Panlobular emphysema is associated with COPD disease severity: A study of emphysema subtype by computed tomography.

BACKGROUND: Computed tomography has the potential to inform COPD prognosis. We sought to determine associations of emphysema phenotype with clinical parameters including lung function, inflammatory markers, and quality of life. METHODS: Participants of this single-center observational cohort (n = 83) were 40-80 years old, had ≥10 pack-year smoking, and a diagnosis of COPD confirmed by spirometry. All participants had available historic chest CT scans which were systematically reviewed by a single expert radiologist and scored for emphysema subtype, extent, and distribution. Associations between radiographic findings and clinical parameters were determined. RESULTS: Median age of participants was 72 years, median smoking 40 pack-years, and median FEV1 59% predicted. 84% of the participants had radiographic emphysema. Of those, 26% had panlobular emphysema (PLE), 68% centrilobular emphysema (CLE), and 6% paraseptal emphysema (PSE). As compared to the participants with no radiographic emphysema, the presence of PLE-dominant emphysema was associated with a lower BMI (P = 0.012) and greater extent of emphysema (P = 0.014). After adjusting for age, sex, and pack-years smoking history, PLE was associated with greater airflow obstruction by FEV1% (48% vs 71%, P = 0.005), greater symptom burden by CAT score (18 vs 9, P = 0.015), worse quality of life by SGRQ score (43 vs 22, P = 0.025), and more systemic inflammation by erythrocyte sedimentation rate (P = 0.001). CLE- or PSE-dominant emphysema were not similarly associated with clinical features or symptom burden. CONCLUSIONS: The presence of PLE-dominant emphysema was associated with greater extent of emphysema, greater airflow obstruction, increased respiratory symptoms, worse quality of life, and systemic inflammation. Further investigation is indicated to explore the pathogenesis of the PLE phenotype and the prognostic and treatment implications of PLE.

Bacteriologic findings associated with chronic bacterial maxillary sinusitis in adults.

An open-label, multicenter study was performed to assess bacteriologic findings associated with chronic bacterial maxillary sinusitis in adults. Seventy aerobic (52.2%) and 64 anaerobic (47.8%) pathogens were recovered from clinically evaluable patients at baseline (before therapy). The most commonly isolated anaerobes were Prevotella species (31.1%), anaerobic streptococci (21.9%), and Fusobacterium species (15.6%). The aerobes most frequently recovered included Streptococcus species (21.4%), Haemophilus influenzae (15.7%), Pseudomonas aeruginosa (15.7%), and Staphylococcus aureus and Moraxella catarrhalis (10.0% each). Recurrences of signs or symptoms of bacterial maxillary sinusitis associated with anaerobes were twice as frequent as were those associated with aerobes when counts of anaerobes were > or =10(3) cfu/mL. A pathogenic role for Granulicatella species in cases of chronic sinusitis was documented for the first time.

Performance evaluation of computed radiography systems.

Recommended methods to test the performance of computed radiography (CR) digital radiographic systems have been recently developed by the AAPM Task Group No. 10. Included are tests for dark noise, uniformity, exposure response, laser beam function, spatial resolution, low-contrast resolution, spatial accuracy, erasure thoroughness, and throughput. The recommendations may be used for acceptance testing of new CR devices as well as routine performance evaluation checks of devices in clinical use. The purpose of this short communication is to provide a tabular summary of the tests recommended by the AAPM Task Group, delineate the technical aspects of the tests, suggest quantitative measures of the performance results, and recommend uniform quantitative criteria for the satisfactory performance of CR devices. The applicability of the acceptance criteria is verified by tests performed on CR systems in clinical use at five different institutions. This paper further clarifies the recommendations with respect to the beam filtration to be used for exposure calibration of the system, and the calibration of automatic exposure control systems.

Importance of Dialister pneumosintes in human periodontitis.

