Diss. (sammanfattning) Linköping : Linköpings universitet, 2004. / Härtill 5 uppsatser.

Introdução: A área do músculo peitoral (AMP) é uma avaliação facilmente derivada da tomografia computadorizada do tórax com potencial de fornecer informações relevantes sobre outros músculos esqueléticos. A Disfunção muscular respiratória e periférica é cada vez mais reconhecida em pacientes com doença pulmonar intersticial (DPI). A sua relação com a capacidade de exercício tem sido controversa. Nosso objetivo foi investigar se AMP está relacionada com a força muscular esquelética respiratória e periférica em pacientes com DPI, e se a função dos músculos esqueléticos estaria reduzida e independentemente relacionada com a capacidade de exercício e dispneia nesses pacientes. Métodos: Estudo transversal onde foi realizado teste de exercício cardiopulmonar incremental em cicloergômetro com mensuração de pressão inspiratória máxima (PImax), pressão expiratória máxima (PEmax) e contração voluntária máxima (CVM) do quadríceps, antes e após o exercício. Os testes de função pulmonar em repouso e TC de tórax foram obtidos da rotina assistencial dos pacientes. / Background: Pectoralis muscle area (PMA) is an easily derived computed tomography-based assessment that can provide insight into clinical features of other skeletal muscles. Respiratory and locomotor muscle dysfunction has been increasingly recognized in patients with interstitial lung disease (ILD). Its contribution to exercise performance has been controversial. We aimed investigate if PMA is related with respiratory and locomotor skeletal muscle strength in ILD patients, and if skeletal muscle function is compromised and independently related with exercise capacity and dyspnea in these patients. Methods: Cross-sectional study where subjects performed incremental cycling cardiopulmonary exercise testing with maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and quadriceps maximal voluntary contraction (MVC) before and after exercise.

Introdução: A área do músculo peitoral (AMP) é uma avaliação facilmente derivada da tomografia computadorizada do tórax com potencial de fornecer informações relevantes sobre outros músculos esqueléticos. A Disfunção muscular respiratória e periférica é cada vez mais reconhecida em pacientes com doença pulmonar intersticial (DPI). A sua relação com a capacidade de exercício tem sido controversa. Nosso objetivo foi investigar se AMP está relacionada com a força muscular esquelética respiratória e periférica em pacientes com DPI, e se a função dos músculos esqueléticos estaria reduzida e independentemente relacionada com a capacidade de exercício e dispneia nesses pacientes. Métodos: Estudo transversal onde foi realizado teste de exercício cardiopulmonar incremental em cicloergômetro com mensuração de pressão inspiratória máxima (PImax), pressão expiratória máxima (PEmax) e contração voluntária máxima (CVM) do quadríceps, antes e após o exercício. Os testes de função pulmonar em repouso e TC de tórax foram obtidos da rotina assistencial dos pacientes. / Background: Pectoralis muscle area (PMA) is an easily derived computed tomography-based assessment that can provide insight into clinical features of other skeletal muscles. Respiratory and locomotor muscle dysfunction has been increasingly recognized in patients with interstitial lung disease (ILD). Its contribution to exercise performance has been controversial. We aimed investigate if PMA is related with respiratory and locomotor skeletal muscle strength in ILD patients, and if skeletal muscle function is compromised and independently related with exercise capacity and dyspnea in these patients. Methods: Cross-sectional study where subjects performed incremental cycling cardiopulmonary exercise testing with maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and quadriceps maximal voluntary contraction (MVC) before and after exercise.

