• Journal of the Korean Society of Radiology
• /
• v.82 no.4
• /
• pp.808-816
• /
• 2021

Pulmonary emphysema is a cause of chronic obstructive pulmonary disease. Emphysema can be accurately diagnosed via CT. The severity of emphysema can be assessed using visual interpretation or quantitative analysis. Various studies on emphysema using deep learning have also been conducted. Although the classification of emphysema has proven clinically useful, there is a need to improve the reliability of the measurement.

• Tuberculosis and Respiratory Diseases
• /
• v.85 no.2
• /
• pp.122-136
• /
• 2022

Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.

• Tuberculosis and Respiratory Diseases
• /
• v.78 no.1
• /
• pp.8-17
• /
• 2015

Background: AMP-activated protein kinase (AMPK) not only functions as an intracellular energy sensor and regulator, but is also a general sensor of oxidative stress. Furthermore, there is recent evidence that it participates in limiting acute inflammatory reactions, apoptosis and cellular senescence. Thus, it may oppose the development of chronic obstructive pulmonary disease. Methods: To investigate the role of AMPK in cigarette smoke-induced lung inflammation and emphysema we first compared cigarette smoking and polyinosinic-polycytidylic acid [poly(I:C)]-induced lung inflammation and emphysema in $AMPK{\alpha}1$-deficient ($AMPK{\alpha}1$-HT) mice and wild-type mice of the same genetic background. We then investigated the role of AMPK in the induction of interleukin-8 (IL-8) by cigarette smoke extract (CSE) in A549 cells. Results: Cigarette smoking and poly(I:C)-induced lung inflammation and emphysema were elevated in $AMPK{\alpha}1$-HT compared to wild-type mice. CSE increased AMPK activation in a CSE concentration- and time-dependent manner. 5-Aminoimidazole-4-carboxamide-1-${\beta}$-4-ribofuranoside (AICAR), an AMPK activator, decreased CSE-induced IL-8 production while Compound C, an AMPK inhibitor, increased it, as did pretreatment with an $AMPK{\alpha}1$-specific small interfering RNA. Conclusion: $AMPK{\alpha}1$-deficient mice have increased susceptibility to lung inflammation and emphysema when exposed to cigarette smoke, and AMPK appears to reduce lung inflammation and emphysema by lowering IL-8 production.

• Tuberculosis and Respiratory Diseases
• /
• v.72 no.3
• /
• pp.310-317
• /
• 2012

Background: Airway obstruction and the extent of emphysema are reported to be responsible for reduced bone mineral density (BMD). Corresponding to different phenotypes of a pulmonary disease, different severity in extra pulmonary features may exist. We compared BMDs of subjects with or without airway obstruction and/or emphysema and investigated the relationships among BMD, the severity of airway obstruction, and the extent of emphysema. Methods: Using a university hospital database, we reviewed patients over 40 years old who performed spirometry, computed tomography of chest, and measurement of BMD of the lumbar (L) spine. According to the presence or absence of airway obstruction and/or emphysema, four groups were classified. Results: Among a total of 59 subjects, 33 (56%) had osteoporosis. The prevalence of osteoporosis in subjects with no airway obstruction and no emphysema, those with only emphysema, those with only airway obstruction, and those with both airway obstruction and emphysema were 42%, 57%, 64%, and 73%, respectively (p=0.047 by linear-by-linear association). The mean T-scores of BMD of L1 (p=0.032) and L1-4 spines were different among the four groups (p=0.034). Although the T-score of L1 BMD negatively correlated with the extent of emphysema (r=-0.275, p=0.035) and positively with each of body mass index (BMI) (r=0.520, p<0.001), forced expiratory volume in one second ($FEV_1$) (r=0.330, p=0.011), $FEV_1$/forced vital capacity (r=0.409, p=0.001), and forced expiratory flow at 25~75% of FVC ($FEF_{25-75%}$) (r=0.438, p=0.0001), respectively, multiple linear regression analysis indicated that BMI (p<0.001) and $FEF_{25-75%}$ were predictive of BMD (p=0.012). Conclusion: Low BMI and airway obstruction were strongly associated with reduced bone density rather than the extent of emphysema.

