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Session 2 - Pulmonary System, SKMC Surface Anatomy 2019 Thomas Jefferson University

Session 2 - Pulmonary System, Skmc Surface Anatomy

Student Organizations

Learning Objectives

  1. Understand the location and role of pleura in normal and abnormal physiology.
  2. Understand the various anatomical locations of auscultation and their correlation to specific breath sounds.
  3. Understand what pneumothorax/hemothorax/hydrothorax are and how surface anatomy informs your procedure to fix it.


Rapid And Robust Restoration Of Breathing Long After Spinal Cord Injury, Philippa M. Warren, Stephanie C. Steiger, Thomas E. Dick, Peter M. MacFarlane, Warren J. Alilain, Jerry Silver 2018 Case Western Reserve University

Rapid And Robust Restoration Of Breathing Long After Spinal Cord Injury, Philippa M. Warren, Stephanie C. Steiger, Thomas E. Dick, Peter M. Macfarlane, Warren J. Alilain, Jerry Silver

Spinal Cord and Brain Injury Research Center Faculty Publications

There exists an abundance of barriers that hinder functional recovery following spinal cord injury, especially at chronic stages. Here, we examine the rescue of breathing up to 1.5 years following cervical hemisection in the rat. In spite of complete hemidiaphragm paralysis, a single injection of chondroitinase ABC in the phrenic motor pool restored robust and persistent diaphragm function while improving neuromuscular junction anatomy. This treatment strategy was more effective when applied chronically than when assessed acutely after injury. The addition of intermittent hypoxia conditioning further strengthened the ventilatory response. However, in a sub-population of animals, this combination treatment caused ...


Interfering With Dna Decondensation As A Strategy Against Mycobacteria, Enzo M. Scutigliani, Edwin R. Scholl, Anita E. Grootemaat, Sadhana Khanal, Jakub A. Kochan, Przemek M. Krawczyk, Eric A. Reits, Atefeh Garzan, Huy X. Ngo, Keith D. Green, Sylvie Garneau-Tsodikova, Jan M. Ruijter, Henk A. van Veen, Nicole N. van der Wel 2018 University of Amsterdam, Netherlands

Interfering With Dna Decondensation As A Strategy Against Mycobacteria, Enzo M. Scutigliani, Edwin R. Scholl, Anita E. Grootemaat, Sadhana Khanal, Jakub A. Kochan, Przemek M. Krawczyk, Eric A. Reits, Atefeh Garzan, Huy X. Ngo, Keith D. Green, Sylvie Garneau-Tsodikova, Jan M. Ruijter, Henk A. Van Veen, Nicole N. Van Der Wel

Pharmaceutical Sciences Faculty Publications

Tuberculosis is once again a major global threat, leading to more than 1 million deaths each year. Treatment options for tuberculosis patients are limited, expensive and characterized by severe side effects, especially in the case of multidrug-resistant forms. Uncovering novel vulnerabilities of the pathogen is crucial to generate new therapeutic strategies. Using high resolution microscopy techniques, we discovered one such vulnerability of Mycobacterium tuberculosis. We demonstrate that the DNA of M. tuberculosis can condense under stressful conditions such as starvation and antibiotic treatment. The DNA condensation is reversible and specific for viable bacteria. Based on these observations, we hypothesized that ...


The Effects Of Tracheal Occlusion On Wnt Signaling In A Rabbit Model Of Congenital Diaphragmatic Hernia, Martina M. Mudri 2018 The University of Western Ontario

The Effects Of Tracheal Occlusion On Wnt Signaling In A Rabbit Model Of Congenital Diaphragmatic Hernia, Martina M. Mudri

Electronic Thesis and Dissertation Repository

Purpose: Tracheal occlusion (TO) reverses pulmonary hypoplasia (PH) in congenital diaphragmatic hernia (CDH), but its effect on epithelial-mesenchymal transition (EMT) in lung development remains poorly understood. The purpose of this study was to a) confirm the CDH rabbit model produced PH which was reversed by TO and b) determine the effects of CDH +/- TO on EMT pathways.

