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1.
Lancet Digit Health ; 5(2): e83-e92, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36707189

RESUMO

BACKGROUND: Quantitative CT is becoming increasingly common for the characterisation of lung disease; however, its added potential as a clinical tool for predicting severe exacerbations remains understudied. We aimed to develop and validate quantitative CT-based models for predicting severe chronic obstructive pulmonary disease (COPD) exacerbations. METHODS: We analysed the Subpopulations and Intermediate Outcome Measures In COPD Study (SPIROMICS) cohort, a multicentre study done at 12 clinical sites across the USA, of individuals aged 40-80 years from four strata: individuals who never smoked, individuals who smoked but had normal spirometry, individuals who smoked and had mild to moderate COPD, and individuals who smoked and had severe COPD. We used 3-year follow-up data to develop logistic regression classifiers for predicting severe exacerbations. Predictors included age, sex, race, BMI, pulmonary function, exacerbation history, smoking status, respiratory quality of life, and CT-based measures of density gradient texture and airway structure. We externally validated our models in a subset from the Genetic Epidemiology of COPD (COPDGene) cohort. Discriminative model performance was assessed using the area under the receiver operating characteristic curve (AUC), which was also compared with other predictors, including exacerbation history and the BMI, airflow obstruction, dyspnoea, and exercise capacity (BODE) index. We evaluated model calibration using calibration plots and Brier scores. FINDINGS: Participants in SPIROMICS were enrolled between Nov 12, 2010, and July 31, 2015. Participants in COPDGene were enrolled between Jan 10, 2008, and April 15, 2011. We included 1956 participants from the SPIROMICS cohort who had complete 3-year follow-up data: the mean age of the cohort was 63·1 years (SD 9·2) and 1017 (52%) were men and 939 (48%) were women. Among the 1956 participants, 434 (22%) had a history of at least one severe exacerbation. For the CT-based models, the AUC was 0·854 (95% CI 0·852-0·855) for at least one severe exacerbation within 3 years and 0·931 (0·930-0·933) for consistent exacerbations (defined as ≥1 acute episode in each of the 3 years). Models were well calibrated with low Brier scores (0·121 for at least one severe exacerbation; 0·039 for consistent exacerbations). For the prediction of at least one severe event during 3-year follow-up, AUCs were significantly higher with CT biomarkers (0·854 [0·852-0·855]) than exacerbation history (0·823 [0·822-0·825]) and BODE index 0·812 [0·811-0·814]). 6965 participants were included in the external validation cohort, with a mean age of 60·5 years (SD 8·9). In this cohort, AUC for at least one severe exacerbation was 0·768 (0·767-0·769; Brier score 0·088). INTERPRETATION: CT-based prediction models can be used for identification of patients with COPD who are at high risk of severe exacerbations. The newly identified CT biomarkers could potentially enable investigation into underlying disease mechanisms responsible for exacerbations. FUNDING: National Institutes of Health and the National Heart, Lung, and Blood Institute.

3.
Chest ; 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36395858

RESUMO

BACKGROUND: Bronchodilator responsiveness (BDR), in obstructive lung disease varies over time and may be associated with distinct clinical features. RESEARCH QUESTION: Is consistent BDR over time (always present) differentially associated with obstructive lung disease features relative to inconsistent (sometimes present) or never (never present) BDR in tobacco-exposed people with or without COPD. STUDY DESIGN AND METHODS: We retrospectively analyzed data of 2,269 tobacco-exposed participants in SPIROMICS with or without COPD. We used various BDR definitions: change ≥200ml and ≥12% in FEV1 (FEV1-BDR), in FVC (FVC-BDR), and in FEV1 and/or FVC (ATS-BDR). Using generalized linear models adjusted for demographics, smoking history, post-bronchodilator FEV1 %predicted, and number of visits that the participant completed, we assess the association of BDR group: i) consistent BDR, ii) inconsistent BDR, and iii) never BDR with asthma, CT features, blood eosinophils, and FEV1 decline in participants without COPD (GOLD0) and the entire cohort (participants with or without COPD). RESULTS: Both consistent and inconsistent ATS-BDR were associated with asthma history and greater small airway disease (%PRMfSAD) relative to never ATS-BDR in GOLD0 participants and the entire cohort. We observed similar findings using FEV1-BDR and FVC-BDR definitions. Eosinophils did not consistently vary between BDR groups. Consistent BDR was associated with FEV1 decline over time relative to never BDR in the entire cohort. In GOLD0, both inconsistent (OR=3.20;95%CI 2.21 to 4.66;P<0.001) and consistent ATS-BDR group (OR=9.48;95%CI 3.77 to 29.12;P<0.001) were associated with progression to COPD relative to never ATS-BDR group. INTERPRETATION: Demonstration of BDR, even once, describes an obstructive lung disease phenotype with history of asthma, and greater small airway disease. Consistent demonstration of BDR indicates a high risk for lung function decline over time in the entire cohort and was associated with higher risk for progression to COPD in GOLD0.

