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Kola G, Hamada E, Dhingra RR, Jacono FJ, Dick TE, Dewald D, Strohl KP, Fleury-Curado T, Dutschmann M. Persistent Glossopharyngeal Nerve Respiratory Discharge Patterns after Ponto-Medullary Transection. Respir Physiol Neurobiol 2024:104281. [PMID: 38768741 DOI: 10.1016/j.resp.2024.104281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
Shape and size of the nasopharyngeal airway is controlled by muscles innervated facial, glossopharyngeal, vagal, and hypoglossal cranial nerves. Contrary to brainstem networks that drive facial, vagal and hypoglossal nerve activities (FNA, VNA, HNA) the discharge patterns and origins of glossopharyngeal nerve activity (GPNA) remain poorly investigated. Here, an in situ perfused brainstem preparation (n=19) was used for recordings of GPNA in relation to phrenic (PNA), FNA, VNA and HNA. Brainstem transections were performed (n=10/19) to explore the role of pontomedullary synaptic interactions in generating GPNA. GPNA generally mirrors FNA and HNA discharge patterns and displays pre-inspiratory activity relative to the PNA, followed by robust inspiratory discharge in coincidence with PNA. Postinspiratory (early expiratory) discharge was, contrary to VNA, generally absent in FNA, GPNA or HNA. As described previously FNA and HNA discharge was virtually eliminated after pontomedullary transection while an apneustic inspiratory motor discharge was maintained in PNA, VNA and GPNA. After brainstem transection GPNA displayed an increased tonic activity starting during mid-expiration and thus developed prolonged pre-inspiratory activity compared to control. In conclusion respiratory GPNA reflects FNA and HNA which implies similar function in controlling upper airway patency during breathing. That GPNA preserved its pre-inspiratory/inspiratory discharge pattern in relation PNA after pontomedullary transection suggest that GPNA premotor circuits may have a different anatomical distribution compared HNA and FNA and thus may therefore hold a unique role in in preserving airway patency.
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Affiliation(s)
- Gijnovefa Kola
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, 44106 USA
| | - Eriko Hamada
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, 44106 USA; Department of Respiratory Medicine, Nara Medical University, Kashihara, Nara 634-8521, Japan
| | - Rishi R Dhingra
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, 44106 USA; Department of Neurosciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Frank J Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, 44106 USA; Pulmonary Section, Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106 USA
| | - Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, 44106 USA; Department of Neurosciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Denise Dewald
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, MetroHealth Medical Center, Cleveland, OH 44130 USA; Center for Sleep Disorders Research, Louis Stokes Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH 44106 USA
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, 44106 USA; Center for Sleep Disorders Research, Louis Stokes Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH 44106 USA
| | - Thomaz Fleury-Curado
- Center for Sleep Disorders Research, Louis Stokes Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH 44106 USA; Department of Otolaryngology, University Hospitals Cleveland Medical Center, Cleveland OH 44106 USA
| | - Mathias Dutschmann
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, 44106 USA; Center for Sleep Disorders Research, Louis Stokes Cleveland VA Medical Center and Case Western Reserve University, Cleveland, OH 44106 USA.
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Kola G, Clifford CW, Campanaro CK, Dhingra RR, Dutschmann M, Jacono FJ, Dick TE. Peritoneal sepsis caused by Escherichia coli triggers brainstem inflammation and alters the function of sympatho-respiratory control circuits. J Neuroinflammation 2024; 21:45. [PMID: 38331902 PMCID: PMC10854125 DOI: 10.1186/s12974-024-03025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Sepsis has a high mortality rate due to multiple organ failure. However, the influence of peripheral inflammation on brainstem autonomic and respiratory circuits in sepsis is poorly understood. Our working hypothesis is that peripheral inflammation affects central autonomic circuits and consequently contributes to multiorgan failure in sepsis. METHODS In an Escherichia coli (E. coli)-fibrin clot model of peritonitis, we first recorded ventilatory patterns using plethysmography before and 24 h after fibrin clot implantation. To assess whether peritonitis was associated with brainstem neuro-inflammation, we measured cytokine and chemokine levels in Luminex assays. To determine the effect of E. coli peritonitis on brainstem function, we assessed sympatho-respiratory nerve activities at baseline and during brief (20 s) hypoxemic ischemia challenges using in situ-perfused brainstem preparations (PBPs) from sham or infected rats. PBPs lack peripheral organs and blood, but generate vascular tone and in vivo rhythmic activities in thoracic sympathetic (tSNA), phrenic and vagal nerves. RESULTS Respiratory frequency was greater (p < 0.001) at 24 h post-infection with E. coli than in the sham control. However, breath-by-breath variability and total protein in the BALF did not differ. IL-1β (p < 0.05), IL-6 (p < 0.05) and IL-17 (p < 0.04) concentrations were greater in the brainstem of infected rats. In the PBP, integrated tSNA (p < 0.05) and perfusion pressure were greater (p < 0.001), indicating a neural-mediated pathophysiological high sympathetic drive. Moreover, respiratory frequency was greater (p < 0.001) in PBPs from infected rats than from sham rats. Normalized phase durations of inspiration and expiration were greater (p < 0.009, p < 0.015, respectively), but the post-inspiratory phase (p < 0.007) and the breath-by-breath variability (p < 0.001) were less compared to sham PBPs. Hypoxemic ischemia triggered a biphasic response, respiratory augmentation followed by depression. PBPs from infected rats had weaker respiratory augmentation (p < 0.001) and depression (p < 0.001) than PBPs from sham rats. In contrast, tSNA in E. coli-treated PBPs was enhanced throughout the entire response to hypoxemic ischemia (p < 0.01), consistent with sympathetic hyperactivity. CONCLUSION We show that peripheral sepsis caused brainstem inflammation and impaired sympatho-respiratory motor control in a single day after infection. We conclude that central sympathetic hyperactivity may impact vital organ systems in sepsis.
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Affiliation(s)
- Gjinovefa Kola
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, BRB 319, Cleveland, OH, 44106-1714, USA
| | - Caitlyn W Clifford
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, BRB 319, Cleveland, OH, 44106-1714, USA
| | - Cara K Campanaro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, BRB 319, Cleveland, OH, 44106-1714, USA
| | - Rishi R Dhingra
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, BRB 319, Cleveland, OH, 44106-1714, USA
| | - Mathias Dutschmann
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, BRB 319, Cleveland, OH, 44106-1714, USA
| | - Frank J Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, BRB 319, Cleveland, OH, 44106-1714, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, 44106, USA
| | - Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, BRB 319, Cleveland, OH, 44106-1714, USA.
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, 44106, USA.
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Sharma P, Pora G, Sharma P, Jacono FJ, Matta M, Singh S, Stull MJ. Keeping Cardiac Arrest Documentation Alive in the Electronic Medical Record. ATS Sch 2023; 4:464-468. [PMID: 38196678 PMCID: PMC10773273 DOI: 10.34197/ats-scholar.2023-0031br] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/31/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Pallavi Sharma
- Department of Pulmonary & Critical Care Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Gavriella Pora
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania
| | - Paarth Sharma
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | | | - Maroun Matta
- Department of Pulmonary & Critical Care Medicine and
| | - Simran Singh
- Department of Internal Medicine, Case Western Reserve School of Medicine, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
| | - Matthew J. Stull
- Department of Emergency Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio; and
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Campanaro CK, Nethery DE, Guo F, Kaffashi F, Loparo KA, Jacono FJ, Dick TE, Hsieh YH. Dynamics of ventilatory pattern variability and Cardioventilatory Coupling during systemic inflammation in rats. Front Netw Physiol 2023; 3:1038531. [PMID: 37583625 PMCID: PMC10423997 DOI: 10.3389/fnetp.2023.1038531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/20/2023] [Indexed: 08/17/2023]
Abstract
Introduction: Biometrics of common physiologic signals can reflect health status. We have developed analytics to measure the predictability of ventilatory pattern variability (VPV, Nonlinear Complexity Index (NLCI) that quantifies the predictability of a continuous waveform associated with inhalation and exhalation) and the cardioventilatory coupling (CVC, the tendency of the last heartbeat in expiration to occur at preferred latency before the next inspiration). We hypothesized that measures of VPV and CVC are sensitive to the development of endotoxemia, which evoke neuroinflammation. Methods: We implanted Sprague Dawley male rats with BP transducers to monitor arterial blood pressure (BP) and recorded ventilatory waveforms and BP simultaneously using whole-body plethysmography in conjunction with BP transducer receivers. After baseline (BSLN) recordings, we injected lipopolysaccharide (LPS, n = 8) or phosphate buffered saline (PBS, n =3) intraperitoneally on 3 consecutive days. We recorded for 4-6 h after the injection, chose 3 epochs from each hour and analyzed VPV and CVC as well as heart rate variability (HRV). Results: First, the responses to sepsis varied across rats, but within rats the repeated measures of NLCI, CVC, as well as respiratory frequency (fR), HR, BP and HRV had a low coefficient of variation, (<0.2) at each time point. Second, HR, fR, and NLCI increased from BSLN on Days 1-3; whereas CVC decreased on Days 2 and 3. In contrast, changes in BP and the relative low-(LF) and high-frequency (HF) of HRV were not significant. The coefficient of variation decreased from BSLN to Day 3, except for CVC. Interestingly, NLCI increased before fR in LPS-treated rats. Finally, we histologically confirmed lung injury, systemic inflammation via ELISA and the presence of the proinflammatory cytokine, IL-1β, with immunohistochemistry in the ponto-medullary respiratory nuclei. Discussion: Our findings support that NLCI reflects changes in the rat's health induced by systemic injection of LPS and reflected in increases in HR and fR. CVC decreased over the course to the experiment. We conclude that NLCI reflected the increase in predictability of the ventilatory waveform and (together with our previous work) may reflect action of inflammatory cytokines on the network generating respiration.