Anaerobic bacteria play important roles in the pathogenesis of human periodontitis. This study examined the relationship between a potentially new periodontopathic bacterium Dialister pneumosintes and periodontal disease. A total of 73 women and 62 men aged 18 to 86 years participated in the study. Using a 16S rRNA polymerase chain reaction identification method, the presence of D. pneumosintes was determined in paper-point samples from periodontal pockets of 105 periodontitis and 30 gingivitis patients. D. pneumosintes was detected in 83% of patients having severe periodontitis and in 19% of patients having slight periodontitis. We suggest adding D. pneumosintes to the group of suspected periodontal pathogens.

Method for measuring veiling glare in high-performance display devices.

An experimental method for measuring the veiling glare characteristics of display devices is presented. The measured veiling glare ratio (G) is taken to be the luminance in the surrounding bright field divided by the luminance in a dark circle. The method is based on a collimated conic probe that minimizes signal contamination from bright surroundings allowing for measurements of low luminance in a circular dark spot of a test pattern. A correction factor computed with test patterns having opaque spots is introduced. The factor is expressed as a bivariate function of the dark-spot radius and the distance between the probe and the emissive surface. We studied the uncertainty introduced by the method by measuring veiling glare test patterns printed on radiographic film for which the transmission of the dark spots was determined experimentally. Performance characterization measurements show that signal contamination is less than 10(-4) of the bright field surrounding a dark circle. Our results show that G of a few hundred can be measured with an uncertainty of a few percent, and ratios of approximately 10(3) can be reported within 10%. Finally, we demonstrate the method by measuring G for a high-performance monochrome cathode-ray tube display.

Detection of subtle lung nodules: relative influence of quantum and anatomic noise on chest radiographs.

PURPOSE: To assess the relative influence of quantum mottle and structured lung patterns (anatomic noise) on the detection of subtle lung nodules on chest radiographs. MATERIALS AND METHODS: Sixty 8 x 8-cm lung pattern images were extracted from digital chest radiographs in healthy individuals. Sixty quantum mottle images of the same size and quantum noise level were extracted from uniformly exposed digital radiographs. Simulated nodules with various peak contrast-diameter products (CD) that emulated subtle tissue-equivalent lung nodules were numerically superimposed at the center on three-fourths of the images. Printouts were independently viewed and scored by five experienced radiologists. The area under the receiver operating characteristic curve (Az) was estimated as a measure of the detectability of the nodules. RESULTS: At a fixed observer performance level (e.g., Az = 0.8), much smaller and lower-contrast nodules were detected on quantum mottle images (1-mm diameter, CD = 0.01 mm), compared with those on anatomic images (4.5-mm diameter, CD = 0.20 mm). The findings generally agreed with the signal-to-noise ratio calculations based on statistical observer models. CONCLUSION: The detection of subtle lung nodules on chest radiographs is limited by anatomic noise.

High-fidelity electronic display of digital radiographs.

A fully digital radiography system requires high-fidelity electronic display devices that preserve diagnostic quality. Current cathode-ray tube monitors do not meet desired performance criteria for displaying radiographs and have excessive size, weight, and power consumption. Recent developments in flat-panel display technology (in particular active-matrix liquid crystal displays, field-emission displays, and organic light-emitting displays) suggest that high-fidelity, lightweight displays will be available in the near future. Large-size active-matrix liquid crystal display devices have been demonstrated. High brightness can be easily achieved with bright back illumination. Further developments in optical design for monochrome displays should provide high fidelity and improve the angular dependence of the emitted light. Field-emission display devices have attractive emission distribution and potential for low veiling glare. This technology needs to be extended to a large area, and problems with cathode aging and nonuniformity have to be contemplated. Organic light-emitting displays represent a simple and potentially inexpensive display technology with the ability to achieve high image quality. However, extensive research and development is required to achieve large-area manufacturing methods.

Experimental comparison of noise and resolution for 2k and 4k storage phosphor radiography systems.

