WorldWideScience

Sample records for neurodegeneration emphysema asthma

  1. Quantitative computed tomography measurements of emphysema for diagnosing asthma-chronic obstructive pulmonary disease overlap syndrome.

    Science.gov (United States)

    Xie, Mengshuang; Wang, Wei; Dou, Shuang; Cui, Liwei; Xiao, Wei

    2016-01-01

    The diagnostic criteria of asthma-COPD overlap syndrome (ACOS) are controversial. Emphysema is characteristic of COPD and usually does not exist in typical asthma patients. Emphysema in patients with asthma suggests the coexistence of COPD. Quantitative computed tomography (CT) allows repeated evaluation of emphysema noninvasively. We investigated the value of quantitative CT measurements of emphysema in the diagnosis of ACOS. This study included 404 participants; 151 asthma patients, 125 COPD patients, and 128 normal control subjects. All the participants underwent pulmonary function tests and a high-resolution CT scan. Emphysema measurements were taken with an Airway Inspector software. The asthma patients were divided into high and low emphysema index (EI) groups based on the percentage of low attenuation areas less than -950 Hounsfield units. The characteristics of asthma patients with high EI were compared with those having low EI or COPD. The normal value of percentage of low attenuation areas less than -950 Hounsfield units in Chinese aged >40 years was 2.79%±2.37%. COPD patients indicated more severe emphysema and more upper-zone-predominant distribution of emphysema than asthma patients or controls. Thirty-two (21.2%) of the 151 asthma patients had high EI. Compared with asthma patients with low EI, those with high EI were significantly older, more likely to be male, had more pack-years of smoking, had more upper-zone-predominant distribution of emphysema, and had greater airflow limitation. There were no significant differences in sex ratios, pack-years of smoking, airflow limitation, or emphysema distribution between asthma patients with high EI and COPD patients. A greater number of acute exacerbations were seen in asthma patients with high EI compared with those with low EI or COPD. Asthma patients with high EI fulfill the features of ACOS, as described in the Global Initiative for Asthma and Global Initiative for Chronic Obstructive Lung Disease

  2. Long-term dynamics of death rates of emphysema, asthma, and pneumonia and improving air quality.

    Science.gov (United States)

    Kravchenko, Julia; Akushevich, Igor; Abernethy, Amy P; Holman, Sheila; Ross, William G; Lyerly, H Kim

    2014-01-01

    The respiratory tract is a major target of exposure to air pollutants, and respiratory diseases are associated with both short- and long-term exposures. We hypothesized that improved air quality in North Carolina was associated with reduced rates of death from respiratory diseases in local populations. We analyzed the trends of emphysema, asthma, and pneumonia mortality and changes of the levels of ozone, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and particulate matters (PM2.5 and PM10) using monthly data measurements from air-monitoring stations in North Carolina in 1993-2010. The log-linear model was used to evaluate associations between air-pollutant levels and age-adjusted death rates (per 100,000 of population) calculated for 5-year age-groups and for standard 2000 North Carolina population. The studied associations were adjusted by age group-specific smoking prevalence and seasonal fluctuations of disease-specific respiratory deaths. Decline in emphysema deaths was associated with decreasing levels of SO2 and CO in the air, decline in asthma deaths-with lower SO2, CO, and PM10 levels, and decline in pneumonia deaths-with lower levels of SO2. Sensitivity analyses were performed to study potential effects of the change from International Classification of Diseases (ICD)-9 to ICD-10 codes, the effects of air pollutants on mortality during summer and winter, the impact of approach when only the underlying causes of deaths were used, and when mortality and air-quality data were analyzed on the county level. In each case, the results of sensitivity analyses demonstrated stability. The importance of analysis of pneumonia as an underlying cause of death was also highlighted. Significant associations were observed between decreasing death rates of emphysema, asthma, and pneumonia and decreases in levels of ambient air pollutants in North Carolina.

  3. Urinary polyaromatic hydrocarbons are associated with adult emphysema, chronic bronchitis, asthma, and infections: US NHANES, 2011-2012.

    Science.gov (United States)

    Shiue, Ivy

    2016-12-01

    Links between environmental chemicals and human health have emerged over the last few decades, but the effects from polyaromatic hydrocarbons were less studied, compared to other commonly known environmental chemicals such as heavy metals, phthalates, arsenic, phenols, pesticides, etc. Therefore, the aim of the study was to examine the relationships of urinary polyaromatic hydrocarbons and adult respiratory health conditions using a large human sample in a national and population-based setting in recent years. Data were retrieved from United States National Health and Nutrition Examination Surveys, 2011-2012 including demographics, self-reported health conditions, and urinary polyaromatic hydrocarbons. Statistical analyses including chi-square test, t test, and survey-weighted logistic regression modeling were performed. Of 5560 American adults aged 20-80, urinary 2-hydroxyfluorene and 3-hydroxyfluorene were positively associated with emphysema (OR, 1.60, 95 % CI 1.26 to 2.03, P = 0.001 and OR, 1.42, 95 % CI 1.15 to 1.77, P = 0.003, respectively) and chronic bronchitis (OR, 1.42, 95 % CI 1.04 to 1.94, P = 0.031 and OR, 1.40, 95 % CI 1.03 to 1.91, P = 0.036, respectively), while 2-hydroxynaphthalene (2-naphthol) was likely to be borderline associated with emphysema and chronic bronchitis. Conversely, urinary 1-hydroxyphenanthrene, 3-hydroxyphenanthrene, 1-hydroxypyrene, and 4-hydroxyphenanthrene were inversely associated with asthma and infections. Urinary polyaromatic hydrocarbons are associated with adult respiratory health conditions, although the causality cannot be established. For future research, studies using large human sample across regions to longitudinally monitor would be suggested. For practice and policy-making, regulation on minimizing polyaromatic hydrocarbons exposure to protect respiratory health might need to be considered in future health and environmental policies and intervention programs.

  4. Analysis of Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome Defined on the Basis of Bronchodilator Response and Degree of Emphysema.

    Science.gov (United States)

    Cosentino, James; Zhao, Huaqing; Hardin, Megan; Hersh, Craig P; Crapo, James; Kim, Victor; Criner, Gerard J

    2016-09-01

    Despite the increasing recognition of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) as a clinical entity, it remains poorly characterized due to a lack of agreement on its definition and diagnostic criteria. The aim of this study was to use spirometry and computed tomography (CT) to help better define ACOS as well as to classify subjects with ACOS based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) letter grade. We analyzed 10,192 subjects enrolled in the COPDGene Study. Subjects were non-Hispanic white or African American current or former smokers aged 45-80 years with at least a 10-pack-year smoking history. Subjects were categorized as having either ACOS with a bronchodilator response or chronic obstructive pulmonary disease with emphysema on the basis of spirometry, high-resolution CT, and a history of asthma or hay fever. Subjects with ACOS were younger (60.6 vs. 65.9 years old; P emphysema can help define ACOS. When defined on the basis of bronchodilator responsiveness and degree of emphysema, patients with ACOS represent a unique and high-risk group with distinct clinical features.

  5. Inhaler use in adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema in the city of Pelotas, Brazil

    Directory of Open Access Journals (Sweden)

    Paula Duarte de Oliveira

    2013-06-01

    Full Text Available OBJECTIVE: To evaluate the characteristics of users of inhalers and the prevalence of inhaler use among adolescents and adults with self-reported physician-diagnosed asthma, bronchitis, or emphysema. METHODS: A population-based study conducted in the city of Pelotas, Brazil, involving 3,670 subjects ≥ 10 years of age, evaluated with a questionnaire. RESULTS: Approximately 10% of the sample reported at least one of the respiratory diseases studied. Among those individuals, 59% reported respiratory symptoms in the last year, and, of those, only half reported using inhalers. The use of inhalers differed significantly by socioeconomic status (39% and 61% for the lowest and the highest, respectively, p = 0.01. The frequency of inhaler use did not differ by gender or age. Among the individuals reporting emphysema and inhaler use, the use of the bronchodilator-corticosteroid combination was more common than was that of a bronchodilator alone. Only among the individuals reporting physician-diagnosed asthma and current symptoms was the proportion of inhaler users higher than 50%. CONCLUSIONS: In our sample, inhalers were underutilized, and the type of medication used by the individuals who reported emphysema does not seem to be in accordance with the consensus recommendations.

  6. Characteristics of phenotypes of elderly patients with asthma

    Directory of Open Access Journals (Sweden)

    Hiroyuki Sano

    2016-04-01

    Conclusions: Half of elderly patients with asthma are characterized by asthma-emphysema overlap. Our results showed that elderly patients with asthma who are smokers and have moderate or severe OAD are also likely to have emphysema.

  7. Pneumomediastinum and subcutaneous cervical emphysema ...

    African Journals Online (AJOL)

    PROF. EZECHUKWU

    2012-09-08

    Sep 8, 2012 ... to trauma or pathological disease state3, with gastroin- testinal and respiratory diseases most commonly impli- cated.4,5. The respiratory disease commonly associated with pneu- momediastinum and subcutaneous cervical emphysema is bronchial asthma.6 Pneumonia, though a very com- mon childhood ...

  8. Asthma

    Science.gov (United States)

    ... babies. Poor asthma control increases the risk of preeclampsia, a condition in which a pregnant woman develops ... other conditions that can interfere with your asthma management. Watch for Signs That Your Asthma Is Getting ...

  9. Asthma

    Science.gov (United States)

    ... their experiences with clinical research. More Information Related Health Topics Cough How the Lungs Work Oxygen Therapy Pulmonary Function Tests Other Resources NHLBI Resources "Asthma Action Plan" "Asthma and Physical Activity in the School" "At-A-Glance: Asthma" "How Asthma-Friendly Is ...

  10. Subcutaneous emphysema during status astmaticus

    Energy Technology Data Exchange (ETDEWEB)

    Schwarz, E.

    1985-09-01

    Spontaneous subcutaneous accumulations of air in the soft parts of the thorax during an asthmatic crisis (status asthmaticus) are rarely seen. The pathomechanism of the phenomenon, which may lead to the formation of an emphysema of the soft parts via the pneumomediastinum, is discussed, and the possible complications which must be taken into account are pointed out. The value of radiological examination of the thorax in children suffering from asthma bronchiale, is explained briefly. (orig.).

  11. Relationship between lung function and quantitative computed tomographic parameters of airway remodeling, air trapping, and emphysema in patients with asthma and chronic obstructive pulmonary disease: A single-center study.

    Science.gov (United States)

    Hartley, Ruth A; Barker, Bethan L; Newby, Chris; Pakkal, Mini; Baldi, Simonetta; Kajekar, Radhika; Kay, Richard; Laurencin, Marie; Marshall, Richard P; Sousa, Ana R; Parmar, Harsukh; Siddiqui, Salman; Gupta, Sumit; Brightling, Chris E

    2016-05-01

    There is a paucity of studies comparing asthma and chronic obstructive pulmonary disease (COPD) based on thoracic quantitative computed tomographic (QCT) parameters. We sought to compare QCT parameters of airway remodeling, air trapping, and emphysema between asthmatic patients and patients with COPD and explore their relationship with airflow limitation. Asthmatic patients (n = 171), patients with COPD (n = 81), and healthy subjects (n = 49) recruited from a single center underwent QCT and clinical characterization. Proximal airway percentage wall area (%WA) was significantly increased in asthmatic patients (62.5% [SD, 2.2]) and patients with COPD (62.7% [SD, 2.3]) compared with that in healthy control subjects (60.3% [SD, 2.2], P Emphysema assessed based on lung density measured by using Hounsfield units below which 15% of the voxels lie (Perc15) was a feature of COPD only (patients with COPD: mean, -964 [SD, 19.62] vs asthmatic patients: mean, -937 [SD, 22.7] and healthy subjects: mean, -937 [SD, 17.1], P < .001). Multiple regression analyses showed that the strongest predictor of lung function impairment in asthmatic patients was %WA, whereas in the COPD and asthma subgrouped with postbronchodilator FEV1 percent predicted value of less than 80%, it was air trapping. Factor analysis of QCT parameters in asthmatic patients and patients with COPD combined determined 3 components, with %WA, air trapping, and Perc15 values being the highest loading factors. Cluster analysis identified 3 clusters with mild, moderate, or severe lung function impairment with corresponding decreased lung density (Perc15 values) and increased air trapping. In asthmatic patients and patients with COPD, lung function impairment is strongly associated with air trapping, with a contribution from proximal airway narrowing in asthmatic patients. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  12. Asthma

    Directory of Open Access Journals (Sweden)

    Kim Harold

    2011-11-01

    Full Text Available Abstract Asthma is the most common respiratory disorder in Canada. Despite significant improvement in the diagnosis and management of this disorder, the majority of Canadians with asthma remain poorly controlled. In most patients, however, control can be achieved through the use of avoidance measures and appropriate pharmacological interventions. Inhaled corticosteroids (ICSs represent the standard of care for the majority of patients. Combination ICS/long-acting beta2-agonists (LABA inhalers are preferred for most adults who fail to achieve control with ICS therapy. Allergen-specific immunotherapy represents a potentially disease-modifying therapy for many patients with asthma, but should only be prescribed by physicians with appropriate training in allergy. Regular monitoring of asthma control, adherence to therapy and inhaler technique are also essential components of asthma management. This article provides a review of current literature and guidelines for the appropriate diagnosis and management of asthma.

  13. Asthma and COPD: Differences and Similarities

    Science.gov (United States)

    ... and COPD: differences and similarities Share | Asthma and COPD: Differences and Similarities This article has been reviewed ... or you could have Chronic Obstructive Pulmonary Disease (COPD) , such as emphysema or chronic bronchitis. Because asthma ...

  14. Emphysema and Alpha-1

    Science.gov (United States)

    ... emphysema, but generally they will only develop the disease if they are also cigarette smokers or have been exposed to excessive amounts of environmental pollution. When emphysema does develop in carriers, it is ...

  15. Crowdsourced emphysema assessment

    DEFF Research Database (Denmark)

    Ørting, Silas Nyboe; Cheplygina, Veronika; Petersen, Jens

    2017-01-01

    Classification of emphysema patterns is believed to be useful for improved diagnosis and prognosis of chronic obstructive pulmonary disease. Emphysema patterns can be assessed visually on lung CT scans. Visual assessment is a complex and time-consuming task performed by experts, making...... it unsuitable for obtaining large amounts of labeled data. We investigate if visual assessment of emphysema can be framed as an image similarity task that does not require expert. Substituting untrained annotators for experts makes it possible to label data sets much faster and at a lower cost. We use crowd...... annotators to gather similarity triplets and use t-distributed stochastic triplet embedding to learn an embedding. The quality of the embedding is evaluated by predicting expert assessed emphysema patterns. We find that although performance varies due to low quality triplets and randomness in the embedding...

  16. Fibrosis with emphysema.

    Science.gov (United States)

    Wright, Joanne L; Tazelaar, Henry D; Churg, Andrew

    2011-03-01

    The concept of fibrosis with emphysema is confused by the existence of two very different clinical/pathological scenarios: first, cases in which a diffuse fibrosing interstitial pneumonia, most commonly usual interstitial pneumonia (UIP), occurs in a patient with emphysema. This combination is largely of clinical interest because of its effects on pulmonary function and pulmonary hypertension, but can produce unusual appearances in surgical lung biopsies when the fibrotic areas are wrapped around emphysematous spaces. However, the underlying morphology of emphysema and UIP or other interstitial lung disease remains unchanged. Radiological consultation is often helpful to show that the patient has both lesions; secondly, cases in which there is localized fibrosis that is part of emphysema, or related to respiratory bronchiolitis, or both. These lesions have been called 'respiratory bronchiolitis' (RB), 'respiratory bronchiolitis-interstitial lung disease' (RB-ILD), 'airspace enlargement with fibrosis', 'RB-ILD with fibrosis' and 'clinically occult interstitial fibrosis in smokers', but are probably all the same entity. Such changes are associated only rarely with the physiological or radiological features of an interstitial lung disease. Care should be taken when describing these lesions in biopsies so as not to give the impression that a diffuse interstitial lung disease is present. © 2010 Blackwell Publishing Limited.

  17. Neuroinflammation, neurodegeneration, and depression.

    Science.gov (United States)

    Hurley, Laura L; Tizabi, Yousef

    2013-02-01

    Neurodegeneration and depression are two common co-morbid conditions, particularly within the aging population. Research has linked neuroinflammation as a major contributing factor to both of these diseases. The key to neuroinflammation effects on neurodegeneration and depression appears to lie within the dysregulation of the control and release of pro- and anti-inflammatory cytokines. This can come from an internal or external insult to the system, or from changes in the individual due to aging that culminate in immune dysregulation. The need to reduce neuroinflammation has led to extensive research into neuroprotectants. We discuss the efficacy found with nicotine, alcohol, resveratrol, curcumin, and ketamine. Our main focus will be on what research tells us about the connections between neuroinflammation, neurodegeneration, and depression, and the hope that neuroprotectants research gives people suffering from neurodegeneration and depression stemming from neuroinflammation. We will conclude by making suggestions for future research in this area.

  18. Alpha-1 Antitrypsin Deficiency (Inherited Emphysema)

    Science.gov (United States)

    ... general term used to describe diseases such as emphysema and chronic bronchitis. In emphysema there is damage to the walls of the ... alveoli) in the lungs. The earliest symptom of emphysema is shortness of breath during activity. Later the ...

  19. Crowdsourced emphysema assessment

    DEFF Research Database (Denmark)

    Ørting, Silas Nyboe; Petersen, Jens; Thomsen, Laura H.

    2017-01-01

    it unsuitable for obtaining large amounts of labeled data. We investigate if visual assessment of emphysema can be framed as an image similarity task that does not require expert. Substituting untrained annotators for experts makes it possible to label data sets much faster and at a lower cost. We use crowd......, we still achieve a median F1 score of 0.58 for prediction of four patterns....

  20. Early detection of emphysema progression

    DEFF Research Database (Denmark)

    Gorbunova, Vladlena; Jacobs, Sander S. A. M.; Lo, Pechin Chien Pau

    2010-01-01

    Emphysema is one of the most widespread diseases in subjects with smoking history. The gold standard method for estimating the severity of emphysema is a lung function test, such as forced expiratory volume in first second (FEV1). However, several clinical studies showed that chest CT scans offer...... score. We applied the proposed algorithm on 27 patients with severe emphysema with CT scans acquired five time points, at baseline, after 3, after 12, after 21 and after 24 or 30 months. The results showed consistent emphysema progression with time and the overall progression score correlates...

  1. Early detection of emphysema progression

    DEFF Research Database (Denmark)

    Gorbunova, Vladlena; Jacobs, Sander S A M; Lo, Pechin

    2010-01-01

    Emphysema is one of the most widespread diseases in subjects with smoking history. The gold standard method for estimating the severity of emphysema is a lung function test, such as forced expiratory volume in first second (FEV1). However, several clinical studies showed that chest CT scans offer...... emphysema progression from longitudinal chest CT scans. First, images are registered to a common system of coordinates and then local image dissimilarities are computed in corresponding anatomical locations. Finally, the obtained dissimilarity representation is converted into a single emphysema progression...

  2. Pulmonary emphysema and smoking

    Energy Technology Data Exchange (ETDEWEB)

    Satoh, Katashi; Murota, Makiko [Kagawa Medical Univ., Miki (Japan); Mitani, Masahiro (and others)

    2001-12-01

    We assessed the relation between PE and smoking in 1,563 cases (1,068 men and 495 women) who underwent CT scaring for suspicion of respiratory disease on chest radiograph or some respiratory complaints. PE was diagnosed by the existence of low attenuation areas in CT scan and not by pulmonary function tests. CT was performed with 10 mm collimation in a standard algorithm. There were 2 subtypes of pulmonary emphysema: centrilobular and paraseptal emphysema. PE, regardless of the grade, was seen: in 189 out of 348 (54.3%) cases in males smokers and in only 2 out of 63 (3.2%) cases in male non-smokers; and in 5 out of 25 (20.0%) in female smokers and in 4 out of 203 (2.0%) in female non-smokers. PE was observed in more than half of male smokers. High incidence of PE was also observed in even younger generation, and severity would progress with advancing age and smoking. Both types of emphysema progress with age and amount of cigarette smoking. (author)

  3. Image Processing Diagnostics: Emphysema

    Science.gov (United States)

    McKenzie, Alex

    2009-10-01

    Currently the computerized tomography (CT) scan can detect emphysema sooner than traditional x-rays, but other tests are required to measure more accurately the amount of affected lung. CT scan images show clearly if a patient has emphysema, but is unable by visual scan alone, to quantify the degree of the disease, as it appears merely as subtle, barely distinct, dark spots on the lung. Our goal is to create a software plug-in to interface with existing open source medical imaging software, to automate the process of accurately diagnosing and determining emphysema severity levels in patients. This will be accomplished by performing a number of statistical calculations using data taken from CT scan images of several patients representing a wide range of severity of the disease. These analyses include an examination of the deviation from a normal distribution curve to determine skewness, a commonly used statistical parameter. Our preliminary results show that this method of assessment appears to be more accurate and robust than currently utilized methods which involve looking at percentages of radiodensities in air passages of the lung.

  4. Massive subcutaneous emphysema with pneumoscrotopenis ...

    African Journals Online (AJOL)

    Chest injury commonly leads to subcutaneous emphysema of the chest, neck and face. It is usually non-life threatening. Massive subcutaneous emphysema may occur and very rarely may spread to involve the scrotal sac and subcutaneous tissue planes of the penis to cause pneumoscrotopenis. This case report presents ...

  5. Enteric neurodegeneration in ageing.

    Science.gov (United States)

    Camilleri, M; Cowen, T; Koch, T R

    2008-04-01

    The objective of this article is to review the clinical presentation and neurobiology of degeneration of the enteric nervous system with emphasis on human data where available. Constipation, incontinence and evacuation disorders are frequently encountered in the ageing population. Healthy lower gastrointestinal function is essential for successful ageing as it is critical to maintaining independence and autonomy to pursue further activity. One clinical expression of enteric neurodegeneration is constipation. However, the aetiology may be multifactorial as disturbances of epithelial, muscle or neural function may all result from neurodegeneration. There is evidence of loss of excitatory (e.g. cholinergic) enteric neurons and interstitial cells of Cajal, whereas inhibitory (including nitrergic) neurons appear unaffected. Understanding neurodegeneration in the enteric nervous system is key to developing treatments to reverse it. Neurotrophins have been shown to accelerate colonic transit and relieve constipation in the medium term; they are also implicated in maintenance programmes in adult enteric neurons through a role in antioxidant defence. However, their effects in ageing colon require further study. There is evidence that 5-HT(2) and 5-HT(4) mechanisms are involved in development, maintenance and survival of enteric neurons. Further research is needed to understand and potentially reverse enteric neurodegeneration.

  6. Towards exaggerated emphysema stereotypes

    Science.gov (United States)

    Chen, C.; Sørensen, L.; Lauze, F.; Igel, C.; Loog, M.; Feragen, A.; de Bruijne, M.; Nielsen, M.

    2012-03-01

    Classification is widely used in the context of medical image analysis and in order to illustrate the mechanism of a classifier, we introduce the notion of an exaggerated image stereotype based on training data and trained classifier. The stereotype of some image class of interest should emphasize/exaggerate the characteristic patterns in an image class and visualize the information the employed classifier relies on. This is useful for gaining insight into the classification and serves for comparison with the biological models of disease. In this work, we build exaggerated image stereotypes by optimizing an objective function which consists of a discriminative term based on the classification accuracy, and a generative term based on the class distributions. A gradient descent method based on iterated conditional modes (ICM) is employed for optimization. We use this idea with Fisher's linear discriminant rule and assume a multivariate normal distribution for samples within a class. The proposed framework is applied to computed tomography (CT) images of lung tissue with emphysema. The synthesized stereotypes illustrate the exaggerated patterns of lung tissue with emphysema, which is underpinned by three different quantitative evaluation methods.

  7. Oxidative Stress in Neurodegeneration

    Directory of Open Access Journals (Sweden)

    Varsha Shukla

    2011-01-01

    Full Text Available It has been demonstrated that oxidative stress has a ubiquitous role in neurodegenerative diseases. Major source of oxidative stress due to reactive oxygen species (ROS is related to mitochondria as an endogenous source. Although there is ample evidence from tissues of patients with neurodegenerative disorders of morphological, biochemical, and molecular abnormalities in mitochondria, it is still not very clear whether the oxidative stress itself contributes to the onset of neurodegeneration or it is part of the neurodegenerative process as secondary manifestation. This paper begins with an overview of how oxidative stress occurs, discussing various oxidants and antioxidants, and role of oxidative stress in diseases in general. It highlights the role of oxidative stress in neurodegenerative diseases like Alzheimer's, Parkinson's, and Huntington's diseases and amyotrophic lateral sclerosis. The last part of the paper describes the role of oxidative stress causing deregulation of cyclin-dependent kinase 5 (Cdk5 hyperactivity associated with neurodegeneration.

  8. Towards exaggerated emphysema stereotypes

    DEFF Research Database (Denmark)

    Chen, Chen; Sørensen, Lauge; Lauze, Francois Bernard

    2012-01-01

    We introduce the notion of an exaggerated image stereotype for some image class of interest, which emphasizes/exaggerates the characteristic patterns in an image class and visualizes what visual information the classication relies on. This is useful for gaining insight into the classi cation...... and serves for comparison with thebiological models of disease. We build the exaggerated image stereotypes by optimizing an objective function which consists of a discriminativeterm based on the classi cation accuracy, and a generative term based on the class distribution. Agradient descent method...... is employed for optimization. We use this idea with Fisher's Linear Discriminant rule,and assume a multivariate normal distribution for samples within a class. The proposed framework is appliedto computed tomography (CT) images of lung tissue with emphysema. The synthesized stereotypes illustratethe...

  9. Cardiovascular function in pulmonary emphysema.

    Science.gov (United States)

    Visca, Dina; Aiello, Marina; Chetta, Alfredo

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) and chronic cardiovascular disease, such as coronary artery disease, congestive heart failure, and cardiac arrhythmias, have a strong influence on each other, and systemic inflammation has been considered as the main linkage between them. On the other hand, airflow limitation may markedly affect lung mechanics in terms of static and dynamic hyperinflation, especially in pulmonary emphysema, and they can in turn influence cardiac performance as well. Skeletal mass depletion, which is a common feature in COPD especially in pulmonary emphysema patients, may have also a role in cardiovascular function of these patients, irrespective of lung damage. We reviewed the emerging evidence that highlights the role of lung mechanics and muscle mass impairment on ventricular volumes, stroke volume, and stroke work at rest and on exercise in the presence of pulmonary emphysema. Patients with emphysema may differ among COPD population even in terms of cardiovascular function.

  10. Viruses and neurodegeneration.

    Science.gov (United States)

    Zhou, Li; Miranda-Saksena, Monica; Saksena, Nitin K

    2013-05-31

    Neurodegenerative diseases (NDs) are chronic degenerative diseases of the central nervous system (CNS), which affect 37 million people worldwide. As the lifespan increases, the NDs are the fourth leading cause of death in the developed countries and becoming increasingly prevalent in developing countries. Despite considerable research, the underlying mechanisms remain poorly understood. Although the large majority of studies do not show support for the involvement of pathogenic aetiology in classical NDs, a number of emerging studies show support for possible association of viruses with classical neurodegenerative diseases in humans. Space does not permit for extensive details to be discussed here on non-viral-induced neurodegenerative diseases in humans, as they are well described in literature.Viruses induce alterations and degenerations of neurons both directly and indirectly. Their ability to attack the host immune system, regions of nervous tissue implies that they can interfere with the same pathways involved in classical NDs in humans. Supporting this, many similarities between classical NDs and virus-mediated neurodegeneration (non-classical) have been shown at the anatomic, sub-cellular, genomic and proteomic levels suggesting that viruses can explain neurodegenerative disorders mechanistically. The main objective of this review is to provide readers a detailed snapshot of similarities viral and non-viral neurodegenerative diseases share, so that mechanistic pathways of neurodegeneration in human NDs can be clearly understood. Viruses can guide us to unveil these pathways in human NDs. This will further stimulate the birth of new concepts in the biological research, which is needed for gaining deeper insights into the treatment of human NDs and delineate mechanisms underlying neurodegeneration.

  11. Spontaneous Retropharyngeal Emphysema: A Case Report | Chi ...

    African Journals Online (AJOL)

    ... is a rare clinical condition in pediatric otolaryngology. The predominant symptoms are sore throat, odynophagia, dysphagia, and neck pain. Here, we report a case of spontaneous retropharyngeal emphysema. Keywords: Iatrogenic injury, retropharyngeal emphysema, spontaneous retropharyngeal emphysem, trauma ...

  12. Thyroid Emphysema Following Penetrating Neck Trauma

    OpenAIRE

    Demet Karadağ; Egemen Doner; Baki Adapınar

    2011-01-01

    Although traumatic thyroid gland rupture or hemorrhage is usually seen in goitrous glands, injuries of the normal thyroid gland after neck trauma have rarely been described in the literature. We describe a 44-year-old man who presented with thyroid emphysema and subcutaneous emphysema (SCE) that occurred after penetrating neck trauma. CT images showed complete resolution of thyroid emphysema and subcutaneous emphysema at follow-up examination. Neck injuries can be life threatening. After pene...

  13. Thyroid Emphysema Following Penetrating Neck Trauma

    Directory of Open Access Journals (Sweden)

    Demet Karadağ

    2011-03-01

    Full Text Available Although traumatic thyroid gland rupture or hemorrhage is usually seen in goitrous glands, injuries of the normal thyroid gland after neck trauma have rarely been described in the literature. We describe a 44-year-old man who presented with thyroid emphysema and subcutaneous emphysema (SCE that occurred after penetrating neck trauma. CT images showed complete resolution of thyroid emphysema and subcutaneous emphysema at follow-up examination. Neck injuries can be life threatening. After penetrating neck traumas, physicians should consider subtle esophageal or tracheal laceration. Thyroid emphysema can occur as the result of penetrating neck trauma. The mechanism of emphysema of the thyroid parenchyma can be explained by the thyroid gland’s presence in a single visceral compartment that encompasses the larynx, trachea and thyroid gland. We describe an unusual case of thyroid emphysema of a normal thyroid gland following a penetrating neck injury.

  14. Functional Characterization of a Porcine Emphysema Model

    DEFF Research Database (Denmark)

    Bruun, Camilla Sichlau; Jensen, Louise Kruse; Leifsson, Páll Skuli

    2013-01-01

    Lung emphysema is a central feature of chronic obstructive pulmonary disease (COPD), a frequent human disease worldwide. Cigarette smoking is the major cause of COPD, but genetic predisposition seems to be an important factor. Mutations in surfactant protein genes have been linked to COPD...... phenotypes in humans. Also, the catalytic activities of metalloproteinases (MMPs) are central in the pathogenesis of emphysema/COPD. Especially MMP9, but also MMP2, MMP7, and MMP12 seem to be involved in human emphysema. MMP12−/− mice are protected from smoke-induced emphysema. ITGB6−/− mice spontaneously...... with and without emphysema, and no systemic differences were indicated by the haematologic and immunologic studies. However, the immunohistochemical stainings showed an increased expression of MMP9 and MMP12 in older, mutated pigs (with emphysema) compared with normal and young mutated pigs (without emphysema...

  15. Pneumomediastinum and subcutaneous cervical emphysema ...

    African Journals Online (AJOL)

    PROF. EZECHUKWU

    2012-09-08

    Sep 8, 2012 ... department with a history of increasing difficulty with breathing and ... ward and commenced on intravenous antibiotics and high flow oxygen. He made remarkable improvement with complete resolution of subcutaneous emphysema on the 4th day ... the left lateral decubitus position.18 Our patient met most.

  16. Lung volume reduction for emphysema

    NARCIS (Netherlands)

    Shah, Pallav L.; Herth, Felix J.; van Geffen, Wouter H.; Deslee, Gaetan; Slebos, Dirk-Jan

    Advanced emphysema is a lung disease in which alveolar capillary units are destroyed and supporting tissue is lost. The combined effect of reduced gas exchange and changes in airway dynamics impairs expiratory airflow and leads to progressive air trapping. Pharmacological therapies have limited

  17. Asthma Basics

    Science.gov (United States)

    ... Giving Teens a Voice in Health Care Decisions Asthma KidsHealth > For Parents > Asthma Print A A A ... Should I Know? en español Asma What Is Asthma? Asthma is a condition that causes breathing problems. ...

  18. Neurodegeneration in accelerated aging.

    Science.gov (United States)

    Scheibye-Knudsen, Moren

    2016-11-01

    The growing proportion of elderly people represents an increasing economic burden, not least because of age-associated diseases that pose a significant cost to the health service. Finding possible interventions to age-associated disorders therefore have wide ranging implications. A number of genetically defined accelerated aging diseases have been characterized that can aid in our understanding of aging. Interestingly, all these diseases are associated with defects in the maintenance of our genome. A subset of these disorders, Cockayne syndrome, Xeroderma pigmentosum group A and ataxia-telangiectasia, show neurological involvement reminiscent of what is seen in primary human mitochondrial diseases. Mitochondria are the power plants of the cells converting energy stored in oxygen, sugar, fat, and protein into ATP, the energetic currency of our body. Emerging evidence has linked this organelle to aging and finding mitochondrial dysfunction in accelerated aging disorders thereby strengthens the mitochondrial theory of aging. This theory states that an accumulation of damage to the mitochondria may underlie the process of aging. Indeed, it appears that some accelerated aging disorders that show neurodegeneration also have mitochondrial dysfunction. The mitochondrial alterations may be secondary to defects in nuclear DNA repair. Indeed, nuclear DNA damage may lead to increased energy consumption, alterations in mitochondrial ATP production and defects in mitochondrial recycling, a term called mitophagy. These changes may be caused by activation of poly-ADP-ribose-polymerase 1 (PARP1), an enzyme that responds to DNA damage. Upon activation PARP1 utilizes key metabolites that attenuate pathways that are normally protective for the cell. Notably, pharmacological inhibition of PARP1 or reconstitution of the metabolites rescues the changes caused by PARP1 hyperactivation and in many cases reverse the phenotypes associated with accelerated aging. This implies that modulation

  19. Emphysema Distribution and Diffusion Capacity Predict Emphysema Progression in Human Immunodeficiency Virus Infection

    Science.gov (United States)

    Leung, Janice M; Malagoli, Andrea; Santoro, Antonella; Besutti, Giulia; Ligabue, Guido; Scaglioni, Riccardo; Dai, Darlene; Hague, Cameron; Leipsic, Jonathon; Sin, Don D.; Man, SF Paul; Guaraldi, Giovanni

    2016-01-01

    Background Chronic obstructive pulmonary disease (COPD) and emphysema are common amongst patients with human immunodeficiency virus (HIV). We sought to determine the clinical factors that are associated with emphysema progression in HIV. Methods 345 HIV-infected patients enrolled in an outpatient HIV metabolic clinic with ≥2 chest computed tomography scans made up the study cohort. Images were qualitatively scored for emphysema based on percentage involvement of the lung. Emphysema progression was defined as any increase in emphysema score over the study period. Univariate analyses of clinical, respiratory, and laboratory data, as well as multivariable logistic regression models, were performed to determine clinical features significantly associated with emphysema progression. Results 17.4% of the cohort were emphysema progressors. Emphysema progression was most strongly associated with having a low baseline diffusion capacity of carbon monoxide (DLCO) and having combination centrilobular and paraseptal emphysema distribution. In adjusted models, the odds ratio (OR) for emphysema progression for every 10% increase in DLCO percent predicted was 0.58 (95% confidence interval [CI] 0.41–0.81). The equivalent OR (95% CI) for centrilobular and paraseptal emphysema distribution was 10.60 (2.93–48.98). Together, these variables had an area under the curve (AUC) statistic of 0.85 for predicting emphysema progression. This was an improvement over the performance of spirometry (forced expiratory volume in 1 second to forced vital capacity ratio), which predicted emphysema progression with an AUC of only 0.65. Conclusion Combined paraseptal and centrilobular emphysema distribution and low DLCO could identify HIV patients who may experience emphysema progression. PMID:27902753

  20. Computer quantification of "angle of collapse" on maximum expiratory flow volume curve for diagnosing asthma-COPD overlap syndrome.