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Affiliation(s)
- Cara K. Campanaro
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - David E. Nethery
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Fei Guo
- Institute for Smart, Secure and Connected Systems (ISSACS), Case Western Reserve University, Cleveland, OH, United States
| | - Farhad Kaffashi
- Institute for Smart, Secure and Connected Systems (ISSACS), Case Western Reserve University, Cleveland, OH, United States
| | - Kenneth A. Loparo
- Institute for Smart, Secure and Connected Systems (ISSACS), Case Western Reserve University, Cleveland, OH, United States
| | - Frank J. Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Thomas E. Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Department of Neurosciences, Case Western Reserve University, Cleveland, OH, United States
| | - Yee-Hsee Hsieh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
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Horton KKA, Campanaro CK, Clifford C, Nethery DE, Strohl KP, Jacono FJ, Dick TE. Cannabinoid Receptor mRNA Expression in Central and Peripheral Tissues in a Rodent Model of Peritonitis. Cannabis Cannabinoid Res 2023; 8:510-526. [PMID: 35446129 PMCID: PMC10249742 DOI: 10.1089/can.2021.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Our laboratory investigates changes in the respiratory pattern during systemic inflammation in various rodent models. The endogenous cannabinoid system (ECS) regulates cytokine production and mitigates inflammation. Inflammation not only affects cannabinoid (CB) 1 and CB2 receptor gene expression (Cnr1 and Cnr2), but also increases the predictability of the ventilatory pattern. Objectives: Our primary objective was to track ventilatory pattern variability and transcription of Cnr1 and Cnr2 mRNA, and of Il1b, Il6, and tumor necrosis factor-alpha (Tnfa) mRNAs at multiple time points in central and peripheral tissues during systemic inflammation induced by peritonitis. Methods: In male Sprague Dawley rats (n=24), we caused peritonitis by implanting a fibrin clot containing either 0 or 25×106 Escherichia coli intraperitoneally. We recorded breathing with whole-animal plethysmography at baseline and 1 h before euthanasia. We euthanized the rats at 3, 6, or 12 h after inoculation and harvested the pons, medulla, lung, and heart for gene expression analysis. Results: With peritonitis, Cnr1 mRNA more than Cnr2 mRNA was correlated to Il1b, Il6, and Tnfa mRNAs in medulla, pons, and lung and changed oppositely in the pons, medulla, and lung. These changes were associated with increased predictability of ventilatory pattern. Specifically, nonlinear complexity index correlated with increased Cnr1 mRNA in the pons and medulla, and coefficient of variation for cycle duration correlated with Cnr1 and Cnr2 mRNAs in the lung. Conclusion: The mRNAs for ECS receptors varied with time during the central and peripheral inflammatory response to peritonitis. These changes occurred in the brainstem, which contains the network that generates breathing pattern and thus, may participate in ventilatory pattern changes during systemic inflammation.
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Affiliation(s)
- Kofi-Kermit A. Horton
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Cara K. Campanaro
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Caitlyn Clifford
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - David E. Nethery
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kingman P. Strohl
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Frank J. Jacono
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Thomas E. Dick
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Neurosciences, Case Western Reserve University, Cleveland, Ohio, USA
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Litvin DG, Denstaedt SJ, Borkowski LF, Nichols NL, Dick TE, Smith CB, Jacono FJ. Peripheral-to-central immune communication at the area postrema glial-barrier following bleomycin-induced sterile lung injury in adult rats. Brain Behav Immun 2020; 87:610-633. [PMID: 32097765 PMCID: PMC8895345 DOI: 10.1016/j.bbi.2020.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/02/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
The pathways for peripheral-to-central immune communication (P → C I-comm) following sterile lung injury (SLI) are unknown. SLI evokes systemic and central inflammation, which alters central respiratory control and viscerosensory transmission in the nucleus tractus solitarii (nTS). These functional changes coincide with increased interleukin-1 beta (IL-1β) in the area postrema, a sensory circumventricular organ that connects P → C I-comm to brainstem circuits that control homeostasis. We hypothesize that IL-1β and its downstream transcriptional target, cyclooxygenase-2 (COX-2), mediate P → C I-comm in the nTS. In a rodent model of SLI induced by intratracheal bleomycin (Bleo), the sigh frequency and duration of post-sigh apnea increased in Bleo- compared to saline- treated rats one week after injury. This SLI-dependent change in respiratory control occurred concurrently with augmented IL-1β and COX-2 immunoreactivity (IR) in the funiculus separans (FS), a barrier between the AP and the brainstem. At this barrier, increases in IL-1β and COX-2 IR were confined to processes that stained for glial fibrillary acidic protein (GFAP) and that projected basolaterally to the nTS. Further, FS radial-glia did not express TNF-α or IL-6 following SLI. To test our hypothesis, we blocked central COX-1/2 activity by intracerebroventricular (ICV) infusion of Indomethacin (Ind). Continuous ICV Ind treatment prevented Bleo-dependent increases in GFAP + and IL-1β + IR, and restored characteristics of sighs that reset the rhythm. These data indicate that changes in sighs following SLI depend partially on activation of a central COX-dependent P → C I-comm via radial-glia of the FS.
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Affiliation(s)
- David G Litvin
- Department of Physiology & Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Department of Fundamental Neuroscience, University of Lausanne, 1005 Lausanne, Switzerland
| | - Scott J Denstaedt
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Lauren F Borkowski
- Department of Biomedical Sciences, University of Missouri College of Veterinary Medicine, Columbia, MO 65212, United States
| | - Nicole L Nichols
- Department of Biomedical Sciences, University of Missouri College of Veterinary Medicine, Columbia, MO 65212, United States
| | - Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
| | - Corey B Smith
- Department of Physiology & Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
| | - Frank J Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States.
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Sun Y, Guo F, Kaffashi F, Jacono FJ, DeGeorgia M, Loparo KA. INSMA: An integrated system for multimodal data acquisition and analysis in the intensive care unit. J Biomed Inform 2020; 106:103434. [PMID: 32360265 PMCID: PMC7187847 DOI: 10.1016/j.jbi.2020.103434] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/02/2022]
Abstract
Modern intensive care units (ICU) are equipped with a variety of different medical devices to monitor the physiological status of patients. These devices can generate large amounts of multimodal data daily that include physiological waveform signals (arterial blood pressure, electrocardiogram, respiration), patient alarm messages, numeric vitals data, etc. In order to provide opportunities for increasingly improved patient care, it is necessary to develop an effective data acquisition and analysis system that can assist clinicians and provide decision support at the patient bedside. Previous research has discussed various data collection methods, but a comprehensive solution for bedside data acquisition to analysis has not been achieved. In this paper, we proposed a multimodal data acquisition and analysis system called INSMA, with the ability to acquire, store, process, and visualize multiple types of data from the Philips IntelliVue patient monitor. We also discuss how the acquired data can be used for patient state tracking. INSMA is being tested in the ICU at University Hospitals Cleveland Medical Center.
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Affiliation(s)
- Yingcheng Sun
- CDS Department, Case Western Reserve University, Cleveland, OH, United States.
| | - Fei Guo
- ECSE Department, Case Western Reserve University, Cleveland, OH, United States
| | - Farhad Kaffashi
- ECSE Department, Case Western Reserve University, Cleveland, OH, United States
| | - Frank J Jacono
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Michael DeGeorgia
- Department of Neurology, Case Western Reserve University, Cleveland, OH, United States
| | - Kenneth A Loparo
- ECSE Department, Case Western Reserve University, Cleveland, OH, United States
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Hsieh YH, Litvin DG, Zaylor AR, Nethery DE, Dick TE, Jacono FJ. Brainstem inflammation modulates the ventilatory pattern and its variability after acute lung injury in rodents. J Physiol 2020; 598:2791-2811. [PMID: 32378188 DOI: 10.1113/jp279177] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/21/2020] [Indexed: 01/20/2023] Open
Abstract
KEY POINTS Compared with sham rats, rats a week after acute lung injury (ALI) express more pro-inflammatory cytokines in their brainstem respiratory control nuclei, exhibit a higher respiratory frequency (fR) and breathe with a more predictable pattern. These characteristics of the respiratory pattern persist in in situ preparations even after minimizing pulmonary and chemo-afferent inputs. Interleukin (IL)-1β microinjected in the nucleus tractus solitarii increases fR and the predictability of the ventilatory pattern similar to rats with ALI. Intracerebroventricular infusion of indomethacin, an anti-inflammatory drug, mitigates the effect of ALI on fR and ventilatory pattern variability. We conclude that changes in the ventilatory pattern after ALI result not only from sensory input due to pulmonary damage and dysfunction but also from neuro-inflammation. ABSTRACT Acute lung injury (ALI) increases respiratory rate (fR) and ventilatory pattern variability (VPV), but also evokes peripheral and central inflammation. We hypothesized that central inflammation has a role in determining the ventilatory pattern after ALI. In rat pups, we intratracheally injected either bleomycin to induce ALI or saline as a sham control. One week later, we recorded the ventilatory pattern of the rat pups using flow-through plethysmography, then formed in situ preparations from these pups and recorded their 'fictive' patterns from respiratory motor nerves. Compared with the ventilatory pattern of the sham rat pups, injured rat pups had increased fR and predictability. Surprisingly, the fictive patterns of the in situ preparations from ALI pups retained these characteristics despite removing their lungs to eliminate pulmonary sensory inputs and perfusing them with hyperoxic artificial cerebral spinal fluid to minimize peripheral chemoreceptor input. Histological processing revealed increased immunoreactivity of the pro-inflammatory cytokine Interleukin-1β (IL-1β) in the nucleus tractus solitarii (nTS) from ALI but not sham rats. In subsequent experiments, we microinjected IL-1β in the nTS bilaterally in anaesthetized naïve adult rats, which increased fR and predictability of ventilatory pattern variability (VPV) after 2 h. Finally, we infused indomethacin intracerebroventricularly during the week of survival after ALI. This did not affect sham rats, but mitigated changes in fR and VPV in ALI rats. We conclude that neuro-inflammation has an essential role in determining the ventilatory pattern of ALI rats.
