The CPX room was air‐conditioned and kept at a constant temperature of 19°C for all tests, and the hygrometry was not controlled in current practice. The measuring instruments were recalibrated every half day with a reading of the atmospheric pressure. Patients were advised to avoid strenuous exercise and the consumption of alcohol, tobacco or caffeine for 24 hours prior to examination. CPX was performed on an electromagnetic ergometer (Ergoselect 200, Ergoline, Bitz, Germany) using a standardized, incremental protocol.16 Following a three‐minute warm‐up, incremental ramp exercise (5 to 15 W/minute) was maintained until exhaustion. Markers used to consider the CPX as maximal were determined accorded to current guidelines.16 A face mask (Hans Rudolph, Inc., Kansas City, MO), pneumotach and gas analyzer (Ergocard, Medisoft, Louvain, Belgium) were used to measure breath‐by‐breath oxygen uptake (V˙O2) and carbon dioxide production (V˙CO2). Heart rate (HR) was continuously monitored with a 12‐lead electrocardiogram (Ergocard, Medisoft, Louvain, Belgium).
Facemask
Manufactured by Hans Rudolph
Sourced in United States, Italy, Germany
The Facemask is a personal protective equipment designed to cover the user's nose and mouth. It is intended to create a barrier against potential airborne particles and fluids. The core function of the Facemask is to help reduce the spread of respiratory droplets from the wearer to others.
Automatically generated - may contain errors
Lab products found in correlation
3 l syringe, by Cosmed (2 mentions)
Ergocard, by Medisoft (1 mentions)
1110 series, by Hans Rudolph (1 mentions)
Prisma, by Siemens (1 mentions)
Powerlab signal recording unit, by ADInstruments (1 mentions)
Customized occlusion valve, by Hans Rudolph (1 mentions)
Corival, by Lode Ergometry (1 mentions)
Nellcor pm10n, by Medtronic (1 mentions)
Vyntus cpx unit, by Vyaire Medical (1 mentions)
Sentrysuite software, by Vyaire Medical (1 mentions)
Vmax 29, by Cardinal Health (1 mentions)
Quark pft, by Cosmed (1 mentions)
Polar heart rate monitor, by Polar Electro (1 mentions)
K4b2 gas analyzer, by Cosmed (1 mentions)
Lactate pro 2 analyzer, by Arkray (1 mentions)
Powerlab, by ADInstruments (1 mentions)
Labchart version 8, by ADInstruments (1 mentions)
Ml206, by ADInstruments (1 mentions)
Metamax 3b, by Cortex Biophysik (1 mentions)
Rs400, by Polar Electro (1 mentions)
28 protocols using facemask
1
Standardized Incremental Cardiopulmonary Exercise Testing
2
Respiratory Gas Exchange During Exercise
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Respiratory gas exchange was measured during the entire exercise protocol through breath-by-breath analysis using an open spirometric system (Oxycon Pro, Jaeger, Hoechburg, Germany). The gas analyser was calibrated prior to each trial using oxygen and carbon dioxide gases of known concentrations (Cryoservice, Worcester, UK), and the turbine volume transducer was calibrated using a 3 L precision syringe (Hans Rudolph Inc, Shawnee, USA).
During the trials participants breathed room air through a facemask (Hans Rudolph, Kansas City, MO, USA) that was secured in place by a head-cap assembly (Hans Rudolph, Kansas City, MO, USA). Respiratory gas exchange data were subsequently averaged on a 1 s basis and then averaged for the overall exercise protocol, so that the total time of analysis was 432 s ((12 × (6 s sprint + the following 30 s recovery periods)).
During the trials participants breathed room air through a facemask (Hans Rudolph, Kansas City, MO, USA) that was secured in place by a head-cap assembly (Hans Rudolph, Kansas City, MO, USA). Respiratory gas exchange data were subsequently averaged on a 1 s basis and then averaged for the overall exercise protocol, so that the total time of analysis was 432 s ((12 × (6 s sprint + the following 30 s recovery periods)).