Methods: CDH was created at 23 days, TO at 28 days and lung collection at 31 days gestation in fetal rabbits. Lung body weight ratio (LBWR), mean terminal bronchiole density (MTBD), and expression of mRNA and micro-RNA was determined.

Results: Fifteen CDH, 15 ...


Measurement And Protection Of Lung Health In Poultry Farmers Of Southwestern Ontario, Rose-Marie Doyon Dolinar 2018 The University of Western Ontario

Measurement And Protection Of Lung Health In Poultry Farmers Of Southwestern Ontario, Rose-Marie Doyon Dolinar

Electronic Thesis and Dissertation Repository

Chronic obstructive lung disease (COPD), develops gradually, and tends to be noticed by farmers only after there has been a significant loss of lung function. People with symptoms of COPD often present for health care in later stages of disease, because they accept cough or breathlessness as “normal”.

Measurement of lung health for those at risk of developing COPD provides an opportunity for early detection of lung disease, and deter the progression toward irreversible damage to the lungs. COPD is, however, under-diagnosed.

The importance of bringing primary care providers and farmers together, and acknowledging the high-risk nature of occupational exposures ...


Il-16/Mir-125a Axis Controls Neutrophil Recruitment In Pristane-Induced Lung Inflammation, Siobhan Smith, Hardy Kornfeld, Caroline A. Jefferies 2018 Royal College of Surgeons in Ireland

Il-16/Mir-125a Axis Controls Neutrophil Recruitment In Pristane-Induced Lung Inflammation, Siobhan Smith, Hardy Kornfeld, Caroline A. Jefferies

Open Access Articles

Severe lung inflammation and alveolar hemorrhage can be life-threatening in systemic lupus erythematosus (SLE) patients if not treated early and aggressively. Neutrophil influx is the driver key of this pathology, but little is known regarding the molecular events regulating this recruitment. Here, we uncover a role for IL-16/mir-125a in this pathology and show not only that IL-16 is a target for miR-125a but that reduced miR-125a expression in SLE patients associates with lung involvement. Furthermore, in the pristane model of acute "SLE-like" lung inflammation and alveolar hemorrhage, we observed reduced pulmonary miR-125a and enhanced IL-16 expression. Neutrophil infiltration was ...


Direct Cell-To-Cell Transmission Of Respiratory Viruses: The Fast Lanes, Nicolás P. Cifuentes-Muñoz, Rebecca Ellis Dutch, Roberto Cattaneo 2018 University of Kentucky

Direct Cell-To-Cell Transmission Of Respiratory Viruses: The Fast Lanes, Nicolás P. Cifuentes-Muñoz, Rebecca Ellis Dutch, Roberto Cattaneo

Molecular and Cellular Biochemistry Faculty Publications

Virus particles protect genomes from hostile environments within and outside the host, eventually delivering these genomes to target tissues to initiate infection. Complex processes requiring significant energy and time are necessary to assemble these virus particles, but only a small portion of released virus will successfully infect new target cells (Fig 1A). While the science of virology has developed based on the isolation and purification of viral particles, it is becoming increasingly clear that direct cell-to-cell transmission of viruses and/or viral components is also highly relevant [1,2].

Direct cell-to-cell spread of infections has several advantages. The first is ...


Phenotypical Characterization Of Human Rhinovirus Infections In Severely Premature Children, Geovanny F. Perez, Bassem Kurdi, Rosemary Megalaa, Krishna Pancham, Shehlanoor Huseni, Natalia Isaza, Carlos E. Rodriguez-Martinez, Dinesh Pillai, Gustavo Nino 2018 Children’s National Medical Center

Phenotypical Characterization Of Human Rhinovirus Infections In Severely Premature Children, Geovanny F. Perez, Bassem Kurdi, Rosemary Megalaa, Krishna Pancham, Shehlanoor Huseni, Natalia Isaza, Carlos E. Rodriguez-Martinez, Dinesh Pillai, Gustavo Nino

Pediatrics Faculty Publications

Background: Human Rhinovirus (HRV) has been identified as the most common cause of acute respiratory infections and hospitalizations in premature children. It is unclear if premature children are more susceptible to HRV due to their decreased pulmonary reserve or because they have enhanced lower airway reactivity to HRV.