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Affiliation(s)
- Yee-Hsee Hsieh
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - David G Litvin
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States.,Department of Fundamental Neuroscience, University of Lausanne, Lausanne, 1005, Switzerland
| | - Abigail R Zaylor
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, Ohio, United States.,Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes VA Medical Center, Cleveland, Ohio, United States
| | - David E Nethery
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, Ohio, United States
| | - Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, Ohio, United States.,Department of Neurosciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Frank J Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, Ohio, United States.,Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes VA Medical Center, Cleveland, Ohio, United States
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He Z, Nethery D, Campanaro C, Dick TE, Jacono FJ, Hsieh YHH. Cervical Vagal Nerve Stimulation Restores Ventilatory Pattern Variability in an E. Coli Sepsis Rodent Model. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.02963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Getsy PM, Mayer CA, MacFarlane PM, Jacono FJ, Wilson CG. Acute lung injury in neonatal rats causes postsynaptic depression in nucleus tractus solitarii second-order neurons. Respir Physiol Neurobiol 2019; 269:103250. [PMID: 31352011 DOI: 10.1016/j.resp.2019.103250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/14/2019] [Accepted: 07/02/2019] [Indexed: 12/28/2022]
Abstract
Acute Lung Injury (ALI) alters pulmonary reflex responses, in part due to changes in modulation within the lung and airway neuronal control networks. We hypothesized that synaptic efficacy of nucleus tractus solitarii (nTS) neurons, receiving input from lung, airway, and other viscerosensory afferent fibers, would decrease following ALI. Sprague Dawley neonatal rats (postnatal days 9-11) were given intratracheal installations of saline or bleomycin (a well-characterized model that reproduces the pattern of ALI) and then, one week later, in vitro slices were prepared for whole-cell and perforated whole-cell patch-clamp experiments (postnatal days 16-21). In preparations from ALI rats, 2nd-order nTS neurons had significantly decreased amplitudes of both spontaneous and miniature excitatory postsynaptic currents (sEPSCs and mEPSCs), compared to saline controls. Rise and decay times of sEPSCs were slower in whole-cell recordings from ALI animals. Similarly, the amplitude of tractus solitarii evoked EPSCs (TS-eEPSCs) were significantly lower in 2nd-order nTS neurons from ALI rats. Overall these results suggest the presence of postsynaptic depression at TS-nTS synapses receiving lung, airway, and other viscerosensory afferent tractus solitarii input after bleomycin-induced ALI.
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Affiliation(s)
- Paulina M Getsy
- Department of Physiology and Biophysics, CWRU School of Medicine, Cleveland, OH, 44106, United States; Department of Pediatrics, Rainbow Babies & Children's Hospital, CWRU School of Medicine, Cleveland, OH, 44106, United States
| | - Catherine A Mayer
- Department of Pediatrics, Rainbow Babies & Children's Hospital, CWRU School of Medicine, Cleveland, OH, 44106, United States
| | - Peter M MacFarlane
- Department of Pediatrics, Rainbow Babies & Children's Hospital, CWRU School of Medicine, Cleveland, OH, 44106, United States
| | - Frank J Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, CWRU School of Medicine, Cleveland, OH, 44106, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes VA Medical Center, Cleveland, OH, 44106, United States
| | - Christopher G Wilson
- Department of Pediatrics and Lawrence D. Long, MD Center for Perinatal Biology Loma Linda University Loma Linda, CA, United States.
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11
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Young BP, Loparo KA, Dick TE, Jacono FJ. Ventilatory pattern variability as a biometric for severity of acute lung injury in rats. Respir Physiol Neurobiol 2019; 265:161-171. [PMID: 30928542 PMCID: PMC9994622 DOI: 10.1016/j.resp.2019.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 03/05/2019] [Accepted: 03/26/2019] [Indexed: 01/27/2023]
Abstract
We hypothesize that ventilatory pattern variability (VPV) varies with the magnitude of acute lung injury (ALI). In adult male rats, we instilled a low- or high- dose of bleomycin or saline (PBS) intratracheally. While representative samples of pulmonary tissue indicated graded lung injury, coefficient of variation (CV) of TTOT did not differ among the 3 groups. Broncho-alveolar lavage fluid (BALF), respiratory rate (fR), mutual information were greater in ALI than sham rats; but did not differ between bleomycin doses. However, nonlinear complexity index (NLCI), which is the difference in sample entropy between original and surrogate data sets was greater for high- versus low- dose; but did not differ between low-dose and sham groups. Further, NLCI correlated to an injury index based on protein concentration of BALF and failure to gain weight. Finally, Receiver Operator Curves (ROCs) indicated that both mutual information and NLCI had greater sensitivity and specificity than fR and CVTTOT in identifying ALI. Thus, nonlinear analyses of VPV can distinguish ALI and out performs fR as a biometric.
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Affiliation(s)
- Benjamin P Young
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Kenneth A Loparo
- Department of Electrical Engineering and Computer Science, School of Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Thomas E Dick
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Neurosciences, School of Medicine Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Frank J Jacono
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Louis Stokes VA Medical Center, Cleveland, OH 44106, USA
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12
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Tackett SH, Solanki N, Nethery DE, Horton KA, Bonfield TL, Jacono FJ, Dick TE. Dynamics of Ventilatory Pattern Variability (VPV), Cardio‐Respiratory Coupling (CRC) and Cytokines in an
E. coli
Sepsis Model. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.859.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shiloh H Tackett
- Div Pul Crit Care&Sleep Med, Dept MedCase Western Reserve UniversityClevelandOH
| | - Neha Solanki
- Div Pul Crit Care&Sleep Med, Dept MedCase Western Reserve UniversityClevelandOH
| | | | | | | | - Frank J Jacono
- Div Pul Crit Care&Sleep Med, Dept MedCase Western Reserve UniversityClevelandOH
- Div Pul Crit Care&Sleep Med, Dept MedVAClevelandOH
| | - Thomas E Dick
- Div Pul Crit Care&Sleep Med, Dept MedCase Western Reserve UniversityClevelandOH
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13
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Horton KA, Clifford C, Tackett SH, Nethery DE, Dick TE, Jacono FJ, Strohl KP. Modulation of mRNA Expression in Peripheral Tissue in a Rodent
E. coli
Sepsis Model. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.859.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kofi‐Kermit A Horton
- Pulmonary, Critical Care and Sleep MedicineCase Western Reserve UniversityClevelandOH
| | - Caitlyn Clifford
- Pulmonary, Critical Care and Sleep MedicineCase Western Reserve UniversityClevelandOH
| | - Shiloh H Tackett
- Pulmonary, Critical Care and Sleep MedicineCase Western Reserve UniversityClevelandOH
| | - David E Nethery
- Pulmonary, Critical Care and Sleep MedicineCase Western Reserve UniversityClevelandOH
| | - Thomas E Dick
- Pulmonary, Critical Care and Sleep MedicineCase Western Reserve UniversityClevelandOH
| | - Frank J Jacono
- Pulmonary, Critical Care and Sleep MedicineCase Western Reserve UniversityClevelandOH
- Pulmonary, Critical Care and Sleep MedicineLouis Stokes VA Medical CenterClevelandOH
| | - Kingman P Strohl
- Pulmonary, Critical Care and Sleep MedicineCase Western Reserve UniversityClevelandOH
- Pulmonary, Critical Care and Sleep MedicineLouis Stokes VA Medical CenterClevelandOH
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14
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Darrah RJ, Jacono FJ, Joshi N, Mitchell AL, Sattar A, Campanaro CK, Litman P, Frey J, Nethery DE, Barbato ES, Hodges CA, Corvol H, Cutting GR, Knowles MR, Strug LJ, Drumm ML. AGTR2 absence or antagonism prevents cystic fibrosis pulmonary manifestations. J Cyst Fibros 2018; 18:127-134. [PMID: 29937318 DOI: 10.1016/j.jcf.2018.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/01/2018] [Accepted: 05/23/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pulmonary disease remains the primary cause of morbidity and mortality for individuals with cystic fibrosis (CF). Variants at a locus on the X-chromosome containing the type 2 angiotensin II receptor gene (AGTR2) were identified by a large GWAS as significantly associating with lung function in CF patients. We hypothesized that manipulating the angiotensin-signaling pathway may yield clinical benefit in CF. METHODS Genetic subset analysis was conducted on a local CF cohort to extend the GWAS findings. Next, we evaluated pulmonary function in CF mice with a deleted AGTR2 gene, and in those who were given subcutaneous injections of PD123,319, a selective AGTR2 antagonist for 12 weeks beginning at weaning. RESULTS The genetic subset analysis replicated the initial GWAS identified association, and confirmed the association of this locus with additional lung function parameters. Studies in genetically modified mice established that absence of the AGTR2 gene normalized pulmonary function indices in two independent CF mouse models. Further, we determined that pharmacologic antagonism of AGTR2 improved overall pulmonary function in CF mice to near wild-type levels. CONCLUSIONS These results identify that reduced AGTR2 signaling is beneficial to CF lung function, and suggest the potential of manipulating the angiotensin-signaling pathway for treatment and/or prevention of CF pulmonary disease. Importantly, the beneficial effects were not CF gene mutation dependent, and were able to be reproduced with pharmacologic antagonism. As there are clinically approved drugs available to target the renin-angiotensin signaling system, these findings may be quickly translated to human clinical trials.
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Affiliation(s)
- Rebecca J Darrah
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Frank J Jacono
- Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA
| | - Neha Joshi
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Anna L Mitchell
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Abdus Sattar
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Cara K Campanaro
- Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Paul Litman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Jennifer Frey
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - David E Nethery
- Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA
| | - Eric S Barbato
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Craig A Hodges
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Harriet Corvol
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris 75012, France; Pneumologie pédiatrique, APHP, Hôpital Trousseau, Paris 75012, France
| | - Garry R Cutting
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Michael R Knowles
- Marsico Lung Institute/UNC CF Research Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North, Carolina, 27599, USA
| | - Lisa J Strug
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 0A4; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada M5T 3M7
| | - Mitchell L Drumm
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
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15
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Thungtong A, Knoch MF, Jacono FJ, Dick TE, Loparo KA. Periodicity: A Characteristic of Heart Rate Variability Modified by the Type of Mechanical Ventilation After Acute Lung Injury. Front Physiol 2018; 9:772. [PMID: 29971020 PMCID: PMC6018479 DOI: 10.3389/fphys.2018.00772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/04/2018] [Indexed: 11/16/2022] Open
Abstract
We present a novel approach to quantify heart rate variability (HRV) and the results of applying this approach to synthetic and original data sets. Our approach evaluates the periodicity of heart rate by calculating the transform of Relative Shannon Entropy, the maximum value of the RR interval periodogram, and the maximum, mean values, and sample entropy of the autocorrelation function. Synthetic data were generated using a Van der Pol oscillator; and the original data were electrocardiogram (ECG) recordings from anesthetized rats after acute lung injury while on biologically variable (BVV) or continuous mechanical ventilation (CMV). Analysis of the synthetic data revealed that our measures were correlated highly to the bandwidth of the oscillator and assessed periodicity. Then, applying these analytical tools to the ECGs determined that the heart rate (HR) of BVV group had less periodicity and higher variability than the HR of the CMV group. Quantifying periodicity effectively identified a readily apparent difference in HRV during BVV and CMV that was not identified by power spectral density measures during BVV and CMV. Cardiorespiratory coupling is the probable mechanism for HRV increasing during BVV and becoming periodic during CMV. Thus, the absence or presence of periodicity in ventilation determined HRV, and this mechanism is distinctly different from the cardiorespiratory uncoupling that accounts for the loss of HRV during sepsis.
