Pleural pressure increases during inspiration in the zone of apposition of diaphragm to rib cage

The zone of apposition of diaphragm to rib cage provides a theoretical mechanism that may, in part, contribute to rib cage expansion during inspiration. Increases in intra-abdominal pressure (Pab) that are generated by diaphragmatic contraction are indirectly applied to the inner rib cage wall in the zone of apposition. We explored this mechanism, with the expectation that pleural pressure in this zone (Pap) would increase during inspiration and that local transdiaphragmatic pressure in this zone (Pdiap) must be different from conventionally determined transdiaphragmatic pressure (Pdi) during inspiration. Direct measurements of Pap, as well as measurements of pleural pressure (Ppl) cephalad to the zone of apposition, were made during tidal inspiration, during phrenic stimulation, and during inspiratory efforts in anesthetized dogs. Pab and esophageal pressure (Pes) were measured simultaneously. By measuring Ppl's with cannulas placed through ribs, we found that Pap consistently increased during both maneuvers, whereas Ppl and Pes decreased. Whereas changes in Pdi of up to -19 cmH2O were measured, Pdiap never departed from zero by greater than -4.5 cmH2O. We conclude that there can be marked regional differences in Ppl and Pdi between the zone of apposition and regions cephalad to the zone. Our results support the concept of the zone of apposition as an anatomic region where Pab is transmitted to the interior surface of the lower rib cage.     

Mechanical coupling of the rib cage, abdomen, and diaphragm through their area of apposition

Although volumetric displacements of the chest wall are often analyzed in terms of two independent parallel pathways (rib cage and abdomen), Loring and Mead have argued that these pathways are not mechanically independent (J. Appl. Physiol. 53: 756-760, 1982). Because of its apposition with the diaphragm, the rib cage is exposed to two distinct pressure differences, one of which depends on abdominal pressure. Using the analysis of Loring and Mead as a point of departure, we developed a complementary analysis in which mechanical coupling of the rib cage, abdomen, and diaphragm is modeled by a linear translational transformer. This model has the advantage that it possesses a precise electrical analogue. Pressure differences and compartmental displacements are related by the transformation ratio (n), which is the mechanical advantage of abdominal over pleural pressure changes in displacing the rib cage. In the limiting case of very high lung volume, n----0 and the pathways uncouple. In the limit of very small lung volume, n----infinity and the pathways remain coupled; both rib cage and abdomen are driven by abdominal pressure alone, in accord with the Goldman-Mead hypothesis. A good fit was obtained between the model and the previously reported data for the human chest wall from 0.5 to 4 Hz (J. Appl. Physiol. 66:350-359, 1989). The model was then used to estimate rib cage, diaphragm, and abdominal elastance, resistance, and inertance. The abdomen was a high-elastance high-inertance highly damped compartment, and the rib cage a low-elastance low-inertance more lightly damped compartment. Our estimate that n = 1.9 is consistent with the findings of Loring and Mead and suggests substantial pathway coupling.     

Effect of lower rib cage expansion and diaphragm shortening on the zone of apposition

The relationship among diaphragm length (LD), the width of the zone of apposition (WZapp), and transverse chest diameter (Drc) was developed from model equations and statistical analysis. We present a theoretical model of diaphragm motion that predicts that the decrease in WZapp during inspiration is the result not only of shortening of the diaphragm muscle but also of expansion of the lower rib cage. To test our model, static lengths of costal LD, WZapp, and Drc were measured in 15 normal volunteers using posteroanterior chest X-ray films taken at four or five lung volumes spanning the vital capacity. We found a strong correlation between WZapp and LD: WZapp = 0.95 LD - 15.2 (R2 = 0.81). Expressing WZapp as a combined function of LD and Drc significantly reduced the unexplained variance in WZapp: WZapp = 0.96 LD - 0.47 Drc - 2.18 (R2 = 0.95). The coefficients for LD and Drc derived statistically are close to those predicted from our theoretical model. Repeating the analysis with LD as the dependent variable, we obtained similar results: LD = 0.85 WZapp + 17.1 (R2 = 0.81) and LD = 0.98 WZapp + 0.46 Drc + 3.48 (R2 = 0.94). We conclude that shortening of WZapp is dependent on both diaphragm shortening and rib cage expansion and that roentgenographic measurements of Drc and WZapp can be used to predict diaphragm length and length change.     