The purpose of this study was to compare the image quality for a digital storage phosphor system using 1760 x 2140 (2k) and 3520 x 4280 (4k) image arrays. Measurements were made on a chest radiography system (Fuji FCR-9501) with special provisions to be operated in both 2k (standard) and 4k (HQ) modes. Presampled modulation transfer functions (MTF) were measured using an edge method. Noise power spectra (NPS) were determined for different input exposures by two-dimensional Fourier analysis. These measures along with exposure measurements and an x-ray spectral model were used to determine the frequency-dependent detective quantum efficiency DQE (f) of the system for the 4k and the 2k modes. The magnitude of the NPS for the 4k mode was about 1/2 that of the 2k mode. A MTF value of 0.5 was found at 1.25 cycles/mm for the 4k system and 1.50 cycles/mm for the 2k system. The 4k images had an extended MTF of 0.1 at 4.5 cycles/mm in the plate-scan direction. Overall, the DQE (f) of the 4k mode was slightly better than that for the 2k mode by about 0.02 due primarily to its better noise characteristics.

Image quality degradation by light scattering in display devices.

Veiling glare and ambient light reflection can significantly degrade the quality of an image on a display device. Veiling glare is primarily associated with the diffuse spread of image signal caused by multiple light scattering in the emissive structure of the device. The glare ratio associated with a test image with a 1-cm-diameter black spot is reported as 555 for film, 89 for a monochrome monitor, and 25 for a color monitor. Diffuse light reflection results from ambient light entering the display surface and returning at random emission angles. The diffuse reflection coefficient (luminance/illuminance, 1/sr) is reported as 0.026 for film, 0.058 for a monochrome monitor, and 0.025 for a color monitor with an antireflective surface coating. Both processes increase the luminance in black regions and cause contrast reduction. Specular reflections interfere with detail in the displayed scene. The specular reflection coefficient (luminance/luminance) is reported as 0.011 for film, 0.041 for a monochrome monitor, and 0.021 for a color monitor with an antireflective coating.

Chest radiographic image quality: comparison of asymmetric screen-film, digital storage phosphor, and digital selenium drum systems--preliminary study.

Conventional screen-film radiography does not display all regions of the thorax satisfactorily. Three chest radiographic techniques display both the lung and the mediastinum with good contrast. These techniques are asymmetric screen-film (ASF), digital storage phosphor (DSP), and digital selenium drum (DSD) imaging. ASF systems use two asymmetric screen-film combinations to produce a wide-latitude image of the thorax with good contrast in the lungs. In DSP systems, image data are acquired digitally with a wide dynamic range by using the optical output of a photostimulable phosphor plate; in DSD systems, the wide-range digital image data are acquired by using the electronic charge generated on a drum coated with a thin layer of amorphous selenium. The appearance of a DSP or DSD radiograph is then determined by user-selected image processing operations: tone scaling, spatial frequency processing, and dynamic range compensation. Digital chest radiographs processed with strong regional equalization provide both excellent contrast in the lungs and effective display of the mediastinum and chest wall. At visual comparison, the high lung contrast and good mediastinal, retrocardiac, and subdiaphragmatic detail provided by the DSD method distinguish it from the other two methods.

A method for measuring the presampled MTF of digital radiographic systems using an edge test device.

The modulation transfer function (MTF) of radiographic systems is frequently evaluated by measuring the system's line spread function (LSF) using narrow slits. The slit method requires precise fabrication and alignment of a slit and high radiation exposure. An alternative method for determining the MTF uses a sharp, attenuating edge device. We have constructed an edge device from a 250-microm-thick lead foil laminated between two thin slabs of acrylic. The device is placed near the detector and aligned with the aid of a laser beam and a holder such that a polished edge is parallel to the x-ray beam. A digital image of the edge is processed to obtain the presampled MTF. The image processing includes automated determination of the edge angle, reprojection, sub-binning, smoothing of the edge spread function (ESF), and spectral estimation. This edge method has been compared to the slit method using measurements on standard and high-resolution imaging plates of a digital storage phosphor (DSP) radiography system. The experimental results for both methods agree with a mean MTF difference of 0.008. The edge method provides a convenient measurement of the presampled MTF for digital radiographic systems with good response at low frequencies.

Terbutaline pump tocolysis in high-order multiple gestation.

