Classification of Centrilobular Emphysema Based on CT-Pathologic Correlations

Colistin Effects on Emphysematous Lung in an LPS-Sepsis Model

Emphysema is prevalent in various respiratory diseases like Chronic Obstructive Pulmonary Disease (COPD) and cystic fibrosis. Colistin and vasoconstrictive drugs are crucial for treating these patients when diagnosed with sepsis in the ICU. This study examines colistin impact in ether-induced emphysematous septic and non-septic animals, focusing on lung pathophysiology and inflammatory responses, including IL-1β, TNF-α, AMPK, caspase-3, cyclin-D1, and colistin levels in lung tissue. All animals exhibited significant emphysematous changes, accentuated by LPS-induced septic conditions, validating the emphysema model and highlighting the exacerbating effect of sepsis on lung pathology. Colistin, alone or with vasoconstrictive drugs, stimulated immune responses through increased inflammatory cell infiltration and the presence of lymphocytes, indicating potential immunomodulatory effects. Vasoconstriction did not alter the effects of colistin or sepsis but correlated with increased colistin levels in the lungs of septic animals. These observations suggest a potential interplay between vasoconstrictive drugs and colistin distribution/metabolism, leading to enhanced local concentrations of colistin in the lung microenvironment. The findings suggest the need for further investigations to optimize colistin and vasoconstrictive drug delivery in critically ill patients with lung pathologies. Understanding these complexities may guide more effective management of inflammatory responses and lung pathologies in these critical conditions.

Plasma sRAGE levels strongly associate with centrilobular emphysema assessed by HRCT scans

Background

There is a strong need for biomarkers to better characterize individuals with COPD and to take into account the heterogeneity of COPD. The blood protein sRAGE has been put forward as promising biomarker for COPD in general and emphysema in particular. Here, we measured plasma sRAGE levels using quantitative LC–MS and assessed whether the plasma sRAGE levels associate with (changes in) lung function, radiological emphysema parameters, and radiological subtypes of emphysema.

Methods

Three hundred and twenty-four COPD patients (mean FEV₁: 63%predicted) and 185 healthy controls from the COPDGene study were selected. Plasma sRAGE was measured by immunoprecipitation in 96-well plate methodology to enrich sRAGE, followed by targeted quantitative liquid chromatography-mass spectrometry. Spirometry and HRCT scans (inspiration and expiration) with a 5-year follow-up were used; both subjected to high quality control standards.

Results

Lower sRAGE values significantly associated with the presence of COPD, the severity of airflow obstruction, the severity of emphysema on HRCT, the heterogeneous distribution of emphysema, centrilobular emphysema, and 5-year progression of emphysema. However, sRAGE values did not associate with airway wall thickness or paraseptal emphysema.

Conclusions

Rather than being a general COPD biomarker, sRAGE is especially a promising biomarker for centrilobular emphysema. Follow-up studies should elucidate whether sRAGE can be used as a biomarker for other COPD phenotypes as well.

Animal models of emphysema

OBJECTIVE

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease of human beings characterized by not fully reversible airflow limitation. Emphysema is the main pathological feature of COPD which causes high mortality worldwide every year and consumes a large amount of medical expenses. This paper was to review the establishment and evaluation methods of animal models of emphysema or COPD, and put forward some new ideas on animal selection, method of modeling, and model evaluation.

DATA SOURCES

The author retrieved information from the PubMed database up to July 2019, using various combinations of search terms, including emphysema, model, and animal.

STUDY SELECTION

Original articles, reviews, and other articles were searched and reviewed for animal models of emphysema.

RESULTS

This review summarized animal models of emphysema from the perspectives of animal selection, emphysema mechanism, modeling method and model evaluation, and found that passive smoking is the classic method for developing animal model of emphysema, mice are more suitable for experimental study on emphysema. Compared with pulmonary function indicators, airway inflammation indicators and oxidative stress indicators, pathomorphological indicators of lung tissue are the most important parameters for evaluating the establishment of the animal model of emphysema.