Background: Childhood asthma has increased worldwide, although recent studies report a prevalence plateau in some western countries. Aims: To investigate the prevalence of asthma and the associated risk factor patterns from ages 7-8 to 11-12 with special emphasis on the hereditary component, and further to study prevalence trends at age 7-8 from 1996 to 2006 and the possible determinants of these trends. Methods: The studies involved two cohorts from Kiruna, Luleå and Piteå: one previously identified cohort of 3430 children age 7-8 followed by yearly questionnaires until age 11-12 with 97% yearly participation. Skin-prick tests for allergic sensitisation were performed at ages 7-8 and 11-12 in subsets of 2148 and 2155 children respectively (88% of invited). In 2006 a new cohort of 7-8-year-olds was identified and examined identically. 2585 (96% of invited) and 1700 (90% of invited) participated in the questionnaire and skin-prick tests, respectively. The questionnaire included questions about symptoms of asthma, allergic rhinitis and eczema, and possible risk factors. Results: In the 1996 cohort, from age 7-8 to 11-12 the prevalence of physician-diagnosed asthma increased (5.7%-7.7%, P<0.01) while current wheeze decreased (11.7%-9.4%, P<0.01), and 34.7% reported ever wheee at ≥one occasion. Remission was 10% of which half relapsed during the study. Remission was significantly lower among sensitised children. The strongest risk factors for current asthma at ages 7-8 and 11-12 were allergic sensitisation (OR 5) and family history of asthma (OR 3). Several other significant risk factors, e.g. respiratory infections, damp house and low birth weight, had lost importance at age 11-12. At age 7-8, parental asthma was a stronger risk factor (OR 3-4) than parental rhinitis or eczema (OR 1.5-2). Sibling asthma had no independent effect. Biparental asthma had a multiplicative effect (OR 10). Maternal and paternal asthma was equally important, regardless of the child’s sex and sensitisation status. From 1996 to 2006 the prevalence of current wheeze and asthma at age 7-8 did not increase (P=0.13, P=0.18), while lifetime prevalence of ever wheeze and physician-diagnosed asthma increased (P<0.01, P=0.01). Symptoms of rhinitis and eczema were unchanged, despite 45% increase (P<0.01) in allergic sensitisation. For current asthma the adjusted population attributable fractions of sensitisation and parental asthma increased (35%-41%, 27%-45%). This was however balanced by decreased exposure to infections, maternal smoking and home dampness, resulting in stable asthma prevalence. Stratification by sex revealed that current wheeze increased in boys (P<0.01) but tended to decrease in girls (P=0.37), seemingly due to symptom persistence in males. Several asthma indices followed this pattern. The boy-to-girl ratio in exposure to all studied risk factors increased, which may explain the sex-specific prevalence trends in wheeze. Conclusions: The prevalence of current asthma and wheeze did not increase statistically significantly. However, the risk factor pattern has changed considerably since 1996, which will presumably affect the clinical features of childhood wheeze in this region. Sex-specific trends in wheeze can be explained by changes in exposure, and trends in risk factors should be explored parallel to prevalence trends.

published_or_final_version / Paediatrics and Adolescent Medicine / Master / Master of Philosophy

Introdução: A Agamaglobulinemia, a Imunodeficiência Comum Variável (IDCV) e a Síndrome Hiper IgM (SHIGM) são imunodeficiência primárias predominantemente humorais que se beneficiam da reposição de imunoglobulina humana, com redução da morbimortalidade. No entanto, apesar da reposição adequada de imunoglobulina, complicações pulmonares podem ocorrer, influenciando o prognóstico destes pacientes. Objetivo: O objetivo do estudo foi descrever as alterações morfológicas e funcionais pulmonares em pacientes com hipogamaglobulinemia primária em tratamento com reposição de imunoglobulina humana. Métodos: Foram avaliados 30 pacientes (agamaglobulinemia n=14; IDCV n=9; SHIGM n=7) que receberam imunoglobulina e antibioticoterapia profilática regularmente. A avaliação utilizou dados dos prontuários sobre o início e a evolução da doença, bem como dados de espirometria e tomografia computadorizada de tórax. O escore de Bhalla foi aplicado à tomografia mais recente de cada um dos pacientes para correlacionar as alterações tomográficas pulmonares com os dados clínicos, resultados