METHODS: Bibliometric analysis was made, including the publications' profiles, citation analysis and research trends of the relevant literature over the last 60 years. Publications from all time frames were retrieved from Scopus database. A subgroup analysis of publications pertinent to people with SCI was also made.
RESULTS: Research on RMT has been steadily increasing over the last 6 decades and across geographical locations. While medicine continues to dominate the research on RMT, this topic also continues to attract researchers and publications from other areas such as engineering, computer science and social science over the last 10 years. Research collaboration between authors in different backgrounds was observed since 2006. Source titles from non-medical backgrounds have also published articles pertinent to RMT. Among people with SCI, researchers utilised a wide range of technology from simple spirometers to electromyography in both intervention and outcome measures. With various types of interventions implemented, RMT generally improves pulmonary function and respiratory muscle strength among people with SCI.
CONCLUSIONS: While research on RMT has been steadily increasing over the last 6 decades, more collaborations are encouraged in the future to produce more impactful and beneficial research on people who suffer from respiratory disorders.
METHODS: MMG and EMG were used to record the activity of the SCM in 32 untrained singers reciting a monotonous text and a standard folk song. Their voices were recorded and their pitch, or fundamental frequency (FF), and intensity were derived using Praat software. Instants of inhale and exhales were identified during singing from their voice recordings and the corresponding SCM MMG and EMG activities were analysed.
RESULTS: The SCM MMG, and EMG signals during breathing while singing were significantly different than breathing at rest (p < 0.001). On the other hand, MMG was relatively better correlated to voice intensity in both reading and singing than EMG. EMG was better, but not significantly, correlated with FF in both reading and singing as compared to MMG.
CONCLUSIONS: This study established MMG and EMG as the quantitative measurement tool to monitor breathing activities during singing. This is useful for applications related to singing therapy performance measure including potentially pathologically effected population. While the MMG and EMG could not distinguish FF and intensity significantly, it is useful to serve as a proxy of inhalation and exhalation levels throughout a particular singing session. Further studies are required to determine its efficacy in a therapeutic setting.
MATERIALS AND METHODS: This randomised, prospective study was conducted among COPD subjects admitted with exacerbation between June 2021 and August 2022. Subjects were randomly assigned to either the VIS (interventional group) or the control group. Baseline assessments, including spirometry, MIP, CAT score, and the 6-minute walk test (6MWT), were performed. Both groups commenced active cycle of breathing techniques (ACBT) and groundbased walking (GBW) training within 72 hours of admission, with daily sessions involving three repetitions of each phase to complete one cycle, repeated three times daily. The intervention group received VIS. Upon discharge, subjects were provided with a diary and instructed to continue a home-based pulmonary exercise regimen, performed for at least 15 minutes per day, 3 days a week, with compliance monitored through weekly phone calls. At the 4-week followup, repeat assessments of spirometry, MIP, maximal expiratory pressure (MEP), CAT score and 6MWT were conducted to evaluate the outcomes.
RESULTS: A total of 34 subjects with a median age of 68 years (interquartile range [IQR] 65-74.3 years). The cohort predominantly males (32 subjects, 94%). The distribution of disease severity was as follows: GOLD 2 in 15 subjects (44%) and GOLD 3 in 14 subjects (41%). Additionally, 17 subjects (50%) had experienced three or more exacerbations in the preceding year. The majority of patients (29 out of 34, 85%) had a length of stay of less than 7 days. In the interventional group, the median MIP improved from 50 cm H2O (IQR 40.5-70.5) to 59 cm H2O (IQR 39-76.5), though this was not statistically significant (p = 0.407). The control group saw an improvement from 58 cm H2O (IQR 36.5-85) to 60 cm H2O (IQR 33-88), also not statistically significant (p = 0.112). The 6MWT distance improved in the interventional group from 220 meters (IQR 118-275) to 260 meters (IQR 195-327) (p = 0.002) and in the control group from 250 meters (IQR 144-294) to 280 meters (IQR 213-359.5) (p = 0.001). The median CAT score decreased significantly in the interventional group from 22 (IQR 16-28) to 11 (IQR 7.5-13) (p < 0.001) and in the control group from 21 (IQR 14-24.5) to 10 (IQR 8-12.5) (p < 0.001).
CONCLUSION: Early initiation of pulmonary rehabilitation in patients with acute exacerbations, characterised by poor muscle strength and a history of exacerbations, resulted in significant improvements in patient-reported symptoms and 6MWT outcomes. Although there was only a numerical improvement in MIP and MEP, the intervention did not extend the length of hospital stay, highlighting its safety and efficacy in the acute care setting.
CASE SUMMARY: Two special COVID-19 cases-one full-term pregnant woman and one elderly (72-year-old) man-were treated by veno-venous (VV)-ECMO in the Second People's Hospital of Zhongshan, Zhongshan City, Guangdong Province, China. Both patients had developed refractory hypoxemia shortly after hospital admission, despite conventional support, and were therefore managed by VV-ECMO. Although both experienced multiple ECMO-related complications on top of the COVID-19 disease, their conditions improved gradually. Both patients were weaned successfully from the ECMO therapy. At the time of writing of this report, the woman has recovered completely and been discharged from hospital to home; the man remains on mechanical ventilation, due to respiratory muscle weakness and suspected lung fibrosis. As ECMO itself is associated with various complications, it is very important to understand and treat these complications to achieve optimal outcome.
CONCLUSION: VV-ECMO can provide sufficient gas exchange for COVID-19 patients with acute respiratory distress syndrome. However, it is crucial to understand and treat ECMO-related complications.
Learning points: Cushing's syndrome can present in many ways, a high index of suspicion is required for its diagnosis, as often patients present with only few of the pathognomonic symptoms and signs of the syndrome.Proximal lower-limb girdle myopathy is common in Cushing's syndrome. Less often long-term exposure of excess glucocorticoid production can also affect other muscles including respiratory muscle and the diaphragm leading to progressive shortness of breath and even acute respiratory failure.Treatment of Cushing's myopathy involves treating the underlying cause that is hypercortisolism. Various medications have been suggested to hinder the development of GC-induced myopathy, but their effects are poorly analysed.