Funding was provided by the Natural Sciences and Engineering Research Council of Canada and The Heart and Stroke Foundation of Canada.

该协议遵循人类研究伦理委员会在阿尔伯塔大学的指导方针，并符合赫尔辛基宣言的最新版本规定的标准。 1.分级运动试验（VO 2peak） <ol><li>获得书面知情从主体的同意。有阅读的主体和回答关于身体活动能力问卷+（PAR-Q +）上市，以确定运动24他们准备的问题。 </li><li>调整功率自行车的座椅高度，根据拍摄对象的偏好。广场上按照标准3导联ECG安置病人的四名后卫心电图（ECG）电极，以修改肢体导致测量心脏速率（HR）25。 </li><li>插入吸嘴插入被检者的口以测量整个使用代谢的测量系统25在测试的呼出气体和通风。 注：代谢系统将测量实时氧消耗（VO 2），二氧化碳的生产（VCO 2），通风（V E）中 ，心脏心率（HR）和呼气末二氧化碳 （P ET CO 2）。 </li><li>以下收集基线数据的2分钟，指示须用50瓦的初始工作量开始骑自行车，保持≥60RPM一贯的节奏。增加25瓦的步骤每2分钟，直到对象到达意志用尽或要求停止测试25的工作量。 </li></ol> 2.吸入氧分数多（F I O 2）弥散量（DL CO）方法7 <ol><li>计算对应于30％，50％，70％，和90％的VO 2peak使用在分级运动试验中得到的峰值VO 2的工作负荷。至少48小时的分级运动试验后，让主体重新转向实验室DLCO演习。 </li><li>不要超过每天12弥散测试，碳氧血红蛋白（碳氧血红蛋白）积聚可反复测试5出现。因此，执行基于要进行的锻炼的工作负载的数量和弥散数据的质量多天的测试。 </li><li>通过将100％ 的 O 2气体的罐和医用级空气（21％O 2和79％N 2）的空气搅拌器系统的罐制备呼吸预气体。填充两个60升非扩散道格拉斯袋，含40％ 的 O 2之一，并且含有一个60％ 的 O 2，使用空气搅拌器系统。 </li><li>设置了两个大口径，三路活塞阀，将允许吸入气体混合物的调制。这些将被称为“呼吸预阀”。 </li><li>道格拉斯袋连接到使用灵活，无压缩的管阀系统。所述阀系统连接到一个双向，T形非再呼吸阀康恩部对代谢测量系统的质量流量传感器的测试气体入口组件。 </li><li>对于休息的测量，让主体直立坐姿，双脚平放在地板上。对于运动试验，确保主体处于稳定状态，通过使用心电图（HR±3 BPM稳态）监测人力资源。 注意：稳态可能不会在VO 2peak的90％到达;因此，开始测量，一旦受试者已经达到HR相当于VO 2peak 90％的分级运动试验。 </li><li>通过手指刺收集的毛细管一滴血，并分析其对血红蛋白浓度。然后，调整使用下列公式26 [血红蛋白]所有后续DL CO： <img alt="式（1）" src="/files/ftp_upload/54949/54949equation1.jpg" /></li><li>通过切换预呼吸阀到所需方向选择一个F I O 2在随机（21％，40％，或60％）。周仰杰本身在相应的F I O 2 -DL CO转动DL CO气体阀选择器的气体（ 见图1C）。 </li><li>指示受试者对贴上鼻夹和正常呼吸对着话筒用于从对应于各F I O 2的道格拉斯袋5次呼吸。 </li><li>指示受到期残留量。当肺容积在高原残气量，让主体吸入DL CO气体混合物肺总量和呼气残留量前屏住呼吸6秒钟。 </li><li>在呼气期间监控甲烷跟踪以确保该斜率是水平的，因为这表明CO测试气体在肺良好平衡。 注：肺泡体积（V A）和屏气时间会自动计算和代谢测量系统的报道。 </li><li>确保每个弥散回旋V A在5％以内ØF上试验。同样，屏气时间应为6.0±0.3秒。如果没有，重复动作。 </li><li>等待4分钟，使残留的一氧化碳洗出来，然后重复步骤2.8 - 2.11其余每个F I O 2在休息。 </li><li>在每个运动强度为每个F I O 2稳态（30％，50％，70％和90％的VO 2peak的）期间2.15 -至少48小时后，重复步骤2.9。减少工作量之间的呼吸保持在VO 2peak工作量的90％恢复的主题。 </li><li>等待在运动中弥散测试之间的2分钟运动过程中清除肺泡CO。不要超过每天12弥散测试，以避免碳氧血红蛋白（碳氧血红蛋白）集结5。 </li></ol> 3.计算肺毛细血管血量和膜弥散能力<ol><li>计算出O 2（P A O 2）使用跟随着的肺泡氧分压摹方程 <img alt="公式（2）" src="/files/ftp_upload/54949/54949equation2.jpg" /> 注：F I O 2是吸入O 2的分数P BAR是大气压力，P H 2 O是水蒸汽压力P 在 CO 2是动脉的 CO 2的压力，和RER是呼吸交换率。 </li><li>使用测得的30秒平均P 等 的 CO 2和RER用于从在前面的分级运动试验中获得的数据中的各自的运动强度估计RER和P 在 CO 2。 </li><li>计算使用下面的等式7θCO。 <img alt="公式3" src="/files/ftp_upload/54949/54949equation3.jpg" /></li><li>图表为每个F I O 2 1 /弥散形容词和1 /θCO间的关系，并计算回归方程。 注：最小可接受R 2值是0.95，并且当r 2的值是在该范围21以外的DL CO演习应该重复。 </li></ol><img alt="图2" src="/files/ftp_upload/54949/54949fig2.jpg" /> 图2： 对峰值练习1 /θCO 1 / DL CO代表图。 1 / DL CO和1 /θCO之间的关系作图三个呼吸保持在各个F I O 2（21％，40％和60％）。 Vc和Dm的计算是从回归方程为上述的关系的。的直线的斜率（1 / 0.00796）的倒数给出Vc的（125.5毫升）中的值，和y截距的倒数（1 / 0.00869）给出了DM 115.0毫升·分-1·毫米汞柱的值（ -1）。 <a href="http://ecsource.jove.com/files/ftp_upload/54949/54949fig2large.jpg" target="_blank">请点击这里查看LAR</a>GER版本这个数字。 <ol start="5"><li>通过取1 / DL CO和1 /θCO之间的回归方程的斜率的倒数计算Vc的。通过取方程的y截距的倒数计算DM。 </li></ol> 4.肺内动静脉吻合招聘<ol><li>上从DL CO数据收集一个单独的一天，将一个20号静脉（IV）导管插入肘前静脉，它通过一个6第四延伸管连接到一个三路活塞用于对比度搅拌盐水的注射超声心动图11，17。 </li></ol><img alt="图3" src="/files/ftp_upload/54949/54949fig3.jpg" /> 图3：搅动盐水对比度设置。静脉导管被放置在所述肘空间，并通过一个6中延伸连接到三通阀。两个10毫升注射器在tached到活塞以创建对比度溶液，其中含有10毫升盐水和0.5mL室温的空气。 <a href="http://ecsource.jove.com/files/ftp_upload/54949/54949fig3large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <ol start="2"><li>两个10毫升的注射器连接到三路活塞。结合10毫升0.9％的无菌盐水中，用0.5ml的空气，并有力地搅拌它通过三路活塞，来回两个注射器之间，以形成精细，悬浮气泡，直到声谱仪准备对比。 </li><li>拥有一支经验丰富的超声医师或心脏病专家获得心脏的标准心尖四腔心切。休息时，有超声心动图检查评估内部房间隔和室间隔对于心内分流与标准的超声心动图和彩色多普勒成像。 <ol><li>如果没有发现心内分流，指导课题的对比度注射期间执行Valsalva动作离子以评估卵圆孔未闭（PFO）11，17。非主动脉期间重复测量。 </li></ol></li><li>注入对比度，超声医师保持四腔心切。记录在检测中的右心室造影15个心动周期。 </li><li>重复稳态运动时的对比度增强成像在30％，50％，和VO 2peak的70％。由于稳态不能在VO 2peak的90％达成，开始分级运动试验在成像曾经的目标HR，在VO 2peak的90％由HR鉴定，达到。 注意：运动强度之间的时间取决于对比从两个心室间隙，≥2分钟。 </li><li>有谁是盲法的实验条件的的echocardiographer解释根据先前描述的积分系统17 &lt;搅拌的盐水对比度超声心动图/ SUP&gt; 27。 注：评分是基于对比度的最大数量的气泡在一个单一的超声心动图帧左心室（LV）中可见，如下：没有对比度在LV = 0气泡，≤3气泡= 1，4 - 12气泡= 2 ，&gt; 12气泡= 3。 注：对比于左心室的外观五心循环之后显示一个IPAVA。一个内分流通过对比在不到五心动周期27的外观分级。 </li></ol><img alt="图4" src="/files/ftp_upload/54949/54949fig4.jpg" /> 图4：IPAVA评分代表图像。规模为5厘米（白色实线）。 （A）预注射造影剂。 （B）IPAVA得分= 0（C）IPAVA得分= 1（D）IPAVA分数= 3 <a href="http://ecsource.jove.com/files/ftp_upload/54949/54949fig4large.jpg" target="_blank">P</a>租赁点击此处查看该图的放大版本。