4.
Respir Res ; 23(1): 310, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36376879

RESUMO

BACKGROUND: Airway macrophages (AM), crucial for the immune response in chronic obstructive pulmonary disease (COPD), are exposed to environmental particulate matter (PM), which they retain in their cytoplasm as black carbon (BC). However, whether AM BC accurately reflects environmental PM2.5 exposure, and can serve as a biomarker of COPD outcomes, is unknown. METHODS: We analyzed induced sputum from participants at 7 of 12 sites SPIROMICS sites for AM BC content, which we related to exposures and to lung function and respiratory outcomes. Models were adjusted for batch (first vs. second), age, race (white vs. non-white), income (<$35,000, $35,000~$74,999, ≥$75,000, decline to answer), BMI, and use of long-acting beta-agonist/long-acting muscarinic antagonists, with sensitivity analysis performed with inclusion of urinary cotinine and lung function as covariates. RESULTS: Of 324 participants, 143 were current smokers and 201 had spirometric-confirmed COPD. Modeled indoor fine (< 2.5 µm in aerodynamic diameter) particulate matter (PM2.5) and urinary cotinine were associated with higher AM BC. Other assessed indoor and ambient pollutant exposures were not associated with higher AM BC. Higher AM BC was associated with worse lung function and odds of severe exacerbation, as well as worse functional status, respiratory symptoms and quality of life. CONCLUSION: Indoor PM2.5 and cigarette smoke exposure may lead to increased AM BC deposition. Black carbon content in AMs is associated with worse COPD morbidity in current and former smokers, which remained after sensitivity analysis adjusting for cigarette smoke burden. Airway macrophage BC, which may alter macrophage function, could serve as a predictor of experiencing worse respiratory symptoms and impaired lung function.


Assuntos
Poluentes Atmosféricos , Doença Pulmonar Obstrutiva Crônica , Humanos , Qualidade de Vida , Cotinina , Fuligem/efeitos adversos , Fuligem/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Macrófagos , Morbidade , Carbono , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise
5.
J Imaging ; 8(11)2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36422058

RESUMO

Chronic obstructive pulmonary disease (COPD) is an umbrella term used to define a collection of inflammatory lung diseases that cause airflow obstruction and severe damage to the lung parenchyma. This study investigated the robustness of image-registration-based local biomechanical properties of the lung in individuals with COPD as a function of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Image registration was used to estimate the pointwise correspondences between the inspiration (total lung capacity) and expiration (residual volume) computed tomography (CT) images of the lung for each subject. In total, three biomechanical measures were computed from the correspondence map: the Jacobian determinant; the anisotropic deformation index (ADI); and the slab-rod index (SRI). CT scans from 245 subjects with varying GOLD stages were analyzed from the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS). Results show monotonic increasing or decreasing trends in the three biomechanical measures as a function of GOLD stage for the entire lung and on a lobe-by-lobe basis. Furthermore, these trends held across all five image registration algorithms. The consistency of the five image registration algorithms on a per individual basis is shown using Bland-Altman plots.