das espirometrias e ocorrência de processos infecciosos sino-pulmonares após o início da reposição de imunoglobulina. Para as análises estatísticas utilizou-se o programa SPSS 13.0, e valores de p<0,05 foram considerados estatisticamente significantes. As variáveis nominais foram comparadas através do teste de Fisher e as contínuas, através de testes não paramétricos (Mann-Whitney, Kruskal- Wallis e Wilcoxon). Para as correlações do escore de Bhalla com as demais variáveis foi utilizado o coeficiente de Spearman. Resultados: Houve diminuição na frequência de pneumonias (p<0,001) e aumento na frequência de sinusites (p<0,001) após o início da reposição de imunoglobulina. Distúrbios ventilatórios foram evidenciados em 14 dos 23 pacientes que puderam realizaram espirometria (7 obstrutivos, 5 restritivos e 2 inconclusivos). Pacientes com bronquiectasias ao diagnóstico e aqueles à primeira avaliação tomográfica apresentaram mediana de idade mais elevada ao diagnóstico (p=0,015 e p=0,001, respectivamente) e tempo mais prolongado entre o início dos sintomas e o diagnóstico que aqueles sem bronquiectasias (p=0,010 e p=0,001, respectivamente). Sete pacientes desenvolveram bronquiectasias durante o tratamento. Pacientes com bronquiectasias à avaliação final apresentaram maior frequência de sinusites antes do início da reposição de imunoglobulina que aqueles sem bronquiectasias (p=0,010). Houve correlação estatisticamente significante do escore de Bhalla com VEF1 pré e pós-broncodilatador (r= -0,778 e r= -0,837, respectivamente), CVF (r= -0,773), FEF25-75% (r= -0,571) e com a frequência de pneumonias após o início do tratamento (r= 0,561). Conclusões: O tratamento com reposição regular de imunoglobulina e antibioticoterapia profilática reduziu a frequência e gravidade das infecções pulmonares, porém não evitou a ocorrência de sinusites, o aparecimento de bronquiectasias nem de outras alterações morfológicas e funcionais pulmonares / Introduction: Agammaglobulinemia, Common Variable Immunodeficiency (CVID) and Hyper IgM Syndrome (HIGM) are predominantly antibody deficiencies that benefit from immunoglobulin replacement therapy, with reduction of their morbidity and mortality. Despite regular immunoglobulin replacement, pulmonary complications may occur in those patients, affecting their prognosis. Objective: The aim of this study was to describe tomographic and functional pulmonary abnormalities in patients with primary hypogammaglobulinemia receiving immunoglobulin replacement therapy. Methods: Thirty patients (agammaglobulinemia n=14, CVID n=9, HIGM n=7) receiving antimicrobial prophylaxis and regular immunoglobulin infusions were evaluated. Clinical records were reviewed to obtain data concerning the onset and evolution of the disease and the results of spirometry and computed tomography of the chest. Bhalla score was applied to the most recent tomography of each patient to correlate tomographic pulmonary abnormalities with clinical data, spirometry results and the occurrence of sinusal and pulmonary infections after the onset of the immunoglobulin replacement. Statistical analysis was performed using the software SPSS 13.0 and p values < 0.05 were interpreted as statistically significant. Nominal variables were tested using Fisher´s exact test and continuous variables were tested using non-parametric tests (Mann-Whitney, Kruskal-Wallis e Wilcoxon). Spearman coefficient was used to correlate Bhalla score with the other variables. Results: The frequency of pneumonias decreased (p<0.001) and the frequency of sinusitis increased (p<0.001) after the onset of immunoglobulin replacement. Pulmonary function was abnormal in 14 of 23 patients (7 obstructive, 5 restrictive, 2 inconclusive). Patients with bronchiectasis at diagnosis and those with bronchiectasis at the first tomographic evaluation presented higher median age at diagnosis (p=0.015 and p=0.001, respectively) and longer duration between the onset of symptoms and diagnosis than those without bronchiectasis (p=0.010 e p=0.001, respectively). Seven patients developed bronchiectasis during treatment. Patients with bronchiectasis at the last tomographic evaluation presented a higher frequency of sinusitis before therapy onset than those without bronchiectasis (p=0.001). Statistically significant correlation was found between Bhalla score and pre and post bronchodilator FEV1 (r= -0.778 and r= -0.837, respectively), FVC (r= -0.773) and FEF25-75% (r= -0.571) and between Bhalla score and the frequency of pneumonias after the onset of immunoglobulin replacement therapy (r=0.561). Conclusions: Immunoglobulin replacement therapy and antimicrobial prophylaxis reduced the frequency and severity of pulmonary infections but did not prevent the occurrence of sinusitis, the development of bronchiectasis or other morphological and functional pulmonary abnormalities

