI: 10.1111/pan.14362] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 12/25/2022]
Abstract
Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher rate of critical incidents during anesthesia. The immaturity of control of breathing in infants is reflected by prolonged central apneas and periodic breathing, and an increased risk of apneas after anesthesia. The physiology of the pediatric upper and lower airways is characterized by a higher flow resistance and airway collapsibility. The increased chest wall compliance and reduced gas exchange surface of the lungs reduce the pulmonary oxygen reserve vis-à-vis a higher metabolic oxygen demand, which causes more rapid oxygen desaturation when ventilation is compromised. This review describes the various developmental aspects of respiratory physiology and summarizes anesthetic implications.
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Affiliation(s)
- Daniel Trachsel
- Pediatric Intensive Care and PulmonologyUniversity Children’s Hospital of Basel UKBBBaselSwitzerland
| | - Thomas O. Erb
- Department AnesthesiologyUniversity Children’s Hospital of Basel UKBBBaselSwitzerland
| | - Jürg Hammer
- Pediatric Intensive Care and PulmonologyUniversity Children’s Hospital of Basel UKBBBaselSwitzerland
| | - Britta S. von Ungern‐Sternberg
- Department of Anaesthesia and Pain ManagementPerth Children’s HospitalPerthWAAustralia,Division of Emergency Medicine, Anaesthesia and Pain MedicineMedical SchoolThe University of Western AustraliaPerthWAAustralia,Perioperative Medicine TeamTelethon Kids InstitutePerthWAAustralia
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Schlager B, Krump F, Boettinger J, Jonas R, Liebsch C, Ruf M, Beer M, Wilke HJ. Morphological patterns of the rib cage and lung in the healthy and adolescent idiopathic scoliosis. J Anat 2021; 240:120-130. [PMID: 34346505 PMCID: PMC8655162 DOI: 10.1111/joa.13528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 01/01/2023] Open
Abstract
The morphology of the rib cage affects both the biomechanics of the upper body's musculoskeletal structure and the respiratory mechanics. This becomes particularly important when evaluating skeletal deformities, as in adolescent idiopathic scoliosis (AIS). The aim of this study was to identify morphological characteristics of the rib cage in relation to the lung in patients with non‐deformed and scoliotic spines. Computed tomography data of 40 patients without any visible spinal abnormalities (healthy group) and 21 patients with AIS were obtained retrospectively. All bony structures as well as the right and left lung were reconstructed using image segmentation. Morphological parameters were calculated based on the distances between characteristic morphological landmarks. These parameters included the rib position, length, and area, the rib cage depth and width, and the rib inclination angle on either side, as well as the spinal height and length. Furthermore, we determined the left and right lung volumes, and the area of contact between the rib cage and lung. Differences between healthy and scoliotic spines were statistically analysed using the t‐test for unpaired data. The rib cage of the AIS group was significantly deformed in the dorso‐ventral and medio‐lateral directions. The anatomical proximity of the lung to the ribs was nearly symmetrical in the healthy group. By contrast, within the AIS group, the lung covered a significantly greater area on the left side of the rib cage at large thoracic deformities. Within the levels T1–T6, no significant difference in the rib length, depth to width relationship, or area was observed between the healthy and AIS groups. Inferior to the lung (T7–T12), these parameters exhibited greater variability. The ratio between the width of the rib cage at T6 and the thoracic spinal height (T1–T12) was significantly increased within the thoracic AIS group (1.1 ± 0.08) compared with the healthy group (1.0 ± 0.05). No statistical differences were found between the lung volumes among all the groups. While the rib cage was frequently strongly deformed in the AIS group, the lung and its surrounding ribs appeared to be normally developed. The observed rib hump in AIS appeared to be formed particularly by a more ventral position of the ribs on the concave side. Furthermore, the rib cage width to spinal height ratio suggested that the spinal height of the thoracic AIS‐spine is reduced. This indicates that the spine would gain its growth‐related height after correcting the spinal deformity. These are the important aspects to consider in the aetiology research and orthopaedic treatment of AIS.
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Affiliation(s)
- Benedikt Schlager
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Florian Krump
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Julius Boettinger
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - René Jonas
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Michael Ruf
- Skoliosechirurgie, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, SRH Klinikum Karlsbad-Langensteinbach gGmbH, Karlsbad, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
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Chaudhry IUH, Cheema A, Aqeel C, Al Shaer A, Alradei FG, Alquraish F, Tawfeeq M. Modified surgical reconstruction technique for a rare isolated congenital sternal cleft: In a six -year-old child. Ann Med Surg (Lond) 2021; 65:102280. [PMID: 33981421 PMCID: PMC8082199 DOI: 10.1016/j.amsu.2021.102280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/21/2022] Open
Abstract
We report the modified surgical reconstruction technique for correction for a large isolated congenital sternal cleft in 6 years old girl using a methyl methacrylate marlex mesh sandwich plate (MMS). The patient was referred to our tertiary care institution with a sizeable anterior chest wall bony defect. There was a large bulging under the skin due to protrusion of mediastinal viscera and visible cardiac pulsations with breathing. A chest x-ray and computed tomographic scan (CT) of the thorax was done to evaluate the bony defect. We reconstructed the sternal bony defect by our innovative technique using methyl methacrylate. The patient was discharged after three days for further follow up in outpatient. One year follow up patient is doing well with excellent results. Our technique is simple, cost-effective, and provides a perfect cosmetic effect for children's sternal large defects. INTRODUCTION Sternal clefts are rare congenital malformations that result from the defective embryologic fusion of paired mesodermal bands in the midline. This rare anomaly incidence is 1:100,000 cases per live births, which constitute 1% of all congenital chest wall deformities. The first Case of the sternal cleft was reported in 1740. The hereditary sternal gap is rare, and hence sporadic cases have been reported in the medical literature. Ravitch described that the first surgical correction was reported by Lannelongue et al., in 1988., But Burton published the first successful repair in 19474. An isolated sternal cleft is a rare entity and is classified into two categories' complete and incomplete sternal gap. Early repair is recommended; otherwise, surgical correction is challenging in children as the hypo plastic sternal edges cannot be approximated primarily, and this requires prosthetic, autologous grafts or some kind of parasternal chondroplasties. CASE PRESENTATION Since birth, a six-year-old girl was referred to our tertiary care center with a large central chest wall defect. She was a full-term normal delivery with no other congenital malformations. The defect was noticed at birth and became more evident as she grew up. In addition to cosmetic concern on coughing, there was bulging under the skin and visible cardiac pulsation. On examination, there was a large gap (7cm) in the midline of the chest with sternal adages well apart, moving independently. DISCUSSION The sternal cleft is a congenital anomaly with less than 0.15% and is more common in the female gender. Isolated sternal cleft without any other associated abnormalities is very rare. It has been reported as a part of defined syndromes like PENTALOGY OF CANTRELL, VACTREL, DANDY WALKER, and PHASE (Posterior fossa brain malformation, hemangioma, arterial lesions, cardiac abnormalities, and eye abnormality).6 Embryo logically sternum originate from the somatic layer of lateral mesodermal plates as bilateral bands. They fuse in the midline by the 10th week to constitute a cartilaginous framework of manubrium, sternum, and xiphoid process. Failure of this fusion can lead to a partial or complete sternal cleft.7 Etiology of this disease is unknown; however, it has been linked with riboflavin or methyl-cobalamin deficiency, high alcohol intake during pregnancy. CONCLUSION in conclusion, our improvised reconstruction technique for large sternal cleft in children has several advantages. There is no need to do extensive chordotomies or using bone grafts. Less complicated procedure Provides more rigid frame for protection of thoracic structures and better chest wall stability. Hospital stay is minimal and is very cost-effective. The child's future growth is not affected as ribs and costal cartilages are left intact in this technique. There is no chance of displacement or excursion of the MMS plate. In female patients, this provides better cosmoses as there is no need to mobilize the pectoralis significant muscles flaps for coverage. The geometry of the rib cage is well preserved.