Pleural pressure between diaphragm and rib cage during inspiratory muscle activity

We measured the changes in pleural surface pressure (delta Ppl) in the area of apposition of the rib cage to the diaphragm (Aap) in anesthetized dogs during spontaneous breathing, inspiratory efforts after airway occlusion at functional residual capacity, and phrenic stimulation. Intact dogs were in supine or lateral posture; partially eviscerated dogs were in lateral posture. delta Ppl,ap often differed significantly from changes in abdominal pressure (delta Pab); sometimes they differed in sign (except during phrenic stimulation). Changes in transdiaphragmatic pressure in Aap (delta Pdi,ap) could be positive or negative and were less in eviscerated than in intact dogs. delta Pdi,ap could differ in sign among respiratory maneuvers and over different parts of Aap. Hence average delta Pdi,ap should be closer to zero than delta Pdi,ap at a given site. Since delta Ppl,ap = delta Prc,ap, where Prc,ap represents rib cage pressure in Aap, delta Pdi,ap = delta Pab - delta Prc,ap. Hence, considering that delta Pab and delta Prc depend on different factors, delta Pdi,ap may differ from zero. This pressure difference seems related to the interaction between two semisolid structures (contracted diaphragm and rib cage in Aap) constrained to the same shape and position.     

Paradoxical inward rib cage motion during rapid eye movement sleep in infants and young children

In neonates, rib cage motion on inspiration during rapid eye movement sleep is almost exclusively paradoxical. We wondered whether or not duration of paradoxical inward rib cage motion on inspiration during rapid eye movement sleep decreases in infancy and early childhood. Thirteen healthy infants from 7 to 31 months of age were tested during natural afternoon naps. Electroencephalogram, electrooculogram and electromyogram were all recorded. Airflow was measured by nasal and buccal thermistors, abdominal and rib cage anteroposterior diameters by magnetometers. Transcutaneous partial pressure of O2 was monitored. Diaphragmatic electromyographic activity was recorded using surface electrodes. The average total sleep time was 138 min ranging from 107 to 186 and rapid eye movement sleep time amounted to 15% of total sleep time ranging from 6 to 25. During rapid eye movement sleep, the total duration of paradoxical inward rib cage motion was measured and expressed as a percentage of rapid eye movement sleep time. We found that duration of paradoxical inward rib cage motion during rapid eye movement sleep decreased significantly with age (r = -0.66, P less than 0.02) which may be explained by the changes in chest wall compliance and geometry of the rib cage occurring with growth. We observed no decrease in transcutaneous partial pressure in O2 during paradoxical inward rib cage motion during rapid eye movement sleep in infants in contrast to that reported in neonates.     

Determinants of diaphragm motion in unilateral diaphragmatic paralysis.

Cranial displacement of a hemidiaphragm during sniffs is a cardinal sign of unilateral diaphragmatic paralysis in clinical practice. However, we have recently observed that isolated stimulation of one phrenic nerve in dogs causes the contralateral (inactive) hemidiaphragm to move caudally. In the present study, therefore, we tested the idea that, in unilateral diaphragmatic paralysis, the pattern of inspiratory muscle contraction plays a major role in determining the motion of the inactive hemidiaphragm. We induced a hemidiaphragmatic paralysis in six anesthetized dogs and assessed the contour of the diaphragm during isolated unilateral phrenic nerve stimulation and during spontaneous inspiratory efforts. Whereas the inactive hemidiaphragm moved caudally in the first instance, it moved cranially in the second. The parasternal intercostal muscles were then severed to reduce the contribution of the rib cage muscles to inspiratory efforts and to enhance the force generated by the intact hemidiaphragm. Although the change in pleural pressure (DeltaPpl) was unaltered, the cranial displacement of the paralyzed hemidiaphragm was consistently reduced. A pneumothorax was finally induced to eliminate DeltaPpl during unilateral phrenic nerve stimulation, and this enhanced the caudal displacement of the inactive hemidiaphragm. These observations indicate that, in unilateral diaphragmatic paralysis, the motion of the inactive hemidiaphragm is largely determined by the balance between the force related to DeltaPpl and the force generated by the intact hemidiaphragm.     