by Alice Yee-men Jones (Nee Ho). / Thesis (M.Phil.)--Chinese University of Hong Kong, 1992. / Includes bibliographical references (leaves [196]-221). / Abstract --- p.i / Publications --- p.iii / Acknowledgement --- p.v / Chapter SECTION I --- INTRODUCTION / Chapter Chapter 1 --- General Introduction --- p.1 / Chapter 1.1 --- Objectives / Chapter 1.2 --- History & Advances in Chest Physiotherapy / Chapter 1.3 --- Problems of Chest Physiotherapy Research / Chapter 1.4 --- Plan of work / Chapter Chapter 2 --- Previous Studies in Chest Physiotherapy --- p.15 / Chapter 2.1 --- Chest Physiotherapy and oxygenation / Chapter 2.2 --- Chest Physiotherapy and sputum clearance / Chapter 2.3 --- Chest Physiotherapy and lung function / Chapter Chapter 3 --- "Chest Physiotherapy Practice in ICUs in Australia, the UK and Hong Kong" --- p.34 / Chapter SECTION II --- METHODS / Chapter Chapter 4 --- Measurement of Oxygenation --- p.55 / Chapter 4.1 --- Measurement of arterial oxygenation / Chapter 4.2 --- Indirect measurement of arterial oxygenation / Chapter Chapter 5 --- Respiratory Function Analysis --- p.66 / Chapter 5.1 --- Spirometry measurement / Chapter 5.2 --- Measurement of lung mechanics / Chapter Chapter 6 --- Transcutaneous Electrical Nerve Stimulation --- p.74 / Chapter SECTION III --- RESPIRATORY PHYSIOTHERAPY TECHNIQUES / Chapter Chapter 7 --- Effects of Percussion and Bagging on Static Lung Compliance --- p.80 / Chapter Chapter 8 --- Peak Expiratory Flow from two Breathing Circuits --- p.106 / Chapter Chapter 9 --- Peak Expiratory Flow in Tracheal Intubated Patients --- p.127 / Chapter SECTION IV --- PHYSIOTHERAPY AND PAIN MANA GEMENT IN ICU PATIENTS / Chapter Chapter 10 --- Transcutaneous Electrical Nerve Stimulation (TENS) following Thoracotomy --- p.142 / Chapter Chapter 11 --- TENS following Cholecystectomy --- p.154 / Chapter Chapter 12 --- TENS and Entonox --- p.167 / Chapter SECTION V --- SUMMARY AND CONCLUSIONS / Chapter Chapter 13 --- Summary --- p.185 / Chapter Chapter 14 --- Conclusion --- p.194 / Chapter SECTION VI --- REFERENCES --- p.197 / Chapter SECTION VII --- APPENDICES --- p.222

by Ping-Fu Fung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 98-102). / Abstract also in Chinese. / Abstract --- p.iv / Acknowledgements --- p.vi / Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Medical Visualization System --- p.4 / Chapter 1.1.1 --- Data Acquisition --- p.4 / Chapter 1.1.2 --- Computer-aided Medical Visualization --- p.5 / Chapter 1.1.3 --- Existing Systems --- p.6 / Chapter 1.2 --- Research Goal --- p.8 / Chapter 1.2.1 --- System Architecture --- p.9 / Chapter 1.3 --- Organization of this Thesis --- p.10 / Chapter 2 --- Volume Visualization --- p.11 / Chapter 2.1 --- Sampling Grid and Volume Representation --- p.11 / Chapter 2.2 --- Priori Work in Volume Rendering --- p.13 / Chapter 2.2.1 --- Surface VS Direct --- p.14 / Chapter 2.2.2 --- Image-order VS Object-order --- p.18 / Chapter 2.2.3 --- Orthogonal VS Perspective --- p.22 / Chapter 2.2.4 --- Hardware Acceleration VS Software Acceleration --- p.23 / Chapter 2.3 --- Chapter Summary --- p.29 / Chapter 3 --- IsoRegion Leaping Technique for Perspective Volume Rendering --- p.30 / Chapter 3.1 --- Compositing Projection in Direct Volume Rendering --- p.31 / Chapter 3.2 --- IsoRegion Leaping Acceleration --- p.34 / Chapter 3.2.1 --- IsoRegion Definition --- p.35 / Chapter 3.2.2 --- IsoRegion Construction --- p.37 / Chapter 3.2.3 --- IsoRegion Step Table --- p.38 / Chapter 3.2.4 --- Ray Traversal Scheme --- p.41 / Chapter 3.3 --- Experiment Result --- p.43 / Chapter 3.4 --- Improvement --- p.47 / Chapter 3.5 --- Chapter Summary --- p.48 / Chapter 4 --- Parallel Volume Rendering by Distributed Processing --- p.50 / Chapter 4.1 --- Multi-platform Loosely-coupled Parallel Environment Shell --- p.51 / Chapter 4.2 --- Distributed Rendering Pipeline (DRP) --- p.55 / Chapter 4.2.1 --- Network Architecture of a Loosely-Coupled System --- p.55 / Chapter 4.2.2 --- Data and Task Partitioning --- p.58 / Chapter 4.2.3 --- Communication Pattern and Analysis --- p.59 / Chapter 4.3 --- Load Balancing --- p.69 / Chapter 4.4 --- Heterogeneous Rendering --- p.72 / Chapter 