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Affiliation(s)
- Ikram ul Haq Chaudhry
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Ahsan Cheema
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Chaudhry Aqeel
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Ahmed Al Shaer
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Fahad G. Alradei
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Fatima Alquraish
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Mansour Tawfeeq
- Department of Surgical Specialties, Maternity and Children Hospital, Dammam, Saudi Arabia
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12
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Azevedo IG, Peres AL, Moran CA, de Oliveira Holanda NS, Gomes DC, Pereira SA. Relationship between thoracoabdominal mobility and hours of life in infants: A cross-sectional study. Respir Physiol Neurobiol 2021; 290:103676. [PMID: 33910080 DOI: 10.1016/j.resp.2021.103676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/29/2021] [Accepted: 04/21/2021] [Indexed: 11/27/2022]
Abstract
Assessing the relationship between thoracoabdominal mobility (TAM) in newborns (NBs) is relevant for a greater understanding of pulmonary kinematics. This study aimed to assess the association between TAM, hours of life and respiratory rate (RR) in term NBs. Healthy NBs were included in the sample. They were filmed for 2 min, with markers in the lateral region of the trunk, delimiting the thoracic and abdominal areas. TAM and RR were assessed using a MATLAB® routine. For kinematic analysis, an algorithm created graphs presenting thoracoabdominal mobility. A total of 26 NBs were evaluated. TAM was the only variable that exhibited a statistically significant intergroup difference, showing that the fewer the hours of life, the greater the mobility. Simple linear regression analysis showed that RR can explain 31% of the variation in abdominal mobility (p = 0.002). Thus, the fewer the hours of life, the greater the TAM of NBs, with a predominance of abdominal compartment mobility.
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Affiliation(s)
| | - Ana Lorena Peres
- Faculty of Health Sciences, Federal University of Rio Grande do Norte (FACISA - UFRN), Santa Cruz, Brazil
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13
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Di Cicco M, Kantar A, Masini B, Nuzzi G, Ragazzo V, Peroni D. Structural and functional development in airways throughout childhood: Children are not small adults. Pediatr Pulmonol 2021; 56:240-251. [PMID: 33179415 DOI: 10.1002/ppul.25169] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 12/19/2022]
Abstract
Children are not small adults and this fact is particularly true when we consider the respiratory tract. The anatomic peculiarities of the upper airway make infants preferential nasal breathers between 2 and 6 months of life. The pediatric larynx has a more complex shape than previously believed, with the narrowest point located anatomically at the subglottic level and functionally at the cricoid cartilage. Alveolarization of the distal airways starts conventionally at 36-37 weeks of gestation, but occurs mainly after birth, continuing until adolescence. The pediatric chest wall has unique features that are particularly pronounced in infants. Neonates, infants, and toddlers have a higher metabolic rate, and consequently, their oxygen consumption at rest is more than double that of adults. The main anatomical and functional differences between pediatric and adult airways contribute to the understanding of various respiratory symptoms and disease conditions in childhood. Knowing the peculiarities of pediatric airways is helpful in the prevention, management, and treatment of acute and chronic diseases of the respiratory tract. Developmental modifications in the structure of the respiratory tract, in addition to immunological and neurological maturation, should be taken into consideration during childhood.
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Affiliation(s)
- Maria Di Cicco
- Allergology Section, Paediatrics Unit, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ahmad Kantar
- Paediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, Gruppo Ospedaliero San Donato, Bergamo, Italy.,Nursing School, Vita-Salute San Raffaele University, Milan, Italy
| | - Beatrice Masini
- Allergology Section, Paediatrics Unit, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Nuzzi
- Allergology Section, Paediatrics Unit, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vincenzo Ragazzo
- Paediatrics and Neonatology Division, Women's and Children's Health Department, Versilia Hospital, Lido di Camaiore, Italy
| | - Diego Peroni
- Allergology Section, Paediatrics Unit, Pisa University Hospital, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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14
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Rib cage anatomy in Homo erectus suggests a recent evolutionary origin of modern human body shape. Nat Ecol Evol 2020; 4:1178-1187. [PMID: 32632258 DOI: 10.1038/s41559-020-1240-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 06/04/2020] [Indexed: 01/13/2023]
Abstract
The tall and narrow body shape of anatomically modern humans (Homo sapiens) evolved via changes in the thorax, pelvis and limbs. It is debated, however, whether these modifications first evolved together in African Homo erectus, or whether H. erectus had a more primitive body shape that was distinct from both the more ape-like Australopithecus species and H. sapiens. Here we present the first quantitative three-dimensional reconstruction of the thorax of the juvenile H. erectus skeleton, KNM-WT 15000, from Nariokotome, Kenya, along with its estimated adult rib cage, for comparison with H. sapiens and the Kebara 2 Neanderthal. Our three-dimensional reconstruction demonstrates a short, mediolaterally wide and anteroposteriorly deep thorax in KNM-WT 15000 that differs considerably from the much shallower thorax of H. sapiens, pointing to a recent evolutionary origin of fully modern human body shape. The large respiratory capacity of KNM-WT 15000 is compatible with the relatively stocky, more primitive, body shape of H. erectus.
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15
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Beresheim AC, Pfeiffer S, Grynpas M. Ontogenetic changes to bone microstructure in an archaeologically derived sample of human ribs. J Anat 2019; 236:448-462. [PMID: 31729033 DOI: 10.1111/joa.13116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 11/30/2022] Open
Abstract
There is considerable variation in the gross morphology and tissue properties among the bones of human infants, children, adolescents, and adults. Using 18 known-age individuals (nfemale = 8, nmale = 9, nunknown = 1; birth to 21 years old), from a well-documented cemetery collection, Spitalfields Christ Church, London, UK, this study explores growth-related changes in cortical and trabecular bone microstructure. Micro-CT scans of mid-shaft middle thoracic ribs are used for quantitative analysis. Results are then compared to previously quantified conventional histomorphometry of the same sample. Total area (Tt.Ar), cortical area (Ct.Ar), cortical thickness (Ct.Th), and the major (Maj.Dm) and minor (Min.Dm) diameters of the rib demonstrate positive correlations with age. Pore density (Po.Dn) increases, but age-related changes to cortical porosity (Ct.Po) appear to be non-linear. Trabecular thickness (Tb.th) and trabecular separation (Tb.Sp) increase with age, whereas trabecular bone pattern factor (Tb.Pf), structural model index (SMI), and connectivity density (Conn.D) decrease with age. Sex-based differences were not identified for any of the variables included in this study. Some samples display clear evidence of diagenetic alteration without corresponding changes in radiopacity, which compromises the reliability of bone mineral density (BMD) data in the study of past populations. Cortical porosity data are not correlated with two-dimensional measures of osteon population density (OPD). This suggests that unfilled resorption spaces contribute more significantly to cortical porosity than do the Haversian canals of secondary osteons. Continued research using complementary imaging techniques and a wide array of histological variables will increase our understanding of age- and sex-specific ontogenetic patterns within and among human populations.
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Affiliation(s)
- Amy C Beresheim
- Department of Anatomy, Des Moines University, Des Moines, IA, USA
| | - Susan Pfeiffer
- Department of Anthropology, University of Toronto, Toronto, ON, Canada.,Department of Anthropology, Center for the Advanced Study of Human Paleobiology, George Washington University, Washington, DC, USA.,Department of Archaeology, University of Cape Town, Cape Town, South Africa
| | - Marc Grynpas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology and Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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16
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Okuno K, Ishizu K, Matsubayashi J, Fujii S, Sakamoto R, Ishikawa A, Yamada S, Yoneyama A, Takakuwa T. Rib Cage Morphogenesis in the Human Embryo: A Detailed Three‐Dimensional Analysis. Anat Rec (Hoboken) 2019; 302:2211-2223. [DOI: 10.1002/ar.24226] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/05/2019] [Accepted: 06/03/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Kasumi Okuno
- Human Health Science, Graduate School of MedicineKyoto University Kyoto Japan
| | - Koichi Ishizu
- Human Health Science, Graduate School of MedicineKyoto University Kyoto Japan
| | - Jun Matsubayashi
- Human Health Science, Graduate School of MedicineKyoto University Kyoto Japan
| | - Sena Fujii
- Human Health Science, Graduate School of MedicineKyoto University Kyoto Japan
| | - Rino Sakamoto
- Human Health Science, Graduate School of MedicineKyoto University Kyoto Japan
| | - Aoi Ishikawa
- Human Health Science, Graduate School of MedicineKyoto University Kyoto Japan
| | - Shigehito Yamada
- Human Health Science, Graduate School of MedicineKyoto University Kyoto Japan
- Congenital Anomaly Research CenterGraduate School of Medicine, Kyoto University Kyoto Japan
| | | | - Tetsuya Takakuwa
- Human Health Science, Graduate School of MedicineKyoto University Kyoto Japan
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17
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Coultas JA, Smyth R, Openshaw PJ. Respiratory syncytial virus (RSV): a scourge from infancy to old age. Thorax 2019; 74:986-993. [PMID: 31383776 DOI: 10.1136/thoraxjnl-2018-212212] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/19/2019] [Accepted: 06/14/2019] [Indexed: 01/02/2023]
Abstract
Respiratory syncytial virus (RSV) is the most common single cause of respiratory hospitalisation of infants and is the second largest cause of lower respiratory infection mortality worldwide. In adults, RSV is an under-recognised cause of deterioration in health, particularly in frail elderly persons. Infection rates typically rise in late autumn and early winter causing bronchiolitis in infants, common colds in adults and insidious respiratory illness in the elderly. Virus detection methods optimised for use in children have low detection rate in adults, highlighting the need for better diagnostic tests. There are many vaccines under development, mostly based on the surface glycoprotein F which exists in two conformations (prefusion and postfusion). Much of the neutralising antibody appears to be to the prefusion form. Vaccines being developed include live attenuated, subunit, particle based and live vectored agents. Different vaccine strategies may be appropriate for different target populations: at-risk infants, school-age children, adult caregivers and the elderly. Antiviral drugs are in clinical trial and may find a place in disease management. RSV disease is one of the major remaining common tractable challenges in infectious diseases and the era of vaccines and antivirals for RSV is on the near horizon.