Methods: We conducted a retrospective analysis of the clinical respiratory presentation of all PCR-confirmed HRV infections in full-term and premature children aged ≤ 3 years in our institution. Standardized respiratory distress scores were developed to examine lower airway obstruction (i.e., wheezing, hyperinflation, and sub-costal retractions) along with markers of decreased pulmonary reserve ...


The Singing Voice During The First Two Years Of Testosterone Therapy: Working With The Trans Or Gender Queer Voice, Tessa M. Romano 2018 University of Colorado Boulder

The Singing Voice During The First Two Years Of Testosterone Therapy: Working With The Trans Or Gender Queer Voice, Tessa M. Romano

Voice and Opera Graduate Theses & Dissertations

In order to better serve singers who identify as trans men or gender queer, voice teachers must understand the vocal effects of hormone replacement therapy, specifically that of testosterone therapy. Testosterone therapy is the only type of hormone replacement therapy that permanently changes the voice and eventually results in a full octave drop or more of a person’s spoken fundamental frequency. Due to such a dramatic shift, the voice change process can be turbulent.

This dissertation is designed to educate both cis gender voice teachers and trans and gender queer singers on the process of vocal change during the ...


Tuberculosis And Lung Damage: From Epidemiology To Pathophysiology, Shruthi Ravimohan, Hardy Kornfeld, Drew Weissman, Gregory P. Bisson 2018 University of Pennsylvania

Tuberculosis And Lung Damage: From Epidemiology To Pathophysiology, Shruthi Ravimohan, Hardy Kornfeld, Drew Weissman, Gregory P. Bisson

Open Access Articles

A past history of pulmonary tuberculosis (TB) is a risk factor for long-term respiratory impairment. Post-TB lung dysfunction often goes unrecognised, despite its relatively high prevalence and its association with reduced quality of life. Importantly, specific host and pathogen factors causing lung impairment remain unclear. Host immune responses probably play a dominant role in lung damage, as excessive inflammation and elevated expression of lung matrix-degrading proteases are common during TB. Variability in host genes that modulate these immune responses may determine the severity of lung impairment, but this hypothesis remains largely untested. In this review, we provide an overview of ...


Mobile Critical Care Recovery Program (M-Ccrp) For Acute Respiratory Failure Survivors: Study Protocol For A Randomized Controlled Trial, Sikandar Khan, Ashok Biju, Sophia Wang, Sujuan Gao, Omar Irfan, Amanda Harrawood, Stephanie Martinez, Anthony Perkins, Frederick W. Unverzagt, Sue Lasiter 2018 Indiana University School of Medicine

Mobile Critical Care Recovery Program (M-Ccrp) For Acute Respiratory Failure Survivors: Study Protocol For A Randomized Controlled Trial, Sikandar Khan, Ashok Biju, Sophia Wang, Sujuan Gao, Omar Irfan, Amanda Harrawood, Stephanie Martinez, Anthony Perkins, Frederick W. Unverzagt, Sue Lasiter

Medical College Documents

Background: Patients admitted to intensive care units (ICU) with acute respiratory failure (ARF) face chronic complications that can impede return to normal daily function. A mobile, collaborative critical care model may enhance the recovery of ARF survivors.
Methods: The Mobile Critical Care Recovery Program (m-CCRP) study is a two arm, randomized clinical trial. We will randomize 620 patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation in a 1:1 ratio to one of two arms (310 patients per arm) – m-CCRP intervention versus attention control. Those in the intervention group will meet with a care coordinator after ...