6.
Sci Rep ; 12(1): 20569, 2022 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-36446818

RESUMO

The distribution of marine organisms is shaped by geographic distance and oceanographic features like currents. Among migratory species, individuals from multiple populations may share feeding habitats seasonally or across life stages. Here, we introduce a modification for many-to-many mixed stock models to include distance between breeding and foraging sites as an ecological covariate and evaluate how the composition of green turtle, Chelonia mydas, juvenile mixed stock aggregations changed in response to population growth over time. Our modified many-to-many model is more informative and generally tightens credible intervals over models that do not incorporate distance. Moreover, we identified a decrease in genetic diversity in a Florida nesting site and two juvenile aggregations. Mixed stock aggregations in central Florida have changed from multiple sources to fewer dominant source populations over the past ~ 20 years. We demonstrate that shifts in contributions from source populations to mixed stock aggregations are likely associated with nesting population growth. Furthermore, our results highlight the importance of long-term monitoring and the need for periodical reassessment of reproductive populations and juvenile aggregations. Understanding how mixed stock aggregations change over time and how different life stages are connected is fundamental for the development of successful conservation plans for imperiled species.


Assuntos
Benchmarking , Tartarugas , Animais , Florida , Oceanografia , Crescimento Demográfico , Reprodução
7.
Front Physiol ; 13: 999263, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36304574

RESUMO

Patients who recovered from the novel coronavirus disease 2019 (COVID-19) may experience a range of long-term symptoms. Since the lung is the most common site of the infection, pulmonary sequelae may present persistently in COVID-19 survivors. To better understand the symptoms associated with impaired lung function in patients with post-COVID-19, we aimed to build a deep learning model which conducts two tasks: to differentiate post-COVID-19 from healthy subjects and to identify post-COVID-19 subtypes, based on the latent representations of lung computed tomography (CT) scans. CT scans of 140 post-COVID-19 subjects and 105 healthy controls were analyzed. A novel contrastive learning model was developed by introducing a lung volume transform to learn latent features of disease phenotypes from CT scans at inspiration and expiration of the same subjects. The model achieved 90% accuracy for the differentiation of the post-COVID-19 subjects from the healthy controls. Two clusters (C1 and C2) with distinct characteristics were identified among the post-COVID-19 subjects. C1 exhibited increased air-trapping caused by small airways disease (4.10%, p = 0.008) and diffusing capacity for carbon monoxide %predicted (DLCO %predicted, 101.95%, p < 0.001), while C2 had decreased lung volume (4.40L, p < 0.001) and increased ground glass opacity (GGO%, 15.85%, p < 0.001). The contrastive learning model is able to capture the latent features of two post-COVID-19 subtypes characterized by air-trapping due to small airways disease and airway-associated interstitial fibrotic-like patterns, respectively. The discovery of post-COVID-19 subtypes suggests the need for different managements and treatments of long-term sequelae of patients with post-COVID-19.

8.
Artigo em Inglês | MEDLINE | ID: mdl-36231196

RESUMO

Around nine million people have been exposed to toxic humidifier disinfectants (HDs) in Korea. HD exposure may lead to HD-associated lung injuries (HDLI). However, many people who have claimed that they experienced HD exposure were not diagnosed with HDLI but still felt discomfort, possibly due to the unknown effects of HD. Therefore, this study examined HD-exposed subjects with normal-appearing lungs, as well as unexposed subjects, in clusters (subgroups) with distinct characteristics, classified by deep-learning-derived computed-tomography (CT)-based tissue pattern latent traits. Among the major clusters, cluster 0 (C0) and cluster 5 (C5) were dominated by HD-exposed and unexposed subjects, respectively. C0 was characterized by features attributable to lung inflammation or fibrosis in contrast with C5. The computational fluid and particle dynamics (CFPD) analysis suggested that the smaller airway sizes observed in the C0 subjects led to greater airway resistance and particle deposition in the airways. Accordingly, women appeared more vulnerable to HD-associated lung abnormalities than men.