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Affiliation(s)
| | - Rosalind Smyth
- Director of the Insitute and Professor of Child Health, Great Ormond Street Institute for Child Health, UCL, London, UK
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18
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Canavese F, Dimeglio A, Bonnel F, Corradin M, Pereira B, Marcoul A, Charles YP. Thoracic cage volume and dimension assessment by optoelectronic molding in normal children and adolescents during growth. Surg Radiol Anat 2018; 41:287-296. [PMID: 30560403 DOI: 10.1007/s00276-018-2164-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/08/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The thoracic spine, the chondral and osseous ribs, and the sternum together make up the thoracic cage. These elements are strictly correlated, although their growth is not synchronous. The purpose of this study is to provide a comprehensive data set of thoracic dimensions and non-invasive volumetric assessment in a large cohort of males and females from early childhood to young adult age. METHODS In all, 622 healthy individuals (406 girls, 216 boys) aged 6-18 years were consecutively enrolled between 2006 and 2016. All had to be healthy with no history of spinal deformity, or any lung, cardiovascular, systemic or neuromuscular disease. The optical ORTEN system for trunk surface data acquisition was used to calculate thoracic cage volume (V) and perimeter (Pe), anterior-posterior depth (AP) and transverse diameter (TD), AP/TD ratio, sternal length (St), and T1-T12 distance (Tle) in all patients. RESULTS The overall average age was 11.1 ± 2.5 years (4-18) for girls and 11.0 ± 3.1 years (4-18) for boys. Average growth parameters were: standing height 146.2 ± 14.6 cm (103-172) for girls and 146.4 ± 20.0 cm (94-192) for boys, sitting height 75.4 ± 8.6 cm (61-91) for girls and 75.5 ± 10.3 cm (60-99) for boys, weight 37.6 ± 10.4 kg (16-65) for girls and 38.3 ± 14.3 kg (13.7-104) for boys, BMI 16.7 ± 3.7 (18.5-26) for girls and 17.0 ± 3.3 (18.7-34.3) for boys. At age 6-8 years: V was 52.5% of its final size in girls and 44.9% in boys; Pe was 80.2% its final length in girls and 76.8% in boys; St reached 68% of its final size in girls and 66.9% in boys; Tle reached 73.3% of its final length in girls and 71.2% in boys. At skeletal maturity, thoracic cage volume in boys was 19.4% greater than in girls (p < 0.05). AP/TD ratio remained < 1 in all age groups and did not differ between genders (p > 0.05). CONCLUSION Growth of the thoracic cage is shown to be a gradual process that is more linear than previously reported. Only small increases in annual growth rates were observed during the pubertal growth spurt. The most important events characterizing thoracic cage development occurred during the first few years of postnatal growth. The circular cross-section of the very young child's thorax reached adult-like proportions together with its ovoid shape before age 6 years.
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Affiliation(s)
- Federico Canavese
- Service de Chirurgie Infantile, CHU Estaing Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
- Pediatric Surgery Department, University Hospital Estaing, 1 Place Lucie-et-Raymond-Aubrac, 63003, Clermont-Ferrand, France.
| | - Alain Dimeglio
- Faculté de Médicine, Université de Montpellier, 2 rue de l'école de Médecine, 34060, Montpellier, France
| | - François Bonnel
- Faculté de Médicine, Université de Montpellier, 2 rue de l'école de Médecine, 34060, Montpellier, France
| | - Marco Corradin
- Service de Chirurgie Infantile, CHU Estaing Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
| | - Bruno Pereira
- Marcenac-Ducros, 1277 Avenue de Toulouse, 34070, Montpellier, France
| | - Amélie Marcoul
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, 58 Place Henri Dunant, 63003, Clermont-Ferrand, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), 1 Place de l'hôpital, BP 426, 67091, Strasbourg Cedex, France
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19
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3D geometric morphometrics of thorax variation and allometry in Hominoidea. J Hum Evol 2017; 113:10-23. [DOI: 10.1016/j.jhevol.2017.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 12/29/2022]
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20
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García-Martínez D, Gil OG, Cambra-Moo O, Canillas M, Rodríguez MA, Bastir M, Martín AG. External and internal ontogenetic changes in the first rib. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2017; 164:750-762. [DOI: 10.1002/ajpa.23313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Daniel García-Martínez
- Paleoanthropology Group; Museo Nacional de Ciencias Naturales (MNCN-CSIC); 28006 Madrid Spain
| | - Orosia García Gil
- Laboratorio de Poblaciones del Pasado (LAPP). Departamento de Biología; Facultad de Ciencias, Universidad Autónoma de Madrid; 28049 Madrid Spain
| | - Oscar Cambra-Moo
- Laboratorio de Poblaciones del Pasado (LAPP). Departamento de Biología; Facultad de Ciencias, Universidad Autónoma de Madrid; 28049 Madrid Spain
- Grupo de Investigación en Arqueología Antigua y Medieval; Universidad de Oviedo; 33011 Oviedo Spain
| | - María Canillas
- Instituto de Cerámica y Vidrio (Consejo Superior de Investigaciones Científicas); 28049 Madrid Spain
| | - Miguel A. Rodríguez
- Instituto de Cerámica y Vidrio (Consejo Superior de Investigaciones Científicas); 28049 Madrid Spain
| | - Markus Bastir
- Paleoanthropology Group; Museo Nacional de Ciencias Naturales (MNCN-CSIC); 28006 Madrid Spain
| | - Armando González Martín
- Laboratorio de Poblaciones del Pasado (LAPP). Departamento de Biología; Facultad de Ciencias, Universidad Autónoma de Madrid; 28049 Madrid Spain
- Grupo de Investigación en Arqueología Antigua y Medieval; Universidad de Oviedo; 33011 Oviedo Spain
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21
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Heath PT, Culley FJ, Jones CE, Kampmann B, Le Doare K, Nunes MC, Sadarangani M, Chaudhry Z, Baker CJ, Openshaw PJM. Group B streptococcus and respiratory syncytial virus immunisation during pregnancy: a landscape analysis. THE LANCET. INFECTIOUS DISEASES 2017; 17:e223-e234. [PMID: 28433702 DOI: 10.1016/s1473-3099(17)30232-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 12/30/2022]
Abstract
Group B streptococcus and respiratory syncytial virus are leading causes of infant morbidity and mortality worldwide. No licensed vaccines are available for either disease, but vaccines for both are under development. Severe respiratory syncytial virus disease can be prevented by passively administered antibody. The presence of maternal IgG antibody specific to respiratory syncytial virus is associated with reduced prevalence and severity of respiratory syncytial virus disease in the first few weeks of life, whereas maternal serotype-specific anticapsular antibody is associated with protection against both early-onset and late-onset group B streptococcus disease. Therefore, vaccination in pregnancy might protect infants against both diseases. This report describes what is known about immune protection against group B streptococcus and respiratory syncytial virus, identifies knowledge gaps regarding the immunobiology of both diseases, and aims to prioritise research directions in maternal immunisation.