The fine morphology of the area of foetal- maternal apposition in the equine placenta

Summary The area of foetal-maternal apposition in the cotyledonary part of the equine placenta has been studied with the electron microscope. An even zone of mutually interdigitating, spatially separated microvilli was present between the cryptal epithelium and the trophoblast. The foetal microvilli were more numerous than the maternal ones. Evidence of pinocytotic activity was observed in the trophoblastic cells. A main transport direction from maternal to foetal cells was postulated.Supported by a grant from Statens medicinska forskningsråd, Uppsala.     

Pleural liquid pressure in dogs measured using a rib capsule

We have developed a minimally invasive method for measuring the hydrostatic pressure in the pleural space liquid. A liquid-filled capsule is bonded into a rib and a small hole is cut in the parietal pleura to allow direct communication between the liquid in the capsule and the pleural space. The pressure can be measured continuously by a strain gauge transducer connected to the capsule. The rib capsule does not distort the pleural space or require removal of intercostal muscle. Pneumothoraces are easily detected when they occur inadvertently on puncturing the parietal pleura. We examined the effect of height on pleural pressure in 15 anesthetized spontaneously breathing dogs. The vertical gradients in pleural pressure were 0.53, 0.42, 0.46, and 0.23 cmH2O/cm height for the head-up, head-down, supine, and prone body positions, respectively. These vertical gradients were much less than the hydrostatic value (1 cmH2O/cm), indicating that the pleural liquid is not in hydrostatic equilibrium. In most body positions the magnitudes of pleural liquid pressure interpolated to midchest level were similar to the mean transpulmonary (surface) pressure determined postmortem. This suggests that pleural liquid pressure is closely related to the lung static recoil.     

A motion analysis marker-based method of determining centre of pressure during two-legged hopping

The fixed position of force plates has led researchers to pursue alternative methods of determining centre of pressure (CoP) location. To date, errors reported using alternative methods to the force plate during dynamic tasks have been high. The aim of this study was to investigate the accuracy of a motion analysis marker-based system to determine CoP during a two-legged hopping task. Five markers were attached to the left and right feet of eight healthy adults (5 females, 3 males, age: 25.0±2.8 years, height: 1.75±0.07 m, mass: 71.3±11.3 kg). Multivariate forward stepwise and forced entry linear regression was used with data from five participants to determine CoP position during quiet standing and hopping at various frequencies. Maximum standard error of the estimate of CoP position was 12 mm in the anteroposterior direction and 8 mm in the mediolateral. Cross-validation was performed using the remaining 3 participants. Maximum root mean square difference between the force plate and marker method was 14 mm for mediolateral CoP and 20 mm for anteroposterior CoP during 1.5 Hz hopping. Differences reduced to a maximum of 7 mm (mediolateral) and 14 mm (anteroposterior) for the other frequencies. The smallest difference in calculated sagittal plane ankle moment and timing of maximum moment was during 3.0 Hz hopping, and largest at 1.5 Hz. Results indicate the marker-based method of determining CoP may be a suitable alternative to a force plate to determine CoP position during a two-legged hopping task at frequencies greater than 1.5 Hz.     

Critical years and stages of puberty for radial bone mass apposition during adolescence.