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E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Principles and Practice of Echocardiography. , (1994).</li><li>Laurie, S. S., Elliott, J. E., Goodman, R. D., Lovering, A. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Catecholamine-induced+opening+of+intrapulmonary+arteriovenous+anastomoses+in+healthy+humans+at+rest.">Catecholamine-induced opening of intrapulmonary arteriovenous anastomoses in healthy humans at rest.</a> J Appl Physiol. 113 (8), 1213-1222 (2012).</li><li>Hopkins, S. R., Bogaard, H. J., Niizeki, K., Yamaya, Y., Ziegler, M. G., Wagner, P. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=&#946;-Adrenergic+or+parasympathetic+inhibition,+heart+rate+and+cardiac+output+during+normoxic+and+acute+hypoxic+exercise+in+humans.">&#946;-Adrenergic or parasympathetic inhibition, heart rate and cardiac output during normoxic and acute hypoxic exercise in humans.</a> J Physiol. 550 (2), 605-616 (2009).</li><li>Zavorsky, G. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+rise+in+carboxyhemoglobin+from+repeated+pulmonary+diffusing+capacity+tests.">The rise in carboxyhemoglobin from repeated pulmonary diffusing capacity tests.</a> Respir Physiol Neurobiol. 186 (1), 103-108 (2013).</li><li>Coffman, K. E., Taylor, B. J., Carlson, A. R., Wentz, R. J., Johnson, B. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimizing+the+calculation+of+DM,CO+and+VC+via+the+single+breath+single+oxygen+tension+DLCO/NO+method.">Optimizing the calculation of DM,CO and VC via the single breath single oxygen tension DLCO/NO method.</a> Respir Physiol Neurobiol. 221, 19-29 (2015).</li><li>Guazzi, M., Pontone, G., Brambilla, R., Agostoni, P., R&#232;ina, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Alveolar-capillary+membrane+gas+conductance:+a+novel+prognostic+indicator+in+chronic+heart+failure.">Alveolar-capillary membrane gas conductance: a novel prognostic indicator in chronic heart failure.</a> Eur Heart J. 23 (6), 467-476 (2002).</li><li>Ofir, D., Laveneziana, P., Webb, K. A., Lam, Y. -. M., O'Donnell, D. 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The authors declare that they have no competing financial interests.

该方法，能够在运动中肺扩散容量和肺内动静脉吻合招募的评估。 该协议中的关键步骤虽然在DL CO屏气在其余的是比较简单的，呼吸运动时保持呈现给受试者一个独特的挑战，因为它是反直觉的，并且受试者具有高的驱动运动时呼吸。因此，VC和DM的优质决心依靠测试仪和拍摄对象之间的关系和清晰的沟通。测试仪的技术能力可与肺泡体积（先前试验的±5％）和6.0±0.3秒的屏气时间甲苯（BHT）的变异性进行定量。 修改和故障排除在VC / DM测试结束，测试人员应迅速绘制三个DL CO演习脱termine数据点的最佳拟合线;所述DL CO 21％F I O 2测得应该总是比与40％，这应该比用60％的更大的大。如果不是，则建议以检查阀开关对应于正确的测试气体。类似地，检查呼吸预袋填充有对应于该检测气体（ 图1B-1D）正确的F I O 2气体。应谨慎测试的参与者谁是吸烟者，如碳氧血红蛋白升高水平可能低估弥散时服用。 对于IPAVA招聘评估，主体的位置是至关重要的，以确保高品质的图像采集。有可能用一个横卧功率自行车来代替直立功率自行车以减少受试者的运动。然而，横卧周期运动将引起对于给定的工作速度不同的代谢反应，因此，分级运动试验应重复上横卧功率自行车。胸上部的扫描可能会不舒服一些妇女;在这种情况下，建议使用雌性声谱仪。最后，推荐的运动方案是专为年轻，健康的人;因此，该锻炼协议可以被修改为不同的目标群。 该技术的局限性多个F I O 2 DL CO技术的主要限制是测试人员的技能和被摄体的跟踪命令和屏气时要保持冷静，因为主动脉或苗勒演习将影响测量的能力。其次，在一个会话中保持呼吸的数目应限制在12，由于增加的CO背压，这可能会影响到Vc和DM测量5，30和对健康造成风险受试者。根据不同的研究设计，它中号AY必须完成在多个会话测试，以便二氧化碳的清除和限制参与者的疲劳。有了良好的参与者教练和良好的技术能力，我们已经确定了试验间变异系数满意为弥散，VC和DM为7％，8％和15％，分别为。 多个F I O 2的DL CO技术假定肺泡的 O 2是相同的毛细管的 O 2，因此，与已知的气体交换障碍个人解释数据时应小心。 搅拌盐水对比度超声成像是由声谱仪的技术能力和受试者在运动时，尽量减少胸廓运动的能力的限制。同样重要的是，图像的解释熟悉刻度按既定程序进球IPAVA招募（ 图4 </str翁&gt;）27。运动过程中的积极生理盐水造影超声心动图的意义仍然是辩论15，16的话题，有一些讨论，在左心室积极的生理盐水搅动对比度可继发于毛细血管扩张，而不是IPAVA招聘。正在进行的工作是试图解决这一问题。 相对于现有的/替代方法的技术意义通过利用这些生理技术，能够在各种条件下运动时，以评估肺血管，包括在健康，疾病和药物干预。虽然质量测试仪的能力取决于这些技能是方便，快捷地与适当的指导和培训获得的。多重F I O 2 DL CO方法被认为是在MEA的“金标准”DM和Vc 31 surement。而临床上不计算这些措施，这些值可以被用来确定用于低氧血症和运动耐受的机制，来预测患者结果，并进一步表征诊断31,32。同样，搅拌盐水超声心动图的技术是在确定IPAVAs招募的最广泛使用的方法。 掌握这一技术后，未来的应用或指示这些技术适用于在一系列的实验条件和干预使用。我们运动时表明这些技术，但他们可以很容易地进行修改，以测量药物输注期间肺血管反应，例如多巴酚丁胺或多巴胺，已知增加心输出17强心剂。此外，有可能在临床人群中使用这些技术，例如如在患有心脏衰竭34或慢性阻塞性肺疾病（COPD）中，其中在DL CO相比年龄匹配的对照受试者35是低级。

