We mimicked important mechanical and ventilatory aspects of restrictive lung disorders by employing chest wall strapping (CWS) and dead space loading (DS) in normal subjects to gain mechanistic insights into dyspnea causation and exercise limitation. We hypothesized that thoracic restriction with increased ventilatory stimulation would evoke exertional dyspnea that was similar in nature to that experienced in such disorders. Twelve healthy young men [28 +/- 2 (SE) yr of age] completed pulmonary function tests and maximal cycle exercise tests under four conditions, in randomized order: 1) control, 2) CWS to 60% of vital capacity, 3) added DS of 600 ml, and 4) CWS + DS. Measurements during exercise included cardiorespiratory parameters, esophageal pressure, and Borg scale ratings of dyspnea. Compared with control, CWS significantly reduced the tidal volume response to exercise, increased dyspnea intensity at any given work rate or ventilation, and thus limited exercise performance. DS stimulated ventilation but had minimal effects on dyspnea and exercise performance. Adding DS to CWS further increased dyspnea by 1.7 +/- 0.6 standardized Borg units (P = 0.012) and decreased exercise performance (total work) by 21 +/- 6% (P = 0.003) over CWS alone. Across conditions, increased dyspnea intensity correlated best with decreased resting inspiratory reserve volume (r = -0.63, P < 0.0005). Dyspnea during CWS was described primarily as "inspiratory difficulty" and "unsatisfied inspiration," similar to restrictive disorders. In conclusion, severe dyspnea and exercise intolerance were provoked in healthy normal subjects when tidal volume responses were constrained in the face of increased ventilatory drive during exercise.

Severe acute respiratory syndrome (SARS) is a transmissible febrile respiratory illness caused by a recently discovered coronavirus. Various patterns of disease progression may be observed that have different implications for the prognosis in those affected by SARS. The appearance of the lungs on chest radiographs of patients with this condition may be normal or may include focal airspace opacity or multifocal or diffuse opacities. Thoracic computed tomography (CT) is more sensitive in depicting SARS than is conventional chest radiography, and CT images obtained in patients with normal chest radiographs may show extensive disease and airspace consolidation. However, because the radiologic appearance of SARS is not distinct from that of other diseases that cause lower respiratory tract infection, early identification of SARS will depend in part on the prompt recognition of clusters of cases of febrile respiratory tract illness. To aid in the differential diagnosis and management of SARS, radiologists must be familiar with the typical clinical and histopathologic findings, as well as the radiologic features of the disease.

Patients presenting with normal findings or focal air-space opacity on chest radiographs had a good clinical outcome. Patients with multifocal opacities that progressed to diffuse air-space opacification and patients presenting with diffuse air-space opacification had a high fatality rate, but patients in this group were also older and more likely to have comorbid conditions. Patients with SARS present with recognizable patterns of disease that have prognostic significance.

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Objective: This study seeks to evaluate the feasibility to conduct clinical studies on the treatment of uterine fibroids (UFs) and related symptoms with a 7-point Tung's acupuncture protocol. Methods: Nine participants who met the study criteria were recruited into 2 treatment groups, a 6-week and a 12week group, with 5 and 4 participants, respectively, in each group. Acupuncture was given twice a week. Ultrasound examination was performed before and after the program to evaluate uterine size, number of fibroids, and volume. Symptom Survey Questionnaire (SSQ) for 14 symptoms was given to the participants every time receiving acupuncture. Results: All 9 participants completed the program. No adverse response nor concerns or complaints to the program was reported. The result from 1 subject was excluded from the study due to age limit. All 8 subjects reported improvement in SSQ after the 6-week acupuncture treatment. The reduction of the scores for 10 of the 14 surveyed symptoms was statistically significant. The average score showed reduction for both the 6-and 12week groups, whereas the 12-week group appeared to have higher percentage reduction than the 6-week group. After 12 weeks of treatment, 9 of the 14 surveyed symptoms were completely eliminated. Ultrasound result for uterine size, number of fibroids, and volume was discussed. Subject recruitment, referrals, long-term follow-up, and challenges in the study were also addressed. Conclusion: It is possible to conduct clinical trial with larger sample size for the treatment of UFs with acupuncture. The study also suggests that acupuncture might reduce symptoms related to UFs. Larger trials with negative control groups and long-term follow-up may help to confirm the result. The changes in uterine size and UF volume cannot be adequately determined due to technical issues for ultrasound examination in the study.