    Science.gov (United States)

    Wang, Wei; Xie, Mengshuang; Dou, Shuang; Cui, Liwei; Xiao, Wei

    2016-01-01

    In a previous study, we demonstrated that asthma patients with signs of emphysema on quantitative computed tomography (CT) fulfill the diagnosis of asthma-COPD overlap syndrome (ACOS). However, quantitative CT measurements of emphysema are not routinely available for patients with chronic airway disease, which limits their application. Spirometry was a widely used examination tool in clinical settings and shows emphysema as a sharp angle in the maximum expiratory flow volume (MEFV) curve, called the "angle of collapse (AC)". The aim of this study was to investigate the value of the AC in the diagnosis of emphysema and ACOS. This study included 716 participants: 151 asthma patients, 173 COPD patients, and 392 normal control subjects. All the participants underwent pulmonary function tests. COPD and asthma patients also underwent quantitative CT measurements of emphysema. The AC was measured using computer models based on Matlab software. The value of the AC in the diagnosis of emphysema and ACOS was evaluated using receiver-operating characteristic (ROC) curve analysis. The AC of COPD patients was significantly lower than that of asthma patients and control subjects. The AC was significantly negatively correlated with emphysema index (EI; r=-0.666, P<0.001), and patients with high EI had a lower AC than those with low EI. The ROC curve analysis showed that the AC had higher diagnostic efficiency for high EI (area under the curve =0.876) than did other spirometry parameters. In asthma patients, using the AC ≤137° as a surrogate criterion for the diagnosis of ACOS, the sensitivity and specificity were 62.5% and 89.1%, respectively. The AC on the MEFV curve quantified by computer models correlates with the extent of emphysema. The AC may become a surrogate marker for the diagnosis of emphysema and help to diagnose ACOS.

  1. DNA repair deficiency in neurodegeneration

    DEFF Research Database (Denmark)

    Jeppesen, Dennis Kjølhede; Bohr, Vilhelm A; Stevnsner, Tinna V.

    2011-01-01

    causing Huntington's disease. Single-strand breaks are common DNA lesions and are associated with the neurodegenerative diseases, ataxia-oculomotor apraxia-1 and spinocerebellar ataxia with axonal neuropathy-1. DNA double-strand breaks are toxic lesions and two main pathways exist for their repair......: homologous recombination and non-homologous end-joining. Ataxia telangiectasia and related disorders with defects in these pathways illustrate that such defects can lead to early childhood neurodegeneration. Aging is a risk factor for neurodegeneration and accumulation of oxidative mitochondrial DNA damage...

  2. Virus-induced exacerbations in asthma and COPD

    Directory of Open Access Journals (Sweden)

    Daisuke eKurai

    2013-10-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is characterized by chronic airway inflammation and/or airflow limitation due to pulmonary emphysema. Chronic bronchitis, pulmonary emphysema, and bronchial asthma may all be associated with airflow limitation; therefore, exacerbation of asthma may be associated with the pathophysiology of COPD. Furthermore, recent studies have suggested that the exacerbation of asthma, namely virus-induced asthma, may be associated with a wide variety of respiratory viruses.COPD and asthma have different underlying pathophysiological processes and thus require individual therapies. Exacerbation of both COPD and asthma, which are basically defined and diagnosed by clinical symptoms, is associated with a rapid decline in lung function and increased mortality. Similar pathogens, including human rhinovirus, respiratory syncytial virus, influenza virus, parainfluenza virus and coronavirus, are also frequently detected during exacerbation of asthma and/or COPD. Immune response to respiratory viral infections, which may be related to the severity of exacerbation in each disease, varies in patients with both COPD and asthma. In this regard, it is crucial to recognize and understand both the similarities and differences of clinical features in patients with COPD and/or asthma associated with respiratory viral infections, especially in the exacerbative stage.In relation to definition, epidemiology, and pathophysiology, this review aims to summarize current knowledge concerning exacerbation of both COPD and asthma by focusing on the clinical significance of associated respiratory virus infections.

  3. Initiation and propagation of neurodegeneration.

    Science.gov (United States)

    Haass, Christian

    2010-11-01

    Although substantial progress has been made in understanding the molecular and pathological bases of neurodegeneration, there have been few successes in the clinic and a number of fundamental questions remain unanswered. Is this skepticism misplaced, or do the words of Sir Isaac Newton hold true, that "what we know is a drop, what we don't know is an ocean"?

  4. Neurodegeneration in the diabetic eye

    DEFF Research Database (Denmark)

    Simó, Rafael; Hernández, Cristina; Bandello, F

    2014-01-01

    Diabetic retinopathy (DR), one of the leading causes of preventable blindness, has been considered a microcirculatory disease of the retina. However, there is emerging evidence to suggest that retinal neurodegeneration is an early event in the pathogenesis of DR, which participates in the develop...

  5. DNA Repair Deficiency in Neurodegeneration

    Science.gov (United States)

    Jeppesen, Dennis Kjølhede; Bohr, Vilhelm A.; Stevnsner, Tinna

    2011-01-01

    Deficiency in repair of nuclear and mitochondrial DNA damage has been linked to several neurodegenerative disorders. Many recent experimental results indicate that the post-mitotic neurons are particularly prone to accumulation of unrepaired DNA lesions potentially leading to progressive neurodegeneration. Nucleotide excision repair is the cellular pathway responsible for removing helix-distorting DNA damage and deficiency in such repair is found in a number of diseases with neurodegenerative phenotypes, including Xeroderma Pigmentosum and Cockayne syndrome. The main pathway for repairing oxidative base lesions is base excision repair, and such repair is crucial for neurons given their high rates of oxygen metabolism. Mismatch repair corrects base mispairs generated during replication and evidence indicates that oxidative DNA damage can cause this pathway to expand trinucleotide repeats, thereby causing Huntington’s disease. Single-strand breaks are common DNA lesions and are associated with the neurodegenerative diseases, ataxia-oculomotor apraxia-1 and spinocerebellar ataxia with axonal neuropathy-1. DNA double-strand breaks are toxic lesions and two main pathways exist for their repair: homologous recombination and non-homologous end-joining. Ataxia telangiectasia and related disorders with defects in these pathways illustrate that such defects can lead to early childhood neurodegeneration. Aging is a risk factor for neurodegeneration and accumulation of oxidative mitochondrial DNA damage may be linked with the age-associated neurodegenerative disorders Alzheimer’s disease, Parkinson’s disease and amyotrophic lateral sclerosis. Mutation in the WRN protein leads to the premature aging disease Werner syndrome, a disorder that features neurodegeneration. In this article we review the evidence linking deficiencies in the DNA repair pathways with neurodegeneration. PMID:21550379

  6. Evolution of emphysema in relation to smoking

    Energy Technology Data Exchange (ETDEWEB)

    Bellomi, Massimo [European Institute of Oncology, Department of Radiology, Milan (Italy); University of Milan - IT, School of Medicine, Milan (Italy); Rampinelli, Cristiano [European Institute of Oncology, Department of Radiology, Milan (Italy); Veronesi, Giulia [European Institute of Oncology, Department of Thoracic Surgery, Milan (Italy); Harari, Sergio [Fatebenefratelli-Milanocuore, Pneumology Operative Unit, San Giuseppe Hospital, Milan (Italy); Lanfranchi, Federica [University of Milan - IT, School of Medicine, Milan (Italy); Raimondi, Sara; Maisonneuve, Patrick [European Institute of Oncology, Department of Epidemiology and Biostatistics, Milan (Italy)

    2010-02-15

    We have little knowledge about the evolution of emphysema, and relatively little is understood about its evolution in relation to smoking habits. This study aims to assess the evolution of emphysema in asymptomatic current and former smokers over 2 years and to investigate the association with subjects' characteristics. The study was approved by our Ethics Committee and all participants provided written informed consent. We measured emphysema by automatic low-dose computed tomography densitometry in 254 current and 282 former smokers enrolled in a lung-cancer screening. The measures were repeated after 2 years. The association between subjects' characteristics, smoking habits and emphysema were assessed by chi-squared and Wilcoxon tests. Univariate and multivariate odds ratios (OR) with 95% confidence intervals (CI) were calculated for the risk of emphysema worsening according to subjects' characteristics. We assessed the trend of increasing risk of emphysema progression by smoking habits using the Mantel-Haenszel chi-squared test. The median percentage increase in emphysema over a 2-year period was significantly higher in current than in former smokers (OR 1.8; 95% CI 1.3-2.6; p < 0.0001). The risk of worsening emphysema (by 30% in 2 years) in current smokers increased with smoking duration (p for trend <0.02). As emphysema is a known risk factor for lung cancer, its evaluation could be used as a potential factor for identification of a high-risk population. The evaluation of emphysema progression can be added to low-dose CT screening programmes to inform and incite participants to stop smoking. (orig.)

  7. Asthma education

    African Journals Online (AJOL)

    2011-01-01

    ). Allergy and Asthma Clinic, Red Cross War Memorial Hospital. Mike Levin runs a secondary level asthma/ allergy clinic and does a tertiary allergy session once a week, focusing on difficult asthma and food allergies. He has ...

  8. Lung volume reduction for emphysema.

    Science.gov (United States)

    Shah, Pallav L; Herth, Felix J; van Geffen, Wouter H; Deslee, Gaetan; Slebos, Dirk-Jan

    2017-02-01

    Advanced emphysema is a lung disease in which alveolar capillary units are destroyed and supporting tissue is lost. The combined effect of reduced gas exchange and changes in airway dynamics impairs expiratory airflow and leads to progressive air trapping. Pharmacological therapies have limited effects. Surgical resection of the most destroyed sections of the lung can improve pulmonary function and exercise capacity but its benefit is tempered by significant morbidity. This issue stimulated a search for novel approaches to lung volume reduction. Alternative minimally invasive approaches using bronchoscopic techniques including valves, coils, vapour thermal ablation, and sclerosant agents have been at the forefront of these developments. Insertion of endobronchial valves in selected patients could have benefits that are comparable with lung volume reduction surgery. Endobronchial coils might have a role in the treatment of patients with emphysema with severe hyperinflation and less parenchymal destruction. Use of vapour thermal energy or a sclerosant might allow focal treatment but the unpredictability of the inflammatory response limits their current use. In this Review, we aim to summarise clinical trial evidence on lung volume reduction and provide guidance on patient selection for available therapies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Combined Pulmonary Fibrosis and Emphysema Syndrome

    Science.gov (United States)

    Rounds, Sharon I. S.

    2012-01-01

    There is increasing clinical, radiologic, and pathologic recognition of the coexistence of emphysema and pulmonary fibrosis in the same patient, resulting in a clinical syndrome known as combined pulmonary fibrosis and emphysema (CPFE) that is characterized by dyspnea, upper-lobe emphysema, lower-lobe fibrosis, and abnormalities of gas exchange. This syndrome frequently is complicated by pulmonary hypertension, acute lung injury, and lung cancer. The CPFE syndrome typically occurs in male smokers, and the mortality associated with this condition, especially if pulmonary hypertension is present, is significant. In this review, we explore the current state of the literature and discuss etiologic factors and clinical characteristics of the CPFE syndrome. PMID:22215830

  10. [Orbital emphysema: radiologic and ophthalmologic findings].

    Science.gov (United States)

    Solanas-Álava, Susana; Rodríguez-Marco, Nelson Arturo; Artigas-Martín, José María; Fernández-Larripa, Sonia

    2017-01-01

    Orbital emphysema, or the presence of air in orbital tissues, is normally associated with an injury although it can arise when a Valsalva maneuver causes an increase in upper airway pressure. This potential complication of an orbital wall fracture, usually in the ethmoid bone, occurs in 50% of such cases. On fracture, air passes from the nasal fossa, sinuses, or subcutaneous tissue. The condition is benign and transient in most cases, and loss of vision is rare. No protocol for treating orbital emphysema with serious complications in which vision is affected has been established. We report 9 cases of orbital emphysema, describing events leading to the fractures, radiologic findings, and treatments.

  11. Severity of pulmonary emphysema and lung cancer: analysis using quantitative lobar emphysema scoring

    Science.gov (United States)

    Bae, Kyungsoo; Jeon, Kyung Nyeo; Lee, Seung Jun; Kim, Ho Cheol; Ha, Ji Young; Park, Sung Eun; Baek, Hye Jin; Choi, Bo Hwa; Cho, Soo Buem; Moon, Jin Il

    2016-01-01

    Abstract The aim of this study was to determine the relationship between lobar severity of emphysema and lung cancer using automated lobe segmentation and emphysema quantification methods. This study included 78 patients (74 males and 4 females; mean age of 72 years) with the following conditions: pathologically proven lung cancer, available chest computed tomographic (CT) scans for lobe segmentation, and quantitative scoring of emphysema. The relationship between emphysema and lung cancer was analyzed using quantitative emphysema scoring of each pulmonary lobe. The most common location of cancer was the left upper lobe (LUL) (n = 28), followed by the right upper lobe (RUL) (n = 27), left lower lobe (LLL) (n = 13), right lower lobe (RLL) (n = 9), and right middle lobe (RML) (n = 1). Emphysema ratio was the highest in LUL, followed by that in RUL, LLL, RML, and RLL. Multivariate logistic regression analysis revealed that upper lobes (odds ratio: 1.77; 95% confidence interval: 1.01–3.11, P = 0.048) and lobes with emphysema ratio ranked the 1st or the 2nd (odds ratio: 2.48; 95% confidence interval: 1.48–4.15, P emphysema patients, lung cancer has a tendency to develop in lobes with more severe emphysema. PMID:27902611

  12. Cervical surgical emphysema following routine tonsillectomy.

    LENUS (Irish Health Repository)

    Al Omari, B

    2011-01-01

    Complications of tonsillectomy have been well documented. However spontaneous subcutaneous emphysema of the neck following tonsillectomy has rarely been described. We report a case of this complication in a young female patient.

  13. Massive Subcutaneous Emphysema in Robotic Sacrocolpopexy

    Science.gov (United States)

    Celik, Hatice; Cremins, Angela; Jones, Keisha A.

    2013-01-01

    The advent of robotic surgery has increased the popularity of laparoscopic sacrocolpopexy. Carbon dioxide insufflation, an essential component of laparoscopy, may rarely cause massive subcutaneous emphysema, which may be coincident with life-threatening situations such as hypercarbia, pneumothorax, and pneumomediastinum. Although the literature contains several reports of massive subcutaneous emphysema after a variety of laparoscopic procedures, we were not able to identify any report of this complication associated with laparoscopic or robotic sacrocolpopexy. Massive subcutaneous emphysema occurred in 3 women after robotic sacrocolpopexy in our practice. The patients had remarkable but reversible physical deformities lasting up to 1 week. A valveless endoscopic dynamic pressure system was used in all 3 of our cases. Our objective is to define the risk of massive subcutaneous emphysema during robotic sacrocolpopexy in light of these cases and discuss probable predisposing factors including the use of valveless endoscopic dynamic pressure trocars. PMID:23925018

  14. Pulmonary emphysema subtypes on computed tomography: the MESA COPD study.

    Science.gov (United States)

    Smith, Benjamin M; Austin, John H M; Newell, John D; D'Souza, Belinda M; Rozenshtein, Anna; Hoffman, Eric A; Ahmed, Firas; Barr, R Graham

    2014-01-01

    Pulmonary emphysema is divided into 3 major subtypes at autopsy: centrilobular, paraseptal, and panlobular emphysema. These subtypes can be defined by visual assessment on computed tomography (CT); however, clinical characteristics of emphysema subtypes on CT are not well defined. We developed a reliable approach to visual assessment of emphysema subtypes on CT and examined if emphysema subtypes have distinct characteristics. The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with chronic obstructive pulmonary disease (COPD) and controls ages 50-79 years with ≥ 10 pack-years. Participants underwent CT following a standardized protocol. Definitions of centrilobular, paraseptal, and panlobular emphysema were obtained by literature review. Six-minute walk distance and pulmonary function were performed following guidelines. Twenty-seven percent of 318 smokers had emphysema on CT. Interrater reliability of emphysema subtype was substantial (K: 0.70). Compared with participants without emphysema, individuals with centrilobular or panlobular emphysema had greater dyspnea, reduced walk distance, greater hyperinflation, and lower diffusing capacity. In contrast, individuals with paraseptal emphysema were similar to controls, except for male predominance. Centrilobular, but not panlobular or paraseptal, emphysema was associated with greater smoking history (+21 pack-years P emphysema, was associated with reduced body mass index (-5 kg/m(2); P = .01). Other than for dyspnea, these findings were independent of the forced expiratory volume in 1 second. Seventeen percent of smokers without COPD on spirometry had emphysema, which was independently associated with reduced walk distance. Emphysema subtypes on CT are common in smokers with and without COPD. Centrilobular and panlobular emphysema, but not paraseptal emphysema, have considerable symptomatic and physiological consequences. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Asthma Research

    Science.gov (United States)

    EPA is working to explore the role of common air pollutants in the development and exacerbation of asthma at different life stages as well as other environmental and genetic factors that might make a person more sensitive to developing asthma.

  16. The impact of emphysema in pulmonary fibrosis

    Directory of Open Access Journals (Sweden)

    Vincent Cottin

    2013-06-01

    Full Text Available Several groups have described a syndrome in which idiopathic pulmonary fibrosis (IPF coexists with pulmonary emphysema. This comes as no surprise since both diseases are associated with a history of exposure to cigarette smoke. The syndrome of combined pulmonary fibrosis and emphysema (CPFE is characterised by upper lobe emphysema and lower lobe fibrosis. Physiological testing of these patients reveals preserved lung volume indices contrasted by markedly impaired diffusion capacity. The incidence of CPFE remains unknown but several case series suggest that this subgroup may comprise up to 35% of patients with IPF. CPFE is a strong determinant of associated pulmonary hypertension (PH. In addition, CPFE has major effects on measures of physiological function, exercise capacity and prognosis, and may affect the results of pulmonary fibrosis trials. Further studies are needed to ascertain the aetiology, morbidity, mortality and management of the CPFE syndrome, with or without PH, and to evaluate novel therapeutic options in CPFE.

  17. Pulmonary Emphysema Subtypes on Computed Tomography in Smokers

    Science.gov (United States)

    Smith, Benjamin M.; Austin, John H.M.; Newell, John D.; D’Souza, Belinda M.; Rozenshtein, Anna; Hoffman, Eric A.; Ahmed, Firas; Barr, R. Graham

    2013-01-01

    Background Pulmonary emphysema is divided into three major subtypes at autopsy: centrilobular, paraseptal and panlobular emphysema. These subtypes can be defined by visual assessment on computed tomography (CT); however, clinical characteristics of emphysema subtypes on CT are not well-defined. We developed a reliable approach to visual assessment of emphysema subtypes on CT and examined if emphysema subtypes have distinct characteristics. Methods The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with COPD and controls age 50–79 years with ≥10 pack-years. Participants underwent CT following a standardized protocol. Definitions of centrilobular, paraseptal and panlobular emphysema were obtained by literature review. Six-minute walk distance and pulmonary function were performed following guidelines. Results Twenty-seven percent of 318 smokers had emphysema on CT. Inter-rater reliability of emphysema subtype was substantial (K:0.70). Compared to participants without emphysema, individuals with centrilobular or panlobular emphysema had greater dyspnea, reduced walk distance, greater hyperinflation, and lower diffusing capacity. In contrast, individuals with PSE were similar to controls, except for male predominance. Centrilobular but not panlobular or paraseptal emphysema was associated with greater smoking history (+21 pack-years Pemphysema was associated with reduced body mass index (−5 kg/m2;P=0.01). Other than for dyspnea, these findings were independent of the forced expiratory volume in one second. Seventeen percent of smokers without COPD on spirometry had emphysema, which was independently associated with reduced walk distance. Conclusions Emphysema subtypes on CT are common in smokers with and without COPD. Centrilobular and panlobular emphysema but not paraseptal emphysema have considerable symptomatic and physiological consequences. PMID:24384106

  18. An Unusual Presentation of Congenital Lobar Emphysema

    Directory of Open Access Journals (Sweden)

    Daniel Arnaud

    2017-01-01

    Full Text Available Congenital lobar emphysema is an uncommon bronchopulmonary malformation characterized by lobar overinflation and accompanying alveolar septum damage that leads to compression atelectasis of the lung parenchyma and displacement of mediastinal structures, with the resultant ventilation-perfusion mismatch. We present a case of a 33-year-old lady with progressive exertional dyspnea. Chest radiograph findings lead to the suspicion of congenital lobar emphysema, which was then confirmed by a computed tomography (CT scan. This condition is most commonly identified in newborns, with very few cases being reported in adults. Lobectomy remains the treatment of choice and in general has good outcome.

  19. Clinical review: Endobronchial valve treatment for emphysema.

    Science.gov (United States)

    Jarad, Nabil

    2016-05-01

    Breathlessness and impaired quality of life are prominent features in patients with severe emphysema even when conventional methods of treatment are optimal. Lung volume reduction using endobronchial management for emphysema has emerged as a new method to relieve symptoms and improve lung function tests in this group. The endobronchial valves (EBVs) are the most widely used treatment. This article outlines current criteria of patients' selection with literature review and evidence of efficacy. Complications of EBV insertion as well as current shortfalls of this method of treatment are also discussed. © The Author(s) 2016.

  20. CT analysis of lung cancer and coexistent emphysema

    Energy Technology Data Exchange (ETDEWEB)

    Noh, Kyung Hee; Chung, Myung Hee; Sung, Mi Sook; Yoo, Won Jong; Son, Kyung Myung; Son, Jung Min; Park, Seog Hee [College of Medicine, The Catholic Univ. of Korea, Bucheon (Korea, Republic of)

    2004-08-01

    To evaluate the relation of the location and cell type of lung cancer to the location and degree in coexistent emphysema on high-resolution computed tomography (HRCT) scans. Ninety-eight of 209 lung cancer patients having HRCT scans were retrospectively analyzed to assess the total lung emphysema and peritumoral regional emphysema. Single and primary lung cancers were included. The clinical data, including sex, age, smoking history and the pathologic cancer subtype, were recorded to correlate with the HRCT findings. The lobar distribution, central-peripheral predominance, surrounding parenchymal abnormality for cancer, cephalocaudal predominance, and subtype for emphysema were analyzed on HRCT. Using a CT scoring method, we scored the whole lung emphysema and peritumoral emphysema, and correlated the grading of emphysema with pulmonary functional values. Sixty-nine of 98 patients with lung cancer (71%) had emphysema. Lung cancer with emphysema was significantly higher in men than in women, and was significantly related to smoking. The mean age of cancer patients without emphysema was significantly lower than that of cancer patients with emphysema (68 yrs vs. 61 yrs, p= 0.0006). Emphysema of grade I (0-25%) was found in 52 cases, grade II (25-50%) in 15, and grade III (50-75%) in 2. Total emphysema score was paralleled to peritumoral emphysema score in 64.3%, while the remaining patients had a higher peritumoral emphysema score (grade II or III) than total emphysema score (grade 0 or I). There was no statistical correlation in the developmental location between the emphysema and the lung cancer (significant correlation was only noted in grade II group of total emphysema score). The incidence of non-small cell carcinoma tended to be higher than that of small cell carcinoma in the two groups. The possibility of lung cancer in patients with pulmonary nodule, coexisting emphysema, and especially in elderly patients having a history of smoking must be clarified on HRCT

  1. CT of pulmonary emphysema - current status, challenges, and future directions

    Energy Technology Data Exchange (ETDEWEB)

    Litmanovich, Diana; Boiselle, Phillip M.; Bankier, Alexander A. [Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA (United States)

    2009-03-15

    Pulmonary emphysema is characterized by irreversible destruction of lung parenchyma. Emphysema is a major contributor to chronic obstructive pulmonary disease (COPD), which by itself is a major cause of morbidity and mortality in the western world. Computed tomography (CT) is an established method for the in-vivo analysis of emphysema. This review first details the pathological basis of emphysema and shows how the subtypes of emphysema can be characterized by CT. The review then shows how CT is used to quantify emphysema, and describes the requirements and foundations for quantification to be accurate. Finally, the review discusses new challenges and their potential solution, notably focused on multi-detector-row CT, and emphasizes the open questions that future research on CT of pulmonary emphysema will have to address. (orig.)

  2. Mechanism of Neurodegeneration Following Viral Infection

    National Research Council Canada - National Science Library

    Maheshwari, Radha

    2001-01-01

    The long term goal of this proposal is to delineate the mechanism(s) for neurodegeneration and neuropathogenesis following infection with a neurovirulent virus, Venezuelan equine encephalitis virus (VEE...

  3. Medical image of the week: panloubular emphysema

    Directory of Open Access Journals (Sweden)

    Mathur A

    2015-08-01

    Full Text Available No abstract available. Article truncated after 150 words. A 60 year old female, non-smoker with a past medical history of chronic rhinosinusitis with nasal polyps presented with an eight year history of productive cough and dyspnea. Previous treatment with inhaled corticosteroids, courses of systemic corticosteroids and antibiotics provided modest improvement in her symptoms. Pulmonary function testing revealed a severe obstructive ventilatory defect without significant bronchodilator response and reduced diffusing capacity (DLCO. Chest x-ray surprisingly revealed lower lobe predominant emphysematous changes (Figure 1. Alpha-1-antitrypsin level was within normal range at 137 mg/dL. Panlobular emphysema represents permanent destruction of the entire acinus distal to the respiratory bronchioles and is more likely to affect the lower lobes compared to centrilobular emphysema (1. Panlobular emphysema is associated with alpha-1-antitrypsin deficiency, intravenous drug abuse specifically with methylphenidate and methadone, Swyer-James syndrome, and obliterative bronchiolitis. Whether this pattern is seen as part of normal senescence in non-smoking individuals remains controversial (2. Panlobular emphysema may ...

  4. Impaired Glutathione Synthesis in Neurodegeneration

    Science.gov (United States)

    Aoyama, Koji; Nakaki, Toshio

    2013-01-01

    Glutathione (GSH) was discovered in yeast cells in 1888. Studies of GSH in mammalian cells before the 1980s focused exclusively on its function for the detoxication of xenobiotics or for drug metabolism in the liver, in which GSH is present at its highest concentration in the body. Increasing evidence has demonstrated other important roles of GSH in the brain, not only for the detoxication of xenobiotics but also for antioxidant defense and the regulation of intracellular redox homeostasis. GSH also regulates cell signaling, protein function, gene expression, and cell differentiation/proliferation in the brain. Clinically, inborn errors in GSH-related enzymes are very rare, but disorders of GSH metabolism are common in major neurodegenerative diseases showing GSH depletion and increased levels of oxidative stress in the brain. GSH depletion would precipitate oxidative damage in the brain, leading to neurodegenerative diseases. This review focuses on the significance of GSH function, the synthesis of GSH and its metabolism, and clinical disorders of GSH metabolism. A potential approach to increase brain GSH levels against neurodegeneration is also discussed. PMID:24145751

  5. Computer quantification of “angle of collapse” on maximum expiratory flow volume curve for diagnosing asthma-COPD overlap syndrome

    Directory of Open Access Journals (Sweden)

    Wang W

    2016-12-01

    Full Text Available Wei Wang, Mengshuang Xie, Shuang Dou, Liwei Cui, Wei Xiao Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People’s Republic of China Background: In a previous study, we demonstrated that asthma patients with signs of emphysema on quantitative computed tomography (CT fulfill the diagnosis of asthma-COPD overlap syndrome (ACOS. However, quantitative CT measurements of emphysema are not routinely available for patients with chronic airway disease, which limits their application. Spirometry was a widely used examination tool in clinical settings and shows emphysema as a sharp angle in the maximum expiratory flow volume (MEFV curve, called the “angle of collapse (AC”. The aim of this study was to investigate the value of the AC in the diagnosis of emphysema and ACOS. Methods: This study included 716 participants: 151 asthma patients, 173 COPD patients, and 392 normal control subjects. All the participants underwent pulmonary function tests. COPD and asthma patients also underwent quantitative CT measurements of emphysema. The AC was measured using computer models based on Matlab software. The value of the AC in the diagnosis of emphysema and ACOS was evaluated using receiver-operating characteristic (ROC curve analysis. Results: The AC of COPD patients was significantly lower than that of asthma patients and control subjects. The AC was significantly negatively correlated with emphysema index (EI; r=-0.666, P<0.001, and patients with high EI had a lower AC than those with low EI. The ROC curve analysis showed that the AC had higher diagnostic efficiency for high EI (area under the curve =0.876 than did other spirometry parameters. In asthma patients, using the AC ≤137° as a surrogate criterion for the diagnosis of ACOS, the sensitivity and specificity were 62.5% and 89.1%, respectively. Conclusion: The AC on the MEFV curve quantified by computer models correlates with the extent of emphysema. The AC may become a

  6. Comparison of efficacy of long-acting bronchodilators in emphysema dominant and emphysema nondominant chronic obstructive pulmonary disease.

    Science.gov (United States)

    Fujimoto, Keisaku; Kitaguchi, Yoshiaki; Kanda, Shintaro; Urushihata, Kazuhisa; Hanaoka, Masayuki; Kubo, Keishi

    2011-01-01

    The purpose of this study was to clarify the association between morphological phenotypes according to the predominance of emphysema and efficacy of long-acting muscarinic antagonist and β(2) agonist bronchodilators in patients with chronic obstructive pulmonary disease (COPD). Seventy-two patients with stable COPD treated with tiotropium (n = 41) or salmeterol (n = 31) were evaluated for pulmonary function, dynamic hyperinflation following metronome-paced incremental hyperventilation, six-minute walking distance, and St George's Respiratory Questionnaire (SGRQ) before and 2-3 months following treatment with tiotropium or salmeterol. They were then visually divided into an emphysema dominant phenotype (n = 25 in the tiotropium-treated group and n = 22 in the salmeterol-treated group) and an emphysema nondominant phenotype on high-resolution computed tomography, and the efficacy of the two drugs in each phenotype was retrospectively analyzed. Tiotropium significantly improved airflow limitation, oxygenation, and respiratory impedance in both the emphysema dominant and emphysema nondominant phenotypes, and improved dynamic hyperinflation, exercise capacity, and SGRQ in the emphysema dominant phenotype but not in the emphysema nondominant phenotype. Salmeterol significantly improved total score for SGRQ in the emphysema phenotype, but no significant effects on other parameters were found for either of the phenotypes. These findings suggest that tiotropium is more effective than salmeterol for airflow limitation regardless of emphysema dominance, and also can improve dynamic hyperinflation in the emphysema dominant phenotype, which results in further improvement of exercise capacity and health-related quality of life.

  7. Severe Asthma

    Science.gov (United States)

    Erzurum, Serpil C.; Bleecker, Eugene R.; Calhoun, William J.; Castro, Mario; Comhair, Suzy A. A.; Chung, Kian Fan; Curran-Everett, Douglas; Dweik, Raed A.; Fain, Sean B.; Fitzpatrick, Anne M.; Gaston, Benjamin M.; Israel, Elliot; Hastie, Annette; Hoffman, Eric A.; Holguin, Fernando; Levy, Bruce D.; Meyers, Deborah A.; Moore, Wendy C.; Peters, Stephen P.; Sorkness, Ronald L.; Teague, W. Gerald; Wenzel, Sally E.; Busse, William W.

    2012-01-01

    The National Heart, Lung, and Blood Institute Severe Asthma Research Program (SARP) has characterized over the past 10 years 1,644 patients with asthma, including 583 individuals with severe asthma. SARP collaboration has led to a rapid recruitment of subjects and efficient sharing of samples among participating sites to conduct independent mechanistic investigations of severe asthma. Enrolled SARP subjects underwent detailed clinical, physiologic, genomic, and radiological evaluations. In addition, SARP investigators developed safe procedures for bronchoscopy in participants with asthma, including those with severe disease. SARP studies revealed that severe asthma is a heterogeneous disease with varying molecular, biochemical, and cellular inflammatory features and unique structure–function abnormalities. Priorities for future studies include recruitment of a larger number of subjects with severe asthma, including children, to allow further characterization of anatomic, physiologic, biochemical, and genetic factors related to severe disease in a longitudinal assessment to identify factors that modulate the natural history of severe asthma and provide mechanistic rationale for management strategies. PMID:22095547

  8. Reproducibility of scoring emphysema by HRCT

    Energy Technology Data Exchange (ETDEWEB)

    Malinen, A.; Partanen, K.; Rytkoenen, H.; Vanninen, R. [Kuopio Univ. Hospital (Finland). Dept. of Clinical Radiology; Erkinjuntti-Pekkanen, R. [Kuopio Univ. Hospital (Finland). Dept. of Pulmonary Diseases

    2002-04-01

    Purpose: We evaluated the reproducibility of three visual scoring methods of emphysema and compared these methods with pulmonary function tests (VC, DLCO, FEV1 and FEV%) among farmer's lung patients and farmers. Material and Methods: Three radiologists examined high-resolution CT images of farmer's lung patients and their matched controls (n=70) for chronic interstitial lung diseases. Intraobserver reproducibility and interobserver variability were assessed for three methods: severity, Sanders' (extent) and Sakai. Pulmonary function tests as spirometry and diffusing capacity were measured. Results: Intraobserver -values for all three methods were good (0.51-0.74). Interobserver varied from 0.35 to 0.72. The Sanders' and the severity methods correlated strongly with pulmonary function tests, especially DLCO and FEV1. Conclusion: The Sanders' method proved to be reliable in evaluating emphysema, in terms of good consistency of interpretation and good correlation with pulmonary function tests.