• Tuberculosis and Respiratory Diseases
• /
• v.85 no.4
• /
• pp.302-312
• /
• 2022

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease. Not all patients with COPD respond to available drugs. Identifying respondents to therapy is critical to delivering the most appropriate treatment and avoiding unnecessary medication. Recognition of individual patients' dominant characteristics by phenotype is a useful tool to better understand their disease and tailor treatment accordingly. To look for a suitable phenotype, it is important to understand what makes COPD complex and heterogeneous. The pathology of COPD includes small airway disease and/or emphysema. Thus, COPD is not a single disease entity. In addition, there are two types (panlobular and centrilobular) of emphysema in COPD. The coexistence of different pathological subtypes could be the reason for the complexity and heterogeneity of COPD. Thus, it is necessary to look for the phenotype based on the difference in the underlying pathology. Review of the literature has shown that clinical manifestation and therapeutic response to pharmacological therapy are different depending on the presence of computed tomography-defined airway wall thickening in COPD patients. Defining the phenotype of COPD based on the underlying pathology is encouraging as most clinical manifestations can be distinguished by the presence of increased airway wall thickness. Pharmacological therapy has shown significant effect on COPD with airway wall thickening. However, it has limited use in COPD without an airway disease. The phenotype of COPD based on the underlying pathology can be a useful tool to better understand the disease and adjust treatment accordingly.

• Tuberculosis and Respiratory Diseases
• /
• v.82 no.2
• /
• pp.158-165
• /
• 2019

Background: A recent study reported that mesenchymal stem cells possess potential cellular therapeutic properties for treating patients with chronic obstructive pulmonary disease, which is characterized by emphysema. We examined the potential therapeutic effect of Wharton's Jelly-derived mesenchymal stem cells (WJMSCs), following pretreatment with pioglitazone, in lung regeneration mouse emphysema models. Methods: We used two mouse emphysema models, an elastase-induced model and a cigarette smoke-induced model. We intravenously injected WJMSCs ($1{\times}10^4/mouse$) to mice, pretreated or not, with pioglitazone for 7 days. We measured the emphysema severity by mean linear intercepts (MLI) analysis using lung histology. Results: Pioglitazone pretreated WJMSCs (pioWJMSCs) were associated with greater lung regeneration than non-augmented WJMSCs in the two mouse emphysema models. In the elastase-induced emphysema model, the MLIs were $59.02{\pm}2.42{\mu}m$ (n=6), $72.80{\pm}2.87{\mu}m$ (n=6), for pioWJMSCs injected mice, and non-augmented WJMSCs injected mice, respectively (p<0.01). Both pioWJMSCs and non-augmented WJMSCs showed regenerative effects in the cigarette smoke emphysema model (MLIs were $41.25{\pm}0.98$ [n=6] for WJMSCs and $38.97{\pm}0.61{\mu}m$ [n=6] for pioWJMSCs) compared to smoking control mice ($51.65{\pm}1.36{\mu}m$, n=6). The mean improvement of MLI appeared numerically better in pioWJMSCs than in non-augmented WJMSCs injected mice, but the difference did not reach the level of statistical significance (p=0.071). Conclusion: PioWJMSCs may produce greater lung regeneration, compared to non-augmented WJMSCs, in a mouse emphysema model.

• Korean Journal of Veterinary Service
• /
• v.26 no.1
• /
• pp.81-88
• /
• 2003

A cross-sectional epidemiological study using a multistage sampling strategy in slaughter cattle in Mymensingh, Bangladesh was conducted during September 2001 to April 2002 to study distributions and risk factors of specific pulmonary lesions and diseases. The pulmonary lesions and diseases were diagnosed on the basis of macroscopic and microscopic pathological and parasitological findings. The frequency distribution of pulmonary lesions and diseases in slaughter cattle was found to vary among categories of the study variables. The risk factors identified on statistical basis were male cattle and ${\leq}3$ years old cattle and summer in congestion, slightly thin physical condition and summer season in pulmonary emphysema, slightly thin physical condition in parasitic bronchitis as well as female cattle, autumn and rainy seasons in pulmonary hydatidosis. The population impact and etiologic significance of summer season on pulmonary congestion and emphysema was more important than that of adult male cattle. The population impact and etiologic significance of autumn season on pulmonary hydatidosis was more important than that of female cattle during rainy season. Population impact of slightly thin cattle on parasitic bronchitis was poor.