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Affiliation(s)
- Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Fiona J Culley
- Respiratory Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beate Kampmann
- Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK; Medical Research Council Unit, Serrekunda, The Gambia
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK; Centre for International Child Health, Department of Paediatrics, Imperial College London, London, UK
| | - Marta C Nunes
- Department of Science and Technology and National Research Foundation, Vaccine Preventable Diseases and Medical Research Council, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Manish Sadarangani
- Department of Paediatrics, University of Oxford, Oxford, UK; Vaccine Evaluation Centre, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Zain Chaudhry
- Respiratory Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Carol J Baker
- Department of Pediatrics, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Peter J M Openshaw
- Respiratory Medicine, National Heart and Lung Institute, Imperial College London, London, UK
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22
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Eastwood MP, Joyeux L, Pranpanus S, Van der Merwe J, Verbeken E, De Vleeschauwer S, Gayan-Ramirez G, Deprest J. A growing animal model for neonatal repair of large diaphragmatic defects to evaluate patch function and outcome. PLoS One 2017; 12:e0174332. [PMID: 28358826 PMCID: PMC5373533 DOI: 10.1371/journal.pone.0174332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/07/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives We aimed to develop a more representative model for neonatal congenital diaphragmatic hernia repair in a large animal model, by creating a large defect in a fast-growing pup, using functional pulmonary and diaphragmatic read outs. Background Grafts are increasingly used to repair congenital diaphragmatic hernia with the risk of local complications. Growing animal models have been used to test novel materials. Methods 6-week-old rabbits underwent fiberoptic intubation, left subcostal laparotomy and hemi-diaphragmatic excision (either nearly complete (n = 13) or 3*3cm (n = 9)) and primary closure (Gore-Tex patch). Survival was further increased by moving to laryngeal mask airway ventilation (n = 15). Sham operated animals were used as controls (n = 6). Survivors (90 days) underwent chest X-Ray (scoliosis), measurements of maximum transdiaphragmatic pressure and breathing pattern (tidal volume, Pdi). Rates of herniation, lung histology and right hemi-diaphragmatic fiber cross-sectional area was measured. Results Rabbits surviving 90 days doubled their weight. Only one (8%) with a complete defect survived to 90 days. In the 3*3cm defect group all survived to 48 hours, however seven (78%) died later (16–49 days) from respiratory failure secondary to tracheal stricture formation. Use of a laryngeal mask airway doubled 90-day survival, one pup displaying herniation (17%). Cobb angel measurements, breathing pattern, and lung histology were comparable to sham. Under exertion, sham animals increased their maximum transdiaphragmatic pressure 134% compared to a 71% increase in patched animals (p<0.05). Patched animals had a compensatory increase in their right hemi-diaphragmatic fiber cross-sectional area (p<0.0001). Conclusions A primarily patched 3*3cm defect in growing rabbits, under laryngeal mask airway ventilation, enables adequate survival with normal lung function and reduced maximum transdiaphragmatic pressure compared to controls.
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Affiliation(s)
- Mary Patrice Eastwood
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Luc Joyeux
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Savitree Pranpanus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Prince of Songkla University, Hat Yai, Thailand
| | - Johannes Van der Merwe
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Clinical department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Eric Verbeken
- Department of Pathology, Group Biomedical Sciences, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Jan Deprest
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Clinical department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- * E-mail:
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Trachsel D, Svendsen J, Erb T, von Ungern-Sternberg B. Effects of anaesthesia on paediatric lung function. Br J Anaesth 2016; 117:151-63. [DOI: 10.1093/bja/aew173] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Reinaux CMA, Aliverti A, da Silva LGM, da Silva RJ, Gonçalves JN, Noronha JB, Filho JEC, de Andrade AD, de Amorim Britto MC. Tidal volume measurements in infants: Opto-electronic plethysmography versus pneumotachograph. Pediatr Pulmonol 2016; 51:850-7. [PMID: 26991671 DOI: 10.1002/ppul.23394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/18/2015] [Accepted: 01/15/2016] [Indexed: 11/11/2022]
Abstract
Tidal breathing measurements by Opto-Electronic Plethysmography (OEP) has been reported for infants limited to protocols with two chest wall compartments. Standard protocol for the analysis of adults, with three compartments of chest wall, has been unavailable for analysis of infants. We aimed to study the agreement of simultaneous measurements of tidal volume by OEP (VT,OEP ) and a heated pneumotachograph (PNT) (VT,PNT ) performed during sleeping in 20 infants (gestational age 35.1 ± 4.6 weeks) at 3-4 months postconceptual age with a three compartment protocol. From PNT and OEP measurements, tidal volume corrected (VT,PNT ) for ambient conditions were calculated with a total number of 200 breaths. The two methods were in good agreement with tidal volume mean difference of 0.02 ml and limit of agreement -4.11 to 4.08 ml (95%CI), no relationship was found between differences and means of OEP and PNT measurements. Pulmonary rib cage, abdominal rib cage and abdomen contributed by 12.4 ± 9.7%, 5.2 ± 5.1%, and 82.4 ± 11.4% to VT,OEP , respectively. The OEP experimental protocol based on 52 markers and a three-compartment model of the chest wall could be used in spontaneously sleeping infants. Pediatr Pulmonol. 2016;51:850-857. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Cyda Maria Albuquerque Reinaux
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | | | - Rafael Justino da Silva
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Juliane Neves Gonçalves
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Jessica Brito Noronha
- Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Walle EA. Infant Social Development across the Transition from Crawling to Walking. Front Psychol 2016; 7:960. [PMID: 27445923 PMCID: PMC4921474 DOI: 10.3389/fpsyg.2016.00960] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/09/2016] [Indexed: 11/16/2022] Open
Abstract
The onset of walking is a developmental transition that sets in motion a cascade of change across a range of domains, including social interactions and language learning. However, research on the unfolding of such change in the infant across this transition is limited. This investigation utilized a longitudinal design to examine the effect of walking acquisition on infant social development and parent perceptions of the infant to explore how changes in these factors relate with infant language development. Parents reported on infant social behaviors and their perception of the infant, as well as motor and language development, in 2-week intervals from 10.5 to 13 months of age. Mixed linear models revealed infant initiation of joint engagement (e.g., pointing, bringing objects to the parent) and following of the parent's joint engagement cues (e.g., point following, gaze following) increased as a function of infant walking experience, particularly between 2- and 4-weeks after the onset of walking, independent of age. Additionally, the parent's perception of the infant as an individual increased between 2- and 4-weeks after the infant began to walk. Finally, the unique relations of infant walking experience, following of social cues, and the parents' perception of the infant as an individual with infant language development were examined. Infant following of joint engagement behaviors and parent perception of the infant as an individual were related to receptive, but not productive, vocabulary size. Additionally, infant walking experience remained a significant predictor of infant receptive and productive language. These findings provide insight on important factors that change as the infant begins to walk. Future research utilizing more direct assessment of these factors is described, as well as general patterning of developmental change across the transition from crawling to walking.
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Affiliation(s)
- Eric A. Walle
- Psychological Sciences, University of California, MercedMerced, CA, USA
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26
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A biomechanical hypothesis for the pathophysiology of apical lung disease. Med Hypotheses 2016; 92:88-93. [PMID: 27241265 DOI: 10.1016/j.mehy.2016.04.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/18/2016] [Accepted: 04/27/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A hypothesis is presented suggesting that the pathogenesis of apical lung disease is due to progression of subclinical congenital apical bullae in people with low Body Mass Index (BMI), a combination present in 15% of the population, due to high pleural stress levels present in the antero-posteriorly flattened chests of these individuals. DESIGN The hypothesis was tested for validity in two apical lung pathologies with widespread epidemiological literature, namely tuberculosis (TB) and primary spontaneous pneumothorax (PSP), assessing whether the hypothesis could identify high-risk populations, explain exceptional cases like apical lower lobe disease and confirm predictions. RESULTS The biomechanical hypothesis can explain the high-risk factors of apical location, age, gender and low-BMI build, as well as the occurrence of disease in the apex of the lower lobe, in both TB and PSP patients. A predicted common pathogenesis for apical lung disease was confirmed by the higher-than-expected incidence of concomitant TB and PSP. CONCLUSION Pleural stress levels depend on chest wall shape, but are highest in the apex of young males with low BMI, leading to growth of congenital bullae that can eventually limit clearance inhaled material, superinfect or burst. This hypothesis suggests that low-dose computerized tomography may be used to screen for TB eradication. This paper is the first to propose a biomechanical mechanism for all apical lung disease pathophysiology.