  9. Acute Gastric Dilatation Resulting in Gastric Emphysema Following Postpartum Hemorrhage

    Directory of Open Access Journals (Sweden)

    Suhail Aslam Khan

    2012-01-01

    Full Text Available Acute gastric dilatation is a rare entity, with varying aetiologies the majority of which are benign. Delay in diagnosis and treatment could result in sequelae such as gastric emphysema (pneumatosis, emphysematous gastritis, gangrene, and perforation. Gastric emphysema as a result of a benign nongangrenous condition such as gastroparesis, adynamic ileus can be successfully managed conservatively. Here, we present an interesting case of acute gastric dilatation resulting in gastric emphysema following massive postpartum hemorrhage.

  10. Congenital lobar emphysema in neonates: Anaesthetic challenges

    Directory of Open Access Journals (Sweden)

    Mridu Paban Nath

    2011-01-01

    Full Text Available Congenital lobar emphysema (CLE is a potentially reversible, though possibly life-threatening, cause of respiratory distress in the neonate. It poses dilemma in diagnosis and management. We are presenting a 6-week-old baby who presented with a sudden onset of respiratory distress related to CLE affecting the left upper lobe. Lobectomy was performed under general anaesthesia with one lung ventilation. The details of anaesthetic challenges and management are described here.

  11. Cervicofacial subcutaneous emphysema associated with dental laser treatment.

    Science.gov (United States)

    Mitsunaga, S; Iwai, T; Kitajima, H; Yajima, Y; Ohya, T; Hirota, M; Mitsudo, K; Aoki, N; Yamashita, Y; Omura, S; Tohnai, I

    2013-12-01

    Cervicofacial subcutaneous emphysema is a rare complication of dental procedures. Although most cases of emphysema occur incidentally with the use of a high-speed air turbine handpiece, there have been some reports over the past decade of cases caused by dental laser treatment. Emphysema as a complication caused by the air cooling spray of a dental laser is not well known, even though dental lasers utilize compressed air just as air turbines and syringes do. In this study, we comprehensively reviewed cases of emphysema attributed to dental laser treatment that appeared in the literature between January 2001 and September 2012, and we included three such cases referred to us. Among 13 cases identified in total, nine had cervicofacial subcutaneous and mediastinal emphysema. Compared with past reviews, the incidence of mediastinal emphysema caused by dental laser treatment was higher than emphysema caused by dental procedure without dental laser use. Eight patients underwent CO2 laser treatment and two underwent Er:YAG laser treatment. Nine patients had emphysema following laser irradiation for soft tissue incision. Dentists and oral surgeons should be cognizant of the potential risk for iatrogenic emphysema caused by the air cooling spray during dental laser treatment and ensure proper usage of lasers. © 2013 Australian Dental Association.

  12. Iatrogenic subcutaneous cervicofacial emphysema with pneumomediastinum after class V restoration.

    Science.gov (United States)

    Lee, Sang-Woon; Huh, Yoon-Hyuk; Cha, Min-Sang

    2017-02-01

    Subcutaneous facial emphysema after dental treatment is an uncommon complication caused by the invasion of high-pressure air; in severe cases, it can spread to the neck, mediastinum, and thorax, resulting in cervical emphysema, pneumomediastinum, and pneumothorax. The present case showed subcutaneous cervicofacial emphysema with pneumomediastinum after class V restoration. The patient was fully recovered after eight days of conservative treatment. The cause of this case was the penetration of high-pressure air through the gingival sulcus, which had a weakened gingival attachment. This case indicated that dentists should be careful to prevent subcutaneous emphysema during common dental treatments using a high-speed hand piece and gingival retraction cord.

  13. Using Image Processing to Determine Emphysema Severity

    Science.gov (United States)

    McKenzie, Alexander; Sadun, Alberto

    2010-10-01

    Currently X-rays and computerized tomography (CT) scans are used to detect emphysema, but other tests are required to accurately quantify the amount of lung that has been affected by the disease. These images clearly show if a patient has emphysema, but are unable by visual scan alone, to quantify the degree of the disease, as it presents as subtle, dark spots on the lung. Our goal is to use these CT scans to accurately diagnose and determine emphysema severity levels in patients. This will be accomplished by performing several different analyses of CT scan images of several patients representing a wide range of severity of the disease. In addition to analyzing the original CT data, this process will convert the data to one and two bit images and will then examine the deviation from a normal distribution curve to determine skewness. Our preliminary results show that this method of assessment appears to be more accurate and robust than the currently utilized methods, which involve looking at percentages of radiodensities in the air passages of the lung.

  14. Caveolin-1, cellular senescence and pulmonary emphysema

    Science.gov (United States)

    Volonte, Daniela; Galbiati, Ferruccio

    2009-01-01

    Caveolae are vesicular invaginations of the plasma membrane. Caveolin-1 is the structural protein component of caveolae. Caveolin-1 participates in signal transduction processes by acting as a scaffolding protein that concentrates, organizes and functional regulates signaling molecules within caveolar membranes. Cigarette smoke, a source of oxidants, is an environmental hazard that causes pulmonary emphysema. Recently, we reported that the development of cigarette smoking-induced pulmonary emphysema was inhibited in caveolin-1 null mice, which do not express caveolin-1. We demonstrated that lack of caveolin-1 expression in lung fibroblasts dramatically inhibited premature senescence induced by oxidants contained in cigarette smoke. Mechanistically, we uncovered that premature senescence of lung fibroblasts induced by oxidative stress occurred through activation of an ataxia telangiectasia-mutated (ATM)/p53-depedent pathway following sequestration of the catalytic subunit of protein phosphatase 2A (PP2A-C), an inhibitor of ATM, by caveolin-1 into caveolar membranes. We propose caveolin-1 as a key player of a novel signaling pathway that links cigarette smoke to premature senescence of lung fibroblasts and development of pulmonary emphysema. PMID:20157570

  15. Medical image of the week: bullous emphysema

    Directory of Open Access Journals (Sweden)

    Tey KR

    2016-04-01

    Full Text Available No abstract available. Article truncated at 150 words. A 63-year-old gentleman, with a history of 90-pack-years of smoking and stage IV chronic obstructive pulmonary disease was receiving home oxygen at 2 L/min at baseline. He has had multiple prior hospital admissions for respiratory failure. Over the past 2 weeks he has had increased production of sputum, associated with worsening shortness of breath. He is on fluticasone-salmeterol inhaler, albuterol inhaler, and tiotropium as an outpatient. On examination, he was hemodynamically stable, SpO2 was 92% on 4L/min of oxygen. He was in obvious respiratory distress, in a tripod position with tachypnea and using respiratory accessory muscles. Lung examination revealed diffuse expiratory wheezing. Chest radiograph shows severe emphysema (Figure 1. Chest computed tomography showed diffuse centrilobular and bullous emphysema (Figure 2. He was treated as an acute severe exacerbation of COPD and was eventually discharged to follow-up with the pulmonary clinic. Emphysema is defined as alveolar destruction and airspace enlargement distal ...

  16. Diagnosing Asthma

    Science.gov (United States)

    ... Ribbon Commands Skip to main content Turn off Animations Turn on Animations Our Sponsors Log in | Register Menu Log in | ... were tried and if they helped Any family history of allergies or asthma It is very important ...

  17. Occupational Asthma

    Science.gov (United States)

    ... the enzymes of the bacteria Bacillus subtilis, while bakers may develop an allergy and occupational asthma symptoms ... counts Continuing education center Find an allergist / immunologist Journals Login / My membership Search your symptoms Shop the ...

  18. Do Allergies Cause Asthma?

    Science.gov (United States)

    ... Voice in Health Care Decisions Do Allergies Cause Asthma? KidsHealth > For Parents > Do Allergies Cause Asthma? Print ... son la causa del asma? Do Allergies Cause Asthma? Allergies don't cause asthma. But kids who ...

  19. Asthma Medications and Pregnancy

    Science.gov (United States)

    ... Associated Conditions Asthma & Pregnancy Asthma & Pregnancy: Medications Asthma & Pregnancy: Medications Make an Appointment Refer a Patient Ask ... mother and child. Making Decisions about Medication During Pregnancy It is important that your asthma be controlled ...

  20. Comparison of efficacy of long-acting bronchodilators in emphysema dominant and emphysema nondominant chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Fujimoto K

    2011-04-01

    Full Text Available Keisaku Fujimoto1, Yoshiaki Kitaguchi2, Shintaro Kanda2, Kazuhisa Urushihata2, Masayuki Hanaoka2, Keishi Kubo21Department of Biomedical Laboratory Sciences, 2First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, JapanBackground: The purpose of this study was to clarify the association between morphological phenotypes according to the predominance of emphysema and efficacy of long-acting muscarinic antagonist and β2 agonist bronchodilators in patients with chronic obstructive pulmonary disease (COPD.Methods: Seventy-two patients with stable COPD treated with tiotropium (n = 41 or salmeterol (n = 31 were evaluated for pulmonary function, dynamic hyperinflation following metronome-paced incremental hyperventilation, six-minute walking distance, and St George’s Respiratory Questionnaire (SGRQ before and 2–3 months following treatment with tiotropium or salmeterol. They were then visually divided into an emphysema dominant phenotype (n = 25 in the tiotropium-treated group and n = 22 in the salmeterol-treated group and an emphysema nondominant phenotype on high-resolution computed tomography, and the efficacy of the two drugs in each phenotype was retrospectively analyzed.Results: Tiotropium significantly improved airflow limitation, oxygenation, and respiratory impedance in both the emphysema dominant and emphysema nondominant phenotypes, and improved dynamic hyperinflation, exercise capacity, and SGRQ in the emphysema dominant phenotype but not in the emphysema nondominant phenotype. Salmeterol significantly improved total score for SGRQ in the emphysema phenotype, but no significant effects on other parameters were found for either of the phenotypes.Conclusion: These findings suggest that tiotropium is more effective than salmeterol for airflow limitation regardless of emphysema dominance, and also can improve dynamic hyperinflation in the emphysema dominant phenotype, which results in further

  1. Combined pulmonary fibrosis and emphysema (CPFE): an entity different from emphysema or pulmonary fibrosis alone

    Science.gov (United States)

    Lin, Huijin

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) and idiopathic interstitial pneumonias (IIP), with different radiological, pathological, functional and prognostic characteristics, have been regarded as separate entities for a long time. However, there is an increasing recognition of the coexistence of emphysema and pulmonary fibrosis in individuals. The association was first described as a syndrome by Cottin in 2005, named “combined pulmonary fibrosis and emphysema (CPFE)”, which is characterized by exertional dyspnea, upper-lobe emphysema and lower-lobe fibrosis, preserved lung volume and severely diminished capacity of gas exchange. CPFE is frequently complicated by pulmonary hypertension, acute lung injury and lung cancer and prognosis of it is poor. Treatments for CPFE patients with severe pulmonary hypertension are less effective other than lung transplantation. However, CPFE has not yet attracted wide attention of clinicians and there is no research systematically contrasting the differences among CPFE, emphysema/COPD and IIP at the same time. The authors will review the existing knowledge of CPFE and compare them to either entity alone for the first time, with the purpose of improving the awareness of this syndrome and exploring novel effective therapeutic strategies in clinical practice. PMID:25973246

  2. Mortality by Level of Emphysema and Airway Wall Thickness

    DEFF Research Database (Denmark)

    Johannessen, Ane; Skorge, Trude Duelien; Bottai, Matteo

    2013-01-01

    There is limited knowledge of the prognostic value of quantitative computed tomography (CT) measures of emphysema and airway wall thickness (AWT) on mortality.......There is limited knowledge of the prognostic value of quantitative computed tomography (CT) measures of emphysema and airway wall thickness (AWT) on mortality....

  3. Cement dust exposure-related emphysema in a construction worker

    Directory of Open Access Journals (Sweden)

    V Karkhanis

    2011-01-01

    Full Text Available Although, smoking is considered the most important predisposing factor in development of emphysema; environmental exposures also play an important role. There have been several studies on work related respiratory symptoms and ventilatory disorders among employees of cement industry. We report a case of cement exposure related emphysema in 75 years old woman construction worker.

  4. Cathepsin E Promotes Pulmonary Emphysema via Mitochondrial Fission

    Science.gov (United States)

    Zhang, Xuchen; Shan, Peiying; Homer, Robert; Zhang, Yi; Petrache, Irina; Mannam, Praveen; Lee, Patty J.

    2015-01-01

    Emphysema is characterized by loss of lung elasticity and irreversible air space enlargement, usually in the later decades of life. The molecular mechanisms of emphysema remain poorly defined. We identified a role for a novel cathepsin, cathepsin E, in promoting emphysema by inducing mitochondrial fission. Unlike previously reported cysteine cathepsins, which have been implicated in cigarette smoke-induced lung disease, cathepsin E is a nonlysosomal intracellular aspartic protease whose function has been described only in antigen processing. We examined lung tissue sections of persons with chronic obstructive pulmonary disease, a clinical entity that includes emphysematous change. Human chronic obstructive pulmonary disease lungs had markedly increased cathepsin E protein in the lung epithelium. We generated lung epithelial-targeted transgenic cathepsin E mice and found that they develop emphysema. Overexpression of cathepsin E resulted in increased E3 ubiquitin ligase parkin, mitochondrial fission protein dynamin-related protein 1, caspase activation/apoptosis, and ultimately loss of lung parenchyma resembling emphysema. Inhibiting dynamin-related protein 1, using a small molecule inhibitor in vitro or in vivo, inhibited cathepsin E-induced apoptosis and emphysema. To the best of our knowledge, our study is the first to identify links between cathepsin E, mitochondrial fission, and caspase activation/apoptosis in the pathogenesis of pulmonary emphysema. Our data expand the current understanding of molecular mechanisms of emphysema development and may provide new therapeutic targets. PMID:25239563

  5. Screening for emphysema via exhaled volatile organic compounds.

    NARCIS (Netherlands)

    Cristescu, S.M.; Gietema, H.A.; Blanchet, L.M.; Kruitwagen, C.L.J.J.; Munnik, P.; Klaveren, R.J.J. van; Lammers, J.W.; Buydens, L.; Harren, F.J.M.; Zanen, P.

    2011-01-01

    Chronic obstructive pulmonary disease (COPD)/emphysema risk groups are well defined and screening allows for early identification of disease. The capability of exhaled volatile organic compounds (VOCs) to detect emphysema, as found by computed tomography (CT) in current and former heavy smokers

  6. Screening for emphysema via exhaled volatile organic compounds

    NARCIS (Netherlands)

    S.M. Cristescu (S.); H.A. Gietema (Hester); L. Blanchet (Lionel); C.L.J.J. Kruitwagen (Cas); P. Munnik (P.); R.J. van Klaveren (Rob); J.-W.J. Lammers (Jan-Willem); L.M.C. Buydens (Lutgarde); F.J.M. Harren (F. J M); P. Zanen (Pieter)

    2011-01-01

    textabstractChronic obstructive pulmonary disease (COPD)/emphysema risk groups are well defined and screening allows for early identification of disease. The capability of exhaled volatile organic compounds (VOCs) to detect emphysema, as found by computed tomography (CT) in current and former heavy

  7. Lung emphysema induced by cigarette smoke: Studies in mice

    NARCIS (Netherlands)

    Eijl, Teunis Jan Ahasuerus van

    2006-01-01

    The experiments described in this thesis were designed to shed some more light on the mechanisms underlying cigarette smoke-induced lung emphysema. We used elastase instillation to induce lung emphysema, and subsequently perfused the lungs ex-vivo with buffer at a range of flows to measure changes

  8. Bullae, Bronchiectasis and Nutritional Emphysema in Severe Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Victoria J Cook

    2001-01-01

    Full Text Available STUDY OBJECTIVES: Pulmonary complications of anorexia nervosa are rarely documented. The case of a patient with anorexia nervosa and pulmonary disease is presented, a new quantitative computed tomography (CT method for the detection of emphysema is employed, the literature is reviewed and the concept of 'nutritional' emphysema is discussed.

  9. Cathepsin E promotes pulmonary emphysema via mitochondrial fission.

    Science.gov (United States)

    Zhang, Xuchen; Shan, Peiying; Homer, Robert; Zhang, Yi; Petrache, Irina; Mannam, Praveen; Lee, Patty J

    2014-10-01

    Emphysema is characterized by loss of lung elasticity and irreversible air space enlargement, usually in the later decades of life. The molecular mechanisms of emphysema remain poorly defined. We identified a role for a novel cathepsin, cathepsin E, in promoting emphysema by inducing mitochondrial fission. Unlike previously reported cysteine cathepsins, which have been implicated in cigarette smoke-induced lung disease, cathepsin E is a nonlysosomal intracellular aspartic protease whose function has been described only in antigen processing. We examined lung tissue sections of persons with chronic obstructive pulmonary disease, a clinical entity that includes emphysematous change. Human chronic obstructive pulmonary disease lungs had markedly increased cathepsin E protein in the lung epithelium. We generated lung epithelial-targeted transgenic cathepsin E mice and found that they develop emphysema. Overexpression of cathepsin E resulted in increased E3 ubiquitin ligase parkin, mitochondrial fission protein dynamin-related protein 1, caspase activation/apoptosis, and ultimately loss of lung parenchyma resembling emphysema. Inhibiting dynamin-related protein 1, using a small molecule inhibitor in vitro or in vivo, inhibited cathepsin E-induced apoptosis and emphysema. To the best of our knowledge, our study is the first to identify links between cathepsin E, mitochondrial fission, and caspase activation/apoptosis in the pathogenesis of pulmonary emphysema. Our data expand the current understanding of molecular mechanisms of emphysema development and may provide new therapeutic targets. Copyright © 2014 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  10. Prothymosin α overexpression contributes to the development of pulmonary emphysema

    Science.gov (United States)

    Su, Bing-Hua; Tseng, Yau-Lin; Shieh, Gia-Shing; Chen, Yi-Cheng; Shiang, Ya-Chieh; Wu, Pensee; Li, Kuo-Jung; Yen, Te-Hsin; Shiau, Ai-Li; Wu, Chao-Liang

    2013-01-01

    Emphysema is one of the disease conditions that comprise chronic obstructive pulmonary disease. Prothymosin α transgenic mice exhibit an emphysema phenotype, but the pathophysiological role of prothymosin α in emphysema remains unclear. Here we show that prothymosin α contributes to the pathogenesis of emphysema by increasing acetylation of histones and nuclear factor-kappaB, particularly upon cigarette smoke exposure. We find a positive correlation between prothymosin α levels and the severity of emphysema in prothymosin α transgenic mice and emphysema patients. Prothymosin α overexpression increases susceptibility to cigarette smoke-induced emphysema, and cigarette smoke exposure further enhances prothymosin α expression. We show that prothymosin α inhibits the association of histone deacetylases with histones and nuclear factor-kappaB, and that prothymosin α overexpression increases expression of nuclear factor-kappaB-dependent matrix metalloproteinase 2 and matrix metalloproteinase 9, which are found in the lungs of patients with chronic obstructive pulmonary disease. These results demonstrate the clinical relevance of prothymosin α in regulating acetylation events during the pathogenesis of emphysema. PMID:23695700

  11. Assessment of regional progression of pulmonary emphysema with CT densitometry

    DEFF Research Database (Denmark)

    Bakker, M Els; Putter, Hein; Stolk, Jan

    2008-01-01

    BACKGROUND: Lung densitometry is an effective method to assess overall progression of emphysema, but generally the location of the progression is not estimated. We hypothesized that progression of emphysema is the result of extension from affected areas toward less affected areas in the lung. To ...... spreads out from affected areas....

  12. A 15-Year-Old Boy with Anterior Chest Pain, Progressive Dyspnea, and Subcutaneous Emphysema of the Neck

    Directory of Open Access Journals (Sweden)

    Nicola Scichilone

    2009-01-01

    Full Text Available We describe the case of an adolescent who was admitted to the hospital because of sudden occurrence of chest pain, dyspnea and subcutaneous emphysema. On admission, physical examination revealed subcutaneous crepitations in the superior part of the rib cage, and auscultation of the chest showed widespread wheezing. The radiological assessment confirmed the diagnosis of pneumomediastinum and pneumothorax. A follow-up CT scan performed one week after the admission showed almost complete resolution of the radiological alterations. At the following visits, the patient was asymptomatic, but reported to have suffered from frequent episodes of rhinorrea, sneezing, nasal blockage, and sometimes, chest tightness, especially during exposure to pets and/or windy weather. Skin prick testing showed sensitivities to dermatophagoides pteronyssinus and farinae, grass pollen and dog dander. Spirometry documented significant improvement in lung function after short-acting bronchodilator, allowing for the diagnosis of asthma to be made. Although pneumomediastinum may be a complication of various respiratory diseases, including asthma, it has never been reported as the first presentation of underlying bronchial asthma. Herein, the physiopathological mechanisms, the diagnostic procedures and treatment of pneumomediastinum in asthma are discussed. We suggest that the diagnosis of asthma should be considered in the differential diagnosis of pneumomediastinum in adolescence.

  13. PPARγ in emphysema: blunts the damage and triggers repair?

    Science.gov (United States)

    Kelly, Neil J.; Shapiro, Steven D.

    2014-01-01

    Cigarette smoke is the most common cause of pulmonary emphysema, which results in an irreversible loss of lung structure and function. Th1 and Th17 immune responses have been implicated in emphysema pathogenesis; however, the drivers of emphysema-associated immune dysfunction are not fully understood. In this issue of the JCI, Shan and colleagues found that peroxisome proliferator–activated receptor γ (PPARγ) is downregulated in APCs isolated from the lungs of emphysematous chronic smokers and mice exposed to cigarette smoke. Furthermore, treatment with a PPARγ agonist prevented emphysema development and appeared to reduce emphysema-associated lung volume expansion in mice exposed to cigarette smoke. Further work will need to be done to evaluate the potential of PPARγ agonists to restore lung capacity in emphysematous patients. PMID:24569365

  14. Expression profiling identifies genes involved in emphysema severity

    Directory of Open Access Journals (Sweden)

    Bowman Rayleen V

    2009-09-01

    Full Text Available Abstract Chronic obstructive pulmonary disease (COPD is a major public health problem. The aim of this study was to identify genes involved in emphysema severity in COPD patients. Gene expression profiling was performed on total RNA extracted from non-tumor lung tissue from 30 smokers with emphysema. Class comparison analysis based on gas transfer measurement was performed to identify differentially expressed genes. Genes were then selected for technical validation by quantitative reverse transcriptase-PCR (qRT-PCR if also represented on microarray platforms used in previously published emphysema studies. Genes technically validated advanced to tests of biological replication by qRT-PCR using an independent test set of 62 lung samples. Class comparison identified 98 differentially expressed genes (p p Gene expression profiling of lung from emphysema patients identified seven candidate genes associated with emphysema severity including COL6A3, SERPINF1, ZNHIT6, NEDD4, CDKN2A, NRN1 and GSTM3.

  15. Surgical Outcomes of Lung Cancer Patients with Combined Pulmonary Fibrosis and Emphysema and Those with Idiopathic Pulmonary Fibrosis without Emphysema.

    Science.gov (United States)

    Sato, Seijiro; Koike, Terumoto; Hashimoto, Takehisa; Ishikawa, Hiroyuki; Okada, Akira; Watanabe, Takehiro; Tsuchida, Masanori

    2016-08-23

    Combined pulmonary fibrosis and emphysema (CPFE) is a unique disorder. The aim of this study was to compare the surgical outcomes of lung cancer patients with CPFE and those with idiopathic pulmonary fibrosis (IPF) without emphysema. A total of 1548 patients who underwent surgery for primary lung cancer between January 2001 and December 2012 were retrospectively reviewed. Of the 1548 patients, 55 (3.6%) had CPFE on computed tomography (CT), and 45 (2.9%) had IPF without emphysema. The overall and disease-free 5-year survival rates for patients with CPFE were not significantly worse than those for patients with IPF without emphysema (24.9% vs. 36.8%, p = 0.814; 39.8% vs. 39.3%, p = 0.653, respectively). Overall, 21 (38.1%) patients with CPFE and nine patients (20.0%) with IPF without emphysema developed postoperative cardiopulmonary complications. Patients with CPFE had significantly more postoperative cardiopulmonary complications involving pulmonary air leakage for >6 days, hypoxemia, and arrhythmia than patients with IPF without emphysema (p = 0.048). There was no significant difference in survival after surgical treatment between CPFE patients and IPF patients without emphysema, but CPFE patients had significantly higher morbidity than IPF patients without emphysema.

  16. Posttraumatic orbital emphysema: a numerical model.

    Science.gov (United States)

    Skorek, Andrzej; Kłosowski, Paweł; Plichta, Lukasz; Raczyńska, Dorota; Zmuda Trzebiatowski, Marcin; Lemski, Paweł

    2014-01-01

    Orbital emphysema is a common symptom accompanying orbital fracture. The pathomechanism is still not recognized and the usually assumed cause, elevated pressure in the upper airways connected with sneezing or coughing, does not always contribute to the occurrence of this type of fracture. Observations based on the finite model (simulating blowout type fracture) of the deformations of the inferior orbital wall after a strike in its lower rim. Authors created a computer numeric model of the orbit with specified features-thickness and resilience modulus. During simulation an evenly spread 14400 N force was applied to the nodular points in the inferior rim (the maximal value not causing cracking of the outer rim, but only ruptures in the inferior wall). The observation was made from 1 · 10(-3) to 1 · 10(-2) second after a strike. Right after a strike dislocations of the inferior orbital wall toward the maxillary sinus were observed. Afterwards a retrograde wave of the dislocation of the inferior wall toward the orbit was noticed. Overall dislocation amplitude reached about 6 mm. Based on a numeric model of the orbit submitted to a strike in the inferior wall an existence of a retrograde shock wave causing orbital emphysema has been found.

  17. Posttraumatic Orbital Emphysema: A Numerical Model

    Directory of Open Access Journals (Sweden)

    Andrzej Skorek

    2014-01-01

    Full Text Available Orbital emphysema is a common symptom accompanying orbital fracture. The pathomechanism is still not recognized and the usually assumed cause, elevated pressure in the upper airways connected with sneezing or coughing, does not always contribute to the occurrence of this type of fracture. Observations based on the finite model (simulating blowout type fracture of the deformations of the inferior orbital wall after a strike in its lower rim. Authors created a computer numeric model of the orbit with specified features—thickness and resilience modulus. During simulation an evenly spread 14400 N force was applied to the nodular points in the inferior rim (the maximal value not causing cracking of the outer rim, but only ruptures in the inferior wall. The observation was made from 1·10-3 to 1·10-2 second after a strike. Right after a strike dislocations of the inferior orbital wall toward the maxillary sinus were observed. Afterwards a retrograde wave of the dislocation of the inferior wall toward the orbit was noticed. Overall dislocation amplitude reached about 6 mm. Based on a numeric model of the orbit submitted to a strike in the inferior wall an existence of a retrograde shock wave causing orbital emphysema has been found.

  18. Lung volume reduction surgery for diffuse emphysema.

    Science.gov (United States)

    van Agteren, Joseph Em; Carson, Kristin V; Tiong, Leong Ung; Smith, Brian J

    2016-10-14

    Lung volume reduction surgery (LVRS) performed to treat patients with severe diffuse emphysema was reintroduced in the nineties. Lung volume reduction surgery aims to resect damaged emphysematous lung tissue, thereby increasing elastic properties of the lung. This treatment is hypothesised to improve long-term daily functioning and quality of life, although it may be costly and may be associated with risks of morbidity and mortality. Ten years have passed since the last version of this review was prepared, prompting us to perform an update. The objective of this review was to gather all available evidence from randomised controlled trials comparing the effectiveness of lung volume reduction surgery (LVRS) versus non-surgical standard therapy in improving health outcomes for patients with severe diffuse emphysema. Secondary objectives included determining which subgroup of patients benefit from LVRS and for which patients LVRS is contraindicated, to establish the postoperative complications of LVRS and its morbidity and mortality, to determine which surgical approaches for LVRS are most effective and to calculate the cost-effectiveness of LVRS. We identified RCTs by using the Cochrane Airways Group Chronic Obstructive Pulmonary Disease (COPD) register, in addition to the online clinical trials registers. Searches are current to April 2016. We included RCTs that studied the safety and efficacy of LVRS in participants with diffuse emphysema. We excluded studies that investigated giant or bullous emphysema. Two independent review authors assessed trials for inclusion and extracted data. When possible, we combined data from more than one study in a meta-analysis using RevMan 5 software. We identified two new studies (89 participants) in this updated review. A total of 11 studies (1760 participants) met the entry criteria of the review, one of which accounted for 68% of recruited participants. The quality of evidence ranged from low to moderate owing to an unclear risk

  19. Death due to asthma

    Directory of Open Access Journals (Sweden)

    Albert L. Sheffer

    1996-01-01

    Full Text Available The prevalence and fatality rate of asthma have increased worldwide. Underdiagnosis and undertreatment of asthma are central to the occurrence of fatal asthma. Atopy is the principal risk factor associated with asthma. However, consideration of the epidemiologic, physiologic, pharmacologic, pathologic and clinical parameters of asthma assessment may provide valuable insight into death due to asthma. Psychologic and socioeconomic factors may further aggravate the asthma status. Ethnic minorities are at increased risk of asthma. The perception of dyspnea may be blunted in asthma sufferers. Slow-onset fatal asthma may be associated with submucosal eosinophilic, whereas sudden-onset may be associated with submucosal neutrophilia. Fatal asthma occurs in patients abusing regular |32-agonist therapy. Peak flow assessment often provides insight into asthma deterioration prior to signs of respiratory distress. Markers of risk of death due to asthma further identify the fatality-prone asthma patient.

  20. Oral microbiome link to neurodegeneration in glaucoma.

    Directory of Open Access Journals (Sweden)

    Konstantin Astafurov

    Full Text Available Glaucoma is a progressive optic nerve degenerative disease that often leads to blindness. Local inflammatory responses are implicated in the pathology of glaucoma. Although inflammatory episodes outside the CNS, such as those due to acute systemic infections, have been linked to central neurodegeneration, they do not appear to be relevant to glaucoma. Based on clinical observations, we hypothesized that chronic subclinical peripheral inflammation contributes to neurodegeneration in glaucoma.Mouthwash specimens from patients with glaucoma and control subjects were analyzed for the amount of bacteria. To determine a possible pathogenic mechanism, low-dose subcutaneous lipopolysaccharide (LPS was administered in two separate animal models of glaucoma. Glaucomatous neurodegeneration was assessed in the retina and optic nerve two months later. Changes in gene expression of toll-like receptor 4 (TLR4 signaling pathway and complement as well as changes in microglial numbers and morphology were analyzed in the retina and optic nerve. The effect of pharmacologic blockade of TLR4 with naloxone was determined.Patients with glaucoma had higher bacterial oral counts compared to control subjects (p<0.017. Low-dose LPS administration in glaucoma animal models resulted in enhancement of axonal degeneration and neuronal loss. Microglial activation in the optic nerve and retina as well as upregulation of TLR4 signaling and complement system were observed. Pharmacologic blockade of TLR4 partially ameliorated the enhanced damage.The above findings suggest that the oral microbiome contributes to glaucoma pathophysiology. A plausible mechanism by which increased bacterial loads can lead to neurodegeneration is provided by experiments in animal models of the disease and involves activation of microglia in the retina and optic nerve, mediated through TLR4 signaling and complement upregulation. The finding that commensal bacteria may play a role in the development and

  1. Animal models of pulmonary emphysema: a stereologist's perspective

    Directory of Open Access Journals (Sweden)

    H. Fehrenbach

    2006-12-01

    Full Text Available A variety of animal models have been suggested as models of pulmonary emphysema; these are critically discussed in the present article from a stereologist's perspective. In addition, a stereological design for the quantification of experimentally induced emphysema is proposed. On the basis of the widely accepted definition of pulmonary emphysema being an "abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls," quantitative morphology is the only method with which to reliably assess the presence of emphysema. Recognising this, careful inspection of animal models that are based on instillation of elastase, genetic alterations, inhalation of cigarette smoke or induction of apoptosis, reveals that both criteria of emphysema definition were demonstrated in surprisingly few of them. Several aspects are suggested to be critical for the understanding of animal models of human emphysema. For example, genetic models that rely on the inhibition of the formation of alveoli during post-natal alveolarisation should clearly be distinguished from models that rely on the loss of mature alveoli after alveolarisation is complete. Furthermore, inhalation models that are characterised by exposed animals exhibiting a severe loss of body weight should carefully examine the relative contribution of intervention and weight loss, respectively. Models that rely on the exposure of juvenile animals for several weeks or even months should take into account the effects of normal lung growth and ageing. Stereology offers appropriate tools with which to quantify the parameters relevant to assess development and the regeneration of emphysema. Stereologists continue to develop tools that will help ascertain the reliability of established and new models. If inappropriate parameters continue to be used for the evaluation of animal models of emphysema, thinking and resources are likely to be misdirected and the

  2. Death due to asthma

    OpenAIRE

    Sheffer, Albert L.

    1996-01-01

    The prevalence and fatality rate of asthma have increased worldwide. Underdiagnosis and undertreatment of asthma are central to the occurrence of fatal asthma. Atopy is the principal risk factor associated with asthma. However, consideration of the epidemiologic, physiologic, pharmacologic, pathologic and clinical parameters of asthma assessment may provide valuable insight into death due to asthma. Psychologic and socioeconomic factors may further aggravate the asthma status. Ethnic minoriti...

  3. Asthma - children

    Science.gov (United States)

    ... BS, Burks AW, et al, eds. Middleton's Allergy Principles and Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 53. Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et ...