3
MRI-Compatible Airway Occlusion Apparatus
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The general setting of the apparatus was described previously18 (link),43 (link)–45 (link). MRI experiments were conducted by a 3T MRI scanner (Prisma, Siemens, Erlangen, Germany) with 20-ch head coil at National Taiwan University. Briefly, participants were laying in supine position in the MRI scanner. They were breathing through a two-way non-rebreathing valve with a facemask (Hans Rudolph Inc., Kansas City, USA). The participant’s mouth pressure was monitored by a pressure tubing at the center of the non-rebreathing valve connected to a differential pressure transducer of a pneumotachograph amplifier (1110 series, Hans Rudolph Inc., Kansas City, MO, USA) and a PowerLab signal recording unit (ADInstruments Inc., Bella Vista, NSW, Australia). The two-way non-rebreathing valve was connected to a customized occlusion valve (Hans Rudolph Inc., Kansas City, USA), which can be controlled manually. To be compatible with the MRI requirement, the customized occlusion valve was placed 3 meters away from the MRI scanner (Hans Rudolph Inc., Kansas City, USA). The occlusion valve was manually controlled by the experimenter via a customized trigger outside of the scanning room. For the stimulus events, the experimenter manually triggered a Transistor-Transistor Logic (TTL) pulse to activate the solenoid, which allows the pressure air tank to close the occlusion valve.
4
Cardiorespiratory Fitness Assessment via CPET
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The peak oxygen uptake (VO2peak) as measure of cardiorespiratory fitness was assessed by Cardio Pulmonary Exercise Testing (CPET) on an electronically braked upright cycle ergometer (Lode Corival, Groningen, The Netherlands). A RAMP incremental Godfrey protocol was used during the CPET [16 (link)]. The participant breathed through a facemask (Hans Rudolph, Inc. USA) connected to a calibrated metabolic cart (Geratherm Respiratory GmbH, Bad Kissingen, Germany). A gas analyzer and flow meter were used to measure oxygen (VO2) and carbon dioxide volume (VCO2) and breath-by-breath respiratory gas analyzes were performed during the test.
Children and young adults were verbally encouraged to perform the test until exhaustion. The exercise performance was at the maximum when there were subjective and objective signs of maximal effort (i.e. RERpeak (= VCO2/VO2) > 1.0, heart rate > 180/min, sweating, muscular fatigue, plateau of VO2).
The VO2peak/kg (ml/kg/min) was used to measure the cardiorespiratory fitness. The standard deviations scores (SDS) of the VO2peak and the VO2peak/kg were calculated using the reference values of the healthy population in the Netherlands, adjusted for age and gender [17 ].
Children and young adults were verbally encouraged to perform the test until exhaustion. The exercise performance was at the maximum when there were subjective and objective signs of maximal effort (i.e. RERpeak (= VCO2/VO2) > 1.0, heart rate > 180/min, sweating, muscular fatigue, plateau of VO2).
The VO2peak/kg (ml/kg/min) was used to measure the cardiorespiratory fitness. The standard deviations scores (SDS) of the VO2peak and the VO2peak/kg were calculated using the reference values of the healthy population in the Netherlands, adjusted for age and gender [17 ].
5
Treadmill Exercise Lung Function
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At 7 years, the child exercised on a motor-driven treadmill for at least 4 minutes with a pulse rate >80% of the maximal pulse [19 (link)] breathing fully dehumidified atmospheric air through a facemask (Hans Rudolph, Kansas City, MO, US). Spirometry was performed before, and 1, 3, 5, 10, and 15 minutes after exercise using the maximum percentage decline in FEV1 from baseline within 10 minutes after exercise as the outcome.
We excluded lung function measurements in children with respiratory tract symptoms in the preceding week and if β2-agonists had been used within the preceding 12 hours. Bronchial challenge test results were excluded if the child had a respiratory infection in the preceding 3 weeks [21 (link)].
We excluded lung function measurements in children with respiratory tract symptoms in the preceding week and if β2-agonists had been used within the preceding 12 hours. Bronchial challenge test results were excluded if the child had a respiratory infection in the preceding 3 weeks [21 (link)].
6
Treadmill VO2peak Assessment in Normoxia
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To determine the VO2peak in normoxic conditions, a test was performed with progressive intensity on a treadmill (LifeFitness®- 9700HR, Rosemont, IL, USA) with an initial speed of 7 km/h and increase of 1 km/h every minute until exhaustion (defined as the incapacity to keep up with the speed of the treadmill for 15 s or until the volunteer requested to stop the test after being encouraged to continue [31 (link)]) The encouragement for the volunteers was similar in all tests and carried out by the same person. During the test, we used a fixed inclination of 1% to simulate the physical stress of field tests [32 (link)].
Heart rate was monitored with a Polar Vantage NV watch (Polar®, Sark Products, Waltham, MA, USA), blood pressure was monitored by sphygmomanometer and stethoscope, and perceived exertion by the Borg scale (6 to 20) [33 (link)]. The respiratory parameters were measured by a gas analyzer (Cosmed Quark PFT model, Albano Laziale, Rome, Italy), pulmonary function (FRC & DLCO, Albano Laziale, Rome, Italy) was analyzed using a facemask (Hans Rudolph Inc., Shawnee, KS, USA). All calibration procedures were performed according to the manufacturer’s recommendations.