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García-Martínez D, Recheis W, Bastir M. Ontogeny of 3D rib curvature and its importance for the understanding of human thorax development. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2015; 159:423-31. [PMID: 26890054 DOI: 10.1002/ajpa.22893] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/26/2015] [Accepted: 10/29/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Sagittal and axial rib orientation relative to the spine are two factors that modify rib cage morphology during ontogeny. Some studies suggest that these factors do not operate in the same way at the upper (ribs 1-5) and lower thorax (ribs 6-10) during postnatal growth, but it is unknown if the ontogenetic thoracic changes are produced by morphological changes of the ribs (intrinsic rib factors) or by external factors related to costal joints (extrinsic rib factors). MATERIAL AND METHODS To clarify these questions, we applied 3D geometric morphometrics of landmarks and sliding semilandmarks (N = 20/rib) to 280 individual ribs (1-10) of Homo sapiens comprising the entire human ontogeny and growth simulations were carried out. RESULTS PCA shows that intrinsic rib factors (rib torsion and axial rib curvature) are ontogenetic factors of variability that contribute to configuring the adult thorax shape. Moreover, growth simulations and regression slopes suggest that the upper thorax unit is comprised by ribs 1-7 and the lower unit at least by ribs 8-10. DISCUSSION These results suggest anatomical constraints for ontogenetic rib variation, since ribs 1-7 (true ribs) are directly linked to the sternum. Moreover, these results are supported by functional anatomy because pulmonary kinematics would influence the upper unit and diaphragmatic kinematics would influence the lower one. Our findings are relevant not only to understanding how changes at individual ribs contribute to the adult thorax morphology, but also to the development and evolution of the modern human rib cage.
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Affiliation(s)
- Daniel García-Martínez
- Paleoanthropology Group, Paleobiology Department, Museo Nacional de Ciencias Naturales (MNCN-CSIC), JG. Abascal 2, Madrid, 28006, Spain.,Biology Department, Faculty of Sciences, Universidad Autónoma De Madrid. Darwin 2, Madrid, 28049, Spain
| | - Wolfgang Recheis
- Department of Radiology, Medizinische Universität Innsbruck, 6020, Austria
| | - Markus Bastir
- Paleoanthropology Group, Paleobiology Department, Museo Nacional de Ciencias Naturales (MNCN-CSIC), JG. Abascal 2, Madrid, 28006, Spain
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Seeger A, Krumm P, Hornung A, Schäfer JF, Kramer U, Sieverding L. 3-D cardiac MRI in free-breathing newborns and infants: when is respiratory gating necessary? Pediatr Radiol 2015; 45:1448-54. [PMID: 25903840 DOI: 10.1007/s00247-015-3346-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/31/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Newborns and small infants have shallow breathing. OBJECTIVE To suggest criteria for when respiratory gating is necessary during cardiac MRI in newborns and infants. MATERIALS AND METHODS One-hundred ten data sets of newborns and infants with (n = 92, mean age: 1.9 ± 1.7 [SD] years) and without (n = 18, mean age: 1.6 ± 1.8 [SD] years) navigator gating were analysed retrospectively. The respiratory motion of the right hemidiaphragm was recorded and correlated to age, weight, body surface area and qualitative image quality on a 4-point score. Quantitative image quality assessment was performed (sharpness of the delineation of the ventricular septal wall) as well as a matched-pair comparison between navigator-gated and non-gated data sets. RESULTS No significant differences were found in overall image quality or in the sharpness of the ventricular septal wall between gated and non-gated scans. A navigator acceptance of >80% was frequently found in patients ages <12 months, body surface area <0.40 m(2), body weight <10 kg and a size of <80 cm. CONCLUSION Sequences without respiratory gating may be used in newborns and small infants, in particular if age <12 months, body surface area <0.40 m(2), body weight <10 kg and height <80 cm.
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Affiliation(s)
- Achim Seeger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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Schwend RM, Schmidt JA, Reigrut JL, Blakemore LC, Akbarnia BA. Patterns of Rib Growth in the Human Child. Spine Deform 2015; 3:297-302. [PMID: 27927473 DOI: 10.1016/j.jspd.2015.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/01/2015] [Accepted: 01/29/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Whereas there is substantial information on the changes of the rib cage during childhood and asymmetry of the thorax in children with scoliosis, there are virtually no normative data on the growth of individual ribs throughout childhood. METHODS The Hamann-Todd (HT) Osteological Collection provided the bones of 32 human specimens aged 1-18 years. A total of 6,226 individual photographs of all vertebral bodies and ribs were obtained from these specimens. Quantitative measurements were taken with image analysis software and the results of 2 of the measurements, the outer costal length (OCL) and the base diameter (BD), are presented here. RESULTS With the exception of the ribs at T12, both the OCL and BD showed linear, statistically significant growth with age for all ribs. The relationship of OCL and BD to each other within each rib was obtained by multiplying and dividing these 2 measurements. The BD × OCL product indicates that the ribs grow through coupled symmetry, by which ribs in the upper and lower thorax start at the same size and grow at the same rate within the pair; ribs 1 and 12, 2 and 11, and 3 and 10. Each rib pair grows at a significantly different rate from all other pairs. Measurements of BD and OCL from a specimen with scoliosis from the collection compared with these normative values were greatly different. The principle that ribs resemble a known geometric form, called the logarithmic spiral, is introduced. CONCLUSIONS This article is 1 of the first studies of the change in length and shape of normal ribs in an osteology collection of a wide age range of pediatric specimens. The data provide a framework for determining the difference between ribs from normal children and those with scoliosis.
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Affiliation(s)
- Richard M Schwend
- Division of Orthopaedics, University of Missouri Kansas City, University of Kansas, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | | | | | - Laurel C Blakemore
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, University of Florida Orthopaedics and Sports Medicine Institute, FL 32611-2727, USA
| | - Behrooz A Akbarnia
- University of California, 6190 Cornerstone CT, Ste 212, San Diego, San Diego, CA 92121, USA
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Casha AR, Camilleri L, Manché A, Gatt R, Attard D, Wolak W, Dudek K, Gauci M, Giordimaina C, Grima JN. A hypothesis for reactivation of pulmonary tuberculosis: How thoracic wall shape affects the epidemiology of tuberculosis. Clin Anat 2015; 28:614-20. [PMID: 25851916 DOI: 10.1002/ca.22544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/08/2015] [Indexed: 11/11/2022]
Abstract
This study was aimed at determining the cause for the high incidence of tuberculosis (TB) reactivation occurring in males with a low body mass index (BMI). Current thinking about pulmonary TB describes infection in the lung apex resulting in cavitation after reactivation. A different hypothesis is put forward for TB infection, suggesting that this occurs in subclinical apical cavities caused by increased pleural stress due to a low BMI body habitus. A finite element analysis (FEA) model of a lung was constructed including indentations for the first rib guided by paramedian sagittal CT reconstructions, and simulations were conducted with varying antero-posterior (AP) diameters to mimic chests with a different thoracic index (ratio of AP to the transverse chest diameters). A Pubmed search was conducted about gender and thoracic index, and the effects of BMI on TB. FEA modeling revealed a tenfold increase in stress levels at the lung apex in low BMI chests, and a four-fold increase with a low thoracic index, r(2) = 0.9748 P < 0.001. Low thoracic index was related to BMI, P = 0.001. The mean thoracic index was statistically significantly lower in males, P = 0.001, and increased with age in both genders. This article is the first to suggest a possible mechanism linking pulmonary TB reactivation to low BMI due to the flattened thoracic wall shape of young male adults. The low thoracic index in young males may promote TB reactivation due to tissue destruction in the lung apex from high pleural stress levels.