在运动过程中，心输出量可提高到六倍以上的休息值1。鉴于肺部的唯一机构接收心输出量的100％，运动呈现相当大的压力，以肺系统。对于增量运动，肺弥散量（DL CO）必须增加，以满足增加的需氧量2。从静止到峰值运动，DL CO可增加到静止值高达150％，没有达到相对于一个上限心输出3，4，5。在弥散量增加的发生是由于在膜弥散量（DM）和毛细血管血量（VC），继发于肺毛细血管6的招聘和扩张增加的结果。 Roughton和福斯特（1957）开发出一种技术，分区D米和VC 7里由一氧化碳测试（DL CO）标准的扩散能力时调节吸入氧浓度（F I O 2）的比例。氧气和一氧化碳（CO）的竞争性结合对血红蛋白血红素网站，例如，增加F I O 2会降低DL CO 8,9。通过标准DL CO动作时调制F I O 2，这种关系可以被利用来衡量Vc和DM 7。我们最近适于这种技术锻炼5期间使用。到以前的工作类似，我们已经发现，DL CO连续增加高达二次峰值运动在两个Vc和DM 5增加。有趣的是，我们已经发现，在谁具有更大的氧消耗，从而对弥散能力更需要耐力训练的运动员，有在运动高峰的增加在DL CO。，继发于增加Dm和不Vc的，这表明在运动员5的肺膜的电位的适应。 运动过程中Vc和DM的增加是通过增加肺动脉压力，这将导致在休息4，10以前低灌注肺毛细血管的招聘和扩张来实现的。这导致增加了肺毛细血管网的横截面面积，由此降低肺血管阻力和衰减在肺动脉压力的增加。 用生理盐水激动超声造影研究运动11，12，13时已经显示肺内动静脉吻合（IPAVA）招募的证据14。 IPAVA招聘的意义尚不清楚，虽然一些研究表明，它们可能有助于气体交换障碍12,14和可用于卸载右心室11，12，话题仍存在争议15,16。此外，虽然IPAVA招募的确切机制是未知的，我们已经发现，增加心输出量，以及外源性多巴胺，使IPAVA招募在休息17。一个敏锐地增加肺动脉压力18或多巴胺阻断不会出现运动11时显著影响IPAVA招聘。有人猜测，这些大直径IPAVA血管可能有助于保护肺毛细血管从肺动脉大幅增加通过降低肺血管阻力12，17，19，20，21的压力。 当与Vc和DM的评价相结合，激动生理盐水造影是肺循环的适应性研究锻炼22,23的压力的重要工具。