The acquisition of radial mineral density was evaluated in relation to anthropometric characteristics, menarche status, calcium intake and physical activity in a healthy young female population (200 girls and 100 women, respectively aged 11-16 yrs and 20-24 yrs) living in an area of Southern Italy. We performed bone mineral density (BMD) by dual energy X-ray absorptiometry on the ultradistal and middistal radius. Dietary calcium intake was evaluated by a detailed Food Frequency Questionnaire and confirmed by a 3-day record. A questionnaire on energy expenditure was used to assess physical activity in each participant. Morning blood samples were drawn from fasting girls to measure 25-hydroxycalciferol (25 OH-D). We found current calcium above the levels reported by Recommended Dietary Allowances (RDA) in only 31% of women and 6% of girls. BMD steadily increased up to the age of 16 and was increased in postmenarcheal girls compared to premenarcheals of the same pubertal stage. Bone density was also significantly related to age, weight and height in postmenarcheal adolescents, while in girls before and after menarche, no relation was observed between radial BMD and calcium intake or physical activity. In the presence of comparable calcium-intake values recorded in pre- and in postmenarcheal girls, the latter subgroup displayed a marked increase of 25 OH-D serum levels. Our study revealed a calcium intake lower than the RDA in a large percentage of healthy girls and young women, and emphasized the importance of menarche occurrence in bone mass acquisition during pubertal development.     

Three-dimensional dynamic hip contact area and pressure distribution during activities of daily living

Estimation of the hip joint contact area and pressure distribution during activities of daily living is important in predicting joint degeneration mechanism, prosthetic implant wear, providing biomechanical rationales for preoperative planning and postoperative rehabilitation. These biomechanical data were estimated utilizing a generic hip model, the Discrete Element Analysis technique, and the in vivo hip joint contact force data. The three-dimensional joint potential contact area was obtained from the anteroposterior radiograph of a subject and the actual joint contact area and pressure distribution in eight activities of daily living were calculated. During fast, normal, and slow walking, the peak pressure of moderate magnitude was located at the lateral roof of the acetabulum during mid-stance. In standing up and sitting down, and during knee bending, the peak pressures were located at the edge of the posterior horn and the magnitude of the peak pressure during sitting down was 2.8 times that of normal walking. The peak pressure was found at the lateral roof in climbing up stairs which was higher than that in going down stairs. These results can be used to rationalize rehabilitation protocols, functional restrictions after complex acetabular reconstructions, and prosthetic component wear and fatigue test set up. The same model and analysis can provide further insight to soft tissue loading and pathology such as labral injury. When the pressure distribution on the acetabulum is inverted onto the femoral head, prediction of subchondral bone collapse associated with avascular necrosis can be achieved with improved accuracy.     

Analysis of human chest wall motion using a two-compartment rib cage model.

We present a model of chest wall mechanics that extends the model described previously by Macklem et al. (J. Appl. Physiol. 55: 547-557, 1983) and incorporates a two-compartment rib cage. We divide the rib cage into that apposed to the lung (RCpul) and that apposed to the diaphragm (RCab). We apply this model to determine rib cage distortability, the mechanical coupling between RCpul and RCab, the contribution of the rib cage muscles to the pressure change during spontaneous inspiration (Prcm), and the insertional component of transdiaphragmatic pressure in humans. We define distortability as the relationship between distortion and transdiaphragmatic pressure (Pdi) and mechanical coupling as the relationship between rib cage distortion and the pressure acting to restore the rib cage to its relaxed configuration (Plink), as assessed during bilateral transcutaneous phrenic nerve stimulation. Prcm was calculated at end inspiration as the component of the pressure displacing RCpul not accounted for by Plink or pleural pressure. Prcm and Plink were approximately equal during quiet breathing, contributing 3.7 and 3.3 cmH2O on average during breaths associated with a change in Pdi of 3.9 cmH2O. The insertional component of Pdi was measured as the pressure acting on RCab not accounted for by the change in abdominal pressure during an inspiration without rib cage distortion and was 40 +/- 12% (SD) of total Pdi. We conclude that there is substantial resistance of the human rib cage to distortion, that, along with rib cage muscles, contributes importantly to the fall in pleural pressure over the costal surface of the lung.