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Affiliation(s)
- Aaron R Casha
- Department of Cardiothoracic Surgery, Mater Dei Hospital, L-Imsida, Malta.,Department of Anatomy, Faculty of Medicine, University of Malta, Msida MSD
| | - Liberato Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida MSD, Malta
| | - Alexander Manché
- Department of Cardiothoracic Surgery, Mater Dei Hospital, L-Imsida, Malta
| | - Ruben Gatt
- Metamaterials Unit, Faculty of Science, University of Malta, Msida MSD, Malta
| | - Daphne Attard
- Metamaterials Unit, Faculty of Science, University of Malta, Msida MSD, Malta
| | - Wiktor Wolak
- Department of Physics and Astronomy, Uniwersytet Zielonogórski, Zielona Góra, Poland
| | - Krzysztof Dudek
- Department of Physics and Astronomy, Uniwersytet Zielonogórski, Zielona Góra, Poland
| | - Marilyn Gauci
- Department of Anaesthesia, Mater Dei Hospital, L-Imsida, Malta
| | | | - Joseph N Grima
- Metamaterials Unit, Faculty of Science, University of Malta, Msida MSD, Malta
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Casha AR, Camilleri L, Manché A, Gatt R, Attard D, Gauci M, Camilleri-Podesta MT, Grima JN. External rib structure can be predicted using mathematical models: An anatomical study with application to understanding fractures and intercostal muscle function. Clin Anat 2015; 28:512-9. [PMID: 25716367 DOI: 10.1002/ca.22513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 12/26/2014] [Accepted: 01/06/2015] [Indexed: 11/07/2022]
Abstract
As ribs adapt to stress like all bones, and the chest behaves as a pressure vessel, the effect of stress on the ribs can be determined by measuring rib height and thickness. Rib height and thickness (depth) were measured using CT scans of seven rib cages from anonymized cadavers. A Finite Element Analysis (FEA) model of a rib cage was constructed using a validated approach and used to calculate intramuscular forces as the vectors of both circumferential and axial chest wall forces at right angles to the ribs. Nonlinear quadratic models were used to relate rib height and rib thickness to rib level, and intercostal muscle force to vector stress. Intercostal muscle force was also related to vector stress using Pearson correlation. For comparison, rib height and thickness were measured on CT scans of children. Rib height increased with rib level, increasing by 13% between the 3rd and 7th rib levels, where the 7th/8th rib was the widest part or "equator" of the rib cage, P < 0.001 (t-test). Rib thickness showed a statistically significant 23% increase between the 3rd and 7th ribs, P = 0.004 (t-test). Intercostal muscle force was significantly related to vector stress, Pearson correlation r = 0.944, P = 0.005. The three nonlinear quadratic models developed all had statistically significant parameter estimates with P < 0.03. External rib morphology, in particular rib height and thickness, can be predicted using statistical mathematical models. Rib height is significantly related to the calculated intercostal muscle force, showing that environmental factors affect external rib morphology.
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Affiliation(s)
- Aaron R Casha
- Department of Anatomy, University of Malta, Msida, Malta; Department of Cardiothoracic Surgery, Mater Dei Hospital, Msida, Malta
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He M, Walle EA, Campos JJ. A Cross-National Investigation of the Relationship Between Infant Walking and Language Development. INFANCY 2015. [DOI: 10.1111/infa.12071] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Agnew AM, Schafman M, Moorhouse K, White SE, Kang YS. The effect of age on the structural properties of human ribs. J Mech Behav Biomed Mater 2015; 41:302-14. [DOI: 10.1016/j.jmbbm.2014.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/28/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
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Hutchison AA, Leclerc F, Nève V, Pillow JJ, Robinson PD. The Respiratory System. PEDIATRIC AND NEONATAL MECHANICAL VENTILATION 2015. [PMCID: PMC7193717 DOI: 10.1007/978-3-642-01219-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This chapter addresses upper airway physiology for the pediatric intensivist, focusing on functions that affect ventilation, with an emphasis on laryngeal physiology and control in breathing. Effective control of breathing ensures that the airway is protected, maintains volume homeostasis, and provides ventilation. Upper airway structures are effectors for all of these functions that affect the entire airway. Nasal functions include air conditioning and protective reflexes that can be exaggerated and involve circulatory changes. Oral cavity and pharyngeal patency enable airflow and feeding, but during sleep pharyngeal closure can result in apnea. Coordination of breathing with sucking and nutritive swallowing alters during development, while nonnutritive swallowing at all ages limits aspiration. Laryngeal functions in breathing include protection of the subglottic airway, active maintenance of its absolute volume, and control of tidal flow patterns. These are vital functions for normal lung growth in fetal life and during rapid adaptations to breathing challenges from birth through adulthood. Active central control of breathing focuses on the coordination of laryngeal and diaphragmatic activities, which adapts according to the integration of central and peripheral inputs. For the intensivist, knowledge of upper airway physiology can be applied to improve respiratory support. In a second part the mechanical properties of the respiratory system as a critical component of the chain of events that result in translation of the output of the respiratory rhythm generator to ventilation are described. A comprehensive understanding of respiratory mechanics is essential to the delivery of optimized and individualized mechanical ventilation. The basic elements of respiratory mechanics will be described and developmental changes in the airways, lungs, and chest wall that impact on measurement of respiratory mechanics with advancing postnatal age are reviewed. This will be follwowed by two sections, the first on respiratory mechanics in various neonatal pathologies and the second in pediatric pathologies. The latter can be classified in three categories. First, restrictive diseases may be of pulmonary origin, such as chronic interstitial lung diseases or acute lung injury/acute respiratory distress syndrome, which are usually associated with reduced lung compliance. Restrictive diseases may also be due to chest wall abnormalities such as obesity or scoliosis (idiopathic or secondary to neuromuscular diseases), which are associated with a reduction in chest wall compliance. Second, obstructive diseases are represented by asthma and wheezing disorders, cystic fibrosis, long term sequelae of neonatal lung disease and bronchiolitis obliterans following hematopoietic stem cell transplantation. Obstructive diseases are defined by a reduced FEV1/VC ratio. Third, neuromuscular diseases, mainly represented by DMD and SMA, are associated with a decrease in vital capacity linked to respiratory muscle weakness that is better detected by PImax, PEmax and SNIP measurements.
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Lupton-Smith AR, Argent AC, Rimensberger PC, Morrow BM. Challenging a paradigm: positional changes in ventilation distribution are highly variable in healthy infants and children. Pediatr Pulmonol 2014; 49:764-71. [PMID: 24009188 DOI: 10.1002/ppul.22893] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 07/17/2013] [Accepted: 07/17/2013] [Indexed: 11/06/2022]
Abstract
RATIONALE Current understanding is that infants and children preferentially ventilate non-dependent lungs, a reversal of that of adults, based on studies using krypton-81m ventilation scanning. Participants in these studies had lung disease and were either sedated or ventilated. There is little understanding of the distribution of ventilation in spontaneous breathing healthy infants and children. OBJECTIVES This study aimed to determine the effects of side lying on the distribution of ventilation in healthy, spontaneously breathing infants and children between the ages of 6 months and 9 years. METHODS AND MEASUREMENTS Measurements were taken using electrical impedance tomography (EIT) in supine, left and right side lying. Distribution of ventilation was described using end-expiratory to end-inspiratory relative impedance change. RESULTS Fifty-six (31, 55% male) participants were studied. Nineteen (35%) participants consistently showed greater ventilation in the non-dependent lung, eight (15%) consistently showed greater ventilation in the dependent lung and 28 (51%) showed a varied pattern between left and right side lying. Overall, left side lying resulted in significantly better mean ventilation of the right (non-dependent) lung (P < 0.01). Distribution of ventilation in right side lying was relatively equal between left and right lungs. CONCLUSIONS This study demonstrates that the distribution of ventilation in spontaneously breathing infants and children is not as straightforward as previously described. The distribution of ventilation was variably affected by body position with no clear reversal of the adult pattern evident.