<table border="0" cellpadding="0" cellspacing="0" width="681">
	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:259px;">Metabolic Measurement System</td>
			<td style="width:136px;">SensorMedics Inc.</td>
			<td style="width:119px;">Encore 299 Vmax</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:259px;">Cycle Ergometer</td>
			<td style="width:136px;">Ergoline</td>
			<td style="width:119px;">Ergoselect II 1200</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:259px;">60L Douglas Bags</td>
			<td style="width:136px;">Hans Rudolph</td>
			<td style="width:119px;">6100 Series</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:259px;">Two-way T Valve</td>
			<td style="width:136px;">Hans Rudolph</td>
			<td style="width:119px;">2700 Series</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:259px;">Hemoglobin Measurement System</td>
			<td style="width:136px;">HemoCue</td>
			<td style="width:119px;">Hb 201+</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:259px;">22-gauge Intravenous Catheter</td>
			<td style="width:136px;">BD</td>
			<td style="width:119px;">Insyte-W</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:259px;">Ultrasound&#160;</td>
			<td style="width:136px;">Vivid Q</td>
			<td style="width:119px;">ECHOpac</td>
			<td></td>
		</tr>
		<tr height="50">
			<td height="50" style="height:50px;width:259px;">Compressed gas 21% O2, 0.3% CO, 0.3% CH4, balance nitrogen</td>
			<td style="width:136px;">Praxair</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:259px;">Compressed gas 40% O2, 0.3% CO, 0.3% CH4, balance nitrogen</td>
			<td style="width:136px;">Praxair</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:259px;">Compressed gas 60% O2, 0.3% CO, 0.3% CH4, balance nitrogen</td>
			<td style="width:136px;">Praxair</td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:259px;">Nose-clip</td>
			<td style="width:136px;">Vacu-Med</td>
			<td style="width:119px;">snuffer #1008</td>
			<td></td>
		</tr>
	</tbody>
</table>

assessment of pulmonary capillary blood volume, membrane diffusing capacity, and intrapulmonary arteriovenous anastomoses during exercise

运动是一个偏重于肺血管。随着增量运动，肺弥散功能（DL CO）必须增加以应付增加的需氧量;否则，可能会发生扩散限制。与运动中的DL CO的增加是由于增加的毛细血管血液体积（Vc）的和膜弥散能力（DM）。 Vc和DM增加继发招募和肺毛细血管扩张，增加了气体交换的表面积和降低肺血管阻力，由此衰减肺动脉压力的增加。与此同时，肺内动静脉吻合（IPAVA）运动过程中招募可有助于气体交换障碍和/或预防肺动脉压力的大幅增加。 我们描述两种技术在休息和运动过程中，评估肺部扩散和流通。第一种技术使用多离吸入氧ction（F I O 2）DL 有限公司持有的气息，以确定Vc和DM在休息和运动过程中。此外，超声心动图静脉注射生理盐水激动的对比来评估IPAVAs招聘。 代表性的数据表明，在DL CO。，Vc的和Dm与运动强度增加。超声心动图的数据显示，没有IPAVA招聘在休息，而相比之下泡沫是与运动左心室看出，这表明运动诱发IPAVA招聘。 肺毛细血管血体积，膜弥散能力，并利用超声心动图的方法IPAVA招募的评估是有用的表征肺脉管系统的适应锻炼在健康的应力的能力，以及在患病群体，如那些与肺动脉高血压和慢性阻塞性肺疾病。

示于表1氧消耗量增加运动强度，弥散能力，肺毛细血管血液体积，膜扩散能力，并IPAVA得分的效果。 VO 2，DL CO。，Vc的和Dm增加响应于增加输出功率。 图2显示了在运动中使用多个F I O 2 -DL CO技术Vc和DM的代表计算。 DL CO随着F I O 2减少，这种关系被利用来划分Vc和DM。计算1 / DL CO的与在VC 1 /θCO结果的斜率的倒数，和y截距的逆产生用于DM的值。正如预期的那样，无论是运动过程中Vc和DM相比增加休息值。 I O 2 DL CO和激动盐水超声造影方法提供调查人员更深入地了解肺毛细血管和膜招聘整体扩散能力的贡献，并可以补充在临床上传统的肺功能检测。未能扩大Vc的或Dm运动时会导致一个扩散限制和低氧血症。例如，一个低的DL CO继发低Vc的将指示改变到肺毛细血管;同样地，降低的DM将指示变更至肺膜。 图4示出的四腔对比度echocardiographs代表描。随着运动强度的IPAVA得分从0增加（ <eM&gt;即，在剩下的3在最高运动强度（ 表1）IPAVAs没有证据）。先前的研究表明，运动增加IPAVA得分11，12，14，但没有达成共识，以这些IPAVAs是如何招募的。有证据表明，IPAVAs可以药理学上在休息与多巴胺17,28通过增加多巴酚丁胺17,28和肾上腺素28心输出招募，以及。强心剂如多巴胺和肾上腺素是特别感兴趣的，因为它们的运动29期间内源性增加。此外，还有一些证据表明，行使血流动力学，在该缺席IPAVAs的出现造成更大的肺动脉压力IPAVA招募可能是重要的，降低Çardiac输出，降低峰值功率输出12。因此，该技术可以在研究探讨与肺动脉高压的个体使用。 <img alt="图1" src="/files/ftp_upload/54949/54949fig1.jpg" /> 图1：多个F I O 2 DL CO设置。 （ 一 ）设置概述。 （B）含21％，40％，和60％ 的 O 2 0.3％CO，0.3％的甲烷，和其余为氮的压缩气体钢瓶，以及一个补充氧气压缩气瓶。 （C），三通阀切换三个F I O 2 DL CO坦克。 （D）的阀系列中与F I O 2的选择用于预呼吸切换为三通阀。 <a href="http://ecsource.jove.com/files/ftp_upload/54949/54949fig1large.jpg" target="_blank">请点击这里查看LAR</a>GER版本这个数字。 <img alt="表格1" src="/files/ftp_upload/54949/54949table1.jpg" /> 表1：在休息一个主题，并在运动过程中，在30，50，70代表性的数据，90％的VO 2peak的。 VO 2，相对于体重的氧消耗量的容积; DL CO，一氧化碳弥散能力; VC，肺毛细血管血液量; DM，膜弥散能力; IPAVA得分，五心循环后对比外观在左心室的得分。从Tedjasaputra 等人修改的数据。 2016年。