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Affiliation(s)
- Anurak Thungtong
- School of Engineering and Resources, Walailak University, Nakhon Si Thammarat, Thailand.,Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, United States
| | - Matthew F Knoch
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center (UHCMC), Cleveland, OH, United States
| | - Frank J Jacono
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center (UHCMC), Cleveland, OH, United States.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Thomas E Dick
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University Hospitals Cleveland Medical Center (UHCMC), Cleveland, OH, United States.,Department of Neurosciences, Case Western Reserve University, Cleveland, OH, United States
| | - Kenneth A Loparo
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, United States
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16
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Litvin DG, Dick TE, Smith CB, Jacono FJ. Lung-injury depresses glutamatergic synaptic transmission in the nucleus tractus solitarii via discrete age-dependent mechanisms in neonatal rats. Brain Behav Immun 2018; 70:398-422. [PMID: 29601943 PMCID: PMC6075724 DOI: 10.1016/j.bbi.2018.03.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 12/26/2022] Open
Abstract
Transition periods (TPs) are brief stages in CNS development where neural circuits can exhibit heightened vulnerability to pathologic conditions such as injury or infection. This susceptibility is due in part to specialized mechanisms of synaptic plasticity, which may become activated by inflammatory mediators released under pathologic conditions. Thus, we hypothesized that the immune response to lung injury (LI) mediated synaptic changes through plasticity-like mechanisms that depended on whether LI occurred just before or after a TP. We studied the impact of LI on brainstem 2nd-order viscerosensory neurons located in the nucleus tractus solitarii (nTS) during a TP for respiratory control spanning (postnatal day (P) 11-15). We injured the lungs of Sprague-Dawley rats by intratracheal instillation of Bleomycin (or saline) just before (P9-11) or after (P17-19) the TP. A week later, we prepared horizontal slices of the medulla and recorded spontaneous and evoked excitatory postsynaptic currents (sEPSCs/eEPSCs) in vitro from neurons in the nTS that received monosynaptic glutamatergic input from the tractus solitarii (TS). In rats injured before the TP (pre-TP), neurons exhibited blunted sEPSCs and TS-eEPSCs compared to controls. The decreased TS-eEPSCs were mediated by differences in postsynaptic α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic-acid receptors (AMPAR). Specifically, compared to controls, LI rats had more Ca2+-impermeable AMPARs (CI-AMPARs) as indicated by: 1) the absence of current-rectification, 2) decreased sensitivity to polyamine, 1-Naphthyl-acetyl-spermine-trihydrochloride (NASPM) and 3) augmented immunoreactive staining for the CI-AMPAR GluA2. Thus, pre-TP-LI acts postsynaptically to blunt glutamatergic transmission. The neuroimmune response to pre-TP-LI included microglia hyper-ramification throughout the nTS. Daily intraperitoneal administration of minocycline, an inhibitor of microglial/macrophage function prevented hyper-ramification and abolished the pre-TP-LI evoked synaptic changes. In contrast, rat-pups injured after the TP (post-TP) exhibited microglia hypo-ramification in the nTS and had increased sEPSC amplitudes/frequencies, and decreased TS-eEPSC amplitudes compared to controls. These synaptic changes were not associated with changes in CI-AMPARs, and instead involved greater TS-evoked use-dependent depression (reduced paired pulse ratio), which is a hallmark of presynaptic plasticity. Thus we conclude that LI regulates the efficacy of TS → nTS synapses through discrete plasticity-like mechanisms that are immune-mediated and depend on whether the injury occurs before or after the TP for respiratory control.
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Affiliation(s)
- David G Litvin
- Department of Physiology & Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States
| | - Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
| | - Corey B Smith
- Department of Physiology & Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
| | - Frank J Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes VA Medical Center, Cleveland, OH 44106, United States.
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17
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Warren PM, Campanaro C, Jacono FJ, Alilain WJ. Mid-cervical spinal cord contusion causes robust deficits in respiratory parameters and pattern variability. Exp Neurol 2018; 306:122-131. [PMID: 29653187 PMCID: PMC6333202 DOI: 10.1016/j.expneurol.2018.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/24/2018] [Accepted: 04/06/2018] [Indexed: 02/08/2023]
Abstract
Mid-cervical spinal cord contusion disrupts both the pathways and motoneurons vital to the activity of inspiratory muscles. The present study was designed to determine if a rat contusion model could result in a measurable deficit to both ventilatory and respiratory motor function under “normal” breathing conditions at acute to chronic stages post trauma. Through whole body plethysmography and electromyography we assessed respiratory output from three days to twelve weeks after a cervical level 3 (C3) contusion. Contused animals showed significant deficits in both tidal and minute volumes which were sustained from acute to chronic time points. We also examined the degree to which the contusion injury impacted ventilatory pattern variability through assessment of Mutual Information and Sample Entropy. Mid-cervical contusion significantly and robustly decreased the variability of ventilatory patterns. The enduring deficit to the respiratory motor system caused by contusion was further confirmed through electromyography recordings in multiple respiratory muscles. When isolated via a lesion, these contused pathways were insufficient to maintain respiratory activity at all time points post injury. Collectively these data illustrate that, counter to the prevailing literature, a profound and lasting ventilatory and respiratory motor deficit may be modelled and measured through multiple physiological assessments at all time points after cervical contusion injury.
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Affiliation(s)
- Philippa M Warren
- Department of Neurosciences, MetroHealth Medical Center, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Cara Campanaro
- Division of Pulmonary Critical Care and Sleep Medicine and Louis Stokes VA Medical Center, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Frank J Jacono
- Division of Pulmonary Critical Care and Sleep Medicine and Louis Stokes VA Medical Center, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Warren J Alilain
- Department of Neurosciences, MetroHealth Medical Center, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Spinal Cord and Brain Injury Research Centre, University of Kentucky, Lexington, KY 40536, USA.
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18
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Rusu M, Rajiah P, Gilkeson R, Yang M, Donatelli C, Thawani R, Jacono FJ, Linden P, Madabhushi A. Co-registration of pre-operative CT with ex vivo surgically excised ground glass nodules to define spatial extent of invasive adenocarcinoma on in vivo imaging: a proof-of-concept study. Eur Radiol 2017; 27:4209-4217. [PMID: 28386717 DOI: 10.1007/s00330-017-4813-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 01/25/2017] [Accepted: 03/14/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To develop an approach for radiology-pathology fusion of ex vivo histology of surgically excised pulmonary nodules with pre-operative CT, to radiologically map spatial extent of the invasive adenocarcinomatous component of the nodule. METHODS Six subjects (age: 75 ± 11 years) with pre-operative CT and surgically excised ground-glass nodules (size: 22.5 ± 5.1 mm) with a significant invasive adenocarcinomatous component (>5 mm) were included. The pathologist outlined disease extent on digitized histology specimens; two radiologists and a pulmonary critical care physician delineated the entire nodule on CT (in-plane resolution: <0.8 mm, inter-slice distance: 1-5 mm). We introduced a novel reconstruction approach to localize histology slices in 3D relative to each other while using CT scan as spatial constraint. This enabled the spatial mapping of the extent of tumour invasion from histology onto CT. RESULTS Good overlap of the 3D reconstructed histology and the nodule outlined on CT was observed (65.9 ± 5.2%). Reduction in 3D misalignment of corresponding anatomical landmarks on histology and CT was observed (1.97 ± 0.42 mm). Moreover, the CT attenuation (HU) distributions were different when comparing invasive and in situ regions. CONCLUSION This proof-of-concept study suggests that our fusion method can enable the spatial mapping of the invasive adenocarcinomatous component from 2D histology slices onto in vivo CT. KEY POINTS • 3D reconstructions are generated from 2D histology specimens of ground glass nodules. • The reconstruction methodology used pre-operative in vivo CT as 3D spatial constraint. • The methodology maps adenocarcinoma extent from digitized histology onto in vivo CT. • The methodology potentially facilitates the discovery of CT signature of invasive adenocarcinoma.
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Affiliation(s)
- Mirabela Rusu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA. .,GE Global Research, Niskayuna, NY, 12309, USA.
| | - Prabhakar Rajiah
- UT Southwestern Medical Center, Dallas, TX, USA.,University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Robert Gilkeson
- University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Michael Yang
- University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Christopher Donatelli
- University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Rajat Thawani
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Frank J Jacono
- University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Philip Linden
- University Hospitals, Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
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19
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Vandendriessche B, Abas M, Dick TE, Loparo KA, Jacono FJ. A Framework for Patient State Tracking by Classifying Multiscalar Physiologic Waveform Features. IEEE Trans Biomed Eng 2017; 64:2890-2900. [PMID: 28328498 DOI: 10.1109/tbme.2017.2684244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE state-of-the-art algorithms that quantify nonlinear dynamics in physiologic waveforms are underutilized clinically due to their esoteric nature. We present a generalizable framework for classifying multiscalar waveform features, designed for patient-state tracking directly at the bedside. METHODS an artificial neural network classifier was designed to evaluate multiscale waveform features against a fingerprint database of multifractal synthetic time series. The results are mapped into a physiologic state space for near real-time patient-state tracking. RESULTS the framework was validated on cardiac beat-to-beat dynamics processed with the multiscale entropy algorithm, and assessed using PhysioNet databases. We then applied our algorithm to predict 28-day mortality for sepsis patients, and found it had greater prognostic accuracy than standard clinical severity scores. CONCLUSION we developed a novel framework to classify multiscale features of beat-to-beat dynamics, and performed an initial clinical validation to demonstrate that our approach generates a robust quantification of a patient's state, compatible with real-time bedside implementations. SIGNIFICANCE the framework generates meaningful and actionable patient-specific information, and could facilitate the dissemination of a new class of "always-on" diagnostic tools.