4.5 --- Chapter Summary --- p.73 / Chapter 5 --- User Interface --- p.74 / Chapter 5.1 --- System Design --- p.75 / Chapter 5.2 --- 3D Pen Input Device --- p.76 / Chapter 5.3 --- Visualization Environment Integration --- p.77 / Chapter 5.4 --- User Interaction: Interactive Navigation --- p.78 / Chapter 5.4.1 --- Camera Model --- p.79 / Chapter 5.4.2 --- Zooming --- p.81 / Chapter 5.4.3 --- Image View --- p.82 / Chapter 5.4.4 --- User Control --- p.83 / Chapter 5.5 --- Chapter Summary --- p.87 / Chapter 6 --- Conclusion --- p.88 / Chapter 6.1 --- Final Summary --- p.88 / Chapter 6.2 --- Deficiency and Improvement --- p.89 / Chapter 6.3 --- Future Research Aspect --- p.91 / Appendix --- p.93 / Chapter A --- Common Error in Pre-multiplying Color and Opacity --- p.94 / Chapter B --- Binary Factorization of the Sample Composition Equation --- p.96

Alan George Miller. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (p. 204-230). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Background Idiopathic pulmonary fibrosis (IPF) is one of a number of interstitial lung diseases (ILDs) that result in extensive and chronic pulmonary fibrosis. In IPF pathology, immunological dysfunction has been identified as a contributing factor to the ongoing fibrotic process, implicating cells and mechanisms of both the innate and humoral immune response. Due to the complex and diverse range of cells and mediators involved in IPF, the pathology is still poorly understood. Evidence of complement activation through the classical pathway in IPF lungs implies a role for IgG in the pathology. The active IgG in IPF may be autoreactive in nature, as IgG that target antigens of alveolar epithelial cells have been. Two autoantibodies in IPF, anti-periplakin IgG and anti-Hsp72 IgG, have been associated with poorer prognoses in IPF patients. The association of anti-Hsp72 IgG with IPF patient outcomes has not been validated and little work has been done to study the underlying mechanisms of autoantibodies in IPF pathogenesis. Hypothesis Anti-Hsp72 IgG is associated with poorer outcomes in IPF, and may induce alveolar macrophages to exhibit a pro-fibrotic phenotype. Aims The aims were to:  Optimise an ELISA for anti-Hsp72 IgG detection and determine any association of anti-Hsp72 IgG with IPF patient outcomes  Determine the location of anti-Hsp72 IgG producing cells and detect if Hsp72-IgG complexes are present in IPF patients’ lungs  Explore a potential underlying pro-fibrotic mechanism through which anti-Hps72 IgG modulates macrophage function. Results The presence of anti-Hsp72 IgG was determined in ILD patient and healthy control bronchoalveolar lavage fluid (BALf) and serum. A novel anti-Hsp72 IgG ELISA was developed and optimised and then compared against a commercial anti-Hsp72 IgGAM ELISA which became available during the PhD. Progression in IPF was defined by a decrease of ≥10% vital capacity (VC) over twelve months. Serum anti-Hsp72 IgG(AM) did not associate with changes in VC over 12 months. In contrast, BALf anti-Hsp72 IgG(AM) concentrations were elevated in IPF non-progressors. Patients with high BALf anti-Hsp72 IgGAM, had improved survival compared patient with low anti-Hsp72 IgGAM (adjusted HR 0.39, 95% CI 0.16-0.92; p=0.032) In contrast there was no association between anti-Hsp72 IgG and survival. Detection of anti-Hsp72 IgG subtypes in the serum and BALf of IPF patients revealed no significant difference in anti-Hsp72 IgG subtype detection levels between progressors and non-progressors. BALf anti-Hsp72 IgG1 levels were associated with a significantly lower rate of decline in VC over twelve months than patients with no detectable anti-Hsp72 IgG1. The presence of Hsp72-IgG complexes was confirmed by detection in purified IgG from IPF patient BALf. Immuno-histological detection of C4d deposition in the lungs of IPF patients coincided in areas of Hsp72 expression in alveolar epithelium. Summary These findings do not validate serum and-Hsp72 IgG as a biomarker for IPF. They support a role for anti-Hsp72 IgG in IPF, but associate with decreased rates of lung function decline and increased patient survival. Data also suggests that the decreased rate of decline may be related to specific anti-Hsp72 IgG subtype expression. The immune-histological data further suggests that anti-Hsp72 IgG may be targeting Hsp72 expressed by lung epithelium. Therefore these findings support a role for immunological dysfunction in IPF, but further work is required to determine the underlying mechanism.