Watch this Scientific Journal Video about Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise at JoVE.com

Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

为了评估锻炼肺扩散和血管的反应，我们描述了多吸入氧扩散能力的技术来确定毛细血管血量和膜弥散能力，以及搅动盐水超声造影评估肺内动静脉吻合的招聘。

肺毛细血管血量，膜弥散能力，及肺内动静脉吻合的评估期间行使

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased ...

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Unit 1

An Overview of the Respiratory System: Anatomy, Physiology, Assessment, and Abnormalities

SCIENTISTS IN ACTION

12.9K 次观看.  University of Alberta. 为了评估锻炼肺扩散和血管的反应，我们描述了多吸入氧扩散能力的技术来确定毛细血管血量和膜弥散能力，以及搅动盐水超声造影评估肺内动静脉吻合的招聘。 

视频: Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic conditions. As part of a diagnostic assessment, the early detection of postural deficits is important so that appropriate and targeted interventions can be prescribed. The Sensory Organization Test (SOT) on the EquiTest determines an individual&#39;s use of the sensory systems (somatosensory, visual, and vestibular) that are responsible for postural control. Somatosensory and visual input are altered by the calibrated sway-referenced support surface and visual surround, which move in the anterior-posterior direction in response to the individual&#39;s postural sway. This creates a conflicting sensory experience. The Motor Control Test (MCT) challenges postural control by creating unexpected postural disturbances in the form of backwards and forwards translations. The translations are graded in magnitude and the time to recover from the perturbation is computed.
Intermittent claudication, the most common symptom of peripheral arterial disease, is characterized by a cramping pain in the lower limbs and caused by muscle ischemia secondary to reduced blood flow to working muscles during physical exertion. Claudicants often display poor balance, making them susceptible to falls and activity avoidance. The Ankle Brachial Pressure Index (ABPI) is a noninvasive method for indicating the presence of peripheral arterial disease and intermittent claudication, a common symptom in the lower extremities. ABPI is measured as the highest systolic pressure from either the dorsalis pedis or posterior tibial artery divided by the highest brachial artery systolic pressure from either arm. This paper will focus on the use of computerized dynamic posturography in the assessment of balance in claudicants.

Individuals with intermittent claudication exhibit poor balance compared to healthy controls. Computerized dynamic posturography is an objective method for measuring an individual's postural responses to balance disturbances. This provides an objective reflection of the person&#x2019;s ability to respond to situations under which sensory stimuli are altered and unexpected perturbations occur.

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

科研

医学

Induction and Assessment of Exertional Skeletal Muscle Damage in Humans

Contraction-induced muscle damage via voluntary eccentric (lengthening) contractions offers an excellent model for studying muscle adaptation and recovery in humans. Herein we discuss the design of an eccentric exercise protocol to induce damage in the quadriceps muscles, marked by changes in strength, soreness, and plasma creatine kinase levels. This method is simple, ethical, and widely applicable since it is performed in human participants and eliminates the interspecies translation of the results. Subjects perform 300 maximal eccentric contractions of the knee extensor muscles at a speed of 120&#176;/sec on an isokinetic dynamometer. The extent of the damage is measurable using relatively non-invasive isokinetic and isometric measures of strength loss, soreness, and plasma creatine kinase levels over several days following the exercise. Therefore, its application can be directed to specific populations in an attempt to identify mechanisms for muscle adaptation and regeneration.

This article describes a safe and reliable method to induce and quantify exertional skeletal muscle damage in human subjects.

诱导和人类劳力骨骼肌损伤评估

Contraction-induced muscle damage via voluntary eccentric (lengthening) contractions offers an excellent model for studying muscle adaptation and recovery ...