  4. Childhood asthma

    African Journals Online (AJOL)

    atopy, night cough, exercise-induced cough and/or wheeze and seasonal variation in symptoms. Epidemiology. Asthma is on the increase in both the developed and developing countries of the world. In South Africa, its prevalence in children in Cape Town (measured by exercise challenge) was only three per cent in 1979.

  5. Childhood asthma

    African Journals Online (AJOL)

    prevalence in children in Cape Town (measured by exercise challenge) was only three per ... mortality among the five to 34-year-old age group, and fifth for asthma ... clouded by differences in terminology used by respondents, depending on ...

  6. Exercise-Induced Asthma

    Science.gov (United States)

    ... January 2014 More on this topic for: Parents Kids Teens Can Kids and Teens With Asthma Play Sports? Asthma Center When to Go to the ER if Your Child Has Asthma Kids and Exercise Asthma Triggers Word! Exercise-Induced Asthma ...

  7. Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema

    Science.gov (United States)

    ... Submit Button NCHS Home Chronic Obstructive Pulmonary Disease (COPD) Includes: Chronic Bronchitis and Emphysema Recommend on Facebook ... to emergency departments with chronic obstructive pulmonary disease (COPD): 6.9 million Source: National Hospital Ambulatory Medical ...

  8. Cervicofacial subcutaneous emphysema associated with dental laser treatment

    National Research Council Canada - National Science Library

    Mitsunaga, S; Iwai, T; Kitajima, H; Yajima, Y; Ohya, T; Hirota, M; Mitsudo, K; Aoki, N; Yamashita, Y; Omura, S; Tohnai, I

    2013-01-01

    .... Although most cases of emphysema occur incidentally with the use of a high‐speed air turbine handpiece, there have been some reports over the past decade of cases caused by dental laser treatment...

  9. Combined pulmonary fibrosis and emphysema: an increasingly recognized condition

    Directory of Open Access Journals (Sweden)

    Olívia Meira Dias

    2014-06-01

    Full Text Available Combined pulmonary fibrosis and emphysema (CPFE has been increasingly recognized in the literature. Patients with CPFE are usually heavy smokers or former smokers with concomitant lower lobe fibrosis and upper lobe emphysema on chest HRCT scans. They commonly present with severe breathlessness and low DLCO, despite spirometry showing relatively preserved lung volumes. Moderate to severe pulmonary arterial hypertension is common in such patients, who are also at an increased risk of developing lung cancer. Unfortunately, there is currently no effective treatment for CPFE. In this review, we discuss the current knowledge of the pathogenesis, clinical characteristics, and prognostic factors of CPFE. Given that most of the published data on CPFE are based on retrospective analysis, more studies are needed in order to address the role of emphysema and its subtypes; the progression of fibrosis/emphysema and its correlation with inflammation; treatment options; and prognosis.

  10. Pulmonary hyperinflation and emphysema in infants with the Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Dominguez, R.; Weisgrau, R.A.; Santamaria, M.

    1987-07-01

    Little recognition has been given to the pulmonary manifestations of the Marfan syndrome especially in infants. We report four cases of Marfan's syndrome presenting in infancy with respiratory abnormalities and a common radiographic picture of emphysema.

  11. Pathogenesis of pulmonary emphysema – cellular and molecular events

    OpenAIRE

    Di Petta, Antonio

    2010-01-01

    ABSTRACT Pulmonary emphysema is a chronic obstructive disease, resulting from important alterations in the whole distal structure of terminal bronchioles, either by enlargement of air spaces or by destruction of the alveolar wall, leading to loss of respiratory surface, decreased elastic recoil and lung hyperinflation. For many years, the hypothesis of protease-antiprotease unbalance prevailed as the central theme in the pathogenesis of pulmonary emphysema. According to this hypothesis, the r...

  12. Changes in prevalence of chronic obstructive pulmonary disease and asthma in the US population and associated risk factors.

    Science.gov (United States)

    Halldin, Cara N; Doney, Brent C; Hnizdo, Eva

    2015-02-01

    Chronic lower airway diseases, including chronic obstructive pulmonary disease (COPD) and asthma, are currently the third leading cause of death in the United States. We aimed to evaluate changes in prevalence of and risk factors for COPD and asthma among the US adult population. We evaluated changes in prevalence of self-reported doctor-diagnosed COPD (i.e. chronic bronchitis and emphysema) and asthma and self-reported respiratory symptoms comparing data from the 1988-1994 and 2007-2010 National Health and Nutrition Examination Surveys. To investigate changes in the severity of each outcome over the two periods, we calculated changes in the proportions of spirometry-based airflow obstruction for each outcome. Prevalence of doctor-diagnosed chronic bronchitis and emphysema decreased significantly mainly among males, while asthma increased only among females. The self-reported disease and the respiratory symptoms were associated with increased prevalence of airflow obstruction for both periods. However, the prevalence of airflow obstruction decreased significantly in the second period among those with shortness of breath and doctor-diagnosed respiratory conditions (chronic bronchitis, emphysema, and asthma). COPD outcomes and asthma were associated with lower education, smoking, underweight and obesity, and occupational dusts and fumes exposure. Chronic lower airway diseases continue to be major public health problems. However, decreased prevalence of doctor-diagnosed chronic bronchitis and emphysema (in males) and decreased prevalence of airflow obstruction in those with respiratory symptoms and doctor-diagnosed respiratory diseases may indicate a declining trend and decrease in disease severity between the two periods. Continued focus on prevention of these diseases through public health interventions is prudent. © The Author(s) 2014.

  13. Visual pathway neurodegeneration winged by mitochondrial dysfunction.

    Science.gov (United States)

    Petzold, Axel; Nijland, Philip G; Balk, Lisanne J; Amorini, Angela Maria; Lazzarino, Giacomo; Wattjes, Mike P; Gasperini, Claudio; van der Valk, Paul; Tavazzi, Barbara; Lazzarino, Giuseppe; van Horssen, Jack

    2015-02-01

    To test for structural and functional contribution of mitochondrial dysfunction to neurodegeneration in multiple sclerosis (MS). A visual pathway model void of MS lesions was chosen in order to exclude neurodegeneration secondary to lesion related axonotmesis. A single-centre cohort study (230 MS patients, 63 controls). Spectral domain optical coherence tomography of the retina, 3T magnetic resonance imaging of the brain, spectrophotometric assessment of serum lactate levels. Postmortem immunohistochemistry. The visual pathway was void of MS lesions in 31 patients and 31 age-matched controls. Serum lactate was higher in MS compared to controls (P = 0.029). High serum lactate was structurally related to atrophy of the retinal nerve fiber layer at the optic disc (P = 0.041), macula (P = 0.025), and the macular ganglion cell complex (P = 0.041). High serum lactate was functionally related to poor color vision (P < 0.01), Expanded Disability Status Scale score (R = 0.37, P = 0.041), Guy's Neurological disability score (R = 0.38, P = 0.037), MS walking scale (R = 0.50, P = 0.009), upper limb motor function (R = 0.53, P = 0.002). Immunohistochemistry demonstrated increased astrocytic expression of a key lactate generating enzyme in MS lesions as well as profound vascular expression of monocarboxylate transporter-1, which is involved in lactate transport. This study provides structural, functional, and translational evidence for visual pathway neurodegeneration in MS related to mitochondrial dysfunction.

  14. Fine mapping of gene regions regulating neurodegeneration.

    Directory of Open Access Journals (Sweden)

    Maria Swanberg

    Full Text Available BACKGROUND: Damage to nerve cells and axons leading to neurodegeneration is a characteristic feature of many neurological diseases. The degree of genetic influence on susceptibility to axotomy-induced neuronal death has so far been unknown. We have examined two gene regions, Vra1 and Vra2, previously linked to nerve cell loss after ventral root avulsion in a rat F2 intercross between the DA and PVG inbred rat strains. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we use two generations (G8 and G10 cohorts of an advanced intercross line between DA and PVG(av1 to reproduce linkage to Vra1 and to fine-map this region. By isolating the effect from Vra1 in congenic strains, we demonstrate that Vra1 significantly regulates the loss of motoneurons after avulsion. The regulatory effect mediated by Vra1 thus resides in a congenic fragment of 9 megabases. Furthermore, we have used the advanced intercross lines to give more support to Vra2, originally detected as a suggestive QTL. CONCLUSIONS/SIGNIFICANCE: The results demonstrated here show that naturally occurring allelic variations affect susceptibility to axotomy-induced nerve cell death. Vra1 and Vra2 represent the first quantitative trait loci regulating this phenotype that are characterized and fine mapped in an advanced intercross line. In addition, congenic strains provide experimental evidence for the Vra1 effect on the extent of injury-induced neurodegeneration. Identification of the underlying genetic variations will increase our understanding of the regulation and mechanisms of neurodegeneration.

  15. Allergies, asthma, and molds

    Science.gov (United States)

    Reactive airway - mold; Bronchial asthma - mold; Triggers - mold; Allergic rhinitis - pollen ... Things that make allergies or asthma worse are called triggers. Mold is a common trigger. When your asthma or allergies become worse due to mold, you are ...

  16. Asthma Triggers: Gain Control

    Science.gov (United States)

    ... asthma. Dogs, cats, rodents (including hamsters and guinea pigs) and other warm-blooded mammals can trigger asthma ... Page Contact Us to ask a question, provide feedback, or report a problem. Asthma Indoor Air Quality ...

  17. Quantifying the Extent of Emphysema : Factors Associated with Radiologists' Estimations and Quantitative Indices of Emphysema Severity Using the ECLIPSE Cohort

    NARCIS (Netherlands)

    Gietema, Hester A.; Mueller, Nestor L.; Fauerbach, Paola V. Nasute; Sharma, Sanjay; Edwards, Lisa D.; Camp, Pat G.; Coxson, Harvey O.

    Rationale and Objectives: This study investigated what factors radiologists take into account when estimating emphysema severity and assessed quantitative computed tomography (CT) measurements of low attenuation areas. Materials and Methods: CT scans and spirometry were obtained on 1519 chronic

  18. Vascular Changes and Neurodegeneration in the Early Stages of Diabetic Retinopathy

    DEFF Research Database (Denmark)

    Jonsson, Karoline Boegeberg; Frydkjaer-Olsen, Ulrik; Grauslund, Jakob

    2016-01-01

    INTRODUCTION: Neurodegeneration is an early component of diabetic retinopathy (DR). It is unclear whether neurodegeneration is an independent factor or a consequence of damaged retinal vasculature. The aims of this study were to review the literature concerning neurodegeneration in diabetic...

  19. What Is Asthma?

    Science.gov (United States)

    ... Asthma Awareness National Asthma Awards Federal and Partner Organizations Public Service Announcements & Multimedia Main menu Environmental Topics Air Bed Bugs Chemicals and Toxics Environmental ...

  20. Influence of fissure integrity on quantitative CT and emphysema distribution in emphysema-type COPD using a dedicated COPD software.

    Science.gov (United States)

    Müller, Jan; Lim, Hyun-Ju; Eichinger, Monika; Jobst, Bertram J; Eberhardt, Ralf; Gompelmann, Daniela; Koenigkam-Santos, Marcel; Puderbach, Michael; Kauczor, Hans-Ulrich; Heussel, Claus P; Wielpütz, Mark O

    2017-10-01

    Fissure integrity (FI) plays a key role in selecting patients for interventional emphysema therapy. We investigated its interference with automated lobar segmentation in quantitative computed tomography (CT) and emphysema distribution. CT was available for 50 patients with chronic obstructive pulmonary disease (COPD). Lobe segmentation was performed fully automated by software and corrected manually. FI was evaluated visually using a %-scale. The influence of FI on emphysema ratio (ER=percentage of lung volume with density values0.05). Results for emphysema comparing automated vs. manually corrected segmentation exceeded clinically acceptable values, but were not significantly affected by FI (p>0.05). The widest limits of agreement for ER and MLD were noted in the right middle lobe ([-14, 17.4%], [-22.4, 32.4 Hounsfield Units]). Automated lobe segmentation and emphysema distribution are not significantly affected by FI. Manual correction of automated lobar segmentation is still recommended in severe emphysema. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Systematic review with meta-analysis of the epidemiological evidence relating smoking to COPD, chronic bronchitis and emphysema

    Directory of Open Access Journals (Sweden)

    Thornton Alison J

    2011-06-01

    Full Text Available Abstract Background Smoking is a known cause of the outcomes COPD, chronic bronchitis (CB and emphysema, but no previous systematic review exists. We summarize evidence for various smoking indices. Methods Based on MEDLINE searches and other sources we obtained papers published to 2006 describing epidemiological studies relating incidence or prevalence of these outcomes to smoking. Studies in children or adolescents, or in populations at high respiratory disease risk or with co-existing diseases were excluded. Study-specific data were extracted on design, exposures and outcomes considered, and confounder adjustment. For each outcome RRs/ORs and 95% CIs were extracted for ever, current and ex smoking and various dose response indices, and meta-analyses and meta-regressions conducted to determine how relationships were modified by various study and RR characteristics. Results Of 218 studies identified, 133 provide data for COPD, 101 for CB and 28 for emphysema. RR estimates are markedly heterogeneous. Based on random-effects meta-analyses of most-adjusted RR/ORs, estimates are elevated for ever smoking (COPD 2.89, CI 2.63-3.17, n = 129 RRs; CB 2.69, 2.50-2.90, n = 114; emphysema 4.51, 3.38-6.02, n = 28, current smoking (COPD 3.51, 3.08-3.99; CB 3.41, 3.13-3.72; emphysema 4.87, 2.83-8.41 and ex smoking (COPD 2.35, 2.11-2.63; CB 1.63, 1.50-1.78; emphysema 3.52, 2.51-4.94. For COPD, RRs are higher for males, for studies conducted in North America, for cigarette smoking rather than any product smoking, and where the unexposed base is never smoking any product, and are markedly lower when asthma is included in the COPD definition. Variations by sex, continent, smoking product and unexposed group are in the same direction for CB, but less clearly demonstrated. For all outcomes RRs are higher when based on mortality, and for COPD are markedly lower when based on lung function. For all outcomes, risk increases with amount smoked and pack-years. Limited

  2. Sleep and Neurodegeneration: A Critical Appraisal.

    Science.gov (United States)

    Pillai, Jagan A; Leverenz, James B

    2017-06-01

    Sleep abnormalities are clearly recognized as a distinct clinical symptom of concern in neurodegenerative disorders. Appropriate management of sleep-related symptoms has a positive impact on quality of life in patients with neurodegenerative disorders. This review provides an overview of mechanisms that are currently being considered that tie sleep with neurodegeneration. It appraises the literature regarding specific sleep changes seen in common neurodegenerative diseases, with a focus on Alzheimer disease and synucleinopathies (ie, Parkinson disease, dementia with Lewy bodies, multiple system atrophy), that have been better studied. Sleep changes may also serve as markers to identify patients in the preclinical stage of some neurodegenerative disorders. A hypothetical model is postulated founded on the conjecture that specific sleep abnormalities, when noted to increase in severity beyond that expected for age, could be a surrogate marker reflecting pathophysiological processes related to neurodegenerative disorders. This provides a clinical strategy for screening patients in the preclinical stages of neurodegenerative disorders to enable therapeutic trials to establish the efficacy of neuroprotective agents to prevent or delay the development of symptoms and functional decline. It is unclear if sleep disturbance directly impacts neurodegenerative processes or is a secondary outcome of neurodegeneration; this is an active area of research. The clinical importance of recognizing and managing sleep changes in neurodegenerative disorders is beyond doubt. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  3. Role of Quercetin Benefits in Neurodegeneration.

    Science.gov (United States)

    Elumalai, Preetham; Lakshmi, Sreeja

    2016-01-01

    Neurodegenerative disorders are often life threatening and hired as an economic burden to the health-care system. Nutritional interventions principally involving polyphenols were practiced to arrest or reverse the age-related health disorders. Flavonoids, a class of dietary polyphenols, are rising to superstardom in preventing brain disorders with their potent antioxidant defense mechanism. Quercetin is a ubiquitous flavonoid reported to have all-natural myriad of health benefits. Citrus fruits, apple, onion, parsley, berries, green tea, and red wine comprise the major dietary supplements of quercetin apart from some herbal remedies like Ginkgo biloba. Appositeness of quercetin in reducing risks of neurodegenerative disorders, cancer, cardiovascular diseases, allergic disorders, thrombosis, atherosclerosis, hypertension, and arrhythmia, to name a few, is attributed to its highly pronounced antioxidant and anti-inflammatory properties. Neurodegeneration, characterized by progressive deterioration of the structure and function of neurons, is crucially accompanied by severe cognitive deficits. Aging is the major risk factor for neurodegenerative disorders in Alzheimer's disease (AD), Parkinson's disease (PD), and Huntington's disease (HD) being coequal high hands. Oxidative stress and mitochondrial dysfunction are the key players in triggering neurodegeneration. The upsurge of neurodegenerative disorders is always appalling since there exists a paucity in effective treatment practices. Past few years' studies have underpinned the mechanisms through which quercetin boons the brain health in many aspects including betterment in cognitive output. Undoubtedly, quercetin will be escalating as an arable field, both in scientific research and in pharmacological and clinical applications.

  4. Paraseptal Emphysema: Prevalence and Distribution on CT and Association with Interstitial Lung Abnormalities

    Science.gov (United States)

    Araki, Tetsuro; Nishino, Mizuki; Zazueta, Oscar E.; Gao, Wei; Dupuis, Josée; Okajima, Yuka; Latourelle, Jeanne C.; Rosas, Ivan O.; Murakami, Takamichi; O’Connor, George T.; Washko, George R.; Hunninghake, Gary M.; Hatabu, Hiroto

    2015-01-01

    Objective To investigate the prevalence and distribution of paraseptal emphysema on chest CT images in the Framingham Heart Study (FHS) population, and assess its impact on pulmonary function. Also pursued was the association with interstitial lung abnormalities. Materials and Methods We assessed 2633 participants in the FHS for paraseptal emphysema on chest CT. Characteristics of participants, including age, sex, smoking status, clinical symptoms, and results of pulmonary function tests, were compared between those with and without paraseptal emphysema. The association between paraseptal emphysema and interstitial lung abnormalities was investigated. Results Of the 2633 participants, 86 (3%) had pure paraseptal emphysema (defined as paraseptal emphysema with no other subtypes of emphysema other than paraseptal emphysema or a very few centrilobular emphysema involved) in at least one lung zone. The upper zone of the lungs was almost always involved. Compared to the participants without paraseptal emphysema, those with pure paraseptal emphysema were significantly older, and were more frequently male and smokers (mean 64 years, 71% male, mean 36 pack-years, pemphysema and interstitial lung abnormalities (pemphysema was 3% in the FHS population, predominantly affects the upper lung zone, and contributes to decreased pulmonary function. Cigarette smoking, aging, and male gender were the factors associated with the presence of paraseptal emphysema. Significant association between paraseptal emphysema and interstitial lung abnormalities was observed. PMID:25868675

  5. The impact of emphysema on dosimetric parameters for stereotactic body radiotherapy of the lung

    Science.gov (United States)

    Ochiai, Satoru; Nomoto, Yoshihito; Yamashita, Yasufumi; Inoue, Tomoki; Murashima, Shuuichi; Hasegawa, Daisuke; Kurita, Yoshie; Watanabe, Yui; Toyomasu, Yutaka; Kawamura, Tomoko; Takada, Akinori; Noriko; Kobayashi, Shigeki; Sakuma, Hajime

    2016-01-01

    The purpose of this study was to evaluate the impact of emphysematous changes in lung on dosimetric parameters in stereotactic body radiation therapy (SBRT) for lung tumor. A total of 72 treatment plans were reviewed, and dosimetric factors [including homogeneity index (HI) and conformity index (CI)] were evaluated. Emphysematous changes in lung were observed in 43 patients (60%). Patients were divided into three groups according to the severity of emphysema: no emphysema (n = 29), mild emphysema (n = 22) and moderate to severe emphysema groups (n = 21). The HI (P emphysema in one-way analysis of variance (ANOVA). The HI value was significantly higher in the moderate to severe emphysema group compared with in the no emphysema (Tukey, P emphysema groups (P = 0.002). The CI value was significantly higher in the moderate to severe emphysema group compared with in the no emphysema group (P = 0.044). In multiple linear regression analysis, the severity of emphysema (P emphysema (one-way ANOVA, P = 0.008) and the severity of emphysema (P < 0.001) was one of the significant factors for the density of the lung within the PTV in multiple linear regression analysis. Our results suggest that emphysematous changes in the lung significantly impact on several dosimetric parameters in SBRT, and they should be carefully evaluated before treatment planning. PMID:27380802

  6. The Relationship Between Pulmonary Emphysema and Kidney Function in Smokers

    Science.gov (United States)

    Chandra, Divay; Stamm, Jason A.; Palevsky, Paul M.; Leader, Joseph K.; Fuhrman, Carl R.; Zhang, Yingze; Bon, Jessica; Duncan, Steven R.; Branch, Robert A.; Weissfeld, Joel; Gur, David; Gladwin, Mark T.

    2012-01-01

    Background: It has been reported that the prevalence of kidney dysfunction may be increased in patients exposed to tobacco with airflow obstruction. We hypothesized that kidney dysfunction would associate with emphysema rather than with airflow obstruction measured by the FEV1. Methods: Five hundred eight current and former smokers completed a chest CT scan, pulmonary function tests, medical questionnaires, and measurement of serum creatinine. Glomerular filtration rates (eGFRs) were estimated using the method of the Chronic Kidney Disease Epidemiology Collaboration. Quantitative determinants of emphysema and airway dimension were measured from multidetector chest CT scans. Results: The mean age was 66 ± 7 years, and mean eGFR was 101 ± 22 mL/min/1.73 m2. Univariate and multivariate analysis showed a significant association between radiographically measured emphysema and eGFR: Participants with 10% more emphysema had an eGFR that was lower by 4.4 mL/min/1.73 m2 (P = .01), independent of airflow obstruction (FEV1), age, sex, race, height, BMI, diabetes mellitus, hypertension, coronary artery disease, patient-reported dyspnea, pack-years of smoking, and current smoking. There was no association between eGFR and either FEV1 or quantitative CT scan measures of airway dimension. Conclusions: More severe emphysema, rather than airflow obstruction, is associated with kidney dysfunction in tobacco smokers, independent of common risk factors for kidney disease. This finding adds to recent observations of associations between emphysema and comorbidities of COPD, including osteoporosis and lung cancer, which are independent of the traditional measure of reduced FEV1. The mechanisms and clinical implications of kidney dysfunction in patients with emphysema need further investigation. PMID:22459775

  7. Computed tomography measurement of rib cage morphometry in emphysema.

    Directory of Open Access Journals (Sweden)

    Nicola Sverzellati

    Full Text Available BACKGROUND: Factors determining the shape of the human rib cage are not completely understood. We aimed to quantify the contribution of anthropometric and COPD-related changes to rib cage variability in adult cigarette smokers. METHODS: Rib cage diameters and areas (calculated from the inner surface of the rib cage in 816 smokers with or without COPD, were evaluated at three anatomical levels using computed tomography (CT. CTs were analyzed with software, which allows quantification of total emphysema (emphysema%. The relationship between rib cage measurements and anthropometric factors, lung function indices, and %emphysema were tested using linear regression models. RESULTS: A model that included gender, age, BMI, emphysema%, forced expiratory volume in one second (FEV1%, and forced vital capacity (FVC% fit best with the rib cage measurements (R(2 = 64% for the rib cage area variation at the lower anatomical level. Gender had the biggest impact on rib cage diameter and area (105.3 cm(2; 95% CI: 111.7 to 98.8 for male lower area. Emphysema% was responsible for an increase in size of upper and middle CT areas (up to 5.4 cm(2; 95% CI: 3.0 to 7.8 for an emphysema increase of 5%. Lower rib cage areas decreased as FVC% decreased (5.1 cm(2; 95% CI: 2.5 to 7.6 for 10 percentage points of FVC variation. CONCLUSIONS: This study demonstrates that simple CT measurements can predict rib cage morphometric variability and also highlight relationships between rib cage morphometry and emphysema.

  8. Asthma and obesity

    DEFF Research Database (Denmark)

    Juel, Caroline Trunk-Black; Ali, Zarqa; Nilas, Lisbeth

    2012-01-01

    Obesity is a major health problem, and obesity is associated with a high incidence of asthma and poor asthma control. The aim of the present paper is to systematically review the current knowledge of the effect on overall asthma control of weight reduction in overweight and obese adults with asthma....

  9. Subcutaneous and Scrotal Emphysema Following Suprapubic Cystostomy in a Patient With Colovesical Fistula

    Directory of Open Access Journals (Sweden)

    Hui-Lun Huang

    2010-05-01

    Full Text Available Subcutaneous and scrotal emphysema are rare complications of suprapubic cystostomy. We present here a rare case of an 81-year-old man with colovesical fistula who had severe subcutaneous and scrotal emphysema after percutaneous suprapubic cystostomy was performed. We inserted a new Foley catheter via the urethra, removed the suprapubic cystostomy and incised his scrotal emphysema for open drainage. The patient's subcutaneous emphysema slowly healed.

  10. A probabilistic model of emphysema based on granulometry analysis

    Science.gov (United States)

    Marcos, J. V.; Nava, R.; Cristobal, G.; Munoz-Barrutia, A.; Escalante-Ramírez, B.; Ortiz-de-Solórzano, C.

    2013-11-01

    Emphysema is associated with the destruction of lung parenchyma, resulting in abnormal enlargement of airspaces. Accurate quantification of emphysema is required for a better understanding of the disease as well as for the assessment of drugs and treatments. In the present study, a novel method for emphysema characterization from histological lung images is proposed. Elastase-induced mice were used to simulate the effect of emphysema on the lungs. A database composed of 50 normal and 50 emphysematous lung patches of size 512 x 512 pixels was used in our experiments. The purpose is to automatically identify those patches containing emphysematous tissue. The proposed approach is based on the use of granulometry analysis, which provides the pattern spectrum describing the distribution of airspaces in the lung region under evaluation. The profile of the spectrum was summarized by a set of statistical features. A logistic regression model was then used to estimate the probability for a patch to be emphysematous from this feature set. An accuracy of 87% was achieved by our method in the classification between normal and emphysematous samples. This result shows the utility of our granulometry-based method to quantify the lesions due to emphysema.

  11. Variation of quantitative emphysema measurements from CT scans

    Science.gov (United States)

    Keller, Brad M.; Reeves, Anthony P.; Henschke, Claudia I.; Barr, R. Graham; Yankelevitz, David F.

    2008-03-01

    Emphysema is a lung disease characterized by destruction of the alveolar air sacs and is associated with long-term respiratory dysfunction. CT scans allow for imaging of the anatomical basis of emphysema, and several measures have been introduced for the quantification of the extent of disease. In this paper we compare these measures for repeatability over time. The measures of interest in this study are emphysema index, mean lung density, histogram percentile, and the fractal dimension. To allow for direct comparisons, the measures were normalized to a 0-100 scale. These measures have been computed for a set of 2,027 scan pairs in which the mean interval between scans was 1.15 years (σ: 93 days). These independent pairs were considered with respect to three different scanning conditions (a) 223 pairs where both were scanned with a 5 mm slice thickness protocol, (b) 695 with the first scanned with the 5 mm protocol and the second with a 1.25 mm protocol, and (c) 1109 pairs scanned both times using a 1.25 mm protocol. We found that average normalized emphysema index and histogram percentiles scores increased by 5.9 and 11 points respectively, while the fractal dimension showed stability with a mean difference of 1.2. We also found, a 7 point bias introduced for emphysema index under condition (b), and that the fractal dimension measure is least affected by scanner parameter changes.

  12. Somatic mutations in aging, cancer and neurodegeneration.

    Science.gov (United States)

    Kennedy, Scott R; Loeb, Lawrence A; Herr, Alan J

    2012-04-01

    The somatic mutation theory of aging posits that the accumulation of mutations in the genetic material of somatic cells as a function of time results in a decrease in cellular function. In particular, the accumulation of random mutations may inactivate genes that are important for the functioning of the somatic cells of various organ systems of the adult, result in a decrease in organ function. When the organ function decreases below a critical level, death occurs. A significant amount of research has shown that somatic mutations play an important role in aging and a number of age related pathologies. In this review, we explore evidence for increases in somatic nuclear mutation burden with age and the consequences for aging, cancer, and neurodegeneration. We then review evidence for increases in mitochondrial mutation burden and the consequences for dysfunction in the disease processes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  13. Mechanisms linking circadian clocks, sleep, and neurodegeneration.

    Science.gov (United States)

    Musiek, Erik S; Holtzman, David M

    2016-11-25

    Disruptions of normal circadian rhythms and sleep cycles are consequences of aging and can profoundly affect health. Accumulating evidence indicates that circadian and sleep disturbances, which have long been considered symptoms of many neurodegenerative conditions, may actually drive pathogenesis early in the course of these diseases. In this Review, we explore potential cellular and molecular mechanisms linking circadian dysfunction and sleep loss to neurodegenerative diseases, with a focus on Alzheimer's disease. We examine the interplay between central and peripheral circadian rhythms, circadian clock gene function, and sleep in maintaining brain homeostasis, and discuss therapeutic implications. The circadian clock and sleep can influence a number of key processes involved in neurodegeneration, suggesting that these systems might be manipulated to promote healthy brain aging. Copyright © 2016, American Association for the Advancement of Science.

  14. Insights into Mechanisms of Chronic Neurodegeneration

    Directory of Open Access Journals (Sweden)

    Abigail B. Diack

    2016-01-01

    Full Text Available Chronic neurodegenerative diseases such as Alzheimer’s disease (AD, Parkinson’s disease (PD, and prion diseases are characterised by the accumulation of abnormal conformers of a host encoded protein in the central nervous system. The process leading to neurodegeneration is still poorly defined and thus development of early intervention strategies is challenging. Unique amongst these diseases are Transmissible Spongiform Encephalopathies (TSEs or prion diseases, which have the ability to transmit between individuals. The infectious nature of these diseases has permitted in vivo and in vitro modelling of the time course of the disease process in a highly reproducible manner, thus early events can be defined. Recent evidence has demonstrated that the cell-to-cell spread of protein aggregates by a “prion-like mechanism” is common among the protein misfolding diseases. Thus, the TSE models may provide insights into disease mechanisms and testable hypotheses for disease intervention, applicable to a number of these chronic neurodegenerative diseases.

  15. Neurodegeneration-associated instability of ribosomal DNA.

    Science.gov (United States)

    Hallgren, Justin; Pietrzak, Maciej; Rempala, Grzegorz; Nelson, Peter T; Hetman, Michal

    2014-06-01

    Homologous recombination (HR)-mediated instability of the repetitively organized ribosomal DNA (rDNA) has been proposed as a mediator of cell senescence in yeast triggering the DNA damage response. High individual variability in the content of human rDNA suggests that this genomic region remained relatively unstable throughout evolution. Therefore, quantitative real-time polymerase chain reaction was used to determine the genomic content of rDNA in post mortem samples of parietal cortex from 14 young and 9 elderly individuals with no diagnosis of a chronic neurodegenerative/neurological disease. In addition, rDNA content in that brain region was compared between 10 age-matched control individuals and 10 patients with dementia with Lewy bodies (DLB) which involves neurodegeneration of the cerebral cortex. Probing rRNA-coding regions of rDNA revealed no effects of aging on the rDNA content. Elevated rDNA content was observed in DLB. Conversely, in the DLB pathology-free cerebellum, lower genomic content of rDNA was present in the DLB group. In the parietal cortex, such a DLB-associated instability of rDNA was not accompanied by any major changes of cytosine-phosphate-guanine methylation of the rDNA promoter. As increased cerebro-cortical rDNA content was previously reported in Alzheimer's disease, neurodegeneration appears to be associated with instability of rDNA. The hypothetical origins and consequences of this phenomenon are discussed including possibilities that the DNA damage-induced recombination destabilizes rDNA and that differential content of rDNA affects heterochromatin formation, gene expression and/or DNA damage response. This article is part of a Special Issue entitled: Role of the Nucleolus in Human Disease. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Early CNS neurodegeneration in radiologically isolated syndrome

    Science.gov (United States)

    Overton, Eve; Khadka, Sankalpa; Buckley, Jessica; Liu, Shuang; Sampat, Mehul; Kantarci, Orhun; Lebrun Frenay, Christine; Siva, Aksel; Okuda, Darin T.; Pelletier, Daniel

    2015-01-01

    Objective: Increasing evidence indicates that the thalamus may be a location of early neurodegeneration in multiple sclerosis (MS). Our objective was to identify the presence of gray matter volume loss and thinning in patients with radiologically isolated syndrome (RIS). Methods: Sixty-three participants were included in this case-control study. Twenty-one patients with RIS were age- and sex-matched to 42 healthy controls in a 1:2 ratio. All participants underwent brain MRIs on a single 3T scanner. After lesion segmentation and inpainting, 1 mm3-isometric T1-weighted images were submitted to FreeSurfer (v5.2). Normalized cortical and deep gray matter volumes were compared between patients with RIS and controls using t tests, and thalamic volumes were correlated with white matter lesion volumes using Pearson correlation. Exploratory cortical thickness maps were created. Results: Although traditional normalized total gray and white matter volumes were not statistically different between patients with RIS and controls, normalized left (0.0046 ± 0.0005 vs 0.0049 ± 0.0004, p = 0.006), right (0.0045 ± 0.0005 vs 0.0048 ± 0.0004, p = 0.008), and mean (0.0045 ± 0.0005 vs 0.0049 ± 0.0004, p = 0.004) thalamic volumes were significantly lower in patients with RIS (n = 21, mean age 41.9 ± 12.7 years) than in controls (n = 42, mean age 41.4 ± 11.2 years). Thalamic volumes correlated modestly with white matter lesion volumes (range: r = −0.35 to −0.47). Conclusion: Our data provide novel evidence of thalamic atrophy in RIS and are consistent with previous reports in early MS stages. Thalamic volume loss is present early in CNS demyelinating disease and should be further investigated as a metric associated with neurodegeneration. PMID:25884012

  17. A case of severe subcutaneous emphysema in the post-operative period following cleft lip surgery

    Directory of Open Access Journals (Sweden)

    B Vijayakumar

    2010-01-01

    Full Text Available Subcutaneous emphysema is not an unknown complication following cleft lip surgery. We describe a case of severe subcutaneous emphysema that developed six hours after surgery. The laryngoscopic intubation was smooth. Following subcutaneous emphysema the patient was treated conservatively with mask oxygen and spontaneous resolution occurred within 48 hours.