Assuntos
Aprendizado Profundo , Desinfetantes , Desinfetantes/toxicidade , Feminino , Humanos , Umidificadores , Pulmão/diagnóstico por imagem , Masculino , República da Coreia , Tomografia Computadorizada por Raios X
9.
Artigo em Inglês | MEDLINE | ID: mdl-36194556

RESUMO

RATIONALE: Extra-pulmonary manifestations of asthma, including fatty infiltration in tissues, may reflect systemic inflammation and influence lung function and disease severity. OBJECTIVES: To determine if skeletal muscle adiposity predicts lung function trajectory in asthma. METHODS: Adult Severe Asthma Research Program-3 participants with baseline computed tomography imaging and longitudinal post-bronchodilator FEV1%-predicted (median follow-up 5 years [1132 person-years]) were evaluated. The mean (Hounsfield unit [HU]) of the left and right paraspinous muscle density (PSMD) at the 12th thoracic vertebral body was calculated. A lower PSMD reflects higher muscle adiposity. We derived PSMD reference ranges from healthy, non-asthma controls. A linear multivariable mixed-effects model evaluated associations of baseline PSMD, and lung function trajectory stratified by sex. MEASUREMENTS AND MAIN RESULTS: Participants included 219 with asthma (67% female, mean (SD) BMI of 32.3 [8.8] kg/m2); and 37 controls (51% female, mean [SD] BMI of 26.3 (4.7) kg/m2). Asthmatic participants had lower adjusted PSMD than controls (42.2 vs. 55.8 HU, p<0.001). In adjusted models, PSMD predicted lung function trajectory in asthmatic females, [(ß= -0.47 Δ-slope per 10 HU decrease), p= 0.03], but not males [(ß= 0.11 Δ-slope per 10 HU decrease), p= 0.77]. The highest PSMD tertile predicted a 2.9% improvement while the lowest tertile predicted a 1.8% decline in FEV1%-predicted among asthmatic females over 5 years. CONCLUSIONS: Asthmatic participants have lower PSMD, reflecting greater muscle fat infiltration. Baseline PSMD predicted lung function decline among females with asthma, but not males. These data support an important role of metabolic dysfunction in lung function decline.

10.
Front Physiol ; 13: 867473, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36267579

RESUMO

We applied quantitative CT image matching to assess the degree of motion in the idiopathic ILD such as usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). Twenty-one normal subjects and 42 idiopathic ILD (31 UIP and 11 NSIP) patients were retrospectively included. Inspiratory and expiratory CT images, reviewed by two experienced radiologists, were used to compute displacement vectors at local lung regions matched by image registration. Normalized three-dimensional and two-dimensional (dorsal-basal) displacements were computed at a sub-acinar scale. Displacements, volume changes, and tissue fractions in the whole lung and the lobes were compared between normal, UIP, and NSIP subjects. The dorsal-basal displacement in lower lobes was smaller in UIP patients than in NSIP or normal subjects (p = 0.03, p = 0.04). UIP and NSIP were not differentiated by volume changes in the whole lung or upper and lower lobes (p = 0.53, p = 0.12, p = 0.97), whereas the lower lobe air volume change was smaller in both UIP and NSIP than normal subjects (p = 0.02, p = 0.001). Regional expiratory tissue fractions and displacements showed positive correlations in normal and UIP subjects but not in NSIP subjects. In summary, lung motionography quantified by image registration-based lower lobe dorsal-basal displacement may be used to assess the degree of motion, reflecting limited motion due to fibrosis in the ILD such as UIP and NSIP.

11.
Med Phys ; 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36097259

RESUMO

BACKGROUND: Quantitative analysis of computed tomography (CT) images traditionally utilizes real patient data that can pose challenges with replicability, efficiency, and radiation exposure. Instead, virtual imaging trials (VITs) can overcome these hurdles through computer simulations of models of patients and imaging systems. DukeSim is a scanner-specific CT imaging simulator that has previously been validated with simple cylindrical phantoms, but not with anthropomorphic conditions and clinically relevant measurements. PURPOSE: To validate a scanner-specific CT simulator (DukeSim) for the assessment of lung imaging biomarkers under clinically relevant conditions across multiple scanners using an anthropomorphic chest phantom, and to demonstrate the utility of virtual trials by studying the effects or radiation dose and reconstruction kernels on the lung imaging quantifications. METHODS: An anthropomorphic chest phantom with customized tube inserts was imaged with two commercial scanners (Siemens Force and Siemens Flash) at 28 dose and reconstruction conditions. A computational version of the chest phantom was used with a scanner-specific CT simulator (DukeSim) to simulate virtual images corresponding to the settings of the real acquisitions. Lung imaging biomarkers were computed from both real and simulated CT images and quantitatively compared across all imaging conditions. The VIT framework was further utilized to investigate the effects of radiation dose (20-300 mAs) and reconstruction settings (Qr32f, Qr40f, and Qr69f reconstruction kernels using ADMIRE strength 3) on the accuracy of lung imaging biomarkers, compared against the ground-truth values modeled in the computational chest phantom. RESULTS: The simulated CT images matched closely the real images for both scanners and all imaging conditions qualitatively and quantitatively, with the average biomarker percent error of 3.51% (range 0.002%-18.91%). The VIT study showed that sharper reconstruction kernels had lower accuracy with errors in mean lung HU of 84-94 HU, lung volume of 797-3785 cm3 , and lung mass of -800 to 1751 g. Lower tube currents had the lower accuracy with errors in mean lung HU of 6-84 HU, lung volume of 66-3785 cm3 , and lung mass of 170-1751 g. Other imaging biomarkers were consistent under the studied reconstruction settings and tube currents. CONCLUSION: We comprehensively evaluated the realism of DukeSim in an anthropomorphic setup across a diverse range of imaging conditions. This study paves the way toward utilizing VITs more reliably for conducting medical imaging experiments that are not practical using actual patient images.