CONCLUSIONS

Mice model induced by passive smoking is the classic animal model of emphysema. Pathomorphological indicators are the most important parameters for evaluating the establishment of the animal model of emphysema.

CT-based Visual Classification of Emphysema: Association with Mortality in the COPDGene Study

Purpose

To determine whether visually assessed patterns of emphysema at CT might provide a simple assessment of mortality risk among cigarette smokers.

Materials and Methods

Of the first 4000 cigarette smokers consecutively enrolled between 2007 and 2011 in this COPDGene study, 3171 had data available for both visual emphysema CT scores and survival. Each CT scan was retrospectively visually scored by two analysts using the Fleischner Society classification system. Severity of emphysema was also evaluated quantitatively by using percentage lung volume occupied by low-attenuation areas (voxels with attenuation of −950 HU or less) (LAA-950). Median duration of follow-up was 7.4 years. Regression analysis for the relationship between imaging patterns and survival was based on the Cox proportional hazards model, with adjustment for age, race, sex, height, weight, pack-years of cigarette smoking, current smoking status, educational level, LAA-950, and (in a second model) forced expiratory volume in 1 second (FEV₁).

Results

Observer agreement in visual scoring was good (weighted κ values, 0.71–0.80). There were 519 deaths in the study cohort. Compared with subjects who did not have visible emphysema, mortality was greater in those with any grade of emphysema beyond trace (adjusted hazard ratios, 1.7, 2.5, 5.0, and 4.1, respectively, for mild centrilobular emphysema, moderate centrilobular emphysema, confluent emphysema, and advanced destructive emphysema, P < .001). This increased mortality generally persisted after adjusting for LAA-950.

Conclusion

The visual presence and severity of emphysema is associated with significantly increased mortality risk, independent of the quantitative severity of emphysema.

Online supplemental material is available for this article.

Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS)-study protocol for a 2×2 factorial randomized trial

BACKGROUND

Chronic diseases result in significant morbidity and costs. Although medications and lifestyle changes are effective for improving outcomes in chronic diseases, many patients do not receive these treatments, in part because of financial barriers, patient and provider-level knowledge gaps, and low patient motivation. The Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS) will determine the impact of two interventions: (1) a value-based formulary which eliminates copayment for high-value preventive medications; and (2) a comprehensive self-management support program aimed at promoting health behavior change and medication adherence, combined with relay of information on medication use to healthcare providers, on cardiovascular events and/or mortality in low-income seniors with elevated cardiovascular risk.

METHODS

The ACCESS study will use a parallel, open label, factorial randomized trial design, with blinded endpoint evaluation in 4714 participants who are over age >65 (and therefore have drug insurance provided by Alberta Blue Cross with 30 % co-payment); are at a high risk for cardiovascular events based on a history of any one of the following: coronary heart disease, prior stroke, chronic kidney disease, heart failure, or any two of the following: current cigarette smoking, diabetes mellitus, hypertension, or hypercholesterolemia; and have a household income

DISCUSSION

Given identified gaps in care in chronic disease, and the frequency of financial and knowledge-related barriers in low-income Albertans, this study will test the impact of providing free high-value preventive medications (i.e., value-based insurance) and a tailored self-management education and facilitated relay strategy on outcomes and costs. By measuring the impact on both health outcomes and costs, as well as the impact on reducing health inequities in this vulnerable population, our study will facilitate informed policy decisions.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT02579655 . Registered Oct 15, 2015.