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20
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Darrah RJ, Mitchell AL, Campanaro CK, Barbato ES, Litman P, Sattar A, Hodges CA, Drumm ML, Jacono FJ. Early pulmonary disease manifestations in cystic fibrosis mice. J Cyst Fibros 2016; 15:736-744. [PMID: 27231029 DOI: 10.1016/j.jcf.2016.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/30/2016] [Accepted: 05/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Altered pulmonary function is present early in the course of cystic fibrosis (CF), independent of documented infections or onset of pulmonary symptoms. New initiatives in clinical care are focusing on detection and characterization of preclinical disease. Thus, animal models are needed which recapitulate the pulmonary phenotype characteristic of early stage CF. METHODS We investigated young CF mice to determine if they exhibit pulmonary pathophysiology consistent with the early CF lung phenotype. Lung histology and pulmonary mechanics were examined in 12- to 16-week-old congenic C57bl/6 F508del and R117H CF mice using a forced oscillation technique (flexiVent). RESULTS There were no significant differences in the resistance of the large airways. However, in both CF mouse models, prominent differences in the mechanical properties of the peripheral lung compartment were identified including decreased static lung compliance, increased elastance and increased tissue damping. CF mice also had distal airspace enlargement with significantly increased mean linear intercept distances. CONCLUSIONS An impaired ability to stretch and expand the peripheral lung compartment, as well as increased distances between gas exchange surfaces, were present in young CF mice carrying two independent Cftr mutations. This altered pulmonary histopathophysiology in the peripheral lung compartment, which develops in the absence of infection, is similar to the early lung phenotype of CF patients.
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Affiliation(s)
- Rebecca J Darrah
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, United States; Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, United States.
| | - Anna L Mitchell
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Cara K Campanaro
- Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Eric S Barbato
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Paul Litman
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Abdus Sattar
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Craig A Hodges
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, United States; Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Mitchell L Drumm
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH 44106, United States; Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Frank J Jacono
- Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States; Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, United States
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Seely AJE, Bravi A, Herry C, Green G, Longtin A, Ramsay T, Fergusson D, McIntyre L, Kubelik D, Maziak DE, Ferguson N, Brown SM, Mehta S, Martin C, Rubenfeld G, Jacono FJ, Clifford G, Fazekas A, Marshall J. Erratum to: Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients? Crit Care 2014. [PMCID: PMC4248429 DOI: 10.1186/s13054-014-0620-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hsieh YH, Jacono FJ, Siegel RE, Dick TE. Respiratory modulation of sympathetic activity is attenuated in adult rats conditioned with chronic hypobaric hypoxia. Respir Physiol Neurobiol 2014; 206:53-60. [PMID: 25462835 DOI: 10.1016/j.resp.2014.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/14/2014] [Accepted: 11/15/2014] [Indexed: 11/29/2022]
Abstract
Respiratory modulation of sympathetic nerve activity (SNA) depends on numerous factors including prior experience. In our studies, exposing naïve adult, male Sprague-Dawley rats to acute intermittent hypoxia (AIH) enhanced respiratory-modulation of splanchnic SNA (sSNA); whereas conditioning them to chronic hypobaric hypoxia (CHH) attenuated modulation. Further, AIH can evoke increased SNA in the absence phrenic long-term facilitation. We hypothesized that AIH would restore respiratory modulation of SNA in CHH rats. In anesthetized, CHH-conditioned (0.5 atm, 2 wks) rats (n=16), we recorded phrenic and sSNA before during and after AIH (8% O2 for 45s every 5min for 1h). At baseline, sSNA was not modulated with respiration. The sSNA was not recruited during a single brief exposure of hypoxia nor after 10 repetitive exposures. Further, the sSNA chemoresponse was not restored 1h after completing AIH. Thus, CHH-conditioning blocked the short-term plasticity expressed in sympatho-respiratory efferent activities and this was associated with reduced respiratory modulation of sympathetic activity and with attenuation of the sympatho-respiratory chemoresponse.
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Affiliation(s)
- Yee-Hsee Hsieh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States.
| | - Frank J Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Louis Stokes VA Medical Center, Cleveland, Ohio, United States
| | - Ruth E Siegel
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, United States; Department of Neurosciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States; Department of Neurosciences, Case Western Reserve University, Cleveland, Ohio, United States
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Seely AJE, Bravi A, Herry C, Green G, Longtin A, Ramsay T, Fergusson D, McIntyre L, Kubelik D, Maziak DE, Ferguson N, Brown SM, Mehta S, Martin C, Rubenfeld G, Jacono FJ, Clifford G, Fazekas A, Marshall J. Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients? Crit Care 2014; 18:R65. [PMID: 24713049 PMCID: PMC4057494 DOI: 10.1186/cc13822] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 03/05/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Prolonged ventilation and failed extubation are associated with increased harm and cost. The added value of heart and respiratory rate variability (HRV and RRV) during spontaneous breathing trials (SBTs) to predict extubation failure remains unknown. Methods We enrolled 721 patients in a multicenter (12 sites), prospective, observational study, evaluating clinical estimates of risk of extubation failure, physiologic measures recorded during SBTs, HRV and RRV recorded before and during the last SBT prior to extubation, and extubation outcomes. We excluded 287 patients because of protocol or technical violations, or poor data quality. Measures of variability (97 HRV, 82 RRV) were calculated from electrocardiogram and capnography waveforms followed by automated cleaning and variability analysis using Continuous Individualized Multiorgan Variability Analysis (CIMVA™) software. Repeated randomized subsampling with training, validation, and testing were used to derive and compare predictive models. Results Of 434 patients with high-quality data, 51 (12%) failed extubation. Two HRV and eight RRV measures showed statistically significant association with extubation failure (P <0.0041, 5% false discovery rate). An ensemble average of five univariate logistic regression models using RRV during SBT, yielding a probability of extubation failure (called WAVE score), demonstrated optimal predictive capacity. With repeated random subsampling and testing, the model showed mean receiver operating characteristic area under the curve (ROC AUC) of 0.69, higher than heart rate (0.51), rapid shallow breathing index (RBSI; 0.61) and respiratory rate (0.63). After deriving a WAVE model based on all data, training-set performance demonstrated that the model increased its predictive power when applied to patients conventionally considered high risk: a WAVE score >0.5 in patients with RSBI >105 and perceived high risk of failure yielded a fold increase in risk of extubation failure of 3.0 (95% confidence interval (CI) 1.2 to 5.2) and 3.5 (95% CI 1.9 to 5.4), respectively. Conclusions Altered HRV and RRV (during the SBT prior to extubation) are significantly associated with extubation failure. A predictive model using RRV during the last SBT provided optimal accuracy of prediction in all patients, with improved accuracy when combined with clinical impression or RSBI. This model requires a validation cohort to evaluate accuracy and generalizability. Trial registration ClinicalTrials.gov NCT01237886. Registered 13 October 2010.
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Dick TE, Hsieh YH, Litvin D, Nethery DE, Zhu Y, Galan RF, Wilson CG, Loparo KA, Jacono FJ. Development of brainstem inflammation correlates with uncoupling of the cardiorespiratory system in an endotoxemic rodent model. J Crit Care 2013. [DOI: 10.1016/j.jcrc.2013.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Park S, Kaffashi F, Loparo KA, Jacono FJ. The use of heart rate variability for the early detection of treatable complications after aneurysmal subarachnoid hemorrhage. J Clin Monit Comput 2013; 27:385-93. [DOI: 10.1007/s10877-013-9467-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 04/02/2013] [Indexed: 11/28/2022]
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Dhingra RR, Zhu Y, Jacono FJ, Katz DM, Galán RF, Dick TE. Decreased Hering-Breuer input-output entrainment in a mouse model of Rett syndrome. Front Neural Circuits 2013; 7:42. [PMID: 23565077 PMCID: PMC3615412 DOI: 10.3389/fncir.2013.00042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 03/01/2013] [Indexed: 11/30/2022] Open
Abstract
Rett syndrome, a severe X-linked neurodevelopmental disorder caused by mutations in the gene encoding methyl-CpG-binding protein 2 (Mecp2), is associated with a highly irregular respiratory pattern including severe upper-airway dysfunction. Recent work suggests that hyperexcitability of the Hering-Breuer reflex (HBR) pathway contributes to respiratory dysrhythmia in Mecp2 mutant mice. To assess how enhanced HBR input impacts respiratory entrainment by sensory afferents in closed-loop in vivo-like conditions, we investigated the input (vagal stimulus trains) - output (phrenic bursting) entrainment via the HBR in wild-type and MeCP2-deficient mice. Using the in situ perfused brainstem preparation, which maintains an intact pontomedullary axis capable of generating an in vivo-like respiratory rhythm in the absence of the HBR, we mimicked the HBR feedback input by stimulating the vagus nerve (at threshold current, 0.5 ms pulse duration, 75 Hz pulse frequency, 100 ms train duration) at an inter-burst frequency matching that of the intrinsic oscillation of the inspiratory motor output of each preparation. Using this approach, we observed significant input-output entrainment in wild-type mice as measured by the maximum of the cross-correlation function, the peak of the instantaneous relative phase distribution, and the mutual information of the instantaneous phases. This entrainment was associated with a reduction in inspiratory duration during feedback stimulation. In contrast, the strength of input-output entrainment was significantly weaker in Mecp2 (-/+) mice. However, Mecp2 (-/+) mice also had a reduced inspiratory duration during stimulation, indicating that reflex behavior in the HBR pathway was intact. Together, these observations suggest that the respiratory network compensates for enhanced sensitivity of HBR inputs by reducing HBR input-output entrainment.