13.
Physiol Rep ; 10(17): e15340, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36073059

RESUMO

In cystic fibrosis (CF), the loss of cystic fibrosis transmembrane conductance regulator (CFTR) mediated Cl-  and HCO3 -  secretion across the epithelium acidifies the airway surface liquid (ASL). Acidic ASL alters two key host defense mechanisms: Rapid ASL bacterial killing and mucociliary transport (MCT). Aerosolized tromethamine (Tham) increases ASL pH and restores the ability of ASL to rapidly kill bacteria in CF pigs. In CF pigs, clearance of insufflated microdisks is interrupted due to abnormal mucus causing microdisks to abruptly recoil. Aerosolizing a reducing agent to break disulfide bonds that link mucins improves MCT. Here, we are interested in restoring MCT in CF by aerosolizing Tham, a buffer with a pH of 8.4. Because Tham is hypertonic to serum, we use an acidified formulation as a control. We measure MCT by tracking the caudal movement of individual tantalum microdisks with serial chest computed tomography scans. Alkaline Tham improves microdisk clearance to within the range of that seen in non-CF pigs. It also partially reverses MCT defects, including reduced microdisk recoil and elapse time until they start moving after methacholine stimulation in CF pig airways. The effect is not due to hypertonicity, as it is not seen with acidified Tham or hypertonic saline. This finding indicates acidic ASL impairs CF MCT and suggests that alkalinization of ASL pH with inhaled Tham may improve CF airway disease.


Assuntos
Fibrose Cística , Animais , Bicarbonatos , Fibrose Cística/tratamento farmacológico , Depuração Mucociliar , Mucosa Respiratória , Suínos , Trometamina
14.
Tomography ; 8(5): 2268-2284, 2022 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-36136886

RESUMO

Chronic obstructive pulmonary disease (COPD) and emphysema are characterized by functional and structural damage which increases the spaces for gaseous diffusion and impairs oxygen exchange. Here we explore the potential for hyperpolarized (HP) 3He MRI to characterize lung structure and function in a large-scale population-based study. Participants (n = 54) from the Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study, a nested case-control study of COPD among participants with 10+ packyears underwent HP 3He MRI measuring pAO2, apparent diffusion coefficient (ADC), and ventilation. HP MRI measures were compared to full-lung CT and pulmonary function testing. High ADC values (>0.4 cm2/s) correlated with emphysema and heterogeneity in pAO2 measurements. Strong correlations were found between the heterogeneity of global pAO2 as summarized by its standard deviation (SD) (p < 0.0002) and non-physiologic pAO2 values (p < 0.0001) with percent emphysema on CT. A regional study revealed a strong association between pAO2 SD and visual emphysema severity (p < 0.003) and an association with the paraseptal emphysema subtype (p < 0.04) after adjustment for demographics and smoking status. HP noble gas pAO2 heterogeneity and the fraction of non-physiological pAO2 results increase in mild to moderate COPD. Measurements of pAO2 are sensitive to regional emphysematous damage detected by CT and may be used to probe pulmonary emphysema subtypes. HP noble gas lung MRI provides non-invasive information about COPD severity and lung function without ionizing radiation.