  18. Scan-rescan reproducibility of CT densitometric measures of emphysema

    Science.gov (United States)

    Chong, D.; van Rikxoort, E. M.; Kim, H. J.; Goldin, J. G.; Brown, M. S.

    2011-03-01

    This study investigated the reproducibility of HRCT densitometric measures of emphysema in patients scanned twice one week apart. 24 emphysema patients from a multicenter study were scanned at full inspiration (TLC) and expiration (RV), then again a week later for four scans total. Scans for each patient used the same scanner and protocol, except for tube current in three patients. Lung segmentation with gross airway removal was performed on the scans. Volume, weight, mean lung density (MLD), relative area under -950HU (RA-950), and 15th percentile (PD-15) were calculated for TLC, and volume and an airtrapping mask (RA-air) between -950 and -850HU for RV. For each measure, absolute differences were computed for each scan pair, and linear regression was performed against volume difference in a subgroup with volume difference emphysema treatment efficacy.

  19. Sex differences in emphysema and airway disease in smokers

    DEFF Research Database (Denmark)

    Camp, Pat G; Coxson, Harvey O; Levy, Robert D

    2009-01-01

    BACKGROUND: The authors of previous reports have suggested that women are more susceptible to cigarette smoke and to an airway-predominant COPD phenotype rather than an emphysema-predominant COPD phenotype. The purpose of this study was to test for sex differences in COPD phenotypes by using high......-resolution CT (HRCT) scanning in male and female smokers with and without COPD. METHODS: All subjects completed spirometry and answered an epidemiologic respiratory questionnaire. Inspiratory HRCT scans were obtained on 688 smokers enrolled in a family-based study of COPD. Emphysema was assessed by using......-years of smoking, current smoking status, center of enrollment, and FEV(1) percent predicted; p = 0.0006). Women had a smaller SQRTWA and WA% after adjusting for covariates (p emphysema than female smokers, but female smokers do not show increased wall thickness...

  20. Munchausen syndrome revealed by subcutaneous limb emphysema: a case report.

    Science.gov (United States)

    Koufagued, Kaldadak; Chafry, Bouchaib; Benyass, Youssef; Abissegue, Yves; Benchebba, Driss; Bouabid, Salim; Belkacem, Chagar

    2015-08-18

    Limb subcutaneous emphysema secondary to a Munchausen syndrome represents a rare and severe entity because it involves the functional prognosis of the limb and vital prognosis of the patient. We report the case of an 18-year-old Moroccan woman patient who presented to our hospital with a subcutaneous emphysema of the shoulder girdle and the right arm, caused by our patient. Treatment was aggressive, with a wide surgical debridement, parenteral antibiotic therapy and hyperbaric oxygen therapy. The results have been favorable. The correlation of anamnestic data and clinical and para-clinical exams were essential for the diagnosis of Munchausen syndrome in this case. In this regard, we report a rare case of subcutaneous limb emphysema secondary to Munchausen syndrome.

  1. Pathogenesis of pulmonary emphysema – cellular and molecular events

    Directory of Open Access Journals (Sweden)

    Antonio Di Petta

    2010-06-01

    Full Text Available Pulmonary emphysema is a chronic obstructive disease, resulting fromimportant alterations in the whole distal structure of terminal bronchioles, either by enlargement of air spaces or by destruction of the alveolar wall, leading to loss of respiratory surface, decreased elastic recoil and lung hyperinflation. For many years, the hypothesis of protease-antiprotease unbalance prevailed as the central theme in the pathogenesis of pulmonary emphysema. According to this hypothesis, the release of active proteolytic enzymes, produced mainly by neutrophils and macrophages, degrades the extracellular matrix, affecting the integrity of its components, especially collagen and elastic fibers. However, new concepts involving cellular and molecular events were proposed, including oxidative stress, cell apoptosis, cellular senescence and failed lung tissue repair. The aim of this review paper was to evaluate the cellular and molecular mechanisms seen in the pathogenesis of pulmonary emphysema.

  2. Endothelial progenitor cells in chronic obstructive pulmonary disease and emphysema

    Science.gov (United States)

    Tracy, Russell P.; Parikh, Megha A.; Hoffman, Eric A.; Shimbo, Daichi; Austin, John H. M.; Smith, Benjamin M.; Hueper, Katja; Vogel-Claussen, Jens; Lima, Joao; Gomes, Antoinette; Watson, Karol; Kawut, Steven; Barr, R. Graham

    2017-01-01

    Endothelial injury is implicated in the pathogenesis of COPD and emphysema; however the role of endothelial progenitor cells (EPCs), a marker of endothelial cell repair, and circulating endothelial cells (CECs), a marker of endothelial cell injury, in COPD and its subphenotypes is unresolved. We hypothesized that endothelial progenitor cell populations would be decreased in COPD and emphysema and that circulating endothelial cells would be increased. Associations with other subphenotypes were examined. The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with COPD and controls age 50–79 years without clinical cardiovascular disease. Endothelial progenitor cell populations (CD34+KDR+ and CD34+KDR+CD133+ cells) and circulating endothelial cells (CD45dimCD31+CD146+CD133-) were measured by flow cytometry. COPD was defined by standard spirometric criteria. Emphysema was assessed qualitatively and quantitatively on CT. Full pulmonary function testing and expiratory CTs were measured in a subset. Among 257 participants, both endothelial progenitor cell populations, and particularly CD34+KDR+ endothelial progenitor cells, were reduced in COPD. The CD34+KDR+CD133+ endothelial progenitor cells were associated inversely with emphysema extent. Both endothelial progenitor cell populations were associated inversely with extent of panlobular emphysema and positively with diffusing capacity. Circulating endothelial cells were not significantly altered in COPD but were inversely associated with pulmonary microvascular blood flow on MRI. There was no consistent association of endothelial progenitor cells or circulating endothelial cells with measures of gas trapping. These data provide evidence that endothelial repair is impaired in COPD and suggest that this pathological process is specific to emphysema. PMID:28291826

  3. Endothelial progenitor cells in chronic obstructive pulmonary disease and emphysema.

    Science.gov (United States)

    Doyle, Margaret F; Tracy, Russell P; Parikh, Megha A; Hoffman, Eric A; Shimbo, Daichi; Austin, John H M; Smith, Benjamin M; Hueper, Katja; Vogel-Claussen, Jens; Lima, Joao; Gomes, Antoinette; Watson, Karol; Kawut, Steven; Barr, R Graham

    2017-01-01

    Endothelial injury is implicated in the pathogenesis of COPD and emphysema; however the role of endothelial progenitor cells (EPCs), a marker of endothelial cell repair, and circulating endothelial cells (CECs), a marker of endothelial cell injury, in COPD and its subphenotypes is unresolved. We hypothesized that endothelial progenitor cell populations would be decreased in COPD and emphysema and that circulating endothelial cells would be increased. Associations with other subphenotypes were examined. The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with COPD and controls age 50-79 years without clinical cardiovascular disease. Endothelial progenitor cell populations (CD34+KDR+ and CD34+KDR+CD133+ cells) and circulating endothelial cells (CD45dimCD31+CD146+CD133-) were measured by flow cytometry. COPD was defined by standard spirometric criteria. Emphysema was assessed qualitatively and quantitatively on CT. Full pulmonary function testing and expiratory CTs were measured in a subset. Among 257 participants, both endothelial progenitor cell populations, and particularly CD34+KDR+ endothelial progenitor cells, were reduced in COPD. The CD34+KDR+CD133+ endothelial progenitor cells were associated inversely with emphysema extent. Both endothelial progenitor cell populations were associated inversely with extent of panlobular emphysema and positively with diffusing capacity. Circulating endothelial cells were not significantly altered in COPD but were inversely associated with pulmonary microvascular blood flow on MRI. There was no consistent association of endothelial progenitor cells or circulating endothelial cells with measures of gas trapping. These data provide evidence that endothelial repair is impaired in COPD and suggest that this pathological process is specific to emphysema.

  4. Towards local estimation of emphysema progression using image registration

    Science.gov (United States)

    Staring, M.; Bakker, M. E.; Shamonin, D. P.; Stolk, J.; Reiber, J. H. C.; Stoel, B. C.

    2009-02-01

    Progression measurement of emphysema is required to evaluate the health condition of a patient and the effect of drugs. To locally estimate progression we use image registration, which allows for volume correction using the determinant of the Jacobian of the transformation. We introduce an adaptation of the so-called sponge model that circumvents its constant-mass assumption. Preliminary results from CT scans of a lung phantom and from CT data sets of three patients suggest that image registration may be a suitable method to locally estimate emphysema progression.

  5. Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastimum, pneumothorax, and pancytopenia.

    Science.gov (United States)

    Park, Sang Won; Kim, Jeong Yup; Go, Gang Ji; Jeon, Eun Sil; Pyo, Heui Jung; Kwon, Young Joo

    2011-06-01

    30-year-old male was admitted with general weakness and drowsy mental status. He had eaten only 3-4 spoons of brown rice and fresh vegetable without salt for 3 months to treat his tic disorder, and he had been in bed-ridden state. He has had weight loss of 14 kg in the last 3 months. We report a patient with orthorexia nervosa who developed hyponatremia, metabolic acidosis, subcutaneous emphysema, mediastinal emphysema, pneumothorax, and pancytopenia and we will review the literature. Also, we mention to prevent refeeding syndrome, and to start and maintain feeding in malnourished patients.

  6. Thoracoscopic surgery for lung emphysema using an infrared camera.

    Science.gov (United States)

    Matsumoto, Keitaro; Sano, Isao; Taniguchi, Hideki; Yamasaki, Naoya; Tsuchiya, Tomoshi; Miyazaki, Takuro; Tomoshige, Koichi; Nagayasu, Takeshi

    2013-05-24

    Localized emphysema is difficult to detect on normal thoracoscopy. Indocyanine green (ICG) was used to precisely delineate an emphysematous lesion using an infrared camera system in a 75-year-old woman with a large emphysematous lesion in the right lower lobe. Due to repeated infections of the emphysematous lesion, right basal segmentectomy for localized lung emphysema was performed. During surgery, ICG (0.5 mg/kg) was injected intravenously, and the emphysematous lesion was detected as a fluorescence defect. This method could be used for precise resection of large emphysematous lesions because it permits clear detection with a small amount of ICG.

  7. Pneumomediastinum, subcutaneous emphysema, and pneumothorax after a pulmonary function testing in a patient with bleomycin-induced interstitial pneumonitis

    Directory of Open Access Journals (Sweden)

    Mariana Sponholz Araujo

    2013-09-01

    Full Text Available Spontaneous pneumomediastinum is an uncommon event, the clinical picture of which includes retrosternal chest pain, subcutaneous emphysema, dyspnea, and dysphonia. The pathophysiological mechanism involved is the emergence of a pressure gradient between the alveoli and surrounding structures, causing alveolar rupture with subsequent dissection of the peribronchovascular sheath and infiltration of the mediastinum and subcutaneous tissue with air. Known triggers include acute exacerbations of asthma and situations that require the Valsalva maneuver. We described and documented with HRCT scans the occurrence of pneumomediastinum after a patient with bleomycin-induced interstitial lung disease underwent pulmonary function testing. Although uncommon, the association between pulmonary function testing and air leak syndromes has been increasingly reported in the literature, and lung diseases, such as interstitial lung diseases, include structural changes that facilitate the occurrence of this complication.

  8. Obesity and Asthma

    DEFF Research Database (Denmark)

    Juel, Caroline Trunk-Black; Ulrik, Charlotte Suppli

    2013-01-01

    Asthma is more prevalent in obese compared with normal weight subjects. Our aim has been to review current knowledge of the impact of obesity on asthma severity, asthma control, and response to therapy.Several studies have shown that overweight and obesity is associated with more severe asthma...... and impaired quality of life compared with normal weight individuals. Furthermore, obesity is associated with poorer asthma control, as assessed by asthma control questionnaires, limitations in daily activities, breathlessness and wheezing, use of rescue medication, unscheduled doctor visits, emergency...... department visits, and hospitalizations for acute asthma. Studies of the impact of a high body mass index (BMI) on response to asthma therapy have, however, revealed conflicting results. Most studies show that overweight and obesity is associated with less favorable response to asthma therapy with regard...

  9. Smoking and Asthma (For Teens)

    Science.gov (United States)

    ... Personal Plan Hot Topics Flu Facts Arrhythmias Abuse Smoking and Asthma KidsHealth > For Teens > Smoking and Asthma ... A en español Fumar y el asma Does Smoking Make Asthma Worse? Yes. If you have asthma, ...

  10. Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

    Science.gov (United States)

    Smith, Benjamin M.; Prince, Martin R.; Hoffman, Eric A.; Bluemke, David A.; Liu, Chia-Ying; Rabinowitz, Dan; Hueper, Katja; Parikh, Megha A.; Gomes, Antoinette S.; Michos, Erin D.; Lima, João A. C.; Barr, R. Graham

    2013-01-01

    Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) filling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. Methods: The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defined by spirometry. Percent emphysema was defined as regions emphysema (P emphysema on CT scan, and emphysema without spirometrically defined COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These findings support a mechanism of upstream pulmonary causes of underfilling of the LV in COPD and in patients with emphysema on CT scan. PMID:23764937

  11. Study of serum malondialdehyde and whole blood reduced glutathione in emphysema patients

    Directory of Open Access Journals (Sweden)

    Nagaraj R.Shetkar, Anand Pyati, Rajesh CS

    2013-04-01

    Full Text Available Background: Emphysema is associated with high incidence of morbidity and mortality. The imbalance between oxidants and antioxidants is thought to play an important role in the pathogenesis of Emphysema. Methods: A total number of 80 subjects comprising of 40 healthy controls and 40 Emphysema cases were studied. In all the subjects, serum levels of malondialdehyde (MDA as a biomarker of lipid peroxidation and antioxidant whole blood reduced glutathione (GSH were estimated. Results: The level of whole blood reduced glutathione was significantly decreased in emphysema patients when compared to controls. Serum MDA was significantly increased in Emphysema patients when compared to controls. Conclusion: The presence of increased systemic oxidative stress in emphysema patients seems to be associated with current active smoking and systemic inflammation. The decrease in antioxidants levels appears to be mainly a consequence of increased oxidative stress. This suggests that oxidative stress is likely to be involved in pathogenesis of emphysema.

  12. The clinical and genetic features of COPD-asthma overlap syndrome.

    Science.gov (United States)

    Hardin, Megan; Cho, Michael; McDonald, Merry-Lynn; Beaty, Terri; Ramsdell, Joe; Bhatt, Surya; van Beek, Edwin J R; Make, Barry J; Crapo, James D; Silverman, Edwin K; Hersh, Craig P

    2014-08-01

    Individuals with chronic obstructive pulmonary disease (COPD) and asthma are an important but poorly characterised group. The genetic determinants of COPD and asthma overlap have not been studied. The aim of this study was to identify clinical features and genetic risk factors for COPD and asthma overlap. Subjects were current or former smoking non-Hispanic whites or African-Americans with COPD. Overlap subjects reported a history of physician-diagnosed asthma before the age of 40 years. We compared clinical and radiographic features between COPD and overlap subjects. We performed genome-wide association studies (GWAS) in the non-Hispanic whites and African-American populations, and combined these results in a meta-analysis. More females and African-Americans reported a history of asthma. Overlap subjects had more severe and more frequent respiratory exacerbations, less emphysema and greater airway wall thickness compared to subjects with COPD alone. The non-Hispanic white GWAS identified single nucleotide polymorphisms in the genes CSMD1 (rs11779254, p=1.57 × 10(-6)) and SOX5 (rs59569785, p=1.61 × 10(-6)) and the meta-analysis identified single nucleotide polymorphisms in the gene GPR65 (rs6574978, p=1.18 × 10(-7)) associated with COPD and asthma overlap. Overlap subjects have more exacerbations, less emphysema and more airway disease for any degree of lung function impairment compared to COPD alone. We identified novel genetic variants associated with this syndrome. COPD and asthma overlap is an important syndrome and may require distinct clinical management. ©ERS 2014.

  13. Lobar Emphysema Distribution Is Associated With 5-Year Radiological Disease Progression.

    Science.gov (United States)

    Boueiz, Adel; Chang, Yale; Cho, Michael H; Washko, George R; San José Estépar, Raul; Bowler, Russell P; Crapo, James D; DeMeo, Dawn L; Dy, Jennifer G; Silverman, Edwin K; Castaldi, Peter J

    2017-09-21

    Emphysema has considerable variability in its regional distribution. Craniocaudal emphysema distribution is an important predictor of the response to lung volume reduction. However, there is little consensus regarding how to define upper lobe-predominant and lower lobe-predominant emphysema subtypes. Consequently, the clinical and genetic associations with these subtypes are poorly characterized. We sought to identify subgroups characterized by upper-lobe or lower-lobe emphysema predominance and comparable amounts of total emphysema by analyzing data from 9,210 smokers with without alpha-1-antitrypsin deficiency in the Genetic Epidemiology of COPD (COPDGene) cohort. CT densitometric emphysema was measured in each lung lobe. Random forest clustering was applied to lobar emphysema variables after regressing out the effects of total emphysema. Clusters were tested for association with clinical and imaging outcomes at baseline and at 5-year follow-up. Their associations with genetic variants were also compared. Three clusters were identified: minimal emphysema (n = 1,312), upper lobe-predominant emphysema (n = 905), and lower lobe-predominant emphysema (n = 796). Despite a similar amount of total emphysema, the lower-lobe group had more severe airflow obstruction at baseline and higher rates of metabolic syndrome compared with subjects with upper-lobe predominance. The group with upper-lobe predominance had greater 5-year progression of emphysema, gas trapping, and dyspnea. Differential associations with known COPD genetic risk variants were noted. Subgroups of smokers defined by upper-lobe or lower-lobe emphysema predominance exhibit different functional and radiological disease progression rates, and the upper-lobe predominant subtype shows evidence of association with known COPD genetic risk variants. These subgroups may be useful in the development of personalized treatments for COPD. Copyright © 2017 American College of Chest Physicians. Published by Elsevier

  14. Asthma and obesity.

    Science.gov (United States)

    Boulet, L-P

    2013-01-01

    The prevalence and incidence of asthma have increased among obese children and adults, particularly among women. Obesity seems to be a predisposing factor for the development of asthma, but the underlying mechanisms of its influence are still uncertain. Various hypotheses have been proposed to explain the link between obesity and asthma such as a common genetic predisposition, developmental changes, altered lung mechanics, the presence of a systemic inflammatory process, and an increased prevalence of associated comorbid conditions. Over-diagnosis of asthma does not seem to be more frequent in obese compared to non-obese subjects, but the added effects of obesity on respiratory symptoms can affect asthma control assessment. Obesity can make asthma more difficult to control and is associated with a reduced beneficial effect of asthma medications. This could be due to a change in asthma phenotype, particularly evidenced as a less eosinophilic type of airway inflammation combined to the added effects of changes in lung mechanics. Weight loss is associated with a universal improvement of asthma and should be part of asthma management in the obese patient. Additional research should be conducted to better determine how obesity influences the development and clinical expression of asthma, establish the optimal management of asthma in this population and determine how obesity affects long-term asthma outcomes in these patients. © 2012 Blackwell Publishing Ltd.

  15. Allergy in severe asthma.

    Science.gov (United States)

    Del Giacco, S R; Bakirtas, A; Bel, E; Custovic, A; Diamant, Z; Hamelmann, E; Heffler, E; Kalayci, Ö; Saglani, S; Sergejeva, S; Seys, S; Simpson, A; Bjermer, L

    2017-02-01

    It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-5 of GINA guidelines to prevent their asthma from becoming 'uncontrolled', or whose disease remains 'uncontrolled' despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The 'Allergy and Asthma Severity' EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Immunomodulatory strategies prevent the development of autoimmune emphysema

    Directory of Open Access Journals (Sweden)

    Kraskauskiene Vita

    2010-12-01

    Full Text Available Abstract Background The presence of anti-endothelial cell antibodies and pathogenic T cells may reflect an autoimmune component in the pathogenesis of emphysema. Whether immune modulatory strategies can protect against the development of emphysema is not known. Methods Sprague Dawley rats were immunized with human umbilical vein endothelial cells (HUVEC to induce autoimmune emphysema and treated with intrathymic HUVEC-injection and pristane. Measurements of alveolar airspace enlargement, cytokine levels, immuno histochemical, western blot analysis, and T cell repertoire of the lung tissue were performed. Results The immunomodulatory strategies protected lungs against cell death as demonstrated by reduced numbers of TUNEL and active caspase-3 positive cells and reduced levels of active caspase-3, when compared with lungs from HUVEC-immunized rats. Immunomodulatory strategies also suppressed anti-endothelial antibody production and preserved CNTF, IL-1alpha and VEGF levels. The immune deviation effects of the intrathymic HUVEC-injection were associated with an expansion of CD4+CD25+Foxp3+ regulatory T cells. Pristane treatment decreased the proportion of T cells expressing receptor beta-chain, Vβ16.1 in the lung tissue. Conclusions Our data demonstrate that interventions classically employed to induce central T cell tolerance (thymic inoculation of antigen or to activate innate immune responses (pristane treatment can prevent the development of autoimmune emphysema.

  17. Ventilation inhomogeneity in alpha1-antitrypsin-deficient emphysema

    NARCIS (Netherlands)

    Fregonese, L.; van Veen, H. P. A. A.; Sterk, P. J.; Stolk, J.

    2006-01-01

    The slope of phase III of the single-breath nitrogen wash-out test (sbN2-test) measures ventilation inhomogeneity and, in smokers, is strongly associated with small airways pathology. The present authors aimed to study ventilation inhomogeneity in emphysema related to type Z alpha1-antitrypsin (AAT)

  18. Case Report: Multiple Rib Fracture With Surgical Emphysema At 34 ...

    African Journals Online (AJOL)

    A case of multiple rib fracture with surgical emphysema following a raod traffic accident at 34 weeks gestation is presented. She had spontaneous vertex delivery at 41 weeks gestation with good feto – maternal outcome. This is a case of severe injuries to the maternal trunk in which the uterus and / or the fetus were not ...

  19. Miller–Dieker Syndrome Associated with Congenital Lobar Emphysema

    Directory of Open Access Journals (Sweden)

    Linda Mahgoub

    2014-05-01

    Full Text Available Miller–Dieker syndrome (MDS is a rare genetic syndrome associated with lissencephaly, developmental delay, and high mortality. We describe a patient who was diagnosed postnatally with both MDS and congenital lobar emphysema. We believe that this is the first reported case of the two conditions presenting in the same patient.

  20. Surgical procedures in emphysema: any impact on dynamic hyperinflation?

    Directory of Open Access Journals (Sweden)

    M. I. Polkey

    2006-12-01

    Full Text Available Bullectomy, lung volume reduction surgery and transplantation can palliate dyspnoea in emphysema. The available data suggest that their mode of action, at least with regard to pulmonary mechanics, includes beneficial effects on dynamic hyperinflation. In single lung transplant recipients, this may be asymmetric, causing native lung hyperinflation.

  1. [Rectal ozone therapy for patients with pulmonary emphysema].

    Science.gov (United States)

    Calunga, José Luis; Paz, Yuleidys; Menéndez, Silvia; Martínez, Alfredo; Hernández, Aparicio

    2011-04-01

    Ozone therapy may stimulate antioxidant systems and protect against free radicals. It has not been used formerly in patients with pulmonary emphysema. To assess the effects of rectal ozone therapy in patients with pulmonary emphysema. Sixty four patients with pulmonary emphysema, aged between 40 and 69 years, were randomly assigned to receive rectal ozone in 20 daily sessions, rectal medicinal oxygen or no treatment. Treatments were repeated three months later in the first two groups. At baseline and at the end of the study, spirometry and a clinical assessment were performed. fifty patients completed the protocol, 20 receiving ozone therapy, 20 receiving rectal oxygen and 10 not receiving any therapy. At baseline, patients on ozone therapy had significantly lower values of forced expiratory volume in the first second (fEV1) and fEV1/forced vital capacity. At the end of the treatment period, these parameters were similar in the three treatment groups, therefore they only improved significantly in the group on ozone therapy. No differences were observed in other spirometric parameters. Rectal ozone therapy may be useful in patients with pulmonary emphysema.

  2. Emphysema and chronic obstructive pulmonary disease in coal miners.

    Science.gov (United States)

    Santo Tomas, Linus H

    2011-03-01

    Coal mining remains a major industry that has workers at risk for developing chronic lung disease. Aside from simple coal workers' pneumoconiosis and progressive massive fibrosis, the development of emphysema and obstructive lung disease independent of smoking may be underappreciated. This article reviews more recent studies that may help rectify this faulty view. Cumulative exposure to coal dust is a significant risk factor for the development of emphysema and has an additive effect to smoking. Increased coal dust exposure is associated with increased risk of death from chronic obstructive pulmonary disease (COPD). In newly employed coal miners, bronchitic symptoms are associated with a rapid decline in lung function within 2 years after starting work. In evaluating impairment, the chest radiograph may be helpful as a marker of exposure but the diffusing capacity is most correlated with dyspnea, whereas the emphysema computed tomography score has good association with expiratory flow limitation. Latest studies further support the association of emphysema and COPD with coal dust exposure. Increased cumulative exposure may also increase risk of death from these diseases.

  3. Emphysema and chronic obstructive pulmonary disease in coal miners

    Energy Technology Data Exchange (ETDEWEB)

    Tomas, L.H.S. [Medical College of Wisconsin, Milwaukee, WI (United States)

    2011-03-15

    Coal mining remains a major industry that has workers at risk for developing chronic lung disease. Aside from simple coal workers' pneumoconiosis and progressive massive fibrosis, the development of emphysema and obstructive lung disease independent of smoking may be underappreciated. This article reviews more recent studies that may help rectify this faulty view. Cumulative exposure to coal dust is a significant risk factor for the development of emphysema and has an additive effect to smoking. Increased coal dust exposure is associated with increased risk of death from chronic obstructive pulmonary disease (COPD). In newly employed coal miners, bronchitic symptoms are associated with a rapid decline in lung function within 2 years after starting work. In evaluating impairment, the chest radiograph may be helpful as a marker of exposure but the diffusing capacity is most correlated with dyspnea, whereas the emphysema computed tomography score has good association with expiratory flow limitation. Latest studies further support the association of emphysema and COPD with coal dust exposure. Increased cumulative exposure may also increase risk of death from these diseases.

  4. Nucleotide Salvage Deficiencies, DNA Damage and Neurodegeneration

    Directory of Open Access Journals (Sweden)

    Michael Fasullo

    2015-04-01

    Full Text Available Nucleotide balance is critically important not only in replicating cells but also in quiescent cells. This is especially true in the nervous system, where there is a high demand for adenosine triphosphate (ATP produced from mitochondria. Mitochondria are particularly prone to oxidative stress-associated DNA damage because nucleotide imbalance can lead to mitochondrial depletion due to low replication fidelity. Failure to maintain nucleotide balance due to genetic defects can result in infantile death; however there is great variability in clinical presentation for particular diseases. This review compares genetic diseases that result from defects in specific nucleotide salvage enzymes and a signaling kinase that activates nucleotide salvage after DNA damage exposure. These diseases include Lesch-Nyhan syndrome, mitochondrial depletion syndromes, and ataxia telangiectasia. Although treatment options are available to palliate symptoms of these diseases, there is no cure. The conclusions drawn from this review include the critical role of guanine nucleotides in preventing neurodegeneration, the limitations of animals as disease models, and the need to further understand nucleotide imbalances in treatment regimens. Such knowledge will hopefully guide future studies into clinical therapies for genetic diseases.

  5. Methylenedioxymethamphetamine (MDMA, 'Ecstasy': Neurodegeneration versus Neuromodulation

    Directory of Open Access Journals (Sweden)

    Elena Puerta

    2011-07-01

    Full Text Available The amphetamine analogue 3,4-methylenedioxymethamphetamine (MDMA, ‘ecstasy’ is widely abused as a recreational drug due to its unique psychological effects. Of interest, MDMA causes long-lasting deficits in neurochemical and histological markers of the serotonergic neurons in the brain of different animal species. Such deficits include the decline in the activity of tryptophan hydroxylase in parallel with the loss of 5-HT and its main metabolite 5-hydoxyindoleacetic acid (5-HIAA along with a lower binding of specific ligands to the 5-HT transporters (SERT. Of concern, reduced 5-HIAA levels in the CSF and SERT density have also been reported in human ecstasy users, what has been interpreted to reflect the loss of serotonergic fibers and terminals. The neurotoxic potential of MDMA has been questioned in recent years based on studies that failed to show the loss of the SERT protein by western blot or the lack of reactive astrogliosis after MDMA exposure. In addition, MDMA produces a long-lasting down-regulation of SERT gene expression; which, on the whole, has been used to invoke neuromodulatory mechanisms as an explanation to MDMA-induced 5-HT deficits. While decreased protein levels do not necessarily reflect neurodegeneration, the opposite is also true, that is, neuroregulatory mechanisms do not preclude the existence of 5-HT terminal degeneration.

  6. Post-translational modifications in neurodegeneration

    Directory of Open Access Journals (Sweden)

    Federico Benetti

    2015-12-01

    Full Text Available Post-translational modifications increase proteome functionality for managing all aspects of normal cell biology. They are based on the covalent attachment of functional groups, leading to phosphorylation, acetylation, glycosylation, acylation, ubiquitination, SUMOylation and oxidation of protein targets. Post-translational modifications occur at any step of protein life cycle, modulating in time and space protein folding, subcellular localization and activity. Aberrant post-translational modifications of one or more culprit proteins may lead to neurodegeneration, as shown in paradigmatic neurological disorders such as Alzheimer’s, Parkinson’s and prion diseases. In this review, we report the most important post-translational modifications found in neurodegenerative disorders, illustrating the pathophysiological mechanisms in which they are involved. This work highlights the lack of a global framework of post-translational modifications in terms of complexity and regulation. Therefore, in the next future many efforts are required to describe the interplay existing between post-translational modifications and their combinatorial patterns on protein targets.

  7. For Parents of Children with Asthma

    Science.gov (United States)

    ... Asthma > Managing Asthma For Parents of Children with Asthma Your Child's Asthma: A Parent's Guide to Better Breathing This step- ... health considerations you should keep in mind. Diagnosing Asthma in Young Children Most children who have asthma ...

  8. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Asthma among Persons with Current Asthma Asthma and Obesity Percentage of People with Asthma who Smoke Insurance ... Asthma Resources for Professionals National Asthma Control Program America Breathing Easier Guide for State Programs Interventions Community ...

  9. Quantification of Emphysema: A Bullae Distribution Based Approach

    Science.gov (United States)

    Tan, Kok Liang; Tanaka, Toshiyuki; Nakamura, Hidetoshi; Shirahata, Toru; Sugiura, Hiroaki

    Computed tomography (CT)-based quantifications of emphysema encompass, and are not limited to, the ratio of the low-attenuation area, the bullae size, and the distribution of bullae in the lung. The standard CT-based emphysema describing indices include the mean lung density, the percentage of area of low attenuation [the pixel index (PI)] and the bullae index (BI). These standard emphysema describing indices are not expressive for describing the distribution of bullae in the lung. Consequently, the goal of this paper is to present a new emphysema describing index, the bullae congregation index (BCI), that describes whether bullae gather in a specific area of the lung and form a nearly single mass, and if so, how dense the mass of bullae is in the lung. BCI ranges from zero to ten corresponding to sparsely distributed bullae to densely distributed bullae. BCI is calculated based on the relative distance between every pair of bullae in the lung. The bullae pair distances are sorted into 200 distance classes. A smaller distance class corresponds to a closer proximity between the bullae. BCI is derived by calculating the percentage of the area of bullae in the lung that are separated by a certain distance class. Four bullae congregation classes are defined based on BCI. We evaluate BCI using 114 CT images that are hand-annotated by a radiologist into four bullae congregation classes. The average four-class classification accuracy of BCI is 88.21%. BCI correlates better than PI, BI and other standard statistical dispersion based methods with the radiological consensus-classified bullae congregation class.While BCI is not a specific index for indicating emphysema severity, it complements the existing set of emphysema describing indices to facilitate a more thorough knowledge about the emphysematous conditions in the lung. BCI is especially useful when it comes to comparing the distribution of bullae for cases with approximately the same PI, BI or PI and BI. BCI is easy

  10. What is Asthma?

    Medline Plus

    Full Text Available ... Lung Association 104 COPD Awareness Month: Connecting with Social Support American Lung Association ... Asthma - Duration: 3:36. Nucleus Medical Media 658,979 views 3:36 What is asthma. ...

  11. Obesity, adipokines and asthma

    National Research Council Canada - National Science Library

    Jartti, T; Saarikoski, L; Jartti, L; Lisinen, I; Jula, A; Huupponen, R; Viikari, J; Raitakari, O. T

    2009-01-01

    .... Our objective was to examine whether obesity is associated with asthma in three time points of life, and whether immunomodulatory adipokines, leptin and adiponectin are linked to overweight-associated asthma. Methods...

  12. What is Asthma?

    Medline Plus

    Full Text Available ... Lung Association 139 Barbara Tie talks about Alpha 1-caused COPD American Lung Association 140 Judy Pruitt ... American Lung Association 182 Asthma - Theresa Moore PSA 1 American Lung Association 183 Asthma Walk PSA American ...

  13. Exercise-induced asthma

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000036.htm Exercise-induced asthma To use the sharing features on this page, ... such as running, basketball, or soccer. Use Your Asthma Medicine Before you Exercise Take your short-acting, ...

  14. Allergies, asthma, and pollen

    Science.gov (United States)

    Reactive airway - pollen; Bronchial asthma - pollen; Triggers - pollen; Allergic rhinitis - pollen ... Things that make allergies or asthma worse are called triggers. It is important to know your triggers because avoiding them is your first step toward feeling better. ...

  15. What is Asthma?

    Medline Plus

    Full Text Available ... Clubs American Lung Association 146 Angela Abel on exercise and COPD American Lung Association 147 American Lung ... 40 Types of Asthma - Duration: 11:38. Affinity Health Plan 6,222 views 11:38 Asthma Tech - ...

  16. Smoking and asthma

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000504.htm Smoking and asthma To use the sharing features on ... your allergies or asthma worse are called triggers. Smoking is a trigger for many people who have ...

  17. Asthma - child - discharge

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000001.htm Asthma - child - discharge To use the sharing features on this ... care for your child. Take Charge of Your Child's Asthma at Home Make sure you know the ...