Non-invasive Assessment of Dorsiflexor Muscle Function in Mice

Assessment of skeletal muscle contractile function is an important measurement for both clinical and research purposes. Numerous conditions can negatively affect skeletal muscle. This can result in a loss of muscle mass (atrophy) and/or loss of muscle quality (reduced force per unit of muscle mass), both of which are prevalent in chronic disease, muscle-specific disease, immobilization, and aging (sarcopenia). Skeletal muscle function in animals can be evaluated by a range of different tests. All tests have limitations related to the physiological testing environment, and the selection of a specific test often depends on the nature of the experiments. Here, we describe an in vivo, non-invasive technique involving a helpful and easy assessment of force frequency-curve (FFC) in mice that can be performed on the same animal over time. This permits monitoring of disease progression and/or efficacy&#160;of a potential therapeutic treatment.

Measurement of rodent skeletal muscle contractile function is a useful tool that can be used to track disease progression as well as efficacy of therapeutic intervention. We describe here the non-invasive, in vivo assessment of the dorsiflexor muscles that can be repeated over time in the same mouse.

小鼠肌功能的无创评价

Assessment of skeletal muscle contractile function is an important measurement for both clinical and research purposes. Numerous conditions can negatively ...

Ultrasonographic Assessment During Cardiopulmonary Resuscitation

The US-CAB (Ultrasound, Circulation/Airway/Breathing) protocol integrates several sonographic techniques into a structured assessment of the circulation, airway, and breathing status of a patient during cardiopulmonary resuscitation (CPR) in an advanced life support-compliant manner. US-C provides a subxiphoid view of the heart, to look for potentially reversible causes of disease, such as pericardial effusion, pulmonary embolism, hypovolemia, and acute coronary thrombosis. Sonographic cardiac activity during CPR not only helps differentiate pseudo-pulseless electrical activity (PEA) from true PEA but also represents a higher chance of the return of spontaneous circulation (ROSC) and survival. Evaluation of the inferior vena cava (IVC) shows the fluid status of the patient and indicates the best methods to use for fluid resuscitation. If aortic dissection is suspected, a subxiphoid view of the aorta is suggested for identifying an intimal flap. Once intubation is done, tracheal ultrasound (US-A) at the suprasternal notch helps differentiate endotracheal intubation (one air-mucosal interface with one comet-tail) from esophageal intubation (double tract sign). Immediately following US-A, bilateral lung US (US-B) should be done to confirm proper bilateral ventilation using the lung sliding sign. In addition, US-C can be serially followed to see the dynamic changes in the cardiac chambers and IVC, or any cardiac contraction suggestive of ROSC. US-B can also detect coexisting lung or pleural pathologies without interfering with the performance of CPR. The main concern when implementing this method is maintaining high-quality CPR without delays in chest compressions when performing US-CAB. Rigorous training and continued practice are key to minimize any interruptions during resuscitation.

Here, we present a US-CAB (Ultrasound, Circulation/Airway/Breathing) protocol for use during cardiopulmonary resuscitation (CPR). US-C evaluates the subxiphoid view of the heart and inferior vena cava. After intubation, tracheal US (US-A) and lung US (US-B) help confirm endotracheal intubation and proper ventilation.

心肺复苏期间的超分谱评估

The US-CAB (Ultrasound, Circulation/Airway/Breathing) protocol integrates several sonographic techniques into a structured assessment of the circulation, ...

Providing Visual Biofeedback Using Brightness Mode Ultrasound During a Golf Swing

Using ultrasound biofeedback in conjunction with verbal cueing can increase muscle thickness more than verbal cueing alone and may augment traditional rehabilitation techniques in an athletic, physically active population. Brightness mode (B-mode) ultrasound can be applied using frame-by-frame analysis synchronized with video to understand muscle thickness changes during these dynamic tasks. Visual biofeedback with ultrasound has been established in static positions for the muscles of the lateral abdominal wall. However, by securing the transducer to the abdomen using an elastic belt and foam block, biofeedback can be applied during more specific tasks prevalent in lifetime sports, such as golf. To analyze muscle activity during a golf swing, muscle thickness changes can be compared. The thickness must increase throughout the task, indicating that the muscle is more active. This methodology allows clinicians to immediately replay ultrasound videos for patients as a visual tool to instruct proper activity of the muscles of interest. For example, ultrasound can be used to target the external and internal obliques, which play an important role in swinging a golf club or any other rotational sport or activity. This methodology aims to increase oblique muscle thickness during the golf swing. Additionally, the timing of muscle contraction can be targeted by instructing the patient to contract the abdominal muscles at specific time points, such as the beginning of the downswing, with the goal of improving muscle firing patterns during tasks.

Brightness mode ultrasound can be used to provide visual biofeedback of the muscles of the lateral abdominal wall during a golf swing. Post-swing visual and verbal instruction can increase the muscle activation and timing of the external and internal obliques.

在高尔夫挥杆期间使用亮度模式超声波提供视觉生物反馈

Using ultrasound biofeedback in conjunction with verbal cueing can increase muscle thickness more than verbal cueing alone and may augment traditional ...