Assuntos
Aterosclerose , Enfisema , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Estudos de Casos e Controles , Hélio , Humanos , Isótopos , Masculino , Oxigênio , Pressão Parcial , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Enfisema Pulmonar/diagnóstico por imagem
15.
Ecol Evol ; 12(8): e9208, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35991282

RESUMO

Male mating strategies respond to female availability such that variation in resources that affect spatial distribution can also alter cost-benefit tradeoffs within a population. In arid-adapted species, rainfall alters reproduction, behavior, morphology, and population density such that populations differing in resource availability may also differ in successful reproductive strategies. Here, we compare two populations of Cape ground squirrels (Xerus inauris), a sub-Saharan species with year-round breeding and intense mating competition. Unlike most mammals where males resort to aggressive interactions over females, male X. inauris are tolerant of one another, relying instead on other nonaggressive pre- and postcopulatory strategies to determine reproductive success. Our findings suggest that differences in resource availability affect female distribution, which ultimately leads to intraspecific variation in male reproductive tactics and sexual morphology. Sperm competition, assessed by reproductive morphometrics, was more pronounced in our high resource site where females were distributed evenly across the landscape, whereas dominance seemed to be an important determinant of success in our low resource site where females were more aggregated. Both sites had similar mating intensities, and most males did not sire any offspring. However, our low resource site had a higher variance in fertilization success with fewer males siring multiple offspring compared with our high resource site where more individuals were successful. Our results lend support to resource models where variations in female spatial distribution attributed to environmental resources ultimately impact male reproductive behaviors and morphology.

16.
Circ Cardiovasc Imaging ; 15(8): e014380, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35938411

RESUMO

BACKGROUND: The pulmonary vasculature is essential for gas exchange and impacts both pulmonary and cardiac function. However, it is difficult to assess and its characteristics in the general population are unknown. We measured pulmonary blood volume (PBV) noninvasively using contrast enhanced, dual-energy computed tomography to evaluate its relationship to age and symptoms among older adults in the community. METHODS: The MESA (Multi-Ethnic Study of Atherosclerosis) is an ongoing community-based, multicenter cohort. All participants attending the most recent MESA exam were selected for contrast enhanced dual-energy computed tomography except those with estimated glomerular filtration rate <60 mL/min per 1.73 m2. PBV was calculated by material decomposition of dual-energy computed tomography images. Multivariable models included age, sex, race/ethnicity, education, height, weight, smoking status, pack-years, and scanner model. RESULTS: The mean age of the 727 participants was 71 (range 59-94) years, and 55% were male. The race/ethnicity distribution was 41% White, 29% Black, 17% Hispanic, and 13% Asian. The mean±SD PBV in the youngest age quintile was 547±180 versus 433±194 mL in the oldest quintile (P<0.001), with an approximately linear decrement of 50 mL per 10 years of age ([95% CI, 32-67]; P<0.001). Findings were similar with multivariable adjustment. Lower PBV was associated independently with a greater dyspnea after a 6-minute walk (P=0.04) and greater composite dyspnea symptom scores (P=0.02). Greater PBV was also associated with greater height, weight, lung volume, Hispanic race/ethnicity, and nonsmoking history. CONCLUSIONS: Pulmonary blood volume was substantially lower with advanced age and was associated independently with greater symptoms scores in the elderly.


Assuntos
Volume Sanguíneo , Pulmão , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Dispneia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
17.
Respir Investig ; 60(6): 738-749, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35963780