OBJECTIVE: To review terbutaline pump tocolytic therapy as part of the management of high-order multiple gestations (triplet and quadruplet pregnancies). STUDY DESIGN: We performed a retrospective review of the medical records of triplet and quadruplet pregnancies cared for by Phoenix Perinatal Associates from August 1988 to January 1992 in whom terbutaline pump tocolysis was administered. RESULTS: The study group consisted of 15 triplet pregnancies and 6 quadruplet pregnancies. The 15 patients with triplets delivered at a mean (+/- SD) gestational age of 33.0 +/- 1.9 weeks. The six patients with quadruplets delivered at 33.0 +/- 1.3 weeks. Only 2 of 15 (13%) of the triplets and 1 of 6 (17%) of the quadruplets were delivered for tocolytic failure. CONCLUSION: Terbutaline pump tocolysis provides safe and effective tocolytic therapy in a select group of high-order multifetal gestations.

Simulation of subtle lung nodules in projection chest radiography.

PURPOSE: To measure the radiologic characteristics of subtle lung nodules and develop nodule phantoms that simulate these characteristics. MATERIALS AND METHODS: From a database of chest radiographs, 16 radiographs that showed confirmed subtle lung nodules were selected. The optical density values surrounding each nodule were obtained, and the radiologic characteristic of the nodules were evaluated. A set of Teflon nodule phantoms with similar x-ray transmission and variability was designed and fabricated. The contrast characteristics of the images of the nodule phantoms were measured. RESULTS: Most of the subtle nodules appeared to have diffuse edges with Gaussian-like contrast profiles. The contrast and size characteristics of the nodule phantom images fulfilled the design criteria within a 4% deviation. CONCLUSION: The radiologic pattern of subtle lung nodules is poorly simulated by nodule phantoms with simple spherical or disk shapes. The nodule phantoms in this study produce realistic radiographic patterns with an energy-dependent attenuation equivalent to that of tissue. The nodule phantoms are intended for use in experiments involving human subjects.

A cone beam computed tomography system for true 3D imaging of specimens.

A system for 3D cone beam computed tomography has been developed, consisting of a microfocus x-ray source and x-ray image intensifier coupled to a CCD camera. Full width at half maximum resolving power has been experimentally measured to be 70 microns when imaging 10 mm diameter objects. The 3D nature of the resulting image data can be used to visualize internal structure and compute parameters such as volume, surface area, and surface/volume orientation.

Absence of Porphyromonas asaccharolytica, Bacteroides fragilis and Chlamydia pneumoniae in human subgingival plaque.

Little is known about the presence of common medical pathogens in the human oral cavity. Using a 16S rRNA-based PCR identification method, this study determined the occurrence of Porphyromonas asaccharolytica, Bacteroides fragilis and Chlamydia pneumoniae in subgingival plaque from 50 adults with advanced periodontitis. Each patient contributed samples from 3 deep periodontal pockets collected by paper points. The PCR primers were for P. asaccharolytica 5'-CTC TAG CTA GAG TGT ACT GG-3' and 5'-ATA GGG TTT ATA GAT TAG CTC TCT-3', for B. fragilis 5'-AAT GAT TCC GCA TGG TTT CAT TA-3' and 5'-GCG GTG ATT GCT CAC TGA CA-3', and for C. pneumoniae 5'- TGA CAA CTG TAG AAA TAC AGC-3' and 5'-CGC CTC TCT CCT ATA AAT-3'. The primers yielded a single amplicon with the respective reference strains and produced no amplicon with colonies of 25 groups of oral organisms. None of the three test species were detected in any of the 50 pooled subgingival samples tested. P. asaccharyolytica, B. fragilis and C. pneumoniae do not seem to be part of the periodontopathic microbiota in humans.

Oral food consumption and subgingival microorganisms: subgingival microbiota of gastrostomy tube-fed children and healthy controls.