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Affiliation(s)
- Rishi R. Dhingra
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve UniversityCleveland, OH, USA
- Department of Neurosciences, Case Western Reserve UniversityCleveland, OH, USA
| | - Yenan Zhu
- Department of Neurosciences, Case Western Reserve UniversityCleveland, OH, USA
- Systems Biology and Bioinformatics Program, Case Western Reserve UniversityCleveland, OH, USA
| | - Frank J. Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve UniversityCleveland, OH, USA
- Louis Stokes Veterans Affairs Medical Center, Case Western Reserve UniversityCleveland, OH, USA
| | - David M. Katz
- Department of Neurosciences, Case Western Reserve UniversityCleveland, OH, USA
| | - Roberto F. Galán
- Department of Neurosciences, Case Western Reserve UniversityCleveland, OH, USA
- Systems Biology and Bioinformatics Program, Case Western Reserve UniversityCleveland, OH, USA
| | - Thomas E. Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve UniversityCleveland, OH, USA
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Xu K, Kuang Y, Jacono FJ, Dick TE, LaManna JC. Ventilatory pattern variability predicts long‐term survival following cardiac arrest and resuscitation in rats. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.691.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kui Xu
- NeurologyCase Western Reserve UniversityClevelandOH
| | - Youzhi Kuang
- Physiology and BiophysicsCase Western Reserve UniversityClevelandOH
| | - Frank J. Jacono
- MedicineCase Western Reserve UniversityClevelandOH
- Louis Stokes VA Medical CenterClevelandOH
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Getsy PM, Hsieh Y, Nethery D, Wilson CG, Jacono FJ. Acute Lung Injury Alters Synaptic Drive to Nucleus Tractus Solitarius Neurons. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.721.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paulina M Getsy
- Department of PediatricsCritical Care and Sleep Medicine. Department of MedicineCase Western Reserve UniversityClevelandOH
| | - Yee‐Hsee Hsieh
- Division of PulmonaryCritical Care and Sleep Medicine. Department of MedicineCase Western Reserve UniversityClevelandOH
| | - David Nethery
- Division of PulmonaryCritical Care and Sleep Medicine. Department of MedicineCase Western Reserve UniversityClevelandOH
| | - Christopher G Wilson
- Department of PediatricsCritical Care and Sleep Medicine. Department of MedicineCase Western Reserve UniversityClevelandOH
| | - Frank J Jacono
- Division of PulmonaryCritical Care and Sleep Medicine. Department of MedicineCase Western Reserve UniversityClevelandOH
- Division of PulmonaryCritical Care and Sleep Medicine. Department of MedicineLouis Stokes VA Medical CenterClevelandOH
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Loria CJ, Stevens AM, Crummy E, Casadesus G, Jacono FJ, Dick TE, Siegel RE. Respiratory and behavioral dysfunction following loss of the GABAA receptor α4 subunit. Brain Behav 2013; 3:104-13. [PMID: 23533098 PMCID: PMC3607152 DOI: 10.1002/brb3.122] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/21/2012] [Accepted: 01/02/2013] [Indexed: 11/10/2022] Open
Abstract
γ-Aminobutyric acid type A (GABAA) receptor plasticity participates in mediating adaptation to environmental change. Previous studies in rats demonstrated that extrasynaptic GABAA receptor subunits and receptors in the pons, a brainstem region involved in respiratory control, are upregulated by exposure to sustained hypobaric hypoxia. In these animals, expression of the mRNA encoding the extrasynaptic α4 subunit rose after 3 days in sustained hypoxia, while those encoding the α6 and δ subunits increased dramatically by 2 weeks. However, the participation of extrasynaptic subunits in maintaining respiration in normoxic conditions remains unknown. To examine the importance of α4 in a normal environment, respiratory function, motor and anxiety-like behaviors, and expression of other GABAA receptor subunit mRNAs were compared in wild-type (WT) and α4 subunit-deficient mice. Loss of the α4 subunit did not impact frequency, but did lead to reduced ventilatory pattern variability. In addition, mice lacking the subunit exhibited increased anxiety-like behavior. Finally, α4 subunit loss resulted in reduced expression of other extrasynaptic (α6 and δ) subunit mRNAs in the pons without altering those encoding the most prominent synaptic subunits. These findings on subunit-deficient mice maintained in normoxia, in conjunction with earlier findings on animals maintained in chronic hypoxia, suggest that the expression and regulation of extrasynaptic GABAA receptor subunits in the pons is interdependent and that their levels influence respiratory control as well as adaptation to stress.
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Affiliation(s)
- C Jean Loria
- Department of Pharmacology, Case Western Reserve University 10900 Euclid Avenue, Cleveland, Ohio, 44106
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Zhu Y, Hsieh YH, Dhingra RR, Dick TE, Jacono FJ, Galán RF. Quantifying interactions between real oscillators with information theory and phase models: application to cardiorespiratory coupling. Phys Rev E Stat Nonlin Soft Matter Phys 2013; 87:022709. [PMID: 23496550 PMCID: PMC3767161 DOI: 10.1103/physreve.87.022709] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Indexed: 05/08/2023]
Abstract
Interactions between oscillators can be investigated with standard tools of time series analysis. However, these methods are insensitive to the directionality of the coupling, i.e., the asymmetry of the interactions. An elegant alternative was proposed by Rosenblum and collaborators [M. G. Rosenblum, L. Cimponeriu, A. Bezerianos, A. Patzak, and R. Mrowka, Phys. Rev. E 65, 041909 (2002); M. G. Rosenblum and A. S. Pikovsky, Phys. Rev. E 64, 045202 (2001)] which consists in fitting the empirical phases to a generic model of two weakly coupled phase oscillators. This allows one to obtain the interaction functions defining the coupling and its directionality. A limitation of this approach is that a solution always exists in the least-squares sense, even in the absence of coupling. To preclude spurious results, we propose a three-step protocol: (1) Determine if a statistical dependency exists in the data by evaluating the mutual information of the phases; (2) if so, compute the interaction functions of the oscillators; and (3) validate the empirical oscillator model by comparing the joint probability of the phases obtained from simulating the model with that of the empirical phases. We apply this protocol to a model of two coupled Stuart-Landau oscillators and show that it reliably detects genuine coupling. We also apply this protocol to investigate cardiorespiratory coupling in anesthetized rats. We observe reciprocal coupling between respiration and heartbeat and that the influence of respiration on the heartbeat is generally much stronger than vice versa. In addition, we find that the vagus nerve mediates coupling in both directions.
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Affiliation(s)
- Yenan Zhu
- Department of Neurosciences, School of Medicine, Case Western
Reserve University, Cleveland, Ohio 44106, USA
- Systems Biology and Bioinformatics Program, Case Western Reserve
University, Cleveland, Ohio 44106, USA
| | - Yee-Hsee Hsieh
- Department of Medicine, School of Medicine, Case Western Reserve
University, Cleveland, Ohio 44106, USA
| | - Rishi R. Dhingra
- Department of Neurosciences, School of Medicine, Case Western
Reserve University, Cleveland, Ohio 44106, USA
| | - Thomas E. Dick
- Department of Neurosciences, School of Medicine, Case Western
Reserve University, Cleveland, Ohio 44106, USA
- Department of Medicine, School of Medicine, Case Western Reserve
University, Cleveland, Ohio 44106, USA
| | - Frank J. Jacono
- Department of Medicine, School of Medicine, Case Western Reserve
University, Cleveland, Ohio 44106, USA
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio 44106,
USA
- University Hospitals, Cleveland, Ohio 44106, USA
| | - Roberto F. Galán
- Department of Neurosciences, School of Medicine, Case Western
Reserve University, Cleveland, Ohio 44106, USA
- Systems Biology and Bioinformatics Program, Case Western Reserve
University, Cleveland, Ohio 44106, USA
- Corresponding author:
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Darrah RJ, Bederman IR, Mitchell AL, Hodges CA, Campanaro CK, Drumm ML, Jacono FJ. Ventilatory pattern and energy expenditure are altered in cystic fibrosis mice. J Cyst Fibros 2013; 12:345-51. [PMID: 23290341 DOI: 10.1016/j.jcf.2012.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/15/2012] [Accepted: 11/16/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Altered ventilatory pattern and increased energy expenditure are facets of the complex cystic fibrosis (CF) phenotype. It is not known whether these are inherent attributes of CF, secondary consequences of lung infection or other disease complications. METHODS Studies were performed in congenic C57BL/6J, F508del (Cftr((tm1kth))) and CF gut-corrected (F508del) mice. Ventilatory patterns were measured using whole-body plethysmography. Indirect calorimetry was used to determine oxygen consumption, carbon dioxide production and resting energy expenditure. RESULTS CF mice (F508del and F508del gut-corrected) have a significantly faster respiratory rate and increased ventilatory pattern variability as compared to non-CF mice. F508del but not CF gut-corrected mice had significantly increased energy expenditure per gram body weight. CONCLUSIONS CF mice exhibit a faster, more variable ventilatory pattern. These changes were present in the absence of detectable infection or illness due to gastrointestinal obstruction. Increased resting energy expenditure does not completely account for these differences.
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Affiliation(s)
- Rebecca J Darrah
- Frances Payne Bolton School of Nursing, Case Western Reserve University, USA.
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Chung A, Fishman M, Dasenbrook EC, Loparo KA, Dick TE, Jacono FJ. Isoflurane and ketamine anesthesia have different effects on ventilatory pattern variability in rats. Respir Physiol Neurobiol 2012; 185:659-64. [PMID: 23246800 DOI: 10.1016/j.resp.2012.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 11/16/2012] [Accepted: 12/06/2012] [Indexed: 11/18/2022]
Abstract
We hypothesize that isoflurane and ketamine impact ventilatory pattern variability (VPV) differently. Adult Sprague-Dawley rats were recorded in a whole-body plethysmograph before, during and after deep anesthesia. VPV was quantified from 60-s epochs using a complementary set of analytic techniques that included constructing surrogate data sets that preserved the linear structure but disrupted nonlinear deterministic properties of the original data. Even though isoflurane decreased and ketamine increased respiratory rate, VPV as quantified by the coefficient of variation decreased for both anesthetics. Further, mutual information increased and sample entropy decreased and the nonlinear complexity index (NLCI) increased during anesthesia despite qualitative differences in the shape and period of the waveform. Surprisingly mutual information and sample entropy did not change in the surrogate sets constructed from isoflurane data, but in those constructed from ketamine data, mutual information increased and sample entropy decreased significantly in the surrogate segments constructed from anesthetized relative to unanesthetized epochs. These data suggest that separate mechanisms modulate linear and nonlinear variability of breathing.
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Affiliation(s)
- Augustine Chung
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
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Yamauchi M, Jacono FJ, Fujita Y, Yoshikawa M, Ohnishi Y, Nakano H, Campanaro CK, Loparo KA, Strohl KP, Kimura H. Breathing irregularity during wakefulness associates with CPAP acceptance in sleep apnea. Sleep Breath 2012; 17:845-52. [PMID: 23080481 DOI: 10.1007/s11325-012-0775-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 08/29/2012] [Accepted: 10/08/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Individuals have different breathing patterns at rest, during wakefulness, and during sleep, and patients with sleep apnea are no different. The hypothesis for this study was that breathing irregularity during wakefulness associates with CPAP acceptance in obstructive sleep apnea (OSA). METHODS From a 2007-2010-database of patients with a diagnostic polysomnography (PSG) and prescribed CPAP (n = 380), retrospectively, 66 patients who quit CPAP treatment at 6 months were identified. Among them, 27 OSA patients quit despite having no side effects for discontinuing CPAP (Group A) and were compared to a matched group (age, body mass index, and apnea-hypopnea index) with good 6-month CPAP adherence (Group B; n = 21). Five minutes of respiratory signal during wakefulness at the initial PSG were extracted from respiratory inductance plethysmography recordings, and measured in a blinded fashion. The coefficients of variation (CV) for the breath-to-breath inspiration time (T i), expiration time (T e), T i + T e (T tot), and relative tidal volume, as well as an independent information theory-based metric of signal pattern variability (mutual information) were compared between groups. RESULTS The CV for tidal volume was significantly greater (p = 0.001), and mutual information was significantly lower (p = 0.041) in Group A as compared to Group B. CONCLUSIONS Differences in two independent measures of breathing irregularity correlated with CPAP rejection in OSA patients without nasal symptoms or comorbidity. Prospective studies of adherence should examine traits of breathing stability.