RESUMO

Aggressive, albeit false marketing of electronic nicotine delivery systems (ENDS) or vaping devices as safer alternatives to cigarette smoking, combined with lack of regulations, has led to its mass adoption, especially among youth. A sudden increase in acute lung injuries was noted in 2019 which was linked to ENDS. It was termed by the Centers for Disease Control and Prevention (CDC) as electronic cigarette or vaping product use-associated lung injury (EVALI). Analysis of bronchoalveolar lavage fluid samples linked EVALI to vitamin E acetate (VEA), which is used as a diluting agent for marijuana oils. Patients with EVALI present with a combination of non-specific respiratory, gastrointestinal, and systemic symptoms. Laboratory results may show elevated inflammatory biomarkers. EVALI is a diagnosis of exclusion and must meet the following criteria: i) history of vaping within last 90 days, ii) abnormal chest imaging, iii) negative evaluation for infection, and iv) no other plausible diagnosis. A spectrum of computed tomography (CT) chest findings has been reported in EVALI, ranging from diffuse alveolar damage to organizing pneumonia, characterized by bilateral ground-glass opacities, consolidation, and septal thickening. A similar spectrum is seen on histopathology, characterized by lipid-laden alveolar macrophages, with varying degrees of infiltrative inflammatory cells and fibrin deposition. Early and accurate identification of the EVALI pattern can help optimize patient care. For example, in diffuse alveolar damage (DAD), a lower threshold for ventilation support and corticosteroid may improve outcomes. Here, we review the etiopathogenesis, clinical management, histopathology, and imaging features of EVALI.


Assuntos
Lesão Pulmonar Aguda , Fumar Cigarros , Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar , Vaping , Adolescente , Humanos , Vaping/efeitos adversos , Lesão Pulmonar/diagnóstico por imagem , Lesão Pulmonar/etiologia , Lesão Pulmonar/patologia , Tomografia Computadorizada por Raios X , Lesão Pulmonar Aguda/diagnóstico por imagem , Lesão Pulmonar Aguda/etiologia
18.
Radiology ; 305(3): 699-708, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35916677

RESUMO

Background The prevalence of chronic obstructive pulmonary disease (COPD) in women is fast approaching that in men, and women experience greater symptom burden. Although sex differences in emphysema have been reported, differences in airways have not been systematically characterized. Purpose To evaluate whether structural differences in airways may underlie some of the sex differences in COPD prevalence and clinical outcomes. Materials and Methods In a secondary analyses of a multicenter study of never-, current-, and former-smokers enrolled from January 2008 to June 2011 and followed up longitudinally until November 2020, airway disease on CT images was quantified using seven metrics: airway wall thickness, wall area percent, and square root of the wall thickness of a hypothetical airway with internal perimeter of 10 mm (referred to as Pi10) for airway wall; and lumen diameter, airway volume, total airway count, and airway fractal dimension for airway lumen. Least-squares mean values for each airway metric were calculated and adjusted for age, height, ethnicity, body mass index, pack-years of smoking, current smoking status, total lung capacity, display field of view, and scanner type. In ever-smokers, associations were tested between each airway metric and postbronchodilator forced expiratory volume in 1 second (FEV1)-to-forced vital capacity (FVC) ratio, modified Medical Research Council dyspnea scale, St George's Respiratory Questionnaire score, and 6-minute walk distance. Multivariable Cox proportional hazards models were created to evaluate the sex-specific association between each airway metric and mortality. Results In never-smokers (n = 420), men had thicker airway walls than women as quantified on CT images for segmental airway wall area percentage (least-squares mean, 47.68 ± 0.61 [standard error] vs 45.78 ± 0.55; difference, -1.90; P = .02), whereas airway lumen dimensions were lower in women than men after accounting for height and total lung capacity (segmental lumen diameter, 8.05 mm ± 0.14 vs 9.05 mm ± 0.16; difference, -1.00 mm; P < .001). In ever-smokers (n = 9363), men had greater segmental airway wall area percentage (least-squares mean, 52.19 ± 0.16 vs 48.89 ± 0.18; difference, -3.30; P < .001), whereas women had narrower segmental lumen diameter (7.80 mm ± 0.05 vs 8.69 mm ± 0.04; difference, -0.89; P < .001). A unit change in each of the airway metrics (higher wall or lower lumen measure) resulted in lower FEV1-to-FVC ratio, more dyspnea, poorer respiratory quality of life, lower 6-minute walk distance, and worse survival in women compared with men (all P < .01). Conclusion Airway lumen sizes quantified at chest CT were smaller in women than in men after accounting for height and lung size, and these lower baseline values in women conferred lower reserves against respiratory morbidity and mortality for equivalent changes compared with men. © RSNA, 2022 Online supplemental material is available for this article.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Qualidade de Vida , Feminino , Humanos , Masculino , Caracteres Sexuais , Volume Expiratório Forçado , Tomografia Computadorizada por Raios X/métodos , Pulmão/diagnóstico por imagem , Dispneia
19.
Eur J Pharm Sci ; 177: 106272, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35908637