  18. Psychopathology in difficult asthma

    NARCIS (Netherlands)

    Prins, L.C.; van Son, M.J.M.; Keimpema, A.R.; van Ranst, D; Pommer, A; Meijer, J.W.; Pop, V.J.M.

    2015-01-01

    OBJECTIVE: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed

  19. Revisiting 'Respiratory Function in Emphysema in Relation to Prognosis'

    Directory of Open Access Journals (Sweden)

    David V Bates

    2000-01-01

    Full Text Available BACKGROUND: The 1956 paper by DV Bates, JMS Knott and RV Christie, "Respiratory function in emphysema in relation to prognosis" Quart J Med 1956;97:137-157 is largely reprinted with a commentary by the first author, Dr David Bates. Although the pathology of emphysema was well recognized at the time, the clinical diagnosis and assessment of its severity were known to be imprecise; physiological measurements assessing and following the clinical course had not been established. The study aimed to follow systematically a group of patients, selected by clinical criteria using standardized clinical and physiological techniques, over four years and correlate physiological and clinical changes in relation to prognosis and eventually to postmortem findings. Fifty-nine patients were recruited to an emphysema clinic at St Bartholomew's Hospital, London, England. Inclusion criteria were dyspnea without other causes and no cor pulmonale present. Patients' symptoms were assessed by a standardized questionnaire, and measurements were taken of lung volumes, maximal ventilatory volume, carbon monoxide diffusing capacity at rest, exercise and oxygen saturation by oximetry.  During the four years of the study, 17 patients died (actuarial expected - four and 13 presented with signs of pulmonary heart failure. All postmortem examinations (n=9 showed advanced emphysema. A seasonal variation in dyspnea was established (the period included the infamous 1952 London smog. Four patients improved, and the remainder were unchanged or deteriorated. Close relationships were shown between dyspnea and function results, particularly for the diffusing capacity of lungs for carbon monoxide (DLCO. A comparison among a group of patients with chronic bronchitis without dyspnea showed that the DLCO discriminated between them. A loss of the normal increase in DLCO during exercise was shown in emphysema.

  20. Paraseptal emphysema: Prevalence and distribution on CT and association with interstitial lung abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Araki, Tetsuro, E-mail: taraki@partners.org [Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215 (United States); Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama (Japan); Nishino, Mizuki [Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215 (United States); Zazueta, Oscar E. [The Pulmonary and Critical Care Division, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Gao, Wei [Department of Biostatistics, Boston University School of Public Health, Boston, MA (United States); Dupuis, Josée [Department of Biostatistics, Boston University School of Public Health, Boston, MA (United States); The National Heart Lung and Blood Institute' s Framingham Heart Study, Framingham, MA (United States); Okajima, Yuka [Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women' s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02215 (United States); Latourelle, Jeanne C. [Department of Medicine and Neurology, Boston University School of Medicine, Boston, MA (United States); Rosas, Ivan O. [The Pulmonary and Critical Care Division, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Murakami, Takamichi [Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama (Japan); O’Connor, George T. [The National Heart Lung and Blood Institute' s Framingham Heart Study, Framingham, MA (United States); Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA (United States); Washko, George R.; Hunninghake, Gary M. [The Pulmonary and Critical Care Division, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); and others

    2015-07-15

    Highlights: • The prevalence of pure paraseptal emphysema was 3% (85/2633) in the Framingham Heart Study population, predominantly affects the upper lung zone, and contributes to slightly decreased pulmonary function. • There was significant association between paraseptal emphysema and interstitial lung abnormalities, which is a novel finding. • Prevalence of paraseptal emphysema and its impact on pulmonary function could have been underestimated in the previous reports. - Abstract: Objective: To investigate the prevalence and distribution of paraseptal emphysema on chest CT images in the Framingham Heart Study (FHS) population, and assess its impact on pulmonary function. Also pursued was the association with interstitial lung abnormalities. Materials and methods: We assessed 2633 participants in the FHS for paraseptal emphysema on chest CT. Characteristics of the participants, including age, sex, smoking status, clinical symptoms, and results of pulmonary function tests, were compared between those with and without paraseptal emphysema. The association between paraseptal emphysema and interstitial lung abnormalities was investigated. Results: Of the 2633 participants, 86 (3%) had pure paraseptal emphysema (defined as paraseptal emphysema with no other subtypes of emphysema other than paraseptal emphysema or a very few centrilobular emphysema involved) in at least one lung zone. The upper zone of the lungs was almost always involved. Compared to the participants without paraseptal emphysema, those with pure paraseptal emphysema were significantly older, and were more frequently male and smokers (mean 64 years, 71% male, mean 36 pack-years, P < 0.001) and had significantly decreased FEV{sub 1}/FVC% (P = 0.002), and diffusion capacity of carbon monoxide (DLCO) (P = 0.002). There was a significant association between pure paraseptal emphysema and interstitial lung abnormalities (P < 0.001). Conclusions: The prevalence of pure paraseptal emphysema was 3% in the

  1. Obesity and asthma

    DEFF Research Database (Denmark)

    Ali, Zarqa; Ulrik, Charlotte Suppli

    2013-01-01

    Epidemiological data has established increasing adiposity as a risk factor for incident asthma. However, the mechanisms underlying the association between obesity and asthma are incompletely understood. In the present paper, we review current knowledge of possible mechanisms mediating the observed...... association between obesity and asthma....

  2. Allergy in severe asthma

    NARCIS (Netherlands)

    Del Giacco, Stefano R.; Bakirtas, A.; Bel, E.; Custovic, A.; Diamant, Z.; Hamelmann, E.; Heffler, E.; Kalayci, O.; Saglani, S.; Sergejeva, S.; Seys, S.; Simpson, A.; Bjermer, Leif

    It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps

  3. Clinical phenotypes of asthma

    NARCIS (Netherlands)

    Bel, Elisabeth H.

    2004-01-01

    PURPOSE OF REVIEW: Asthma is a phenotypically heterogeneous disorder and, over the years, many different clinical subtypes of asthma have been described. A precise definition of asthma phenotypes is now becoming more and more important, not only for a better understanding of pathophysiologic

  4. Hepatocyte and keratinocyte growth factors and their receptors in human lung emphysema

    Directory of Open Access Journals (Sweden)

    Marchal Joëlle

    2005-10-01

    Full Text Available Abstract Background Hepatocyte and keratinocyte growth factors are key growth factors in the process of alveolar repair. We hypothesized that excessive alveolar destruction observed in lung emphysema involves impaired expression of hepatocyte and keratinocyte growth factors or their respective receptors, c-met and keratinocyte growth factor receptor. The aim of our study was to compare the expression of hepatocyte and keratinocyte growth factors and their receptors in lung samples from 3 groups of patients: emphysema; smokers without emphysema and non-smokers without emphysema. Methods Hepatocyte and keratinocyte growth factor proteins were analysed by immunoassay and western blot; mRNA expression was measured by real time quantitative polymerase chain reaction. Results Hepatocyte and keratinocyte growth factors, c-met and keratinocyte growth factor receptor mRNA levels were similar in emphysema and non-emphysema patients. Hepatocyte growth factor mRNA correlated negatively with FEV1 and the FEV1/FVC ratio both in emphysema patients and in smokers with or without emphysema. Hepatocyte and keratinocyte growth factor protein concentrations were similar in all patients' groups. Conclusion The expression of hepatocyte and keratinocyte growth factors and their receptors is preserved in patients with lung emphysema as compared to patients without emphysema. Hepatocyte growth factor mRNA correlates with the severity of airflow obstruction in smokers.

  5. [Mechanisms of neurodegeneration in Alzheimer's disease].

    Science.gov (United States)

    Jovanović, Zorica

    2012-01-01

    Recent research into mechanisms of neurodegeneration in Alzheimer's disease has lead to a dramatic increase in our understanding of the mechanisms of cell death and neuroprotection. Alzheimer's disease is a complex disease with multiple etiological factors involved in disease pathogenesis. OXIDATIVE STRESS AND MITOCHONDRIAL DYSFUNCTION IN ALZHEIMER'S DISEASE: Amyloid-beta peptide toxicity is mediated at least in part by oxidative stress. Anmyloid-beta peptide directly generates reactive oxygen species in the presence of redox-active metal ions. In Alzheimer's disease, oxidative stress is present early in pathogenesis and contributes to disease pathogenesis. Unlike other organs, the brain is especially vulnerable to reactive oxygen species due to neurons having relatively low levels of endogenous antioxidants. Overly abundant oxygen radicals cause the destruction of cellular macromolecules and participate in signaling mechanisms that result in apoptotic cell death. MICROGLIAL ACTIVATION AND NICOTINAMIDE ADENINE DINUCLEOTIDE PHOSPHATE OXIDASE IN ALZHEIMER'S DISEASE: There is a wealth of evidence demonstrating that microglia, the resident innate immune cells in the brain, can become deleterious and damage neurons. Microglial activation causes neuron damage through the production of neurotoxic factors, such as reactive oxygen species and cytokines that are toxic to neurons. The neuron also has strong homeostatic mechanisms that can delay or prevent activation of apoptosis and necrosis. INSULIN RESISTANCE AND ALZHEIMER'S DISEASE: Insulin plays a role in Alzheimer's disease, as it is involved in the metabolism of beta-amyloid. Hyperinsulinemia and type-2 diabetes mellitus results in an increased risk of developing Alzheimer's disease, but its implications when the disease is already well established remain unknown. Treatment of central insulin resistance may be a promising avenue, not only in metabolic syndrom, but also in Alzheimer's disease. Increasing evidence

  6. Elastase-induced pulmonary emphysema: insights from experimental models

    Directory of Open Access Journals (Sweden)

    Mariana A. Antunes

    2011-12-01

    Full Text Available Several distinct stimuli can be used to reproduce histological and functional features of human emphysema, a leading cause of disability and death. Since cigarette smoke is the main cause of emphysema in humans, experimental researches have attempted to reproduce this situation. However, this is an expensive and cumbersome method of emphysema induction, and simpler, more efficacious alternatives have been sought. Among these approaches, elastolytic enzymes have been widely used to reproduce some characteristics of human cigarette smoke-induced disease, such as: augmentation of airspaces, inflammatory cell influx into the lungs, and systemic inflammation. Nevertheless, the use of elastase-induced emphysema models is still controversial, since the disease pathways involved in elastase induction may differ from those occurring in smoke-induced emphysema. This indicates that the choice of an emphysema model may impact the results of new therapies or drugs being tested. The aim of this review is to compare the mechanisms of disease induction in smoke and elastase emphysema models, to describe the differences among various elastase models, and to establish the advantages and disadvantages of elastase-induced emphysema models. More studies are required to shed light on the mechanisms of elastase-induced emphysema.Diversos estímulos podem ser utilizados para reproduzir características histológicas e funcionais do enfisema humano, uma das principais causas de incapacidade e morte. Uma vez que a fumaça de cigarro é a principal causa de enfisema em humanos, estudos experimentais têm tentado reproduzir esta situação. No entanto, esse é um método dispendioso e complicado para a indução do enfisema e, alternativas mais simples e eficazes, têm sido pesquisadas. Entre essas abordagens, enzimas elastolíticas vêm sendo amplamente utilizadas para reproduzir algumas das características do enfisema humano, tais como: aumento dos espaços a

  7. Epigenetic Mechanisms in Asthma.

    Science.gov (United States)

    DeVries, Avery; Vercelli, Donata

    2016-03-01

    Asthma and allergic diseases are among the most prevalent chronic noncommunicable diseases of childhood, but the underlying pathogenetic mechanisms are poorly understood. Because epigenetic mechanisms link gene regulation to environmental cues and developmental trajectories, their contribution to asthma and allergy pathogenesis is under active investigation. DNA methylation signatures associated with concurrent disease and with the development of asthma during childhood asthma have been identified, but their significance is not easily interpretable. On the other hand, the characterization of early epigenetic predictors of asthma points to a potential role of epigenetic mechanisms in regulating the inception of, and the susceptibility to, this disease.

  8. CSPα knockout causes neurodegeneration by impairing SNAP-25 function

    Science.gov (United States)

    Sharma, Manu; Burré, Jacqueline; Bronk, Peter; Zhang, Yingsha; Xu, Wei; Südhof, Thomas C

    2012-01-01

    At a synapse, the synaptic vesicle protein cysteine-string protein-α (CSPα) functions as a co-chaperone for the SNARE protein SNAP-25. Knockout (KO) of CSPα causes fulminant neurodegeneration that is rescued by α-synuclein overexpression. The CSPα KO decreases SNAP-25 levels and impairs SNARE-complex assembly; only the latter but not the former is reversed by α-synuclein. Thus, the question arises whether the CSPα KO phenotype is due to decreased SNAP-25 function that then causes neurodegeneration, or due to the dysfunction of multiple as-yet uncharacterized CSPα targets. Here, we demonstrate that decreasing SNAP-25 levels in CSPα KO mice by either KO or knockdown of SNAP-25 aggravated their phenotype. Conversely, increasing SNAP-25 levels by overexpression rescued their phenotype. Inactive SNAP-25 mutants were unable to rescue, showing that the rescue was specific. Under all conditions, the neurodegenerative phenotype precisely correlated with SNARE-complex assembly, indicating that impaired SNARE-complex assembly due to decreased SNAP-25 levels is the ultimate correlate of neurodegeneration. Our findings suggest that the neurodegeneration in CSPα KO mice is primarily produced by defective SNAP-25 function, which causes neurodegeneration by impairing SNARE-complex assembly. PMID:22187053

  9. Obesity and asthma.

    Science.gov (United States)

    Gibson, Peter G

    2013-12-01

    There is a global epidemic of asthma and obesity that is concentrated in Westernized and developed countries. A causal association in some people with asthma is suggested by observations that obesity precedes the onset of asthma and that bariatric surgery for morbid obesity can resolve asthma. The obese asthma phenotype features poor asthma control, limited response to corticosteroids, and an exaggeration of the physiological effects of obesity on lung function, which includes a reduction in expiratory reserve volume and airway closure occurring during tidal breathing. Obesity has important implications for asthma treatment. Increasing corticosteroid doses based on poor asthma control, as currently recommended in guidelines, may lead to overtreatment with corticosteroids in obese asthma. Enhanced bronchodilation, particularly of the small airways, may reduce the component of airway closure due to increased bronchomotor tone and suggests that greater emphasis should be placed on long-acting bronchodilators in obese asthma. The societal implications of this are important: with increasing obesity there will be increasing asthma from obesity, and the need to identify successful individual and societal weight-control strategies becomes a key goal.

  10. Obesity and asthma

    DEFF Research Database (Denmark)

    Sivapalan, Pradeesh; Diamant, Zuzana; Ulrik, Charlotte Suppli

    2015-01-01

    PURPOSE OF REVIEW: Obesity has significant impact on asthma incidence and manifestations. The purpose of the review is to discuss recent observations regarding the association between obesity and asthma focusing on underlying mechanisms, clinical presentation, response to therapy and effect...... of weight reduction. RECENT FINDINGS: Clinical and epidemiological studies indicate that obese patients with asthma may represent a unique phenotype, which is more difficult to control, less responsive to asthma medications and by that may have higher healthcare utilization. A number of common comorbidities...... have been linked to both obesity and asthma, and may, therefore, contribute to the obese-asthma phenotype. Furthermore, recently published studies indicate that even a modest weight reduction can improve clinical manifestations and outcome of asthma. SUMMARY: Compared with normal-weight patients, obese...

  11. Patient's adherence in asthma.

    Science.gov (United States)

    Gillisen, Adrian

    2007-11-01

    Nonadherence in asthma treatment results in increasing mortality, morbidity, and it is associated with increasing treatment costs. In asthma, adherence rates are often below 50%. Understanding of the needs and behaviors of asthma patients as well as treatment barriers to comply with asthma guidelines is important in developing programs to promote adherence. This article presents information on common types of nonadherence in asthma patients, the causes, and it reviews the literature on interventions to overcome these factors to maximize adherence rates. Although several interventions are effective in improving medication adherence in asthma, only few significantly enhance adherence rates and clinical outcomes of these patients. An improvement in treatment adherence is a complex task, requiring asthma self-management, education programs coupled with educational reinforcements, simplifying treatment planes and applications forms. Good communications skills among clinicians and patient education are also central for improving adherence. Methods to overcoming physician barriers ensure consistency in implementing guideline recommendations in practice.

  12. Fourteen-year-old girl with endobronchial carcinoid tumour presenting with asthma and lobar emphysema

    DEFF Research Database (Denmark)

    Andersen, Julie Bjerglund; Mortensen, Jann; Damgaard, Karen

    2010-01-01

    Bronchial carcinoid tumours seldom occur in children, and represent a rare cause of pulmonary obstruction. Because of low clinical suspicion and the variable ways of presentation, diagnosis may be delayed....

  13. Fourteen-year-old girl with endobronchial carcinoid tumour presenting with asthma and lobar emphysema

    DEFF Research Database (Denmark)

    Andersen, Julie Bjerglund; Mortensen, Jann; Damgaard, Karen

    2010-01-01

    Bronchial carcinoid tumours seldom occur in children, and represent a rare cause of pulmonary obstruction. Because of low clinical suspicion and the variable ways of presentation, diagnosis may be delayed.......Bronchial carcinoid tumours seldom occur in children, and represent a rare cause of pulmonary obstruction. Because of low clinical suspicion and the variable ways of presentation, diagnosis may be delayed....

  14. Untapped ethical resources for neurodegeneration research

    Directory of Open Access Journals (Sweden)

    Ivinson Adrian J

    2011-06-01

    Full Text Available Abstract Background The research community has a mandate to discover effective treatments for neurodegenerative disorders. The ethics landscape surrounding this mandate is in a constant state of flux, and ongoing challenges place ever greater demands on investigators to be accountable to the public and to answer questions about the implications of their work for health care, society, and policy. Methods We surveyed US-based investigators involved in neurodegenerative diseases research about how they value ethics-related issues, what motivates them to give consideration to those issues, and the barriers to doing so. Using the NIH CRISP database we identified 1,034 researchers with relevant, active grants and invited them to complete an online questionnaire. We received 193 responses. We used exploratory factor analysis to transform individual survey questions into a smaller set of factors, and linear regression to understand the effect of key variables of interest on the factor scores. Results Ethics-related issues clustered into two groups: research ethics and external influences. Heads of research groups viewed issues of research ethics to be more important than the other respondents. Concern about external influences was related to overall interest in ethics. Motivators clustered into five groups: ensuring public understanding, external forces, requirements, values, and press and public. Heads of research groups were more motivated to ensure public understanding of research than the other respondents. Barriers clustered into four groups: lack of resources, administrative burden, relevance to the research, and lack of interest. Perceived lack of ethics resources was a particular barrier for investigators working in drug discovery. Conclusions The data suggest that senior level neuroscientists working in the field of neurodegeneration (ND, and drug discovery specifically, are motivated to consider ethics issues related to their work, but the

  15. Do bullae and emphysema increase risk of pneumothorax in silicosis?

    Directory of Open Access Journals (Sweden)

    Salarilak Shaker

    2007-09-01

    Full Text Available Abstract Background The occurrence of occupational lung diseases is decreasing due to improvements in occupational health in recent years; however, silicosis and its complications remain important occupational health problems. We have studied the role of emphysema and bullae as predictive factors of secondary spontaneous pneumothorax in acute and accelerated silicosis. Methods This study was carried out using questionnaire items on occupational history and conventional computed tomography of lungs. Differences between two groups (silicosis with and without secondary spontaneous pneumothorax in terms of age, interval of exposure-diagnosis and therefore silica exposure duration were assessed by independent t-test. Fisher's exact test was used to determine the association between secondary spontaneous pneumothorax and both emphysema and bullae. Results We found a significant association between secondary spontaneous pneumothorax and bullae in acute and accelerated silicosis. Conclusion Pneumothorax in silicosis could be attributed to previous bullae.

  16. Subcutaneous emphysema of periorbital region after stainless steel crown preparation in a young child.

    Science.gov (United States)

    Khandelwal, Vishal; Agrawal, Piyush; Agrawal, Deepak; Nayak, Prathibha Anand

    2013-05-22

    Subcutaneous emphysema occurs when air is forced beneath the tissue, leading to swelling, crepitus on palpation and has the potential to spread along the fascial planes. This report describes the youngest case of subcutaneous emphysema related to dental treatment that has been documented to date. In addition to the patient's age, the case is of interest because periorbital subcutaneous emphysema is a rarest complication of stainless steel crown procedure.

  17. Genome-wide Association Study Identifies BICD1 as a Susceptibility Gene for Emphysema

    Science.gov (United States)

    Kong, Xiangyang; Cho, Michael H.; Anderson, Wayne; Coxson, Harvey O.; Muller, Nestor; Washko, George; Hoffman, Eric A.; Bakke, Per; Gulsvik, Amund; Lomas, David A.; Silverman, Edwin K.; Pillai, Sreekumar G.

    2011-01-01

    Rationale: Chronic obstructive pulmonary disease (COPD), characterized by airflow limitation, is a disorder with high phenotypic and genetic heterogeneity. Pulmonary emphysema is a major but variable component of COPD; familial data suggest that different components of COPD, such as emphysema, may be influenced by specific genetic factors. Objectives: To identify genetic determinants of emphysema assessed through high-resolution chest computed tomography in individuals with COPD. Methods: We performed a genome-wide association study (GWAS) of emphysema determined from chest computed tomography scans with a total of 2,380 individuals with COPD in three independent cohorts of white individuals from (1) a cohort from Bergen, Norway, (2) the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Study, and (3) the National Emphysema Treatment Trial (NETT). We tested single-nucleotide polymorphism associations with the presence or absence of emphysema determined by radiologist assessment in two of the three cohorts and a quantitative emphysema trait (percentage of lung voxels less than –950 Hounsfield units) in all three cohorts. Measurements and Main Results: We identified association of a single-nucleotide polymorphism in BICD1 with the presence or absence of emphysema (P = 5.2 × 10−7 with at least mild emphysema vs. control subjects; P = 4.8 × 10−8 with moderate and more severe emphysema vs. control subjects). Conclusions: Our study suggests that genetic variants in BICD1 are associated with qualitative emphysema in COPD. Variants in BICD1 are associated with length of telomeres, which suggests that a mechanism linked to accelerated aging may be involved in the pathogenesis of emphysema. Clinical trial registered with www.clinicaltrials.gov (NCT00292552). PMID:20709820

  18. Quantification of Emphysema in Chronic Obstructive Pulmonary Disease by Volumetric Computed Tomography of Lung.

    Science.gov (United States)

    Fernandes, Lalita; Gulati, Nandani; Mesquita, Anthony M; Sardesai, Mahesh; Fernandes, Yasmin

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with small airway inflammation and emphysema. Emphysema is permanent enlargement of air spaces distal to terminal bronchioles accompanied by destruction of alveolar walls. These morphological changes can be studied on quantitative computed tomography (CT). Thirty-four patients diagnosed to have COPD as per Global Initiative for Chronic Obstructive Lung Disease guidelines underwent chest CT using full inspiration with low dose radiation protocol. Pulmo-CT software was used to analyse the scans. The primary aim was to quantify emphysema and emphysema clusters and secondary aim was to assess correlation between percentage emphysema and lung function. Their mean [standard deviation (SD)] age was 66.4 (7.0) years; 11 (32.4%) were current smokers (median pack years 45.5). Their mean (SD) forced expiratory volume in the first second (FEV1%) was 55.6 (17.6), mean (SD) %emphysema was 26.8 (11.1), mean (SD) lung density was -848.35 (29.5) Hounsfield units (HU), median (interquartile range) %cluster class 4 emphysema was 22.4 (13.5-32.6). There was no significant difference in %low attenuation volume (%LAV) in current and exsmokers (p=0.4); across various severity grades of COPD (p=0.15). Further, no significant correlation was observed between %emphysema and post-bronchodilator FEV1%. Volumetric CT can detect and quantify emphysema. Majority of emphysema clusters in COPD are >25mm. The %emphysema does not correlate to the severity of the disease. Quantitative CT is a good objective method to study emphysema and can be used to phenotype COPD radiologically.

  19. Molecular Basis of Neurodegeneration and Neurodevelopmental Defects in Menkes Disease

    Science.gov (United States)

    Zlatic, Stephanie; Comstra, Heather Skye; Gokhale, Avanti; Petris, Michael J.; Faundez, Victor

    2015-01-01

    ATP7A mutations impair copper metabolism resulting in three distinct genetic disorders in humans. These diseases are characterized by neurological phenotypes ranging from intellectual disability to neurodegeneration. Severe ATP7A loss-of function alleles trigger Menkes disease, a copper deficiency condition where systemic and neurodegenerative phenotypes dominate clinical outcomes. The pathogenesis of these manifestations has been attributed to hypoactivity of a limited number of copper-dependent enzymes, a hypothesis that we refer as the oligoenzymatic pathogenic hypothesis. This hypothesis, which has dominated the field for 25 years, only explains some systemic Menkes phenotypes. However, we argue that this hypothesis does not fully account for the Menkes neurodegeneration or neurodevelopmental phenotypes. Here, we propose revisions of the oligoenzymatic hypothesis that could illuminate the pathogenesis of Menkes neurodegeneration and neurodevelopmental defects through unsuspected overlap with other neurological conditions including Parkinson’s, intellectual disability, and schizophrenia. PMID:25583185

  20. The aging colon: the role of enteric neurodegeneration in constipation.

    Science.gov (United States)

    Wiskur, Brandt; Greenwood-Van Meerveld, Beverley

    2010-12-01

    Constipation is a common problem in the elderly, and abnormalities in the neural innervation of the colon play a significant role in abnormalities in colonic motility leading to delayed colonic transit. The scope of this review encompasses the latest advances to enhance our understanding of the aging colon with emphasis on enteric neurodegeneration, considered a likely cause for the development of constipation in the aging gut in animal models. Neural innervation of the colon and the effects of aging on intrinsic and extrinsic nerves innervating the colonic smooth muscle is discussed. Evidence supporting the concept that neurologic disorders, such as Parkinson's disease, not only affect the brain but also cause neurodegeneration within the enteric nervous system leading to colonic dysmotility is presented. Further research is needed to investigate the influence of aging on the gastrointestinal tract and to develop novel approaches to therapy directed at protecting the enteric nervous system from neurodegeneration.

  1. Cigarette Smoke and DNA Cleavage Promote Lung Inflammation and Emphysema

    OpenAIRE

    Kheradmand, Farrah; You, R. (Ruquan); HEE GU, BON; Corry, D B

    2017-01-01

    Smoking-related lung diseases are among the most preventable and incurable ailments in the world. Smokers are at increased risk of developing chronic obstructive pulmonary disease that can be further complicated by emphysema and lung cancer. A subset of former smokers shows persistent lung inflammation and progressive loss of lung function, indicating a role for activation of acquired immunity in smoking-induced lung diseases. In addition to the well-established noxious effects of volatile co...

  2. Pneumomediastinum, bilateral pneumothorax and subcutaneous emphysema complicating acute silicosis

    Directory of Open Access Journals (Sweden)

    Ramakant Dixit

    2015-06-01

    Full Text Available A case of acute silicosis complicating as spontaneous pneumomediastinum, bilateral pneumothorax and subcutaneous emphysema is described in a 35-year-old male engaged in stone crusher unit. Diagnosis was established on clinical and radiological assessment and supported by occupational history of the patient. This case is unique one as all these 3 complications at the same time are very uncommon in acute silicosis.

  3. Cervicofacial and mediastinal emphysema due to a dental procedure

    Directory of Open Access Journals (Sweden)

    Mityanand Ramnarine

    2017-01-01

    Full Text Available Dental procedures, though commonplace and usually very safe, are not without complications. We report on a case of extensive cervicofacial and mediastinal emphysema after a routine dental procedure, initially masquerading as an allergic reaction in an otherwise young and healthy woman. A review of the relevant literature on this clinical entity is presented, which serves to underscore the need for awareness by the treating clinician of this condition and its potential sequela.

  4. Emphysema Predicts Hospitalisation and Incident Airflow Obstruction among Older Smokers: A Prospective Cohort Study

    Science.gov (United States)

    McAllister, David A.; Ahmed, Firas S.; Austin, John H. M.; Henschke, Claudia I.; Keller, Brad M.; Lemeshow, Adina; Reeves, Anthony P.; Mesia-Vela, Sonia; Pearson, G. D. N.; Shiau, Maria C.; Schwartz, Joseph E.; Yankelevitz, David F.; Barr, R. Graham

    2014-01-01

    Background Emphysema on CT is common in older smokers. We hypothesised that emphysema on CT predicts acute episodes of care for chronic lower respiratory disease among older smokers. Materials and Methods Participants in a lung cancer screening study age ≥60 years were recruited into a prospective cohort study in 2001–02. Two radiologists independently visually assessed the severity of emphysema as absent, mild, moderate or severe. Percent emphysema was defined as the proportion of voxels ≤ −910 Hounsfield Units. Participants completed a median of 5 visits over a median of 6 years of follow-up. The primary outcome was hospitalization, emergency room or urgent office visit for chronic lower respiratory disease. Spirometry was performed following ATS/ERS guidelines. Airflow obstruction was defined as FEV1/FVC ratio emphysema, which was associated with acute episodes of care (rate ratio 1.89; 95% CI: 1.01–3.52) adjusting for age, sex and race/ethnicity, as was percent emphysema, with similar associations for hospitalisation. Emphysema on visual assessment also predicted incident airflow obstruction (HR 5.14; 95% CI 2.19–21.1). Conclusion Visually assessed emphysema and percent emphysema on CT predicted acute episodes of care for chronic lower respiratory disease, with the former predicting incident airflow obstruction among older smokers. PMID:24699215

  5. Pneumomediastinum and subcutaneous emphysema after dental extraction detected incidentally by regular medical checkup: a case report.

    Science.gov (United States)

    Arai, Ikuko; Aoki, Takayuki; Yamazaki, Hiroshi; Ota, Yoshihide; Kaneko, Akihiro

    2009-04-01

    Most cases of pneumomediastinum are caused by iatrogenic injury during surgery on the cervical region and chest or by tracheostomy. It is also well known that emphysema may occur secondary to dental treatment using an air turbine drill, but there have been few cases of emphysema extending to involve the mediastinum. Presented is a rare case in which subcutaneous emphysema and pneumomediastinum developed asymptomatically, probably due to extraction of a mandibular third molar, and were found incidentally on the day after the dental procedure. To avoid subcutaneous emphysema and pneumomediastinum associated with dental treatment and surgical intraoral procedures such as tooth extraction, air turbine drills should be used only when it is essential.

  6. Airway wall thickening and emphysema show independent familial aggregation in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Patel, Bipen D; Coxson, Harvey O; Pillai, Sreekumar G

    2008-01-01

    RATIONALE: It is unclear whether airway wall thickening and emphysema make independent contributions to airflow limitation in chronic obstructive pulmonary disease (COPD) and whether these phenotypes cluster within families. OBJECTIVES: To determine whether airway wall thickening and emphysema (1...... the severity of airway wall thickening and emphysema. MEASUREMENTS AND MAIN RESULTS: A total of 3,096 individuals were recruited to the study, of whom 1,159 (519 probands and 640 siblings) had technically adequate high-resolution computed tomography scans without significant non-COPD-related thoracic disease....... Airway wall thickness correlated with pack-years smoked (P chronic bronchitis (P emphysema at -950...

  7. Widespread subcutaneous emphysema and barotrauma resulting from high pressure gas injection

    National Research Council Canada - National Science Library

    Smith, Barnaby; Brown, Troy

    2012-01-01

    Widespread subcutaneous emphysema is an unusual emergency presentation. We present a case of accidental high pressure insufflation, the pathophysiology and subsequent medical management in the acute setting...

  8. Cigarette Smoke and DNA Cleavage Promote Lung Inflammation and Emphysema.

    Science.gov (United States)

    Kheradmand, Farrah; You, R; Hee Gu, Bon; Corry, D B

    2017-01-01

    Smoking-related lung diseases are among the most preventable and incurable ailments in the world. Smokers are at increased risk of developing chronic obstructive pulmonary disease that can be further complicated by emphysema and lung cancer. A subset of former smokers shows persistent lung inflammation and progressive loss of lung function, indicating a role for activation of acquired immunity in smoking-induced lung diseases. In addition to the well-established noxious effects of volatile compounds in cigarette smoke, incomplete combustion of tobacco generates nano-sized carbon black (nCB) that accumulate in lung myeloid dendritic cells and macrophages. Experimentally, intra-nasal instillation nCB can cause airway inflammation and emphysema in mice, underscoring their pathogenic role in inflammatory lung diseases. High throughput analyses of macrophages that have engulfed nCB reveal de novo activation of DNA repair enzymes, and histological studies provide evidence for DNA double-stranded breaks. Emphysematous lung myeloid dendritic cells that contain nCB express pro-inflammatory cytokines, and can efficiently differentiate naive CD4 T cells to interferon-g-secreting T helper 1 and interleukin 17A expressing cell subsets. Together these findings indicate that nCB accumulation in lung innate immune cells can initiate and sustain lung inflammation and promote emphysema development.

  9. Orbital, subconjunctival, and subcutaneous emphysema after an orbital floor fracture

    Directory of Open Access Journals (Sweden)

    Ababneh OH

    2013-06-01

    Full Text Available Osama H Ababneh Department of Ophthalmology, The University of Jordan and Jordan University Hospital, Amman, Jordan Abstract: A 16-year-old boy presented to the emergency department with the complaint of a sudden, painful left eye and proptosis after an episode of sneezing. A few hours earlier, he had sustained a blunt trauma to the left orbit as the result of a fistfight. The initial examination showed subcutaneous and subconjunctival emphysema. Visual acuity in the left eye was 20/30 (0.67, the pupils were reactive with no relative afferent pupillary defect, and there were mild limitations in levoduction and supraduction. A slit-lamp examination showed normal anterior and posterior segments with an intraocular pressure of 26 mmHg. An orbital computed tomography scan showed orbital, subconjunctival, and subcutaneous emphysema associated with a small fracture of the orbital floor. Following conservative management with broad-spectrum oral antibiotics, a topical antiglaucoma drug, and lubricating eye drops, the patient improved dramatically within one week. Keywords: emphysema, orbital fracture, trauma

  10. Monitoring asthma in childhood

    Directory of Open Access Journals (Sweden)

    Karin C. Lødrup Carlsen

    2015-06-01

    Full Text Available The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. However, to date there is limited evidence on how to monitor patients with asthma. Childhood asthma introduces specific challenges in terms of deciding what, when, how often, by whom and in whom different assessments of asthma should be performed. The age of the child, the fluctuating course of asthma severity, variability in clinical presentation, exacerbations, comorbidities, socioeconomic and psychosocial factors, and environmental exposures may all influence disease activity and, hence, monitoring strategies. These factors will be addressed in herein. We identified large knowledge gaps in the effects of different monitoring strategies in children with asthma. Studies into monitoring strategies are urgently needed, preferably in collaborative paediatric studies across countries and healthcare systems.