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Affiliation(s)
- Alison R Lupton-Smith
- School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Weaver AA, Schoell SL, Nguyen CM, Lynch SK, Stitzel JD. Morphometric analysis of variation in the sternum with sex and age. J Morphol 2014; 275:1284-99. [DOI: 10.1002/jmor.20302] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/01/2014] [Accepted: 05/28/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Ashley A. Weaver
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Department of Biomedical Engineering; Winston-Salem North Carolina
- Wake Forest University School of Medicine, Department of Biomedical Engineering; Winston-Salem North Carolina
| | - Samantha L. Schoell
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Department of Biomedical Engineering; Winston-Salem North Carolina
- Wake Forest University School of Medicine, Department of Biomedical Engineering; Winston-Salem North Carolina
| | - Callistus M. Nguyen
- Wake Forest University School of Medicine, Department of Biomedical Engineering; Winston-Salem North Carolina
| | - Sarah K. Lynch
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Department of Biomedical Engineering; Winston-Salem North Carolina
- Wake Forest University School of Medicine, Department of Biomedical Engineering; Winston-Salem North Carolina
| | - Joel D. Stitzel
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Department of Biomedical Engineering; Winston-Salem North Carolina
- Wake Forest University School of Medicine, Department of Biomedical Engineering; Winston-Salem North Carolina
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Weaver AA, Schoell SL, Stitzel JD. Morphometric analysis of variation in the ribs with age and sex. J Anat 2014; 225:246-61. [PMID: 24917069 DOI: 10.1111/joa.12203] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/30/2022] Open
Abstract
Rib cage morphology changes with age and sex are expected to affect thoracic injury mechanisms and tolerance, particularly for vulnerable populations such as pediatrics and the elderly. The size and shape variation of the external geometry of the ribs was characterized for males and females aged 0-100 years. Computed tomography (CT) scans from 339 subjects were analyzed to collect between 2700 and 10 400 homologous landmarks from each rib. Rib landmarks were analyzed using the geometric morphometric technique known as Procrustes superimposition. Age- and sex-specific functions of 3D rib morphology were produced representing the combined size and shape variation and the isolated shape variation. Statistically significant changes in the size and shape variation (P < 0.0001) and shape variation (P < 0.0053) of all 24 ribs were found to occur with age in males and females. Rib geometry, location, and orientation varied according to the rib level. From birth through adolescence, the rib cage experienced an increase in size, a decrease in thoracic kyphosis, and inferior rotation of the ribs relative to the spine within the sagittal plane. From young adulthood into elderly age, the rib cage experienced increased thoracic kyphosis and superior rotation of the ribs relative to the spine within the sagittal plane. The increased roundedness of the rib cage and horizontal angling of the ribs relative to the spine with age influences the biomechanical response of the thorax. With the plane of the rib oriented more horizontally, loading applied in the anterior-posterior direction will result in increased deformation within the plane of the rib and an increased risk for rib fractures. Thus, morphological changes may be a contributing factor to the increased incidence of rib fractures in the elderly. The morphological functions derived in this study capture substantially more information on thoracic skeleton morphology variation with age and sex than is currently available in the literature. The developed models of rib cage anatomy can be used to study age and sex variations in thoracic injury patterns due to motor vehicle crashes or falls, and clinically relevant changes due to chronic obstructive pulmonary disease or other diseases evidenced by structural and anatomic changes to the chest.
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Affiliation(s)
- Ashley A Weaver
- Virginia Tech-Wake Forest University Center for Injury Biomechanics, Winston-Salem, NC, USA; Wake Forest University School of Medicine, Winston-Salem, NC, USA
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On the chest size of Kebara 2. J Hum Evol 2014; 70:69-72. [DOI: 10.1016/j.jhevol.2014.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 11/17/2022]
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Kindig MW, Kent RW. Characterization of the centroidal geometry of human ribs. J Biomech Eng 2014; 135:111007. [PMID: 24008370 DOI: 10.1115/1.4025329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 09/06/2013] [Indexed: 11/08/2022]
Abstract
While a number of studies have quantified overall ribcage morphology (breadth, depth, kyphosis/lordosis) and rib cross-sectional geometry in humans, few studies have characterized the centroidal geometry of individual ribs. In this study, a novel model is introduced to describe the centroidal path of a rib (i.e., the sequence of centroids connecting adjacent cross-sections) in terms of several physically-meaningful and intuitive geometric parameters. Surface reconstructions of rib levels 2-10 from 16 adult male cadavers (aged 31-75 years) were first extracted from CT scans, and the centroidal path was calculated in 3D for each rib using a custom numerical method. The projection of the centroidal path onto the plane of best fit (i.e., the "in-plane" centroidal path) was then modeled using two geometric primitives (a circle and a semiellipse) connected to give C1 continuity. Two additional parameters were used to describe the deviation of the centroidal path from this plane; further, the radius of curvature was calculated at various points along the rib length. This model was fit to each of the 144 extracted ribs, and average trends in rib size and shape with rib level were reported. In general, upper ribs (levels 2-5) had centroidal paths which were closer to circular, while lower ribs (levels 6-10) tended to be more elliptical; further the centroidal curvature at the posterior extremity was less pronounced for lower ribs. Lower ribs also tended to exhibit larger deviations from the best-fit plane. The rib dimensions and trends with subject stature were found to be consistent with findings previously reported in the literature. This model addresses a critical need in the biomechanics literature for the accurate characterization of rib geometry, and can be extended to a larger population as a simple and accurate way to represent the centroidal shape of human ribs.
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Bastir M, García Martínez D, Recheis W, Barash A, Coquerelle M, Rios L, Peña-Melián Á, García Río F, O’Higgins P. Differential growth and development of the upper and lower human thorax. PLoS One 2013; 8:e75128. [PMID: 24073239 PMCID: PMC3779208 DOI: 10.1371/journal.pone.0075128] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 08/08/2013] [Indexed: 11/18/2022] Open
Abstract
The difficulties in quantifying the 3D form and spatial relationships of the skeletal components of the ribcage present a barrier to studies of the growth of the thoracic skeleton. Thus, most studies to date have relied on traditional measurements such as distances and indices from single or few ribs. It is currently known that adult-like thoracic shape is achieved early, by the end of the second postnatal year, with the circular cross-section of the newborn thorax transforming into the ovoid shape of adults; and that the ribs become inclined such that their anterior borders come to lie inferior to their posterior. Here we present a study that revisits growth changes using geometric morphometrics applied to extensive landmark data taken from the ribcage. We digitized 402 (semi) landmarks on 3D reconstructions to assess growth changes in 27 computed tomography-scanned modern humans representing newborns to adults of both sexes. Our analyses show a curved ontogenetic trajectory, resulting from different ontogenetic growth allometries of upper and lower thoracic units. Adult thoracic morphology is achieved later than predicted, by diverse modifications in different anatomical regions during different ontogenetic stages. Besides a marked increase in antero-posterior dimensions, there is an increase in medio-lateral dimensions of the upper thorax, relative to the lower thorax. This transforms the pyramidal infant thorax into the barrel-shaped one of adults. Rib descent is produced by complex changes in 3D curvature. Developmental differences between upper and lower thoracic regions relate to differential timings and rates of maturation of the respiratory and digestive systems, the spine and the locomotor system. Our findings are relevant to understanding how changes in the relative rates of growth of these systems and structures impacted on the development and evolution of modern human body shape.
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Affiliation(s)
- Markus Bastir
- Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain
- * E-mail:
| | - Daniel García Martínez
- Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain
- Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain
| | - Wolfgang Recheis
- Department of Radiology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Alon Barash
- Faculty of Medicine, Galilee Bar Ilan University, Zefat, Israel
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Michael Coquerelle
- Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain
| | - Luis Rios
- Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain
- Fundación Aranzadi, San Sebastián, Spain
| | - Ángel Peña-Melián
- Departamento de Anatomía y Embriología, Universidad Complutense Madrid, Madrid, Spain
| | - Francisco García Río
- Hospital Universitario La Paz, Biomedical Research Institute (IdiPAZ), Madrid, Spain
| | - Paul O’Higgins
- Hull York Medical School (HYMS), University of York, York, United Kingdom
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Sarwal A, Walker FO, Cartwright MS. Neuromuscular ultrasound for evaluation of the diaphragm. Muscle Nerve 2013; 47:319-29. [PMID: 23382111 DOI: 10.1002/mus.23671] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2012] [Indexed: 12/17/2022]
Abstract
Neuromuscular clinicians are often asked to evaluate the diaphragm for diagnostic and prognostic purposes. Traditionally, this evaluation is accomplished through history, physical exam, fluoroscopic sniff test, nerve conduction studies, and electromyography (EMG). Nerve conduction studies and EMG in this setting are challenging, uncomfortable, and can cause serious complications, such as pneumothorax. Neuromuscular ultrasound has emerged as a non-invasive technique that can be used in the structural and functional assessment of the diaphragm. In this study we review different techniques for assessing the diaphragm using neuromuscular ultrasound and the application of these techniques to enhance diagnosis and prognosis by neuromuscular clinicians.