• Journal of the Korean Society of Radiology
• /
• v.16 no.4
• /
• pp.411-417
• /
• 2022

This study aimed to learn and evaluate the effectiveness of VGGNet in the detection of pulmonary emphysema using low-dose chest computed tomography images. In total, 8000 images with normal findings and 3189 images showing pulmonary emphysema were used. Furthermore, 60%, 24%, and 16% of the normal and emphysema data were randomly assigned to training, validation, and test datasets, respectively, in model learning. VGG16 and VGG19 were used for learning, and the accuracy, loss, confusion matrix, precision, recall, specificity, and F1-score were evaluated. The accuracy and loss for pulmonary emphysema detection of the low-dose chest CT test dataset were 92.35% and 0.21% for VGG16 and 95.88% and 0.09% for VGG19, respectively. The precision, recall, and specificity were 91.60%, 98.36%, and 77.08% for VGG16 and 96.55%, 97.39%, and 92.72% for VGG19, respectively. The F1-scores were 94.86% and 96.97% for VGG16 and VGG19, respectively. Through the above evaluation index, VGG19 is judged to be more useful in detecting pulmonary emphysema. The findings of this study would be useful as basic data for the research on pulmonary emphysema detection models using VGGNet and artificial neural networks.

• Tuberculosis and Respiratory Diseases
• /
• v.51 no.2
• /
• pp.97-107
• /
• 2001

Background : Tuberculosis itself causes not only lung parenchymal destruction but also pulmonary vascular damage. Secondary emphysema also causes pulmonary vascular damage, which can develop as a late sequela of pulmonary tuberculosis. Therefore, pulmonary circulatory impairment tends to be more severe in post-tuberculosis emphysema than in primary emphysema. In post-tuberculosis emphysema, the right ventricular function may play an important role. However, little information regarding the right ventricular function is available. The purpose of this study was to evaluate and compare the right ventricular function between post-tuberculosis emphysema and primary emphysema. Method: Post-tuberculosis emphysema(PTE) or primary emphysema(PE) was diagnosed by history, HRCT finding and pulmonary function. Twenty patients with post-tuberculosis emphysema were matched with 20 patients with primary emphysema according to both $FEV-1$ and FVC. Arterial blood gas analysis and echocardiography were done at rest and immediately after symptom-limited exercise. The right ventricular function was evaluated with the right ventricular ejection fraction using a modification of Simpson's method. Results : There was no significant difference in the demographics and pulmonary function between the two groups. In post-tuberculosis emphysema, the $PaCO_2$ was higher ($42.9{\pm}4.7$ vs $38.8{\pm}3.1\;mmHg$ at rest; $47.9{\pm}7.0$ vs $41.1{\pm}5.9\;mmHg$ after exercise; p<0.01) and the right ventricular ejection fraction was lower ($57.6{\pm}6.5$ vs $61.4{\pm}4.7%$ at rest; $51.1{\pm}10.8$ vs $59.8{\pm}6.6%$ after exercise; p<0.01) both at rest and after exercise. The $PaCO_2$ after exercise was also lower ($65.7{\pm}12.6$ vs $80.2{\pm}14.4\;mmHg$, p<0.01), while the Pa02 at rest tended to be lower($82.9{\pm}12.0$ vs $87.8{\pm}7.5$, p>0.05). In both groups, right ventricular ejection fraction correlated with the $PaCO_2$ after exercise(PTE r=0.536, PE r=0.557), and the $PaCO_2$ at rest(PTE r=-0.576, PE r=-0.588) and after exercise(PTE r=-0.764, PE r=-0.619). Conclusion : Impairment of the right heart function and gas exchange were more serious in post-tuberculosis emphysema than in primary emphysema, and gas exchange may be influenced by the right ventricular function in post-tuberculosis emphysema.

• BMB Reports
• /
• v.50 no.2
• /
• pp.79-84
• /
• 2017

Emphysema, a pathologic component of the chronic obstructive pulmonary disease, causes irreversible destruction of lung. Many researchers have reported that mesenchymal stem cells can regenerate lung tissue after emphysema. We evaluated if spheroid human adipose-derived mesenchymal stem cells (ASCs) showed greater regenerative effects than dissociated ASCs in mice with elastase-induced emphysema. ASCs were administered via an intrapleural route. Mice injected with spheroid ASCs showed improved regeneration of lung tissues, increased expression of growth factors such as fibroblast growth factor-2 (FGF2) and hepatocyte growth factor (HGF), and a reduction in proteases with an induction of protease inhibitors when compared with mice injected with dissociated ASCs. Our findings indicate that spheroid ASCs show better regeneration of lung tissues than dissociated ACSs in mice with elastase-induced emphysema.