Clinical Management Of Pressure Control Ventilation: An Algorithmic Method Of Patient Ventilatory Management To Address “Forgotten But Important Variables”, Lonny Ashworth, Yasuhiro Norisue, Megan Koster, Jeff Anderson, Junko Takada, Hatsuyo Ebisu 2018 Boise State University

Clinical Management Of Pressure Control Ventilation: An Algorithmic Method Of Patient Ventilatory Management To Address “Forgotten But Important Variables”, Lonny Ashworth, Yasuhiro Norisue, Megan Koster, Jeff Anderson, Junko Takada, Hatsuyo Ebisu

Respiratory Therapy Faculty Publications and Presentations

Pressure controlled ventilation is a common mode of ventilation used to manage both adult and pediatric populations. However, there is very little evidence that distinguishes the efficacy of pressure controlled ventilation over that of volume controlled ventilation in the adult population. This gap in the literature may be due to the absence of a consistent and systematic algorithm for managing pressure controlled ventilation. This article provides a brief overview of the applications of both pressure controlled ventilation and volume controlled ventilation and proposes an algorithmic approach to the management of patients receiving pressure controlled ventilation. This algorithmic approach highlights the ...


The South Sudan: Tuberculosis, Blake Schwarz 2018 Augustana College, Rock Island Illinois

The South Sudan: Tuberculosis, Blake Schwarz

Global Public Health

The South Sudan is a country that recently gained independence from the Sudan after a bloody twenty year civil war. They lost nearly two million lives during the war, and are now ravaged by Tuberculosis, or TB. After gaining their independence in 2011, the South Sudan has an average of 18,000 cases of TB at any time. This would consider TB in the South Sudan an endemic, as it always has a base level of TB cases that does not vary. There is medication for TB that is available to the citizens on the South Sudan, but the prescription ...


Increase In Intra-Abdominal Pressure During Airway Suctioning-Induced Cough After A Successful Spontaneous Breathing Trial Is Associated With Extubation Outcome, Lonny Ashworth 2018 Boise State University

Increase In Intra-Abdominal Pressure During Airway Suctioning-Induced Cough After A Successful Spontaneous Breathing Trial Is Associated With Extubation Outcome, Lonny Ashworth

Respiratory Therapy Faculty Publications and Presentations

Background: A patient’s ability to clear secretions and protect the airway with an effective cough is an important part of the pre-extubation evaluation. An increase in intra-abdominal pressure (IAP) is important in generating the flow rate necessary for a cough. This study investigated whether an increase from baseline in IAP during a coughing episode induced by routine pre-extubation airway suctioning is associated with extubation outcome after a successful spontaneous breathing trial (SBT).

Methods: Three hundred thirty-five (335) mechanically ventilated patients who passed an SBT were enrolled. Baseline IAP and peak IAP during successive suctioning-induced coughs were measured with a ...


Towards Using A Physio-Cognitive Model In Tutoring For Psychomotor Tasks., Jong W. Kim, Chris Dancy, Robert A. Sottilare 2018 U.S. Army Research Laboratory

Towards Using A Physio-Cognitive Model In Tutoring For Psychomotor Tasks., Jong W. Kim, Chris Dancy, Robert A. Sottilare

Faculty Conference Papers and Presentations

We report our exploratory research of psychomotor task training in intelligent tutoring systems (ITSs) that are generally limited to tutoring in the desktop learning environment where the learner acquires cognitively oriented knowledge and skills. It is necessary to support computer-guided training in a psychomotor task domain that is beyond the desktop environment. In this study, we seek to extend the current capability of GIFT (Generalized Intelligent Frame-work for Tutoring) to address these psychomotor task training needs. Our ap-proach is to utilize heterogeneous sensor data to identify physical motions through acceleration data from a smartphone and to monitor respiratory activity through ...


Increasing The Use Of Waveform Capnography In Neonatal And Pediatric Patients, Sherry McCool, Lisa Pruitt, Olivia Kaullen 2018 Children's Mercy Hospital

Increasing The Use Of Waveform Capnography In Neonatal And Pediatric Patients, Sherry Mccool, Lisa Pruitt, Olivia Kaullen

Posters

No abstract provided.