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Affiliation(s)
- Aarti Sarwal
- Department of Neurology, Wake Forest School of Medicine, Reynolds M, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA.
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Jiang B, Cao L, Mao H, Wagner C, Marek S, Yang KH. Development of a 10-year-old paediatric thorax finite element model validated against cardiopulmonary resuscitation data. Comput Methods Biomech Biomed Engin 2012. [PMID: 23181559 DOI: 10.1080/10255842.2012.739164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Thoracic injury in the paediatric population is a relatively common cause of severe injury and has an accompanying high mortality rate. However, no anatomically accurate, complex paediatric chest finite element (FE) component model is available for a 10-year old in the published literature. In this study, a 10-year-old thorax FE model was developed based on internal and external geometries segmented from medical images. The model was then validated against published data measured during cardiopulmonary resuscitation performed on paediatric subjects.
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Affiliation(s)
- Binhui Jiang
- a The State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University , ChangSha , Hunan , P.R. China
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Stress profile of infant rib in the setting of child abuse: A finite element parametric study. J Biomech 2012; 45:1861-8. [DOI: 10.1016/j.jbiomech.2012.05.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 05/01/2012] [Accepted: 05/19/2012] [Indexed: 11/22/2022]
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Akbarnia BA, Campbell RM, Dimeglio A, Flynn JM, Redding GJ, Sponseller PD, Vitale MG, Yazici M. Fusionless procedures for the management of early-onset spine deformities in 2011: what do we know? J Child Orthop 2011; 5:159-72. [PMID: 22654977 PMCID: PMC3100462 DOI: 10.1007/s11832-011-0342-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 04/11/2011] [Indexed: 02/03/2023] Open
Abstract
While attempts to understand them better and treat them more effectively, early-onset deformities have gained great pace in the past few years. Large patient series with long follow-ups that would provide high levels of evidence are still almost non-existent. That there is no safe treatment algorithm defined and agreed upon for this patient population continues to pose a challenge for pediatric spine surgeons. In this review, authors who are well known for their research and experience in the treatment of early-onset scoliosis (EOS) have come together in order to answer those questions which are most frequently asked by other surgeons. The most basic eight questions in this field have been answered succinctly by these authors and a current overview is provided.
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Affiliation(s)
| | - Robert M. Campbell
- />Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Alain Dimeglio
- />Service de Chirurgie Orthopedique Pediatrique, CHU Lapeyronie, Montpellier, Cedex 5, France
| | - Jack M. Flynn
- />Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Gregory J. Redding
- />Pulmonary Division, Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | | | | | - Muharrem Yazici
- />Department of Orthopaedics, Faculty of Medicine, Hacettepe University, 06100 Sıhhıye, Ankara, Turkey
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Place et indications de la ventilation non invasive (VNI) en pédiatrie — Apport de cette méthode lors de la décompensation respiratoire aiguë et des pathologies neuromusculaires. MEDECINE INTENSIVE REANIMATION 2010. [DOI: 10.1007/s13546-010-0059-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Larrañaga CL, Ampuero SL, Luchsinger VF, Carrión FA, Aguilar NV, Morales PR, Palomino MAM, Tapia LF, Avendaño LF. Impaired immune response in severe human lower tract respiratory infection by respiratory syncytial virus. Pediatr Infect Dis J 2009; 28:867-73. [PMID: 19738511 DOI: 10.1097/inf.0b013e3181a3ea71] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infection in infants. The immune response plays a leading role in the severity of the disease. We hypothesized that severe RSV disease is associated with an impaired immune response characterized by low circulating T lymphocytes and plasma cytokine concentrations. METHODS We evaluate the in vivo immune responses of previously healthy infants with their first proven RSV-acute lower respiratory infection that required hospitalization. According to the clinical severity, defined by using a strict scoring system, the in vivo immune response was compared through the analysis of plasma cytokine values and the phenotyping of peripheral blood lymphocyte and natural killer (NK) cells. RESULTS Absolute blood cell counts of CD4+, CD8+, and CD19+ lymphocytes and NK cells were lower in subjects with RSV than in control infants. Lowest cell counts were observed in more severe RSV-infected infants. Significant low values were obtained in CD8+ lymphocytes (P = 0.03) and nonactive NK cells, that express CD94 antigen (P = 0.046). In contrast, activated NK cells that do not express CD94 molecules were significantly higher in RSV infected infants than in healthy controls (% of cells: P = 0.004). The interferon-gamma and tumor necrosis factor-alpha values in RSV infected patients were lower than in controls subjects. Interleukin-17 cytokine was not detected in healthy infants and the largest concentration was found in moderately ill patients as compared with severe cases (P = 0.033). RSV infection showed significantly higher interleukin-8 chemokine than in control infants (P = 0.024). CONCLUSION We propose that severe RSV infection in very young infants is associated with poor blood proinflammatory cytokine production, low counts of CD8+ T cells and with a greater activity of a group of NK cells, that are independent of the major histocompatibility complex class Ib recognition system.
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Affiliation(s)
- Carmen L Larrañaga
- Programa de Virologia, ICBM, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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Eifinger F, Lenze M, Brisken K, Welzing L, Roth B, Koebke J. The anterior to midaxillary line between the 4th or 5th intercostal space (Buelau position) is safe for the use of thoracostomy tubes in preterm and term infants. Paediatr Anaesth 2009; 19:612-7. [PMID: 19645980 DOI: 10.1111/j.1460-9592.2009.03040.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Thoracostomy tubes are widely used in neonatology. Complications occurred significantly more frequently in infants, especially neonates, than in adults. Principally, the access is the modified Buelau position which takes place in the anterior axillary line at the 4th or 5th intercostal space above the margin of the ribs. AIM This study seeks to determine the characteristics and topographic conditions of the anatomical structures at the ventral and lateral thoracic wall in the preterm and term neonate. BACKGROUND Fifteen formalin-fixed stillborns were prepared (nine male, six female, 28-43 weeks gestational age). METHODS/MATERIALS The anatomical preparation involved the complete thoracic wall region. RESULTS In all preparations, a venous vessel was detected at the lateral wall and was identified as v. thoracoepigastrica without accompanying artery. Arteria (a.) and vena (v.) thoracica interna were regularly found close to the sternal plate on both sides between rib and fascia. With increasing gestational ages the course of the v. thoracoepigastrica varied significantly between the left and right thoracic wall. It was demonstrated that the v. thoracoepigastrica regularly arose within the abdominal or thoracic subcutaneous fat and drained into the v. subclavia. The variance between its course was almost 5-12 mm to the lateral or medial side. At both thoracic sides, no other organs or organ structures except lung parenchyma could be detected when using the Buelau position. CONCLUSIONS The anterior to midaxillary line between the 4th or 5th intercostal space (Buelau position) is safe for the use of thoracostomy tubes in preterm and term infants.
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Affiliation(s)
- Frank Eifinger
- Department of Neonatology, University of Cologne, Children's Hospital, Cologne, Germany.
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Reilly KJ, Moore CA. Respiratory movement patterns during vocalizations at 7 and 11 months of age. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2009; 52:223-239. [PMID: 18695025 PMCID: PMC3974901 DOI: 10.1044/1092-4388(2008/06-0215)] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE The present investigation was designed to study the modulation of abdomen and rib cage movements during vocalization over a period of development associated with rapid decreases in the compliance of the chest wall. METHOD Rib cage and abdominal kinematics were recorded during spontaneous vocalizations in 7- and 11-month old infants. Principal component analysis was used to represent each infant's abdomen and rib cage traces as the weighted sum of a small number of principal component (PC) waveforms. RESULTS The fundamental periods of infants' PC waveforms in the 11-month group were significantly shorter than those in the 7-month group. In addition, the variance contributed by PCs describing unidirectional patterns of respiratory movement decreased in the 11-month group, whereas the variances contributed by PCs describing modulated patterns of movement increased. Lastly, the extent to which abdomen and rib cage movements predicted the duration of corresponding vocalizations also increased significantly in the 11-month group compared with the 7-month group. CONCLUSIONS The findings of the present study were consistent with the hypothesis that decreases in the compliance of the chest wall result in more rapid modulation of chest wall movements and greater control of those movements by the developing neuromuscular system.
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Affiliation(s)
- Kevin J Reilly
- Department of Speech-Language Pathology and Audiology, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA.
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