Heart rate was monitored with a Polar Vantage NV watch (Polar®, Sark Products, Waltham, MA, USA), blood pressure was monitored by sphygmomanometer and stethoscope, and perceived exertion by the Borg scale (6 to 20) [33 (link)]. The respiratory parameters were measured by a gas analyzer (Cosmed Quark PFT model, Albano Laziale, Rome, Italy), pulmonary function (FRC & DLCO, Albano Laziale, Rome, Italy) was analyzed using a facemask (Hans Rudolph Inc., Shawnee, KS, USA). All calibration procedures were performed according to the manufacturer’s recommendations.
7
Cardiac MRI Gas Exchange Analysis
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Breath-by-breath gas exchange analysis was performed using a commercial CPET system (Ultima, MedGraphics, St Paul, Minnesota, USA). The analyzer was placed in the CMR control room and attached to the facemask (Hans Rudolph, Kansas City, Kansas, USA) via a set of CMR-compatible sampling tubes (umbilicus) passed through the waveguide. This bespoke umbilicus was modified as previously described [2 (link)] increasing overall length from the standard 234–1000 cm and removing ferromagnetic components. It was thoroughly tested by the manufacturer, meeting all quality control standards. Gas and flow calibrations were performed before each test and at least 30 min after system initiation. All measurements were taken at body temperature and ambient pressure.
8
Respiratory Response to Hypercapnia
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Subjects were seated and affixed with a silicone facemask (Hans Rudolph Inc.) that covered their mouth and nose. The facemask was connected through gas-impermeable tubing to a non-diffusing gas bag (Hans Rudolph Inc.), via a three-way stop cock, which allowed the researcher to manually switch from room air to the 7.5% CO2 mixture. Once fitted with mask, participants breathed 5 min of room air (Pre-CO2), followed by 8 min of 7.5% CO2 (CO2-inhalation), followed by 5 min of room air (recovery). The mask was removed after the recovery period. Subjects were blind to CO2 onset, but informed that they could withdraw at any point.
9
Breath-Hold Physiological Monitoring
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Heart rate and SpO2 were measured via fingertip pulse oximeter (Nellcor PM10N, Medtronic, MN, USA). The probe for registration of HR and SpO2 was attached to the forefinger for two minutes prior to each breath-hold. Measurements were recorded immediately prior to the commencement of each static and dynamic breath-hold. As soon as the participant resurfaced from the breath-hold, the probe was placed back on the finger. HR was recorded as soon as data was presented on the screen, i.e. within a few seconds. The post-apnoea SpO2 nadir, which was defined as the lowest SpO2 was achieved within in the one minute post-apnoea period, was also recorded. An online gas analysis system (Cortex Metamax 3B, Leipzig, Germany), calibrated according to the manufacturer's instructions, was used to assess the effects of NO3 - supplementation on pulmonary oxygen uptake (V ̇O2) during breath-holds. Expired air was collected in the final minute pre-apnoea, and the first minute post apnoea, through a face mask (Hans Rudolph, inc, MO, USA.) attached to the gas analysis system. V ̇O2 was calculated as the volume of inspired oxygen (VIO2) minus the volume of expired oxygen (V ̇EO2).
10
Incremental Treadmill Test Protocol
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An incremental treadmill (Woodway PPS 55 Med, Weil am Rhein, Germany) test was applied, using a pre-set modified Bruce protocol [25 (link)]. Speed and elevation were gradually increased every 60 s from an initial slow walking phase. A facemask (Hans Rudolph Inc., Kansas City, MO, USA) connected the patient to a Vyntus CPX unit powered by SentrySuite software (Vyaire Medical GmbH, Leibnizstrasse, Hoechberg, Germany). After baseline variables were established, subjects ran to exhaustion. Parameters of gas exchange and airflow were measured breath-by-breath and averaged over 30 s.
The test was considered successful when the subjects indicated exhaustion, preferably supported by a plateau in V′O2 and/or the heart rate (HR) response. Duration and completed treadmill distance were recorded. V′O2, carbon dioxide output (V′CO2), tidal volume (VT), respiratory rate (RR) and HR were measured directly, while minute ventilation (V′E) was calculated from VT and RR.
The test was considered successful when the subjects indicated exhaustion, preferably supported by a plateau in V′O2 and/or the heart rate (HR) response. Duration and completed treadmill distance were recorded. V′O2, carbon dioxide output (V′CO2), tidal volume (VT), respiratory rate (RR) and HR were measured directly, while minute ventilation (V′E) was calculated from VT and RR.
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