This study examined the effect of oral food consumption on the prevalence and levels of subgingival bacteria and yeasts in 20 gastrostomy tube-fed children and 24 healthy controls. Microbial identification was carried out using anaerobic culture and 16S rRNA-based PCR identification methods. Streptococcal and Actinomyces species were recovered from 100% and 76% of all subjects and averaged 66% and 11% of total cultivable organisms, respectively. In decreasing order of prevalence, Fusobacterium, enteric rods, Prevotella intermedia/Prevotella nigrescens, Capnocytophaga, Propionibacterium, yeasts, Actinobacillus actinomycetemcomitans, coagulase-negative Staphylococcus, Campylobacter rectus, Bacteroides forsythus, and Porphyromonas gingivalis were detected in 48% to 2% of the study subjects. The cultivable levels of these species varied widely among subjects. PCR detection showed C. rectus and Eikenella corrodens both to occur in 93% of the study subjects and to be the most prevalent putative periodontal pathogens examined. In decreasing order of prevalence, PCR identified Treponema denticola, A. actinomycetemcomitans, P. nigrescens, P. intermedia, B. forsythus, and P. gingivalis in 38% to 21% of the subjects studied. Tube-fed children and healthy controls exhibited similar subgingival microbial compositions. It appears from this study that oral food consumption is not a major determinant for the establishment of subgingival microbiota in children.

Tetracycline resistance in Prevotella isolates from periodontally diseased patients is due to the tet(Q) gene.

Tetracycline-resistance in gram-negative periodontal bacteria is often due to the presence of the tet(Q) gene. In the present study the polymerase chain reaction (PCR) was used to examine 54 isolates of gram-negative anaerobic rods (Prevotella intermedia, Prevotella nigrescens and related or Bacteroides-like species) for the presence of the tet(Q) gene. The isolates were recovered from 42 patients with periodontal disease living in northern Europe and North America. An 814 base-pair segment of the tet(Q) gene was amplified from all 41 isolates resistant to tetracycline with minimal inhibitory concentrations of 4 micrograms/ml and above. The presence of the tet(Q) gene was verified using hybridization with a specific oligonucleotide internal to the amplified region and restriction endonuclease digestion with DdeI. A PCR product of the same size was also amplified from one tetracycline susceptible isolate (minimal inhibitory concentration = 0.5 microgram/ml). However, this isolate and the one isolate that was resistant to tetracycline at 4 micrograms/ml showed a weaker signal than the remaining isolates when hybridized with the internal probe. Typing of the PCR products using restriction endonuclease digests with AluI and HpaII revealed two clusters of distinct electrophoresis patterns, indicating that two different subtypes of the tet(Q) gene were present in this material. A control strain containing the tet(Q) gene from Bacteroides thetaiotaomicron had a different electrophoresis pattern for AluI. This study indicated that subtypes of the tet(Q) gene in tetracycline-resistant gram-negative periodontal bacteria exist both within the same patient and within the same species.

Molecular genetic detection of Bacteroides heparinolyticus in adult periodontitis.

Bacteroides heparinolyticus in subgingival plaque was identified using a digoxigenin-labeled whole genomic DNA probe and a polymerase chain reaction (PCR) assay based on 16S rRNA species-specific primers (5'-ATG GTG ATT CCG CAT GGT TTC TCC-3' (base position, 188-212) and 5'-CAA ACT TTC ACA GCT GAC TTA AGC-3' (592-615)). Subgingival specimens obtained by paper points from 3 deep periodontal pockets in each of 113 adults were examined. The DNA probe reacted with all pure isolates tested of B. heparinolyticus and did not react with other oral species tested; the probe showed positive reactions in 74.3% of the patient samples examined. The PCR primers produced the 428 bp species specific amplification product in all B. heparinolyticus test strains and did not reveal detectable amplicons with strains of other subgingival species. The PCR method detected 50 B. heparinolyticus cells dispersed in subgingival plaque. PCR only revealed B. heparinolyticus in 6.2% of the patient samples studied. The higher level of positive specimens with the DNA probe was probably due to false-positive reactions from cross-hybridization with unknown subgingival species. This study suggests that the PCR method amplifying specific 16S rRNA sequences represents an easy and valuable means to detect B. heparinolyticus in subgingival plaque. The low prevalence of subgingival B. heparinolyticus does not incriminate the organism in the etiology of adult periodontitis.