Variations In Practice Of Apnea Test For Brain Death: Review From A Multihospital Health Care System, Jeffrey Stein, Marvi V. Rijhwani, Ernesto Brauer 2017 Department of Internal Medicine, Aurora Sinai Medical Center

Variations In Practice Of Apnea Test For Brain Death: Review From A Multihospital Health Care System, Jeffrey Stein, Marvi V. Rijhwani, Ernesto Brauer

Journal of Patient-Centered Research and Reviews

Background: Ventilation encompasses both active and passive processes. Air is initially drawn into the lungs due to a negative intrathoracic pressure created using the respiratory muscles, most importantly the diaphragm. In contrast, expiration is the passive relaxation of the respiratory muscles. Oxygenation occurs when oxygen diffuses across the alveolar-capillary membrane. The ability to oxygenate without ventilation has been termed apneic diffusion oxygenation or apneic oxygenation. We believe it is crucial to keep alveoli open in order for adequate oxygenation to occur. This can be achieved with the aid of positive end-expiratory pressure (PEEP). We investigated this concept in patients who ...


Impact Of Physician Education And Availability Of Parameters Regarding Esophageal Pressure And Transpulmonary Pressure On Clinical Decisions Involving Ventilator Management, Lonny Ashworth 2017 Boise State University

Impact Of Physician Education And Availability Of Parameters Regarding Esophageal Pressure And Transpulmonary Pressure On Clinical Decisions Involving Ventilator Management, Lonny Ashworth

Respiratory Therapy Faculty Publications and Presentations

Purpose: This study investigated the effects of physician education and the availability of Peso and PL data on physicians' decisions regarding ventilator management during specific simulated clinical conditions.

Materials and methods: The study was a prospective, before–after study using a case scenario–based questionnaire and a case simulator device comprising an Avea ventilator and an artificial lung and esophagus, which was connected to a Series 1101 Electronic Breathing Simulator. The 99 physicians participating in the study were provided with five simulated cases with on-time ventilator graphics without Peso and PL and completed a questionnaire on ...


Global Respiratory Syncytial Virus-Associated Mortality In Young Children (Rsv Gold): A Retrospective Case Series, Nienke M. Scheltema, Angela Gentile, Florencia Lucion, D James Nokes, Patrick K. Munywoki, Shabir A. Madhi, Michelle J. Groome, Cheryl Cohen, Jocelyn Moyes, Syed Asad Ali 2017 University Medical Centre Utrecht,Netherlands

Global Respiratory Syncytial Virus-Associated Mortality In Young Children (Rsv Gold): A Retrospective Case Series, Nienke M. Scheltema, Angela Gentile, Florencia Lucion, D James Nokes, Patrick K. Munywoki, Shabir A. Madhi, Michelle J. Groome, Cheryl Cohen, Jocelyn Moyes, Syed Asad Ali

Department of Paediatrics and Child Health

Background: Respiratory syncytial virus (RSV) infection is an important cause of pneumonia mortality in young children. However, clinical data for fatal RSV infection are scarce. We aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related mortality using individual patient data.

Methods: In this retrospective case series, we developed an online questionnaire to obtain individual patient data for clinical and socioeconomic characteristics of children aged younger than 5 years who died with community-acquired RSV infection between Jan 1, 1995, and Oct 31, 2015, through leading research groups for child pneumonia identified through a comprehensive ...


The Role Of Heterogeneity In Asthma: A Structure-To-Function Perspective, Justin K. Lui, Kenneth R. Lutchen 2017 University of Massachusetts Medical School

The Role Of Heterogeneity In Asthma: A Structure-To-Function Perspective, Justin K. Lui, Kenneth R. Lutchen

Open Access Articles

A number of methods have evolved through the years in probing the dysfunction that impacts mechanics and ventilation in asthma. What has been consistently found is the notion of heterogeneity that is not only captured in the frequency dependence of lung mechanics measurements but also rendered on imaging as patchy diffuse areas of ventilation defects. The degree of heterogeneity has been linked to airway hyperresponsiveness, a hallmark feature of asthma. How these heterogeneous constriction patterns lead to functional impairment in asthma have only been recently explored using computational airway tree models. By synthesizing measurements of lung mechanics and advances in ...


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