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Key Words

• Chronic disease
• Cost
• Drug insurance
• Education
• Randomized clinical trial

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Grants

• Alberta Innovates - Health Solutions
• University of Calgary Clinical Research Fund
• Canadian Institutes of Health Research

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Affiliation(s)

David J. T. Campbell Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
Marcello Tonelli Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
Brenda Hemmelgarn Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
Chad Mitchell Alberta Health, Edmonton, Canada
Ross Tsuyuki Department of Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
Noah Ivers Department of Family Medicine, University of Toronto, Toronto, Canada
Tavis Campbell Department of Psychology, University of Calgary, Calgary, Canada
Raj Pannu Emergence Creative, New york, USA
Eric Verkerke Emergence Creative, New york, USA
Scott Klarenbach Department of Medicine, University of Alberta, Edmonton, Canada
Kathryn King-Shier Faculty of Nursing, University of Calgary, Calgary, Canada
Peter Faris Alberta Health Services, Edmonton, Canada
Derek Exner Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
Vikas Chaubey Department of Medicine, University of British Columbia, Vancouver, Canada
Braden Manns Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada Foothills Medical Centre, 1403 29th St. NW, Calgary, Alberta Canada T2N 2T9
On behalf of the Interdisciplinary Chronic Disease Collaboration Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada Departments of Medicine and Community Health Sciences, Libin Institute and Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada Alberta Health, Edmonton, Canada Department of Pharmaceutical Sciences, University of Alberta, Edmonton, Canada Department of Family Medicine, University of Toronto, Toronto, Canada Department of Psychology, University of Calgary, Calgary, Canada Emergence Creative, New york, USA Department of Medicine, University of Alberta, Edmonton, Canada Faculty of Nursing, University of Calgary, Calgary, Canada Alberta Health Services, Edmonton, Canada Department of Medicine, University of British Columbia, Vancouver, Canada Foothills Medical Centre, 1403 29th St. NW, Calgary, Alberta Canada T2N 2T9

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Cystic and nodular lung disease

Diffuse cystic and nodular lung diseases have characteristic imaging findings. The most common causes of cystic lung disease are lymphangioleiomyomatosis and Langerhans cell histiocytosis. Other less common cystic lung diseases include Birt-Hogg-Dube syndrome, lymphocytic interstitial pneumonitis, and light chain deposition disease. Computed tomography is used to differentiate cystic lung disease from emphysema, honeycombing, cavities, and bronchiectasis, which mimic cystic lung disease. Diffuse nodular lung disease are categorized as centrilobular, perilymphatic, and random types. In diffuse nodular lung disease, a specific diagnosis is achieved through a combination of history, physical examination, and imaging findings.

Computed tomography-based centrilobular emphysema subtypes relate with pulmonary function

Introduction:

Centrilobular emphysema (CLE) is recognized as low attenuation areas (LAA) with centrilobular pattern on high-resolution computed tomography (CT). However, several shapes of LAA are observed. Our preliminary study showed three types of LAA in CLE by CT-pathologic correlations. This study was performed to investigate whether the morphological features of LAA affect pulmonary functions.

Materials and Methods:

A total of 73 Japanese patients with stable CLE (63 males, 10 females) were evaluated visually by CT and classified into three subtypes based on the morphology of LAA including shape and sharpness of border; patients with CLE who shows round or oval LAA with well-defined border (Subtype A), polygonal or irregular-shaped LAA with ill-defined border (Subtype B), and irregular-shaped LAA with ill-defined border coalesced with each other (Subtype C). CT score, pulmonary function test and smoking index were compared among three subtypes.

Results:

Twenty (27%), 45 (62%) and 8 cases (11%) of the patients were grouped into Subtype A, Subtype B and Subtype C, respectively. In CT score and smoking index, both Subtype B and Subtype C were significantly higher than Subtype A. In FEV₁%, Subtype C was significantly lower than both Subtype A and Subtype B. In diffusing capacity of lung for carbon monoxide, Subtype B was significantly lower than Subtype A.

Conclusion:

The morphological differences of LAA may relate with an airflow limitation and alveolar diffusing capacity. To assess morphological features of LAA may be helpful for the expectation of respiratory function.