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Affiliation(s)
- Motoo Yamauchi
- Second Department of Internal Medicine (Department of Respiratory Medicine), Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
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Dick TE, Molkov YI, Nieman G, Hsieh YH, Jacono FJ, Doyle J, Scheff JD, Calvano SE, Androulakis IP, An G, Vodovotz Y. Linking Inflammation, Cardiorespiratory Variability, and Neural Control in Acute Inflammation via Computational Modeling. Front Physiol 2012; 3:222. [PMID: 22783197 PMCID: PMC3387781 DOI: 10.3389/fphys.2012.00222] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/03/2012] [Indexed: 01/10/2023] Open
Abstract
Acute inflammation leads to organ failure by engaging catastrophic feedback loops in which stressed tissue evokes an inflammatory response and, in turn, inflammation damages tissue. Manifestations of this maladaptive inflammatory response include cardio-respiratory dysfunction that may be reflected in reduced heart rate and ventilatory pattern variabilities. We have developed signal-processing algorithms that quantify non-linear deterministic characteristics of variability in biologic signals. Now, coalescing under the aegis of the NIH Computational Biology Program and the Society for Complexity in Acute Illness, two research teams performed iterative experiments and computational modeling on inflammation and cardio-pulmonary dysfunction in sepsis as well as on neural control of respiration and ventilatory pattern variability. These teams, with additional collaborators, have recently formed a multi-institutional, interdisciplinary consortium, whose goal is to delineate the fundamental interrelationship between the inflammatory response and physiologic variability. Multi-scale mathematical modeling and complementary physiological experiments will provide insight into autonomic neural mechanisms that may modulate the inflammatory response to sepsis and simultaneously reduce heart rate and ventilatory pattern variabilities associated with sepsis. This approach integrates computational models of neural control of breathing and cardio-respiratory coupling with models that combine inflammation, cardiovascular function, and heart rate variability. The resulting integrated model will provide mechanistic explanations for the phenomena of respiratory sinus-arrhythmia and cardio-ventilatory coupling observed under normal conditions, and the loss of these properties during sepsis. This approach holds the potential of modeling cross-scale physiological interactions to improve both basic knowledge and clinical management of acute inflammatory diseases such as sepsis and trauma.
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Affiliation(s)
- Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University Cleveland, OH, USA
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Fishman M, Jacono FJ, Park S, Jamasebi R, Thungtong A, Loparo KA, Dick TE. A method for analyzing temporal patterns of variability of a time series from Poincare plots. J Appl Physiol (1985) 2012; 113:297-306. [PMID: 22556398 DOI: 10.1152/japplphysiol.01377.2010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Poincaré plot is a popular two-dimensional, time series analysis tool because of its intuitive display of dynamic system behavior. Poincaré plots have been used to visualize heart rate and respiratory pattern variabilities. However, conventional quantitative analysis relies primarily on statistical measurements of the cumulative distribution of points, making it difficult to interpret irregular or complex plots. Moreover, the plots are constructed to reflect highly correlated regions of the time series, reducing the amount of nonlinear information that is presented and thereby hiding potentially relevant features. We propose temporal Poincaré variability (TPV), a novel analysis methodology that uses standard techniques to quantify the temporal distribution of points and to detect nonlinear sources responsible for physiological variability. In addition, the analysis is applied across multiple time delays, yielding a richer insight into system dynamics than the traditional circle return plot. The method is applied to data sets of R-R intervals and to synthetic point process data extracted from the Lorenz time series. The results demonstrate that TPV complements the traditional analysis and can be applied more generally, including Poincaré plots with multiple clusters, and more consistently than the conventional measures and can address questions regarding potential structure underlying the variability of a data set.
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Affiliation(s)
- Mikkel Fishman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
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36
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Xu K, Kuang Y, Dick TE, Jacono FJ. Ventilatory pattern variability is associated with long‐term recovery following cardiac arrest and resuscitation in rats. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1148.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kui Xu
- NeurologyCase Western Reserve UnivClevelandOH
| | - Youzhi Kuang
- Physiology and BiophysicsCase Western Reserve UnivClevelandOH
| | | | - Frank J Jacono
- MedicineCase Western Reserve UnivClevelandOH
- Louis Stokes VA Medical CenterClevelandOH
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Hsieh YH, Jacono FJ, Dick TE. Cardio‐respiratory Coupling is Negligible in a Rodent Septic‐Model. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1148.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yee Hsee Hsieh
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity Hospitals of ClevelandClevelandOH
| | - Frank J Jacono
- MedicineDivision of Pulmonary, Critical Care, and Sleep MedicineUniversity Hospitals of ClevelandClevelandOH
- MedicineDivision of Pulmonary, Critical Care and Sleep MedicineLouis Stokes VA Medical CenterClevelandOH
| | - Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity Hospitals of ClevelandClevelandOH
- NeuroscienceCase Western Reserve UniversityClevelandOH
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Zaylor AR, Nethery D, Hsieh YH, Dick TE, Jacono FJ. Changes in central respiratory patterns and activity following acute lung injury in the
in situ
rat preparation. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1148.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Abigail Rose Zaylor
- MedicineCase Western Reserve UniversityClevelandOH
- Pulmonary, Critical Care and Sleep MedicineLouis Stokes VA Medical CenterClevelandOH
| | - David Nethery
- MedicineCase Western Reserve UniversityClevelandOH
- Pulmonary, Critical Care and Sleep MedicineLouis Stokes VA Medical CenterClevelandOH
| | | | - Thomas E Dick
- MedicineCase Western Reserve UniversityClevelandOH
- NeurosciencesCase Western Reserve UniversityClevelandOH
| | - Frank J Jacono
- MedicineCase Western Reserve UniversityClevelandOH
- Pulmonary, Critical Care and Sleep MedicineLouis Stokes VA Medical CenterClevelandOH
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Campanaro CK, Darrah RJ, Dick TE, Drumm ML, Jacono FJ. Cystic fibrosis mice display different breathing patterns than non‐CF mice. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1148.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Friedman L, Dick TE, Jacono FJ, Loparo KA, Yeganeh A, Fishman M, Wilson CG, Strohl KP. Cardio-ventilatory coupling in young healthy resting subjects. J Appl Physiol (1985) 2012; 112:1248-57. [PMID: 22267392 DOI: 10.1152/japplphysiol.01424.2010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this work, cardio-ventilatory coupling (CVC) refers to the statistical relationship between the onset of either inspiration (I) or expiration (E) and the timing of heartbeats (R-waves) before and after these respiratory events. CVC was assessed in healthy, young (<45 yr), resting, supine subjects (n = 19). Four intervals were analyzed: time from I-onset to both the prior R-wave (R-to-I) and the following R-wave (I-to-R), as well as time from E-onset to both the prior R-wave (R-to-E) and following R-wave (E-to-R). The degree of coupling was quantified in terms of transformed relative Shannon entropy (tRSE), and χ(2) tests based on histograms of interval times from 200 breaths. Subjects were studied twice, from 5 to 27 days apart, and the test-retest reliability of CVC measures was computed. Several factors pointed to the relative importance of the R-to-I interval compared with other intervals. Coupling was significantly stronger for the R-to-I interval, coupling reliability was largest for the R-to-I interval, and only tRSE for the R-to-I interval was correlated with height, weight, and body surface area. The high test-retest reliability for CVC in the R-to-I interval provides support for the hypothesis that CVC strength is a subject trait. Across subjects, a peak ~138 ms prior to I-onset was characteristic of CVC in the R-to-I interval, although individual subjects also had earlier peaks (longer R-to-I intervals). CVC for the R-to-I interval was unrelated to two separate measures of respiratory sinus arrhythmia (RSA), suggesting that these two forms of coupling (CVC and RSA) are independent.
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Affiliation(s)
- Lee Friedman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
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41
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Jacono FJ, Mayer CA, Hsieh YH, Wilson CG, Dick TE. Lung and brainstem cytokine levels are associated with breathing pattern changes in a rodent model of acute lung injury. Respir Physiol Neurobiol 2011; 178:429-38. [PMID: 21569869 PMCID: PMC3170447 DOI: 10.1016/j.resp.2011.04.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 04/22/2011] [Accepted: 04/27/2011] [Indexed: 02/07/2023]
Abstract
Acute lung injury evokes a pulmonary inflammatory response and changes in the breathing pattern. The inflammatory response has a centrally mediated component which depends on the vagi. We hypothesize that the central inflammatory response, complimentary to the pulmonary inflammatory response, is expressed in the nuclei tractus solitarii (nTS) and that the expression of cytokines in the nTS is associated with breathing pattern changes. Adult, male Sprague-Dawley rats (n=12) received intratracheal instillation of either bleomycin (3units in 120μl of saline) or saline (120μl). Respiratory pattern changed by 24h. At 48h, bronchoalveolar lavage fluid and lung tissue had increased IL-1β and TNF-α levels, but not IL-6. No changes in these cytokines were noted in serum. Immunocytochemical analysis of the brainstem indicated increased expression of IL-1β in the nTS commissural subnucleus that was localized to neurons. We conclude that breathing pattern changes in acute lung injury were associated with increased levels of IL-1β in brainstem areas which integrate cardio-respiratory sensory input.
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Affiliation(s)
- Frank J Jacono
- Division of Pulmonary, Critical Care and Sleep Medicine, CWRU School of Medicine and University Hospitals Case Medical Center, United States.