  11. Tobaksrygning og asthma

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Lange, Peter

    2002-01-01

    Cigarette smoking is a well-known health hazard, probably not least for patients suffering from asthma. This review gives a short overview of the effects of passive and active smoking on the inception and outcome with of longitudinal changes in the lung function and mortality of patients...... with asthma. Substantial evidence suggests that smoking affects asthma adversely. Exposure to environmental tobacco smoke, especially maternal smoking in children, may be a significant risk factor for asthma. Such exposure in patients with established asthma is not only associated with more severe symptoms......, but also with a poorer quality of life, reduced lung function, and increased utilisation of health care including hospital admissions. Active smoking does not appear to be a significant risk factor for asthma, but is associated with a worse outcome with regard to both longitudinal changes in lung function...

  12. Asthma in the Elderly

    Directory of Open Access Journals (Sweden)

    Domenico Lorenzo Urso

    2009-01-01

    Full Text Available Bronchial asthma is a common problem with enormous medical and economics impacts. It is an inflammatory disease of the airways associated with intermittent episodes of bronchospasm. Asthma is not uncommon in the elderly patients. Prevalence of asthma is similar in older and younger adults. Asthma in the elderly patient is underdiagnosed because of false perceptions by both patient and physician. The high incidence of comorbid conditions in the elderly patient makes the diagnosis and management more difficult. Correct diagnosis is demonstrated with spirometry. The goals of asthma treatment are to achieve and maintain control of symptoms and to prevent development of irreversible airflow limitation. Asthma drugs are preferably inhaled because this route minimizes systemic absorption and, thus, improves the ratio of the therapeutic benefit to the potential side-effects in elderly patients.

  13. Asthma and obesity

    DEFF Research Database (Denmark)

    Ulrik, Charlotte S

    2016-01-01

    PURPOSE OF REVIEW: Obesity has significant negative impact on asthma control and risk of exacerbations. The purpose of this review is to discuss recent studies evaluating the effects of weight reduction on asthma control in obese adults. RECENT FINDINGS: Clinical studies have shown that weight...... reduction in obese patients is associated with improvements in symptoms, use of controller medication, and asthma-related quality of life together with a reduction in the risk for severe exacerbations. Furthermore, several studies have also revealed improvements in lung function and airway responsiveness...... reduction in obese adults with asthma leads to an overall improvement in asthma control, including airway hyperresponsiveness and inflammation. Weight reduction should be a cornerstone in the management of obese patients with asthma....

  14. Late-Onset Asthma

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli

    2017-01-01

    , to objectively confirm asthma. If necessary, a trial of oral or inhaled corticosteroid might be necessary. Asthma can be diagnosed when increased airflow variability is identified in a symptomatic patient, and if the patient does not have a history of exposure, primarily smoking, known to cause chronic...... obstructive pulmonary disease, the diagnosis is asthma even if the patient does not have fully reversible airflow obstruction. Pharmacological therapy in patients with late-onset asthma follows international guidelines, including treatment with the lowest effective dose of inhaled corticosteroid to minimize...... the risk of systemic effects. However, most recommendations are based on extrapolation from findings in younger patients. Comorbidities are very common in patients with late-onset asthma and need to be taken into account in the management of the disease. In conclusion, late-onset asthma is poorly...

  15. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... please visit this page: About CDC.gov . Asthma Learn How to Control Asthma Asthma and Severe Weather ... Working on Asthma Follow @CDCasthma on Twitter to learn more about helping people with asthma live healthier ...

  16. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health Know How to Use Your Asthma Inhaler ... MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health File Formats Help: How do I view ...

  17. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health Know How to Use Your Asthma Inhaler ... ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health File Formats Help: How do I view ...

  18. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... 1 MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health Know How to Use Your Asthma ... 1 MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health File Formats Help: How do I ...

  19. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... among Children Asthma-related Missed School Days among Children aged 5–17 Years Asthma Severity among Adults with Current Asthma Asthma Severity among Children with Current Asthma Overuse of quick-relief medication ...

  20. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health Know How to Use Your Asthma ... MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health File Formats Help: How do I ...

  1. Severe Asthma in Children.

    Science.gov (United States)

    Chipps, Bradley E; Parikh, Neil G; Maharaj, Sheena K

    2017-04-01

    The aim of this study is to characterize, diagnose, evaluate, and treat severe childhood asthma. Understanding the occurrence of the physiologic and clinical presentations of childhood severe asthma, the treatment and response may be predicted by biomarkers, but the patient's response is highly variable. The onset of severe asthma occurs early and is primarily predicted by severity of viral infection and coexistence of the atopic state.

  2. Lung Volume Reduction Coil Treatment in Chronic Obstructive Pulmonary Disease Patients with Homogeneous Emphysema : A Prospective Feasibility Trial

    NARCIS (Netherlands)

    Klooster, Karin; ten Hacken, Nick H. T.; Franz, Ina; Kerstjens, Huib A. M.; van Rikxoort, Eva M.; Slebos, Dirk-Jan

    2014-01-01

    Background: In patients with heterogeneous emphysema, surgical and bronchoscopic lung volume reduction (LVR) treatments are available. However, for patients with homogeneous emphysema these treatments are hardly investigated and seem less effective. Bronchoscopic LVR coil treatment has been shown to

  3. Lung Volume Reduction Coil Treatment in Chronic Obstructive Pulmonary Disease Patients with Homogeneous Emphysema: A Prospective Feasibility Trial

    NARCIS (Netherlands)

    Klooster, K.; Hacken, N. Ten; Franz, I.; Kerstjens, H.; Rikxoort, E.M. van; Slebos, D.J.

    2014-01-01

    Background: In patients with heterogeneous emphysema, surgical and bronchoscopic lung volume reduction ({LVR}) treatments are available. However, for patients with homogeneous emphysema these treatments are hardly investigated and seem less effective. Bronchoscopic {LVR} coil treatment has been

  4. Linking obesity and asthma.

    Science.gov (United States)

    Sutherland, E Rand

    2014-04-01

    A growing body of literature suggests that obesity has a significant impact on asthma risk, phenotype, and prognosis. Epidemiological studies have clearly demonstrated that asthma is more likely to occur in obese patients, and health status is impaired in obese individuals with asthma, with obese asthmatics experiencing more symptoms, worse quality of life, increased healthcare use, and increased asthma severity. However, obesity has well-described effects on lung function and mechanics that can lead to symptoms of dyspnea without causing the pathophysiologic changes of asthma. Adding to the challenges of evaluating this association, some studies have failed to demonstrate a robust relationship between obesity and traditional biomarkers of airway inflammation in adult asthmatics, leading to the conclusion that obesity does not necessarily worsen airway inflammation in asthma. In this regard, emerging data suggest that nonatopic mechanisms may be relevant in obese asthmatics, and that these mechanisms may have a direct impact on the response of obese asthmatics to asthma therapies, most notably inhaled glucocorticoids. This article will review selected aspects of the contributions of obesity-related airway and systemic inflammation to asthma, with a focus on the impact of obesity as a modifier of risk, prognosis, and therapeutic response in asthma. © 2014 New York Academy of Sciences.

  5. Asthma in the Elderly.

    Science.gov (United States)

    Braman, Sidney S

    2017-11-01

    The older population has seen the greatest increase in the prevalence of current asthma in recent years. Asthma may begin at any age and when it occurs at an advanced as opposed to a young age, it is often nonatopic, severe, and unremitting. Unfortunately, geriatric-specific guidelines are not available for the diagnosis and treatment of asthma. However, with objective monitoring, avoidance of asthma triggers, appropriate pharmacotherapy, and patient education, the disease can be managed successfully. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Asthma among mink workers

    DEFF Research Database (Denmark)

    Grøntved, Berit; Carstensen, Ole; Petersen, Rolf

    2014-01-01

    We report two cases of asthma among mink workers. The first case is about a mink farmer who had asthma that was difficult to treat. In the medical history there was no clear relation to work, and no conclusive work relation with peak flow monitoring. He had a positive histamine release test to mink...... urine. The second case is about a mink farm worker, who had an asthma attack when handling mink furs. Peak flow monitoring showed a clear relation to this work, but there were no signs of allergy. We conclude that these two cases suggest an increased risk of asthma among mink workers....

  7. Early Neurodegeneration in the Retina of Type 2 Diabetic Patients

    NARCIS (Netherlands)

    van Dijk, Hille W.; Verbraak, Frank D.; Kok, Pauline H. B.; Stehouwer, Marilette; Garvin, Mona K.; Sonka, Milan; DeVries, J. Hans; Schlingemann, Reinier O.; Abràmoff, Michael D.

    2012-01-01

    PURPOSE. The purpose of this study was to determine whether diabetes type 2 causes thinning of retinal layers as a sign of neurodegeneration and to investigate the possible relationship between this thinning and duration of diabetes mellitus, diabetic retinopathy (DR) status, age, sex, and glycemic

  8. Genetics Home Reference: fatty acid hydroxylase-associated neurodegeneration

    Science.gov (United States)

    ... Mutat. 2010 Apr;31(4):E1251-60. doi: 10.1002/humu.21205. Citation on PubMed Edvardson S, Hama H, ... Neurol. 2010 Nov;68(5):611-8. doi: 10.1002/ana.22122. Citation on PubMed Schipper HM. Neurodegeneration ...

  9. Post-traumatic neurodegeneration and chronic traumatic encephalopathy.

    Science.gov (United States)

    Daneshvar, Daniel H; Goldstein, Lee E; Kiernan, Patrick T; Stein, Thor D; McKee, Ann C

    2015-05-01

    Traumatic brain injury (TBI) is a leading cause of mortality and morbidity around the world. Concussive and subconcussive forms of closed-head injury due to impact or blast neurotrauma represent the most common types of TBI in civilian and military settings. It is becoming increasingly evident that TBI can lead to persistent, long-term debilitating effects, and in some cases, progressive neurodegeneration and chronic traumatic encephalopathy (CTE). The epidemiological literature suggests that a single moderate-to-severe TBI may be associated with accelerated neurodegeneration and increased risk of Alzheimer's disease, Parkinson's disease, or motor neuron disease. However, the pathologic phenotype of these post-traumatic neurodegenerations is largely unknown and there may be pathobiological differences between post-traumatic disease and the corresponding sporadic disorder. By contrast, the pathology of CTE is increasingly well known and is characterized by a distinctive pattern of progressive brain atrophy and accumulation of hyperphosphorylated tau neurofibrillary and glial tangles, dystrophic neurites, 43 kDa TAR DNA-binding protein (TDP-43) neuronal and glial aggregates, microvasculopathy, myelinated axonopathy, neuroinflammation, and white matter degeneration. Clinically, CTE is associated with behavioral changes, executive dysfunction, memory deficits, and cognitive impairments that begin insidiously and most often progress slowly over decades. Although research on the long-term effects of TBI is advancing quickly, the incidence and prevalence of post-traumatic neurodegeneration and CTE are unknown. Critical knowledge gaps include elucidation of pathogenic mechanisms, identification of genetic risk factors, and clarification of relevant variables-including age at exposure to trauma, history of prior and subsequent head trauma, substance use, gender, stress, and comorbidities-all of which may contribute to risk profiles and the development of post

  10. Nutrition and Asthma

    Directory of Open Access Journals (Sweden)

    Gupta K

    2007-01-01

    Full Text Available Increase in the asthma prevalence in many countries over the recent decades, highlights the need for a greater understanding of the risk factors for asthma. Be-cause asthma is the result of interaction between genetic and environmental fac-tors, increasing prevalence is certainly the result of changes in environmental fac-tors because of process of wesernization. That is the reason for higher prevalence in countries where a traditional to a westernized lifestyle occurred earlier. This increasing prevalence has affected both rural and urban communities, suggesting that local environmental factors such as exposure to allergens or industrial air pol-lutions are not the sole cause. In the last few years, nutrition has represented an important conditioning factor of many cardiovascular, gastrointestinal and chronic pulmonary diseases. So it has been hypothesized that dietary constituents influence the immune system and thus, may also be actively involved in the onset of asthma and other allergic diseases. Dietary constituents can play beneficial as well as det-rimental role in asthma. The possible role of diet in the development of asthma can be described as follows: first, a food allergen can cause asthma. Second, there is role of breast-feeding for prevention of asthma later in life. Third, a low intake of antioxidative dietary constituents might be a risk factor for asthma. Moreover, role of cations such as sodium, potassium and magnesium has been described in development of asthma. Finally, intake of fatty acids specially the role of omega-3 and omega-6 fatty acids play important role in cause of asthma.

  11. Proteoglycans maintain lung stability in an elastase-treated mouse model of emphysema.

    Science.gov (United States)

    Takahashi, Ayuko; Majumdar, Arnab; Parameswaran, Harikrishnan; Bartolák-Suki, Erzsébet; Suki, Béla

    2014-07-01

    Extracellular matrix remodeling and tissue rupture contribute to the progression of emphysema. Lung tissue elasticity is governed by the tensile stiffness of fibers and the compressive stiffness of proteoglycans. It is not known how proteoglycan remodeling affects tissue stability and destruction in emphysema. The objective of this study was to characterize the role of remodeled proteoglycans in alveolar stability and tissue destruction in emphysema. At 30 days after treatment with porcine pancreatic elastase, mouse lung tissue stiffness and alveolar deformation were evaluated under varying tonicity conditions that affect the stiffness of proteoglycans. Proteoglycans were stained and measured in the alveolar walls. Computational models of alveolar stability and rupture incorporating the mechanical properties of fibers and proteoglycans were developed. Although absolute tissue stiffness was only 24% of normal, changes in relative stiffness and alveolar shape distortion due to changes in tonicity were increased in emphysema (P proteoglycan stiffness, was higher in emphysema (P proteoglycan stiffness was increased. Consequently, this general network model explains why increasing proteoglycan deposition protects the alveolar walls from rupture in emphysema. Our results suggest that the loss of proteoglycans observed in human emphysema contributes to disease progression, whereas treatments that promote proteoglycan deposition in the extracellular matrix should slow the progression of emphysema.

  12. Pulmonary interstitial emphysema: a case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Amoedo, Mauricio Kauark, E-mail: mauricioamoedo@gmail.com [Interventional Radiology, Hospital A.C. Camargo, Sao Paulo, SP (Brazil); Souza, Luciana Volpon Soares; Souza, Antonio Soares [Instituto de Radiodiagnostico Rio Preto (Ultra-X), Sao Jose do Rio Preto, SP (Brazil); Souza Junior, Arthur Soares [Faculdade de Medicina de Sao Jose do Rio Preto (Famerp), SP (Brazil); Marchiori, Edson [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil)

    2013-09-15

    Pulmonary interstitial emphysema is a rare condition that generally affects low-weight preterm infants submitted to mechanical ventilation. The prognosis is variable, depending on early diagnosis and treatment. The radiologist plays a key role in this scenario. The authors report a case of persistent pulmonary interstitial emphysema, describing the main characteristics of such entity. (author)

  13. INFLUENCE OF INVIVO PREDNISOLONE ON INCREASED INVITRO O-2-GENERATION BY NEUTROPHILS IN EMPHYSEMA

    NARCIS (Netherlands)

    RENKEMA, TEJ; POSTMA, DS; NOORDHOEK, JA; SLUITER, HJ; KAUFFMAN, HF

    Evidence is accumulating that neutrophil-derived oxidants substantially contribute to the development of emphysema, especially in smoking individuals. It is not clear, however, why not all smokers develop emphysema. We tested the hypothesis that an abnormality in the oxidative metabolism of

  14. Proteoglycan changes in the extracellular matrix of lung tissue from patients with pulmonary emphysema

    NARCIS (Netherlands)

    van Straaten, JFM; Coers, W; Noordhoek, JA; Flipsen, JTM; Kauffman, HF; Timens, W; Postma, DS

    To characterize the changes in the extracellular matrix in smoking-related pulmonary emphysema, we undertook immunohistochemical studies in lung tissues from controls (n = 7), from patients with mild (n = 11) and severe (n = 8) emphysema, and from patients with lung fibrosis (n = 6). We studied

  15. CT-quantified emphysema distribution is associated with lung function decline

    NARCIS (Netherlands)

    Hoesein, F.A.A.M.; Rikxoort, E. M. van; Ginneken, B. van; Jong, P. A. de; Prokop, M.; Lammers, J.-W.J.; Zanen, P.

    2012-01-01

    Emphysema distribution is associated with COPD. It is however unknown whether CT-quantified emphysema distribution (upper/lower lobe) is associated with lung function decline in heavy (former) smokers.587 male participants underwent lung CT-scanning and pulmonary function testing at baseline and

  16. Usefulness evaluation of low-dose for emphysema: Compared with high-resolution CT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Won Jeong [Dept. of Radiological Technology, Daejeon Health Institute of Technology, Daejeon (Korea, Republic of)

    2016-09-15

    The purpose of this study was to evaluate the usefulness of low-dose CT (LDCT) for emphysema compared with high-resolution CT (HRCT). Measurements of radiation dose and noise were repeated 3 times in same exposure condition which was similar with obtaining HRCT and LDCT images. We analysed reading results of 146 subjects. Six images per participants selected for emphysema grading. Emphysema was graded for all 6 zones on the left and right sides of the lungs by the consensus reading of two chest radiologists using a 4-point scale. Between the HRCT and LDCT images, diagnostic differences and agreements for emphysema were analyzed by McNemar's and unweighted kappa tests, and radiation doses and noise by a Mann-Whitney U-test, using the SPSS 19.0 program. Radiation dose from HRCT was significantly higher than that of LDCT, but the noise was significantly lower in HRCT than in LDCT. Diagnostic agreement for emphysema between HRCT and LDCT images was excellent (k-value=0.88). Emphysema grading scores were not significantly different between HRCT and LDCT images for all six lung zones. Emphysema grading scores from LDCT images were significantly correlated with increased scores on HRCT images (r=0.599, p < 0.001). Considering the tradeoff between radiation dose and image noise, LDCT could be used as the gold standard method instead of HRCT for emphysema detection and grading.

  17. Endobronchial Valve Therapy in Patients with Homogeneous Emphysema Results from the IMPACT Study

    NARCIS (Netherlands)

    Valipour, Arschang; Slebos, Dirk-Jan; Herth, Felix; Darwiche, Kaid; Wagner, Manfred; Ficker, Joachim H.; Petermann, Christoph; Hubner, Ralf-Harto; Stanzel, Franz; Eberhard, Ralf

    2016-01-01

    Rationale: Endobronchial valves (EBVs) have been successfully used in patients with severe heterogeneous emphysema to improve lung physiology. Limited available data suggest that EBVs are also effective in homogeneous emphysema. Objectives: To evaluate the efficacy and safety of EBVs in patients

  18. Quantitative computed tomography measures of emphysema and airway wall thickness are related to respiratory symptoms

    DEFF Research Database (Denmark)

    Grydeland, Thomas B; Dirksen, Asger; Coxson, Harvey O

    2010-01-01

    There is limited knowledge about the relationship between respiratory symptoms and quantitative high-resolution computed tomography measures of emphysema and airway wall thickness.......There is limited knowledge about the relationship between respiratory symptoms and quantitative high-resolution computed tomography measures of emphysema and airway wall thickness....

  19. The presence and progression of emphysema in COPD as determined by CT scanning and biomarker expression

    DEFF Research Database (Denmark)

    Coxson, Harvey O; Dirksen, Asger; Edwards, Lisa D

    2013-01-01

    Emphysema is a key contributor to airflow limitation in chronic obstructive pulmonary disease (COPD) and can be quantified using CT scanning. We investigated the change in CT lung density in a longitudinal, international cohort of patients with COPD. We also explored the potential relation between...... emphysema and patient characteristics, and investigated if certain circulating biomarkers were associated with decline in CT lung density....

  20. Likelihood of pulmonary hypertension in patients with idiopathic pulmonary fibrosis and emphysema.

    Science.gov (United States)

    Jacob, Joseph; Bartholmai, Brian J; Rajagopalan, Srinivasan; Karwoski, Ronald; Nair, Arjun; Walsh, Simon L F; Barnett, Joseph; Cross, Gary; Judge, Eoin P; Kokosi, Maria; Renzoni, Elisabetta; Maher, Toby M; Wells, Athol U

    2017-12-13

    This study evaluated whether patients with combined pulmonary fibrosis and emphysema (CPFE) have an increased likelihood of pulmonary hypertension (PHT) when compared with idiopathic pulmonary fibrosis (IPF) patients without emphysema. Two consecutive IPF populations having undergone transthoracic echocardiography were examined (n = 223 and n = 162). Emphysema and interstitial lung disease (ILD) extent were quantified visually; ILD extent was also quantified by a software tool, CALIPER. Echocardiographic criteria categorized PHT risk. The prevalence of an increased PHT likelihood was 29% and 31% in each CPFE cohort. Survival at 12 months was 60% across both CPFE cohorts with no significantly worsened outcome identified when compared with IPF patients without emphysema. Using logistic regression models in both cohorts, total computed tomography (CT) disease extent (ILD and emphysema) predicted the likelihood of PHT. After adjustment for total disease extent, CPFE had no stronger association with PHT likelihood than IPF patients without emphysema. Our findings indicate that the reported association between CPFE and PHT is explained by the summed baseline CT extents of ILD and emphysema. Once baseline severity is taken into account, CPFE is not selectively associated with a malignant microvascular phenotype, when compared with IPF patients without emphysema. © 2017 Asian Pacific Society of Respirology.

  1. Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis

    Directory of Open Access Journals (Sweden)

    S. Fosi

    2014-01-01

    Full Text Available Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration.

  2. Quantitative assessment of smoking-induced emphysema progression in longitudinal CT screening for lung cancer

    Science.gov (United States)

    Suzuki, H.; Mizuguchi, R.; Matsuhiro, M.; Kawata, Y.; Niki, N.; Nakano, Y.; Ohmatsu, H.; Kusumoto, M.; Tsuchida, T.; Eguchi, K.; Kaneko, M.; Moriyama, N.

    2015-03-01

    Computed tomography has been used for assessing structural abnormalities associated with emphysema. It is important to develop a robust CT based imaging biomarker that would allow quantification of emphysema progression in early stage. This paper presents effect of smoking on emphysema progression using annual changes of low attenuation volume (LAV) by each lung lobe acquired from low-dose CT images in longitudinal screening for lung cancer. The percentage of LAV (LAV%) was measured after applying CT value threshold method and small noise reduction. Progression of emphysema was assessed by statistical analysis of the annual changes represented by linear regression of LAV%. This method was applied to 215 participants in lung cancer CT screening for five years (18 nonsmokers, 85 past smokers, and 112 current smokers). The results showed that LAV% is useful to classify current smokers with rapid progression of emphysema (0.2%/year, pemphysema in CT screening for lung cancer.

  3. Transconjunctival orbital emphysema caused by compressed air injury: A case report

    Directory of Open Access Journals (Sweden)

    Mathew Sunu

    2008-01-01

    Full Text Available Orbital emphysema following conjunctival tear in the absence of orbital wall fracture, caused by air under pressure is rare. Usually orbital emphysema is seen in facial trauma associated with damage to the adjacent paranasal sinuses or facial bones. To the best of our knowledge, there have been only eight reports of orbital emphysema following use of compressed air during industrial work. The air under pressure is pushed through the subconjunctival space into the subcutaneous and retrobulbar spaces. We present here a rare cause of orbital emphysema in a young man working with compressed air gun. Although the emphysema was severe, there were no orbital bone fracture and the visual recovery of the patient was complete without attendant complications.

  4. What is Asthma?

    Medline Plus

    Full Text Available ... Lung Association 104 COPD Awareness Month: Connecting with Social Support American Lung Association 105 Ohio Cares about ... 7:59 Asthma - Duration: 3:36. Nucleus Medical Media 658,979 views 3:36 What is asthma. ...

  5. Traveling and Asthma

    Science.gov (United States)

    ... Stress How Cliques Make Kids Feel Left Out Traveling and Asthma KidsHealth > For Kids > Traveling and Asthma Print A A A en español ... handy at all times. So if you're traveling by car, keep them where you can get ...

  6. Assessment of asthma control using asthma control test in chest ...

    African Journals Online (AJOL)

    ... CI 1.06-3.47) and obesity (OR 1.81; 1.01-3.27). Conclusion: Asthma remains poorly controlled in a large proportion of asthma patients under specialist care in Cameroon. Educational programs for asthma patients targeting women and based on weight loss for obese patients may help in improving the control of asthma.

  7. Advances in pediatric asthma in 2013: coordinating asthma care.

    Science.gov (United States)

    Szefler, Stanley J

    2014-03-01

    Last year's "Advances in pediatric asthma: moving toward asthma prevention" concluded that "We are well on our way to creating a pathway around wellness in asthma care and also to utilize new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma." This year's summary will focus on recent advances in pediatric asthma on prenatal and postnatal factors altering the natural history of asthma, assessment of asthma control, and new insights regarding potential therapeutic targets for altering the course of asthma in children, as indicated in Journal of Allergy and Clinical Immunology publications in 2013 and early 2014. Recent reports continue to shed light on methods to understand factors that influence the course of asthma, methods to assess and communicate levels of control, and new targets for intervention, as well as new immunomodulators. It will now be important to carefully assess risk factors for the development of asthma, as well as the risk for asthma exacerbations, and to improve the way we communicate this information in the health care system. This will allow parents, primary care physicians, specialists, and provider systems to more effectively intervene in altering the course of asthma and to further reduce asthma morbidity and mortality. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  8. Clarithromycin prevents smoke-induced emphysema in mice.

    Science.gov (United States)

    Nakanishi, Yutaka; Kobayashi, Dale; Asano, Yasuo; Sakurai, Takanobu; Kashimura, Masato; Okuyama, Shigeru; Yoneda, Yukio; Shapiro, Steven D; Takayama, Kiyoshi

    2009-02-15

    Modulating the low-grade chronic inflammation in chronic obstructive pulmonary disease remains challenging. Clarithromycin (CAM), a macrolide antibiotic, reportedly ameliorates chronic inflammation via mechanisms independent of its antibacterial activity. The aim of this study was to examine whether CAM can prevent or reduce emphysema induced by chronic cigarette smoke exposure. Mice were exposed to cigarette smoke daily for 6 months and treated with orally administered CAM at doses of 25 to 100 mg/kg twice a day throughout the course of the experiment to test the preventive effects. The administration of CAM at 50 or 100 mg/kg was performed during the second half of a 6-month exposure period to assess the therapeutic effects. Histologic analysis was performed to evaluate the effect of CAM. CAM treatment for 6 months decreased airspace enlargement and the destruction of the alveolar walls and impaired the accumulation of macrophages in bronchoalveolar lavage fluid in a dose-related fashion. The administration of clarithromycin at 100 mg/kg in the therapeutic protocol reduced emphysema compared with the smoke-exposed group without treatment. An immunohistologic analysis revealed that CAM reduced the number of F4/80-positive macrophages in the lung parenchyma. In an in vitro test, CAM at 5 to 20 microM directly suppressed the activation of macrophages stimulated with tumor necrosis factor-alpha. Our data demonstrated that CAM at a clinically achievable dose prevented cigarette smoke-induced emphysema by modulating lung inflammation. This study supports the possibility that low-dose CAM treatment might provide a new therapeutic strategy for chronic obstructive pulmonary diseases.

  9. Genetics of asthma

    DEFF Research Database (Denmark)

    Thomsen, Simon F

    2015-01-01

    Asthma runs in families, and children of asthmatic parents are at increased risk of asthma. Prediction of disease risk is pivotal for the clinician when counselling atopic families. However, this is not always an easy task bearing in mind the vast and ever-increasing knowledge about asthma genetics....... The advent of new genotyping technologies has made it possible to sequence in great detail the human genome for asthma-associated variants, and accordingly, recent decades have witnessed an explosion in the number of rare and common variants associated with disease risk. This review presents an overview...... of methods and advances in asthma genetics in an attempt to help the clinician keep track of the most important knowledge in the field....

  10. Fertility outcomes in asthma

    DEFF Research Database (Denmark)

    Gade, Elisabeth Juul; Thomsen, Simon Francis; Lindenberg, Svend

    2016-01-01

    of fertility treatments, and the number of successful pregnancies differ significantly between women with unexplained infertility with and without asthma.245 women with unexplained infertility (aged 23-45 years) underwent questionnaires and asthma and allergy testing while undergoing fertility treatment. 96...... women entering the study had either a former doctor's diagnosis of asthma or were diagnosed with asthma when included. After inclusion they were followed for a minimum of 12 months in fertility treatment, until they had a successful pregnancy, stopped treatment, or the observation ended.The likelihood...... pregnancies during fertility treatment, 39.6 versus 60.4% (p=0.002). Increasing age was of negative importance for expected time to pregnancy, especially among asthmatic women (interaction between age and asthma on time to pregnancy, p=0.001). Female asthmatics had a longer time to pregnancy and less often...

  11. [Palliative surgical correction of respiratory insufficiency in diffusive pulmonary emphysema].

    Science.gov (United States)

    Gorbunkov, S D; Varlamov, V V; Cherny, S M; Lukina, O V; Kiryukhina, L D; Romanikhin, A I; Zinchenko, A V; Akopov, A L

    2017-01-01

    To analyze early postoperative period in patients with diffuse pulmonary emphysema after palliative surgical correction of respiratory failure. The study included 196 patients who underwent bullectomy (n=111) and surgical reduction of pulmonary volume (n=85). Overall morbidity and mortality were 40.8% and 12.2% respectively. Among patients older than 60 years these values were significantly higher (58.0% and 22.6% respectively). It was shown that age over 60 years is associated with high risk of complications and mortality after excision of large and giant bulls. In patients respiratory failure is generally corresponded to that for lung transplantation. However, these methods should be considered complementary rather competing.

  12. Tension Pneumothorax and Subcutaneous Emphysema Complicating Insertion of Nasogastric Tube

    Directory of Open Access Journals (Sweden)

    Narjis AL Saif

    2015-01-01

    Full Text Available Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.

  13. Pneumomediastinum, bilateral pneumothorax and subcutaneous emphysema complicating acute silicosis.

    Science.gov (United States)

    Dixit, Ramakant; Meena, Manoj; Patil, Chetan B

    2015-01-01

    A case of acute silicosis complicating as spontaneous pneumomediastinum, bilateral pneumothorax and subcutaneous emphysema is described in a 35-year-old male engaged in stone crusher unit. Diagnosis was established on clinical and radiological assessment and supported by occupational history of the patient. This case is unique one as all these 3 complications at the same time are very uncommon in acute silicosis. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  14. Quantification of Emphysema with a Three-Dimensional Chest CT Scan: Correlation with the Visual Emphysema Scoring on Chest CT, Pulmonary Function Tests and Dyspnea Severity

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyun Jeong; Hwang, Jung Hwa [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Seoul (Korea, Republic of)

    2011-09-15

    We wanted to prospectively evaluate the correlation between the quantification of emphysema using 3D CT densitometry with the visual emphysema score, pulmonary function tests (PFT) and the dyspnea score in patients with chronic obstructive pulmonary disease (COPD). Non-enhanced chest CT with 3D reconstruction was performed in 28 men with COPD (age 54-88 years). With histogram analysis, the total lung volume, mean lung density and proportion of low attenuation lung volume below predetermined thresholds were measured. The CT parameters were compared with the visual emphysema score, the PFT and the dyspnea score. A low attenuation lung volume below -950 HU was well correlated with the DLco and FEV{sub 1}/FVC. A Low attenuation lung volume below -950 HU and -930 HU was correlated with visual the emphysema score. A low attenuation lung volume below -950 HU was correlated with the dyspnea score, although the correlations between the other CT parameters and the dyspnea score were not significant. Objective quantification of emphysema using 3D CT densitometry was correlated with the visual emphysema score. A low attenuation lung volume below -950 HU was correlated with the DLco, the FEV{sub 1}/FVC and the dyspnea score.

  15. Aclidinium bromide inhalation powder for the long-term, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease including chronic bronchitis and emphysema.

    Science.gov (United States)

    Matera, Maria Gabriella; Sanduzzi, Alessandro; Alfano, Roberto; Cazzola, Mario

    2016-06-01

    Aclidinium is a twice-daily long-acting muscarinic receptor antagonist (LAMA) with an interesting pharmacological profile. Recent evidence indicates that this LAMA, in addition to causing a significant improvement in lung function and other important supportive outcomes, such as health related quality of life, dyspnea and nighttime/early morning symptoms in patients suffering from COPD, is also able to significantly reduce the rate of exacerbations of any severity, is extremely effective in controlling the COPD symptoms, is able to reduce lung hyperinflation, and has an excellent cardiovascular safety profile. Consequently, aclidinium should be considered a first-line approach at least for the symptomatic treatment of COPD although there are still few head-to-head studies comparing this LAMA with other bronchodilators. In any case, aclidinium can be taken into account in the treatment of different COPD phenotypes (emphysema, chronic bronchitis, exacerbators and patients with overlap COPD asthma).

  16. Advances in Pediatric Asthma in 2013: Coordinating Asthma Care

    Science.gov (United States)

    Szefler, Stanley J.