RESUMO

The respiratory tract is an important route for beneficial drug aerosol or harmful particulate matter to enter the body. To assess the therapeutic response or disease risk, whole-lung deposition models have been developed, but were limited by compartment, symmetry or stochastic approaches. In this work, we proposed an imaging-based subject-specific whole-lung deposition model. The geometries of airways and lobes were segmented from computed tomography (CT) lung images at total lung capacity (TLC), and the regional air-volume changes were calculated by registering CT images at TLC and functional residual capacity (FRC). The geometries were used to create the structure of entire subject-specific conducting airways and acinar units. The air-volume changes were used to estimate the function of subject-specific ventilation distributions among acinar units and regulate flow rates in respiratory airway models. With the airway dimensions rescaled to a desired lung volume and the airflow field simulated by a computational fluid dynamics model, particle deposition fractions were calculated using deposition probability formulae adjusted with an enhancement factor to account for the effects of secondary flow and airway geometry in proximal airways. The proposed model was validated in silico against existing whole-lung deposition models, three-dimensional (3D) computational fluid and particle dynamics (CFPD) for an acinar unit, and 3D CFPD deep lung model comprising conducting and respiratory regions. The model was further validated in vivo against the lobar particle distribution and the coefficient of variation of particle distribution obtained from CT and single-photon emission computed tomography (SPECT) images, showing good agreement. Subject-specific airway structure increased the deposition fraction of 10.0-µm particles and 0.01-µm particles by approximately 10%. An enhancement factor increased the overall deposition fractions, especially for particle sizes between 0.1 and 1.0 µm.


Assuntos
Pulmão , Modelos Biológicos , Aerossóis , Simulação por Computador , Hidrodinâmica , Pulmão/diagnóstico por imagem , Pulmão/fisiologia , Tamanho da Partícula , Tomografia Computadorizada por Raios X/métodos
20.
Magn Reson Imaging ; 92: 140-149, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35777684

RESUMO

PURPOSE: To develop an end-to-end deep learning (DL) framework to segment ventilation defects on pulmonary hyperpolarized MRI. MATERIALS AND METHODS: The Multi-Ethnic Study of Atherosclerosis Chronic Obstructive Pulmonary Disease (COPD) study is a nested longitudinal case-control study in older smokers. Between February 2016 and July 2017, 56 participants (age, mean ± SD, 74 ± 8 years; 34 men) underwent same breath-hold proton (1H) and helium (3He) MRI, which were annotated for non-ventilated, hypo-ventilated, and normal-ventilated lungs. In this retrospective DL study, 820 1H and 3He slices from 42/56 (75%) participants were randomly selected for training, with the remaining 14/56 (25%) for test. Full lung masks were segmented using a traditional U-Net on 1H MRI and were imported into a cascaded U-Net, which were used to segment ventilation defects on 3He MRI. Models were trained with conventional data augmentation (DA) and generative adversarial networks (GAN)-DA. RESULTS: Conventional-DA improved 1H and 3He MRI segmentation over the non-DA model (P = 0.007 to 0.03) but GAN-DA did not yield further improvement. The cascaded U-Net improved non-ventilated lung segmentation (P < 0.005). Dice similarity coefficients (DSC) between manually and DL-segmented full lung, non-ventilated, hypo-ventilated, and normal-ventilated regions were 0.965 ± 0.010, 0.840 ± 0.057, 0.715 ± 0.175, and 0.883 ± 0.060, respectively. We observed no statistically significant difference in DCSs between participants with and without COPD (P = 0.41, 0.06, and 0.18 for non-ventilated, hypo-ventilated, and normal-ventilated regions, respectively). CONCLUSION: The proposed cascaded U-Net framework generated fully-automated segmentation of ventilation defects on 3He MRI among older smokers with and without COPD that is consistent with our reference method.


Assuntos
Aterosclerose , Doença Pulmonar Obstrutiva Crônica , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico por imagem , Estudos de Casos e Controles , Hélio , Humanos , Pulmão/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Masculino , Prótons , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Estudos Retrospectivos
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