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Dhingra RR, Jacono FJ, Fishman M, Loparo KA, Rybak IA, Dick TE. Vagal-dependent nonlinear variability in the respiratory pattern of anesthetized, spontaneously breathing rats. J Appl Physiol (1985) 2011; 111:272-84. [PMID: 21527661 DOI: 10.1152/japplphysiol.91196.2008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Physiological rhythms, including respiration, exhibit endogenous variability associated with health, and deviations from this are associated with disease. Specific changes in the linear and nonlinear sources of breathing variability have not been investigated. In this study, we used information theory-based techniques, combined with surrogate data testing, to quantify and characterize the vagal-dependent nonlinear pattern variability in urethane-anesthetized, spontaneously breathing adult rats. Surrogate data sets preserved the amplitude distribution and linear correlations of the original data set, but nonlinear correlation structure in the data was removed. Differences in mutual information and sample entropy between original and surrogate data sets indicated the presence of deterministic nonlinear or stochastic non-Gaussian variability. With vagi intact (n = 11), the respiratory cycle exhibited significant nonlinear behavior in templates of points separated by time delays ranging from one sample to one cycle length. After vagotomy (n = 6), even though nonlinear variability was reduced significantly, nonlinear properties were still evident at various time delays. Nonlinear deterministic variability did not change further after subsequent bilateral microinjection of MK-801, an N-methyl-D-aspartate receptor antagonist, in the Kölliker-Fuse nuclei. Reversing the sequence (n = 5), blocking N-methyl-D-aspartate receptors bilaterally in the dorsolateral pons significantly decreased nonlinear variability in the respiratory pattern, even with the vagi intact, and subsequent vagotomy did not change nonlinear variability. Thus both vagal and dorsolateral pontine influences contribute to nonlinear respiratory pattern variability. Furthermore, breathing dynamics of the intact system are mutually dependent on vagal and pontine sources of nonlinear complexity. Understanding the structure and modulation of variability provides insight into disease effects on respiratory patterning.
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Affiliation(s)
- R R Dhingra
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA
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Yamauchi M, Tamaki S, Yoshikawa M, Ohnishi Y, Nakano H, Jacono FJ, Loparo KA, Strohl KP, Kimura H. Differences in breathing patterning during wakefulness in patients with mixed apnea-dominant vs obstructive-dominant sleep apnea. Chest 2011; 140:54-61. [PMID: 21393396 DOI: 10.1378/chest.10-1082] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Mixed apneas share both central and obstructive components and are often treated as if they are obstructive events. The hypothesis is that patients with obstructive sleep apnea syndrome (OSAS) who exhibit a majority of mixed apneas will differ in ventilatory control from those with predominantly obstructive apneas during wakefulness; moreover, this difference could affect nasal continuous positive airway pressure (CPAP) adherence. METHODS In a retrospectively derived case-control study, 5 min of respiratory inductance plethysmography signals during wakefulness prior to sleep onset were extracted from a diagnostic polysomnogram in these groups: (1) mixed apnea-dominant OSAS (mix-OSAS) (n = 36), (2) obstructive apnea-dominant OSAS (pure-OSAS) (n = 20), (3) central apnea-dominant sleep apnea syndrome (pure-CSAS) (n = 6), and (4) control subjects (n = 10). Breathing patterning was compared between the groups using the coefficient of variation (CV) for breath-to-breath inspiration time (TI), expiration time (TE), TI + TE (Ttot), and tidal volume, and an information theory-based metric of signal pattern variability (sample entropy). Subsequent CPAP adherence over 12 months was determined in OSAS groups. RESULTS Breath-to-breath CV parameters and sample entropy in the mix-OSAS group were significantly greater as compared with the pure-OSAS and control groups. In a subanalysis, CV and sample entropy were similar in the mix-OSAS and the pure-CSAS groups. CPAP adherence was significantly poorer in mix-OSAS compared with pure-OSAS. CONCLUSIONS During wakefulness, both breath patterning and sample entropy in mix-OSAS are similar to pure-CSAS and more variable than in pure-OSAS. In addition, CPAP adherence was decreased in patients with mix-OSAS, which may be related to basic differences in respiratory control.
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Affiliation(s)
- Motoo Yamauchi
- Second Department of Internal Medicine, Department of Respiratory Medicine, Nara Medical University, Kashihara.
| | - Shinji Tamaki
- Second Department of Internal Medicine, Department of Respiratory Medicine, Nara Medical University, Kashihara
| | - Masanori Yoshikawa
- Second Department of Internal Medicine, Department of Respiratory Medicine, Nara Medical University, Kashihara
| | | | - Hiroshi Nakano
- Department of Pulmonology, Fukuoka National Hospital, Fukuoka, Japan
| | - Frank J Jacono
- Division of Pulmonary, Critical Care, and Sleep Medicine, Case Western Reserve University and Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Kenneth A Loparo
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care, and Sleep Medicine, Case Western Reserve University and Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Hiroshi Kimura
- Second Department of Internal Medicine, Department of Respiratory Medicine, Nara Medical University, Kashihara
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Jacono FJ, De Georgia MA, Wilson CG, Dick TE, Loparo KA. Data Acquisition and Complex Systems Analysis in Critical Care: Developing the Intensive Care Unit of the Future. Journal of Healthcare Engineering 2010. [DOI: 10.1260/2040-2295.1.3.337] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Koo BB, Strohl KP, Gillombardo CB, Jacono FJ. Ventilatory patterning in a mouse model of stroke. Respir Physiol Neurobiol 2010; 172:129-35. [PMID: 20472101 DOI: 10.1016/j.resp.2010.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 05/06/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
Cheyne-Stokes respiration (CSR) is a breathing pattern characterized by waxing and waning of breath volume and frequency, and is often recognized following stroke, when causal pathways are often obscure. We used an animal model to address the hypothesis that cerebral infarction is a mechanism for producing breathing instability. Fourteen male A/J mice underwent either stroke (n=7) or sham (n=7) procedure. Ventilation was measured using whole body plethysmography. Respiratory rate (RR), tidal volume (V(T)) and minute ventilation (V(e)) mean values and coefficient of variation were computed for ventilation and oscillatory behaviors. In addition, the ventilatory data were computationally fit to models to quantify autocorrelation, mutual information, sample entropy and a nonlinear complexity index. At the same time post-procedure, stroke when compared to sham animal breathing consisted of a lower RR and autocorrelation, higher coefficient of variation for V(T) and higher coefficient of variation for V(e). Mutual information and the nonlinear complexity index were higher in breathing following stroke which also demonstrated a waxing/waning pattern. The absence of stroke in the sham animals was verified anatomically. We conclude that ventilatory pattern following cerebral infarction demonstrated increased variability with increased nonlinear patterning and a waxing/waning pattern, consistent with CSR.
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Affiliation(s)
- Brian B Koo
- Department of Neurology, Case Western Reserve University School of Medicine, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH 44106, USA.
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Ibrahim LH, Jacono FJ, Patel SR, Thomas RJ, Larkin EK, Mietus JE, Peng CK, Goldberger AL, Redline S. Heritability of abnormalities in cardiopulmonary coupling in sleep apnea: use of an electrocardiogram-based technique. Sleep 2010; 33:643-6. [PMID: 20469806 PMCID: PMC2864879 DOI: 10.1093/sleep/33.5.643] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
RATIONALE Studies of the genetics of obstructive sleep apnea may be facilitated by identifying intermediate traits with high heritability that quantify etiological pathways, such as those related to respiratory control. Electrocardiogram (ECG)-based sleep spectrograms, measuring the coupling between respiratory modulation of ECG QRS-wave amplitude and heart rate variability, may provide measures of sleep state and ventilatory dynamics during sleep. We evaluated the familial aggregation of distinctive spectrographic biomarkers of unstable sleep, related to elevated-low frequency cardiopulmonary coupling (e-LFC), to assess their utility in genetic studies. METHODS 622 participants from 137 families from the Cleveland Family Study underwent standardized polysomnography (PSG). From the ECG signal on the PSG, the interbeat interval time series and the corresponding ECG-derived respiratory signal were extracted, and the low frequency (0.01-0.1 Hz) component of their coupling was computed using a fully automated method. Narrow sense heritability of e-LFC was calculated using variance component methods. RESULTS A spectral marker of abnormal low frequency cardiopulmonary coupling (e-LFC) demonstrated moderate correlation with apnea hypopnea index (AHI; r = 0.35, P < 0.0001). The heritability estimate for e-LFC, after adjusting for age and sex was 0.32 (P < 10-5) and remained unchanged after additionally adjusting for body mass index or AHI. In biological relatives of those with sleep apnea, a related marker of e-LFC was more prevalent than in controls (P = 0.05). CONCLUSIONS Approximately 30% of the variability of e-LFC, measured from a continuous ECG during sleep, is explained by familial factors other than BMI. ECG-based spectrographic measures of cardiopulmonary coupling may provide novel phenotypes for characterizing subgroups of individuals with different propensities and genetic etiologies for sleep apnea or for other conditions associated with sleep fragmentation.
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Affiliation(s)
- Lamia H Ibrahim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio 44106-6003, USA.
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Thaiyananthan NN, Jacono FJ, Patel SR, Kern JA, Stoller JK. Right-to-Left Anatomic Shunt Associated With a Persistent Left Superior Vena Cava. Chest 2009; 136:617-620. [DOI: 10.1378/chest.08-2641] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Yamauchi M, Ocak H, Dostal J, Jacono FJ, Loparo KA, Strohl KP. Post-sigh breathing behavior and spontaneous pauses in the C57BL/6J (B6) mouse. Respir Physiol Neurobiol 2008; 162:117-25. [PMID: 18565803 DOI: 10.1016/j.resp.2008.05.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 05/07/2008] [Accepted: 05/07/2008] [Indexed: 10/22/2022]
Abstract
The purpose was to examine sighs and spontaneous pauses in regard to the stability of resting breathing in the B6 strain, compared to the A/J strain. A 5-HT1A receptor agonist (buspirone) and a chromosomal substitution strain (B6a1) were used to further alter breathing patterning. Ten-minute recordings of room air breathing were collected from unanaesthetized B6, A/J, and B6a1 mice. Despite no differences between strains in the magnitude and incidence of sighs, post-sigh apneas, the variation for duration of expiration (Te) after sighs, and the number of spontaneous pauses were greater in the B6, while Shannon Entropy (nonlinear metrics) for Te after sighs was lower in B6, compared to the other strains. Buspirone and chromosomal substitution eliminated post-sigh apneas and decreased spontaneous pauses. A greater irregularity and the lower complexity of post-sigh breathing in B6 are reversed by elements on A/J chromosome 1 and by increased 5-HT1A serotonergic tone.
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Affiliation(s)
- Motoo Yamauchi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, USA.
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Palacios MY, Jacono FJ, Ceco E, Fishman M, Loparo KA, Dick TE. Nonlinear analysis of breathing patterns in development of acute and chronic lung injury. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.756.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Frank J. Jacono
- Div Pul, Crit Care & Sleep MedicineDept of Med
- Div Pul, dCrit Care & Sleep MedicineDept of MedLouis Stokes VAMCClevelandOH
| | | | | | - Kenneth A Loparo
- Dept Elec Eng and Computer ScienceCase Western Reserve UniversityClevelandOH
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