Muscle Function Obtained with Motion Mode Ultrasound and Surface Electromyography during Core Endurance Exercise

Motion mode (M-mode) ultrasound allows researchers and clinicians to measure the change of muscle thickness across time. Muscle thickness can be measured between fascial borders at a given time point during an exercise. This selected time point produces a one-dimensional image resulting in real-time, live observation of anatomy. Ultrasound used during functional movement can be referred to as dynamic ultrasound; this is feasible and reliable with the use of a linear transducer, elastic belt, and foam block to secure consistent transducer placement. The lateral abdominal wall is commonly investigated using ultrasound due to the overlapping nature of the muscles. Surface electromyography (sEMG) can complement M-mode ultrasound imaging because it measures the electrical representation of muscle activation. There is minimal evidence using M-mode ultrasound and sEMG simultaneously during core exercise. Exercises that challenge the core musculature involve both isometric holds (e.g., side plank), as well as oscillatory extremity movements (e.g., dead bug). In this study, both instruments will be used simultaneously to measure core muscle function during exercise. Ultrasound measurements will be obtained using a linear transducer and ultrasound unit, and sEMG measurements will be acquired from a wireless sEMG system. To make comparisons between participants and exercises, normalization methods using static, exercise starting positions for both instruments will be used. An activation ratio will be used for ultrasound and calculated by dividing the contracted thickness (thickness during a time point of exercise) by the rested (starting position) thickness. Muscle thickness will be measured in centimeters from the superior inferior fascial border to inferior superior fascial border. These methods aim to offer an innovative and practical measurement of muscle function with M-mode ultrasound and sEMG during core endurance exercises.

This protocol uses motion mode ultrasound and surface electromyography simultaneously to measure muscle function of the core. Muscle thickness and activation of the local stabilizers (e.g., transverse abdominis, internal oblique) and global movers (e.g., external oblique) is achievable during specific time points of the side plank and dead bug exercises.

核心耐力运动期间通过运动模式超声和表面肌电图获得的肌肉功能

Motion mode (M-mode) ultrasound allows researchers and clinicians to measure the change of muscle thickness across time. Muscle thickness can be measured ...

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the allocation of a growing number of donor hearts with extended criteria. These marginal grafts are associated with a high risk of primary graft failure and may benefit from ex situ perfusion before transplant. This technology allows for extended organ preservation using warm oxygenated blood perfusion with continuous metabolic monitoring. The only NESP device currently available for clinical practice perfuses the organ in an unloaded non-working state, which does not allow for functional assessment of the beating heart. We therefore developed an original platform of NESP in working mode conditions with adjustment of left ventricular preload and afterload. This protocol was applied in porcine hearts. Ex situ functional assessment of the heart was achieved with intracardiac conductance catheterization and surface echocardiography. Along with a description of the experimental protocol, we herein report the main results, as well as pearls and pitfalls associated with the acquisition of pressure-volume loops and myocardial power during NESP. Correlations between hemodynamic findings and ultrasound variables are of major interest, especially for further rehabilitation of donor hearts before transplantation. This protocol aims to improve the assessment of donor hearts to both increase the donor pool and reduce the incidence of primary graft failure.

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

A reliable noninvasive approach for functional assessment of the donor heart during normothermic ex situ heart perfusion (NESP) is lacking. We herein describe a protocol for ex situ assessment of myocardial performance using the epicardial echocardiography and conductance catheter method.

非原位灌注期间供体心脏的功能评估：来自压力-容量环和表面超声心动图的见解

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the ...

改良动静脉瘘手术建立 RV 体积超负荷小鼠模型

Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model

Right ventricular (RV) volume overload (VO) is common in children with congenital heart disease. In view of distinct developmental stages,the RV myocardium may respond differently to VO in children compared to adults. The present study aims to establish a postnatal RV VO model in mice using a modified abdominal arteriovenous fistula. To confirm the creation of VO and the following morphological and hemodynamic changes of the RV, abdominal ultrasound, echocardiography, and histochemical staining were performed for 3 months. As a result, the procedure in postnatal mice showed an acceptable survival and fistula success rate. In VO mice, the RV cavity was enlarged with a thickened free wall, and the stroke volume was increased by about 30%-40% within 2 months after surgery. Thereafter, the RV systolic pressure increased, corresponding pulmonary valve regurgitation was observed, and small pulmonary artery remodeling appeared. In conclusion, modified arteriovenous fistula (AVF) surgery is feasible to establish the RV VO model in postnatal mice. Considering the probability of fistula closure and elevated pulmonary artery resistance, abdominal ultrasound and echocardiography must be performed to confirm the model status before application.

作者聚焦：出生后右心室容量超负荷小鼠模型的建立和确认  

This protocol presents the establishment and confirmation of a postnatal right ventricular volume overload (VO) model in mice with abdominal arteriovenous fistula (AVF), which can be applied to investigate how VO contributes to postnatal heart development.