    2014-01-01

    Last year’s Advances in Pediatric Asthma: Moving Toward Asthma Prevention concluded that: “We are well on our way to creating a pathway around wellness in asthma care and also to utilize new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma.” This year’s summary will focus on recent advances in pediatric asthma on pre- and postnatal factors altering the natural history of asthma, assessment of asthma control, and new insights regarding potential therapeutic targets for altering the course of asthma in children as indicated in Journal of Allergy and Clinical Immunology publications in 2013 and early 2014. Recent reports continue to shed light on methods to understand factors that influence the course of asthma, methods to assess and communicate levels of control, and new targets for intervention as well as new immunomodulators. It will now be important to carefully assess risk factors for the development of asthma as well as the risk for asthma exacerbations and to improve the way we communicate this information in the health care system. This will allow parents, primary care physicians, specialists and provider systems to more effectively intervene in altering the course of asthma and to further reduce asthma morbidity and mortality. PMID:24581430

  17. Evidence for autophagic gridlock in aging and neurodegeneration.

    Science.gov (United States)

    Bakhoum, Mathieu F; Bakhoum, Christine Y; Ding, Zhixia; Carlton, Susan M; Campbell, Gerald A; Jackson, George R

    2014-07-01

    Autophagy is essential to neuronal homeostasis, and its impairment is implicated in the development of neurodegenerative pathology. However, the underlying mechanisms and consequences of this phenomenon remain a matter of conjecture. We show that misexpression of human tau in Drosophila induces accumulation of autophagic intermediates with a preponderance of large vacuoles, which we term giant autophagic bodies (GABs), which are reminiscent of dysfunctional autophagic entities. Lowering basal autophagy reduces GABs, whereas increasing autophagy decreases mature autolysosomes. Induction of autophagy is also associated with rescue of the tauopathy phenotype, suggesting that formation of GABs may be a compensatory mechanism rather than a trigger of neurodegeneration. Last, we show that the peculiar Biondi bodies observed in the choroid epithelium of both elderly and Alzheimer's disease human brains express immunoreactive markers similar to those of GABs. Collectively, these data indicate that autophagic gridlock contributes to the development of pathology in aging and neurodegeneration. Published by Mosby, Inc.

  18. Mild traumatic brain injury: a risk factor for neurodegeneration

    Science.gov (United States)

    2010-01-01

    Recently, it has become clear that head trauma can lead to a progressive neurodegeneration known as chronic traumatic encephalopathy. Although the medical literature also implicates head trauma as a risk factor for Alzheimer's disease, these findings are predominantly based on clinical diagnostic criteria that lack specificity. The dementia that follows head injuries or repetitive mild trauma may be caused by chronic traumatic encephalopathy, alone or in conjunction with other neurodegenerations (for example, Alzheimer's disease). Prospective longitudinal studies of head-injured individuals, with neuropathological verification, will not only improve understanding of head trauma as a risk factor for dementia but will also enhance treatment and prevention of a variety of neurodegenerative diseases. PMID:20587081

  19. Cross-Sectional Analysis of the Utility of Pulmonary Function Tests in Predicting Emphysema in Ever-Smokers

    Science.gov (United States)

    Hesselbacher, Sean E.; Ross, Robert; Schabath, Matthew B.; Smith, E. O’Brian; Perusich, Sarah; Barrow, Nadia; Smithwick, Pamela; Mammen, Manoj J.; Coxson, Harvey; Krowchuk, Natasha; Corry, David B.; Kheradmand, Farrah

    2011-01-01

    Emphysema is largely an under-diagnosed medical condition that can exist in smokers in the absence of airway obstruction. We aimed to determine the sensitivity and specificity of pulmonary function tests (PFTs) in assessing emphysema using quantitative CT scans as the reference standard. We enrolled 224 ever-smokers (current or former) over the age of 40. CT of thorax was used to quantify the low attenuation area (% emphysema), and to measure the standardized airway wall thickness. PFTs were used individually and in combination to predict their ability to discriminate radiographic emphysema. Significant emphysema (>7%) was detected in 122 (54%) subjects. Twenty six (21%) emphysema subjects had no evidence of airflow obstruction (FEV1/FVC ratio 23% emphysema showed airflow obstruction. The sensitivity and specificity of spirometry for detecting radiographic emphysema were 79% and 75%, respectively. Standardized airway wall thickness was increased in subjects with airflow obstruction, but did not correlate with emphysema severity. In this cohort of lifetime ever-smokers, PFTs alone were inadequate for diagnosing emphysema. Airway wall thickness quantified by CT morphometry was associated with airflow limitation, but not with emphysema indicating that the heterogeneous nature of lung disease in smokers may represent distinct phenotypes. PMID:21655122

  20. Cross-Sectional Analysis of the Utility of Pulmonary Function Tests in Predicting Emphysema in Ever-Smokers

    Directory of Open Access Journals (Sweden)

    Farrah Kheradmand

    2011-04-01

    Full Text Available Emphysema is largely an under-diagnosed medical condition that can exist in smokers in the absence of airway obstruction. We aimed to determine the sensitivity and specificity of pulmonary function tests (PFTs in assessing emphysema using quantitative CT scans as the reference standard. We enrolled 224 ever-smokers (current or former over the age of 40. CT of thorax was used to quantify the low attenuation area (% emphysema, and to measure the standardized airway wall thickness. PFTs were used individually and in combination to predict their ability to discriminate radiographic emphysema. Significant emphysema (>7% was detected in 122 (54% subjects. Twenty six (21% emphysema subjects had no evidence of airflow obstruction (FEV1/FVC ratio 23% emphysema showed airflow obstruction. The sensitivity and specificity of spirometry for detecting radiographic emphysema were 79% and 75%, respectively. Standardized airway wall thickness was increased in subjects with airflow obstruction, but did not correlate with emphysema severity. In this cohort of lifetime ever-smokers, PFTs alone were inadequate for diagnosing emphysema. Airway wall thickness quantified by CT morphometry was associated with airflow limitation, but not with emphysema indicating that the heterogeneous nature of lung disease in smokers may represent distinct phenotypes.

  1. The Significance of Asthma Follow-Up Consultations for Adherence to Asthma Medication, Asthma Medication Beliefs, and Asthma Control

    OpenAIRE

    Malin Axelsson; Linda Ekerljung; Bo Lundbäck

    2015-01-01

    Objective. The aim was to investigate adherence to asthma medication treatment, medication beliefs, and asthma control in relation to asthma follow-up consultations in asthmatics in the general population. A further aim was to describe associations between adherence, medication beliefs, and asthma control. Method. In the population-based West Sweden Asthma Study, data allowing calculation of adherence for 4.5 years based on pharmacy records were obtained from 165 adult asthmatics. Additional ...

  2. Children with Asthma and Sports

    OpenAIRE

    Selda Yuzer; Sevinc Polat

    2014-01-01

    Asthma is one of the chronic diseases which have are widely seen among the children. The disease has recently been in the increase all over the world and affects many children. In a study conducted with International Study of Asthma and Allergies in Childhood (ISAAC) method, it was found out that prevalence of childhood asthma was 17.1%. Participation in sportive activities by the children with asthma, which is today considered as a part of asthma treatment program, makes contributions to the...

  3. Tobaksrygning og asthma

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; Lange, Peter

    2002-01-01

    Cigarette smoking is a well-known health hazard, probably not least for patients suffering from asthma. This review gives a short overview of the effects of passive and active smoking on the inception and outcome with of longitudinal changes in the lung function and mortality of patients with ast......Cigarette smoking is a well-known health hazard, probably not least for patients suffering from asthma. This review gives a short overview of the effects of passive and active smoking on the inception and outcome with of longitudinal changes in the lung function and mortality of patients...... with asthma. Substantial evidence suggests that smoking affects asthma adversely. Exposure to environmental tobacco smoke, especially maternal smoking in children, may be a significant risk factor for asthma. Such exposure in patients with established asthma is not only associated with more severe symptoms......, but also with a poorer quality of life, reduced lung function, and increased utilisation of health care including hospital admissions. Active smoking does not appear to be a significant risk factor for asthma, but is associated with a worse outcome with regard to both longitudinal changes in lung function...

  4. Vertebral artery dissection after iatrogenic cervical subcutaneous emphysema.

    Science.gov (United States)

    Rabkin, David G; Benharash, Peyman; Shemin, Richard J

    2011-01-01

    We report a case of spontaneous vertebral artery dissection (VAD) in a patient who developed extensive subcutaneous emphysema following the removal of a chest tube after a cardiac transplant. The pathophysiology and management of this uncommon complication are reviewed. Although vertebral and carotid artery dissections are unusual events occurring in 2.5 to 3 per 100,000 people, they are increasingly acknowledged to be important causes of stroke in the young and middle-aged adult population accounting for up to 25% of such cases. VADs are associated with a variety of minor traumatic mechanisms including painting a ceiling, yoga, chiropractic manipulation of the spine, and driving. These events cause injury to the vessel wall either by shearing forces secondary to rotational injuries or direct trauma to the vessel wall on bony prominences, especially the transverse processes of the cervical vertebrae. We present a case of a patient with documented previously normal vertebral arterial anatomy who developed a VAD after mediastinal tube removal resulted in subcutaneous emphysema tracking through fascial planes into his neck. © 2010 Wiley Periodicals, Inc.

  5. Pneumomediastinum, pneumothorax and subcutaneous emphysema complicating MIS herniorrhaphy.

    LENUS (Irish Health Repository)

    Browne, J

    2012-02-03

    PURPOSE: Videoscopic herniorrhaphy is being performed more frequently with advantages claimed over the conventional open approach. This clinical report describes a pneumothorax, pneumomediastinum and subcutaneous emphysema occurring at the end of an extraperitoneal videoscopic herniorrhaphy. CLINICAL FEATURES: A 25 yr old ASA I man presented for elective extraperitoneal videoscopic hernia repair. Following intravenous induction with fentanyl, midazolam and propofol a balanced anesthetic technique using enflurane in N2O and O2 was used. Apart from a prolonged operating time (195 min), the procedure and anesthetic was uneventful. At the conclusion of the operation, prior to reversal of neuromuscular blockade extensive subcutaneous emphysema was noted on removal of the surgical drapes. Chest radiography revealed a pneumomediastinum and pneumothorax. A 25 FG intercostal tube was inserted and connected to an underwater seal drain. Sedation and positive pressure ventilation was maintained overnight to permit resolution and avoid airway compromise. The clinical and radiological features had resolved by the next morning and the patient\\'s trachea was extubated. His subsequent recovery was uneventful. CONCLUSION: Pneumothorax and pneumomediastinum are well recognised complications of laparoscopic techniques but have not been described following extraperitoneal herniorrhaphy. In this report we postulate possible mechanisms which may have contributed to their development, including inadvertent breach of the peritoneum and leakage of gas around the diaphragmatic herniae or tracking of gas retroperitoneally. The case alerts us to the possibility of this complication occurring in patients undergoing videoscopic herniorrhaphy.

  6. Bronchoscopic thermal vapor ablation in a canine model of emphysema

    Directory of Open Access Journals (Sweden)

    Tuck SA

    2012-01-01

    Full Text Available Stephanie A Tuck1, Vanessa Lopes-Berkas2, Sheree Beam3, Joseph C Anderson11Uptake Medical Corp, Seattle, WA, 2American Preclinical Services, Coon Rapids, MN, 3Preclinical Pathology Consulting Services, Ham Lake, MN, USAAbstract: Clinical studies indicate the potential of bronchoscopic thermal vapor ablation to result in clinically relevant improvements in severe chronic obstructive pulmonary disease patients with upper lobe-predominant emphysema. However, the mechanisms by which vapor ablation results in lung volume reduction are not fully known. This study determined the 3-month safety and efficacy of vapor ablation in a canine model of emphysema and described the histopathological changes in the lung. The cranial lobes of papain-exposed dogs were treated with a vapor dose of ten calories per gram of lung tissue (n = 8 or were sham treated (n = 3. Safety was monitored peri- and postoperatively for 3 months. Animals were then sacrificed, estimates of lung volume reduction performed, and the lungs processed for histology. Vapor ablation was associated with an average of 20% volume reduction of the treated lobes and an absence of serious adverse events. The amount of lobar volume reduction was correlated with the amount of fibrosis and atelectasis in the treated lobe. Bronchoscopic thermal vapor ablation at a dose of 10 cal/g results in lobar volume reduction associated with remodeling of the targeted tissue characterized by mature collagen formation in the absence of major adverse events.Keywords: animal models, chronic obstructive pulmonary disease, bronchoscopy, lung volume reduction

  7. Bronchoscopic thermal vapor ablation in a canine model of emphysema.

    Science.gov (United States)

    Tuck, Stephanie A; Lopes-Berkas, Vanessa; Beam, Sheree; Anderson, Joseph C

    2012-01-01

    Clinical studies indicate the potential of bronchoscopic thermal vapor ablation to result in clinically relevant improvements in severe chronic obstructive pulmonary disease patients with upper lobe-predominant emphysema. However, the mechanisms by which vapor ablation results in lung volume reduction are not fully known. This study determined the 3-month safety and efficacy of vapor ablation in a canine model of emphysema and described the histopathological changes in the lung. The cranial lobes of papain-exposed dogs were treated with a vapor dose of ten calories per gram of lung tissue (n = 8) or were sham treated (n = 3). Safety was monitored peri- and postoperatively for 3 months. Animals were then sacrificed, estimates of lung volume reduction performed, and the lungs processed for histology. Vapor ablation was associated with an average of 20% volume reduction of the treated lobes and an absence of serious adverse events. The amount of lobar volume reduction was correlated with the amount of fibrosis and atelectasis in the treated lobe. Bronchoscopic thermal vapor ablation at a dose of 10 cal/g results in lobar volume reduction associated with remodeling of the targeted tissue characterized by mature collagen formation in the absence of major adverse events.

  8. [Combined pulmonary fibrosis and emphysema associated with microscopic polyangiitis].

    Science.gov (United States)

    M'Saad, S; Kammoun, K; Yangui, I; Fourati, H; Feki, W; Marouen, F; Daoud, E; Kammoun, S

    2016-05-01

    Combined pulmonary fibrosis and emphysema (CPFE) is a rare entity of unknown etiology. It usually occurs in the context of smoking and, less commonly, connective tissue disease. However, it has been rarely previously described in the context of vasculitis. We report a case of CPFE occurring in a 44-year-old man, who was a light smoker without any previous medical history. He presented with fever, chronic cough and breathlessness that progressively evolved to acute respiratory failure. At the initial evaluation, CT scan showed emphysema and patchy bilateral areas of ground-glass opacity. Three years later, the patient simultaneously developed a honeycomb fibrosis and a microscopic polyangiitis with renal involvement justifying the introduction of an immunosuppressive treatment in combination with high dose of systemic corticosteroids. After a stabilization period of 6years, the patient gradually developed chronic respiratory failure with moderate pulmonary hypertension requiring long-term oxygen therapy and nocturnal non-invasive ventilation. The association of microscopic polyangiitis to CFPE suggests that autoimmune diseases may have a common pathogenic role in the development of emphysematous and fibrotic lesions in CPFE. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  9. [Lung volume reduction surgery for severe pulmonary emphysema in Iceland].

    Science.gov (United States)

    Gunnarsson, Sverrir I; Johannsson, Kristinn B; Guðjónsdóttir, Marta; Jónsson, Steinn; Beck, Hans J; Magnusson, Bjorn; Gudbjartsson, Tomas

    2011-12-01

    Lung volume reduction surgery (LVRS) can benefit patients with severe emphysema. The aim of this study was to evaluate the outcome of LVRS performed in Iceland. A prospective study of 16 consecutive patients who underwent bilateral LVRS through median sternotomy between January 1996 and December 2008. All patients had disabling dyspnea, lung hyperinflation, and emphysema with upper lobe predominance. Preoperatively all patients underwent pulmonary rehabilitation. Spirometry, lung volumes, arterial blood gases and exercise capacity were measured before and after surgery. Mean follow-up time was 8.7 years. Mean age was 59.2 ± 5.9 years. All patients had a history of heavy smoking. There was no perioperative mortality and survival was 100%, 93%, and 63% at 1, 5, and 10 years, respectively. The forced expiratory volume in 1 second (FEV1) and the forced vital capacity (FVC) improved significantly after surgery by 35% (plung capacity, residual volume and partial pressure of CO2 also showed statistically significant improvements but exercise capacity, O2 consumption and diffusing capacity of the lung for CO did not change. Prolonged air leak (≥ 7 days) was the most common complication (n=7). Five patients required reoperation, most commonly for sternal dehiscence (n=4). In this small prospective study, FEV1 and FVC increased and lung volumes and PaCO2 improved after LVRS. Long term survival was satisfactory although complications such as reoperations for sternal dehiscence were common and hospital stay therefore often prolonged.

  10. Astrocytic Pathological Calcium Homeostasis and Impaired Vesicle Trafficking in Neurodegeneration

    Directory of Open Access Journals (Sweden)

    Nina Vardjan

    2017-02-01

    Full Text Available Although the central nervous system (CNS consists of highly heterogeneous populations of neurones and glial cells, clustered into diverse anatomical regions with specific functions, there are some conditions, including alertness, awareness and attention that require simultaneous, coordinated and spatially homogeneous activity within a large area of the brain. During such events, the brain, representing only about two percent of body mass, but consuming one fifth of body glucose at rest, needs additional energy to be produced. How simultaneous energy procurement in a relatively extended area of the brain takes place is poorly understood. This mechanism is likely to be impaired in neurodegeneration, for example in Alzheimer’s disease, the hallmark of which is brain hypometabolism. Astrocytes, the main neural cell type producing and storing glycogen, a form of energy in the brain, also hold the key to metabolic and homeostatic support in the central nervous system and are impaired in neurodegeneration, contributing to the slow decline of excitation-energy coupling in the brain. Many mechanisms are affected, including cell-to-cell signalling. An important question is how changes in cellular signalling, a process taking place in a rather short time domain, contribute to the neurodegeneration that develops over decades. In this review we focus initially on the slow dynamics of Alzheimer’s disease, and on the activity of locus coeruleus, a brainstem nucleus involved in arousal. Subsequently, we overview much faster processes of vesicle traffic and cytosolic calcium dynamics, both of which shape the signalling landscape of astrocyte-neurone communication in health and neurodegeneration.

  11. Sorbus alnifolia protects dopaminergic neurodegeneration in Caenorhabditis elegans.

    Science.gov (United States)

    Cheon, Se-Myeong; Jang, Insoo; Lee, Myon-Hee; Kim, Dae Keun; Jeon, Hoon; Cha, Dong Seok

    2017-12-01

    The twigs of Sorbus alnifolia (Sieb. et Zucc.) K. Koch (Rosaceae) have been used to treat neurological disorders as a traditional medicine in Korea. However, there are limited data describing the efficacy of S. alnifolia in Parkinson's disease (PD). This study was conducted to identify the protective effects of the methanol extracts of S. alnifolia (MESA) on the dopaminergic (DA) neurodegeneration in Caenorhabditis elegans. To test the neuroprotective action of MESA, viability assay was performed after 48 h exposure to 1-methyl-4-phenylpyridine (MMP+) in PC12 cells and C. elegans (400 μM and 2 mM of MMP+, respectively). Fluorescence intensity was quantified using transgenic mutants such as BZ555 (Pdat-1::GFP) and and UA57 (Pdat-1::GFP and Pdat-1::CAT-2) to determine MESA's effects on DA neurodegeneration in C. elegans. Aggregation of α-synuclein was observed using NL5901 strain (unc-54p::α-synuclein::YFP). MESA's protective effects on the DA neuronal functions were examined by food-sensing assay. Lifespan assay was conducted to test the effects of MESA on the longevity. MESA restored MPP+-induced loss of viability in both PC12 cells and C. elegans (85.8% and 54.9%, respectively). In C. elegans, MESA provided protection against chemically and genetically-induced DA neurodegeneration, respectively. Moreover, food-sensing functions were increased 58.4% by MESA in the DA neuron degraded worms. MESA also prolonged the average lifespan by 25.6%. However, MESA failed to alter α-synuclein aggregation. These results revealed that MESA protects DA neurodegeneration and recovers diminished DA neuronal functions, thereby can be a valuable candidate for the treatment of PD.

  12. Neurodegeneration Triggers Peripheral Immune Cell Recruitment into the Forebrain.

    Science.gov (United States)

    Scheld, Miriam; Rüther, Bernhard Josef; Große-Veldmann, René; Ohl, Kim; Tenbrock, Klaus; Dreymüller, Daniela; Fallier-Becker, Petra; Zendedel, Adib; Beyer, Cordian; Clarner, Tim; Kipp, Markus

    2016-01-27

    Brain-intrinsic degenerative cascades have been proposed to be an initial factor driving lesion formation in multiple sclerosis (MS). Here, we identify neurodegeneration as a potent trigger for peripheral immune cell recruitment into the mouse forebrain. Female C57BL/6 mice were fed cuprizone for 3 weeks, followed by a period of 2 weeks on normal chow to induce the formation of lesion foci in the forebrain. Subsequent immunization with myelin oligodendrocyte glycoprotein 35-55 peptide, which induces myelin autoreactive T cells in the periphery, resulted in massive immune cell recruitment into the affected forebrain. Additional adoptive transfer experiments together with flow cytometry analysis underline the importance of brain-derived signals for immune cell recruitment. This study clearly illustrates the significance of brain-intrinsic degenerative cascades for immune cell recruitment and MS lesion formation. Additional studies have to address the signaling cascades and mechanistic processes that form the top-down communication between the affected brain area, neurovascular unit, and peripheral immune cells. We identify neurodegeneration as a potent trigger for peripheral immune cell recruitment into the forebrain. Thus, immune cell recruitment might be a second step during the formation of new inflammatory lesions in multiple sclerosis. A better understanding of factors regulating neurodegeneration-induced immune cell recruitment will pave the way for the development of novel therapeutic treatment strategies. Copyright © 2016 the authors 0270-6474/16/361410-06$15.00/0.

  13. Asthma control in children

    DEFF Research Database (Denmark)

    Pedersen, Søren

    2016-01-01

    studies have added new information about the effects of poorly controlled asthma on a range of important, but less studied outcomes, including risk of obesity, daily physical activity, cardiovascular fitness, stress, concentration and focused attention, learning disabilities and risk of depression. From...... in whom the tests suggest good asthma control may still have poorly controlled asthma when various objective outcomes are included in the assessment. A main reason for that seems to be that none of the tests accurately detects the child's adaptation in lifestyle. If you do not exercise you have fewer...

  14. Genetics, atopy asthma

    Directory of Open Access Journals (Sweden)

    William O.C.M. Cookson

    1996-01-01

    Full Text Available Asthma is a complex disease which is due to the interaction of an unknown number of genes with strong environmental factors. Segregation analysis suggests the presence of major genes underlying asthma and atopy. Different genetic effects have been recognized which predispose to generalized atopy, or modify the atopic response to particular allergens, or enhance bronchial inflammation, or modify bronchial tone. These known genes or genetic loci do not account for all of the familial clustering of asthma and atopy. Many studies are now under way to identify the remaining genes.

  15. Cluster analysis in severe emphysema subjects using phenotype and genotype data: an exploratory investigation

    Directory of Open Access Journals (Sweden)

    Martinez Fernando J

    2010-03-01

    Full Text Available Abstract Background Numerous studies have demonstrated associations between genetic markers and COPD, but results have been inconsistent. One reason may be heterogeneity in disease definition. Unsupervised learning approaches may assist in understanding disease heterogeneity. Methods We selected 31 phenotypic variables and 12 SNPs from five candidate genes in 308 subjects in the National Emphysema Treatment Trial (NETT Genetics Ancillary Study cohort. We used factor analysis to select a subset of phenotypic variables, and then used cluster analysis to identify subtypes of severe emphysema. We examined the phenotypic and genotypic characteristics of each cluster. Results We identified six factors accounting for 75% of the shared variability among our initial phenotypic variables. We selected four phenotypic variables from these factors for cluster analysis: 1 post-bronchodilator FEV1 percent predicted, 2 percent bronchodilator responsiveness, and quantitative CT measurements of 3 apical emphysema and 4 airway wall thickness. K-means cluster analysis revealed four clusters, though separation between clusters was modest: 1 emphysema predominant, 2 bronchodilator responsive, with higher FEV1; 3 discordant, with a lower FEV1 despite less severe emphysema and lower airway wall thickness, and 4 airway predominant. Of the genotypes examined, membership in cluster 1 (emphysema-predominant was associated with TGFB1 SNP rs1800470. Conclusions Cluster analysis may identify meaningful disease subtypes and/or groups of related phenotypic variables even in a highly selected group of severe emphysema subjects, and may be useful for genetic association studies.

  16. Genome-Wide Association Identifies Regulatory Loci Associated with Distinct Local Histogram Emphysema Patterns

    Science.gov (United States)

    Cho, Michael H.; San José Estépar, Raúl; McDonald, Merry-Lynn N.; Laird, Nan; Beaty, Terri H.; Washko, George; Crapo, James D.; Silverman, Edwin K.

    2014-01-01

    Rationale: Emphysema is a heritable trait that occurs in smokers with and without chronic obstructive pulmonary disease. Emphysema occurs in distinct pathologic patterns, but the genetic determinants of these patterns are unknown. Objectives: To identify genetic loci associated with distinct patterns of emphysema in smokers and investigate the regulatory function of these loci. Methods: Quantitative measures of distinct emphysema patterns were generated from computed tomography scans from smokers in the COPDGene Study using the local histogram emphysema quantification method. Genome-wide association studies (GWAS) were performed in 9,614 subjects for five emphysema patterns, and the results were referenced against enhancer and DNase I hypersensitive regions from ENCODE and Roadmap Epigenomics cell lines. Measurements and Main Results: Genome-wide significant associations were identified for seven loci. Two are novel associations (top single-nucleotide polymorphism rs379123 in MYO1D and rs9590614 in VMA8) located within genes that function in cell-cell signaling and cell migration, and five are in loci previously associated with chronic obstructive pulmonary disease susceptibility (HHIP, IREB2/CHRNA3, CYP2A6/ADCK, TGFB2, and MMP12). Five of these seven loci lay within enhancer or DNase I hypersensitivity regions in lung fibroblasts or small airway epithelial cells, respectively. Enhancer enrichment analysis for top GWAS associations (single-nucleotide polymorphisms associated at P emphysema quantified by computed tomography scan. Enhancer regions are significantly enriched among these GWAS results, with pulmonary fibroblasts among the cell types showing the strongest enrichment. PMID:25006744

  17. Adaptive Quantification and Longitudinal Analysis of Pulmonary Emphysema with a Hidden Markov Measure Field Model

    Science.gov (United States)

    Häme, Yrjö; Angelini, Elsa D.; Hoffman, Eric A.; Barr, R. Graham; Laine, Andrew F.

    2014-01-01

    The extent of pulmonary emphysema is commonly estimated from CT images by computing the proportional area of voxels below a predefined attenuation threshold. However, the reliability of this approach is limited by several factors that affect the CT intensity distributions in the lung. This work presents a novel method for emphysema quantification, based on parametric modeling of intensity distributions in the lung and a hidden Markov measure field model to segment emphysematous regions. The framework adapts to the characteristics of an image to ensure a robust quantification of emphysema under varying CT imaging protocols and differences in parenchymal intensity distributions due to factors such as inspiration level. Compared to standard approaches, the present model involves a larger number of parameters, most of which can be estimated from data, to handle the variability encountered in lung CT scans. The method was used to quantify emphysema on a cohort of 87 subjects, with repeated CT scans acquired over a time period of 8 years using different imaging protocols. The scans were acquired approximately annually, and the data set included a total of 365 scans. The results show that the emphysema estimates produced by the proposed method have very high intra-subject correlation values. By reducing sensitivity to changes in imaging protocol, the method provides a more robust estimate than standard approaches. In addition, the generated emphysema delineations promise great advantages for regional analysis of emphysema extent and progression, possibly advancing disease subtyping. PMID:24759984

  18. Polymorphism of SERPINE2 gene is associated with pulmonary emphysema in consecutive autopsy cases

    Directory of Open Access Journals (Sweden)

    Kida Kozui

    2010-11-01

    Full Text Available Abstract Background The SERPINA1, SERPINA3, and SERPINE2 genes, which encode antiproteases, have been proposed to be susceptible genes for of chronic obstructive pulmonary disease (COPD and related phenotypes. Whether they are associated with emphysema is not known. Methods Twelve previously reported single nucleotide polymorphisms (SNPs in SERPINA1 (rs8004738, rs17751769, rs709932, rs11832, rs1303, rs28929474, and rs17580, SERPINA3 (rs4934, rs17473, and rs1800463, and SERPINE2 (rs840088 and rs975278 were genotyped in samples obtained from 1,335 consecutive autopsies of elderly Japanese people. The association between these SNPs and the severity of emphysema, as assessed using macroscopic scores, was determined. Results Emphysema of more than moderate degree was detected in 189 subjects (14.1% and showed a significant gender difference (males, 20.5% and females, 7.0%; p SERPINE2 gene was positively associated with emphysema. Unlike the major alleles, homozygous minor alleles of rs975278 were associated with emphysema (odds ratio (OR = 1.54; 95% confidence interval (CI = 1.02-2.30; p = 0.037 and the association was very prominent in smokers (OR = 2.02; 95% CI = 1.29-3.15; p = 0.002. Conclusions SERPINE2 may be a risk factor for the development of emphysema and its association with emphysema may be stronger in smokers.

  19. Cluster analysis in severe emphysema subjects using phenotype and genotype data: an exploratory investigation.

    Science.gov (United States)

    Cho, Michael H; Washko, George R; Hoffmann, Thomas J; Criner, Gerard J; Hoffman, Eric A; Martinez, Fernando J; Laird, Nan; Reilly, John J; Silverman, Edwin K

    2010-03-16

    Numerous studies have demonstrated associations between genetic markers and COPD, but results have been inconsistent. One reason may be heterogeneity in disease definition. Unsupervised learning approaches may assist in understanding disease heterogeneity. We selected 31 phenotypic variables and 12 SNPs from five candidate genes in 308 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study cohort. We used factor analysis to select a subset of phenotypic variables, and then used cluster analysis to identify subtypes of severe emphysema. We examined the phenotypic and genotypic characteristics of each cluster. We identified six factors accounting for 75% of the shared variability among our initial phenotypic variables. We selected four phenotypic variables from these factors for cluster analysis: 1) post-bronchodilator FEV1 percent predicted, 2) percent bronchodilator responsiveness, and quantitative CT measurements of 3) apical emphysema and 4) airway wall thickness. K-means cluster analysis revealed four clusters, though separation between clusters was modest: 1) emphysema predominant, 2) bronchodilator responsive, with higher FEV1; 3) discordant, with a lower FEV1 despite less severe emphysema and lower airway wall thickness, and 4) airway predominant. Of the genotypes examined, membership in cluster 1 (emphysema-predominant) was associated with TGFB1 SNP rs1800470. Cluster analysis may identify meaningful disease subtypes and/or groups of related phenotypic variables even in a highly selected group of severe emphysema subjects, and may be useful for genetic association studies.

  20. Normalization of CT scans reconstructed with different kernels to reduce variability in emphysema measurements

    Science.gov (United States)

    Gallardo Estrella, L.; van Ginneken, B.; van Rikxoort, E. M.

    2013-03-01

    Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by progressive air flow limitation caused by emphysema and chronic bronchitis. Emphysema is quantified from chest computed tomography (CT) scans as the percentage of attentuation values below a fixed threshold. The emphysema quantification varies substantially between scans reconstructed with different kernels, limiting the possibilities to compare emphysema quantifications obtained from scans with different reconstruction parameters. In this paper we propose a method to normalize scans reconstructed with different kernels to have the same characteristics as scans reconstructed with a reference kernel and investigate if this normalization reduces the variability in emphysema quantification. The proposed normalization splits a CT scan into different frequency bands based on hierarchical unsharp masking. Normalization is performed by changing the energy in each frequency band to the average energy in each band in the reference kernel. A database of 15 subjects with COPD was constructed for this study. All subjects were scanned at total lung capacity and the scans were reconstructed with four different reconstruction kernels. The normalization was applied to all scans. Emphysema quantification was performed before and after normalization. It is shown that the emphysema score varies substantially before normalization but the variation diminishes after normalization.

  1. Role of Cigarette Smoke–Induced Aggresome Formation in Chronic Obstructive Pulmonary Disease–Emphysema Pathogenesis

    Science.gov (United States)

    Tran, Ian; Ji, Changhoon; Ni, Inzer; Min, Taehong; Tang, Danni

    2015-01-01

    Cigarette smoke (CS) exposure is known to induce proteostasis imbalance that can initiate accumulation of ubiquitinated proteins. Therefore, the primary goal of this study was to determine if first- and secondhand CS induces localization of ubiquitinated proteins in perinuclear spaces as aggresome bodies. Furthermore, we sought to determine the mechanism by which smoke-induced aggresome formation contributes to chronic obstructive pulmonary disease (COPD)–emphysema pathogenesis. Hence, Beas2b cells were treated with CS extract (CSE) for in vitro experimental analysis of CS-induced aggresome formation by immunoblotting, microscopy, and reporter assays, whereas chronic CS–exposed murine model and human COPD–emphysema lung tissues were used for validation. In preliminary analysis, we observed a significant (P emphysema murine model to verify that chronic CS significantly (P emphysema pathogenesis. Finally, significantly higher p62 accumulation in smokers and severe COPD–emphysema lungs (Global Initiative for Chronic Obstructive Lung Disease Stage III/IV) as compared with normal nonsmokers (Global Initiative for Chronic Obstructive Lung Disease Stage 0) substantiates the pathogenic role of autophagy impairment in aggresome formation and COPD–emphysema progression. In conclusion, CS-induced aggresome formation is a novel mechanism involved in COPD–emphysema pathogenesis. PMID:25490051

  2. Impact of exacerbations on emphysema progression in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Tanabe, Naoya; Muro, Shigeo; Hirai, Toyohiro; Oguma, Tsuyoshi; Terada, Kunihiko; Marumo, Satoshi; Kinose, Daisuke; Ogawa, Emiko; Hoshino, Yuma; Mishima, Michiaki

    2011-06-15

    Low-attenuation areas assessed by computed tomography reflect the extent of pathological emphysema and correlate with airflow limitation and mortality in patients with chronic obstructive pulmonary disease. The cumulative size distribution of low-attenuation area clusters follows a power law characterized by an exponent, D. The values of D reflect the complexity of the terminal airspace geometry and sensitively detect alveolar structural changes. Exacerbations of chronic obstructive pulmonary disease have a negative impact on lung function and prognosis. However, the impact on emphysema progression remains unclear. We investigated the relationship between exacerbation and emphysema progression assessed by computed tomography in patients with chronic obstructive pulmonary disease. Exacerbations were prospectively recorded for 2 years. Annual changes in computed tomography parameters of emphysema were compared between patients with and without a history of exacerbations. In patients with exacerbations, increases in the percentage of low-attenuation areas and decreases in D were greater than in patients without exacerbations. To interpret these results, we established a novel simulation model and found that not only enlargement of preexisting low-attenuation areas but also coalescence of adjoining low-attenuation areas due to alveolar wall destruction caused emphysema progression in patients with exacerbations. This is the first longitudinal study to demonstrate that exacerbations are involved in emphysema progression in patients with chronic obstructive pulmonary disease. Emphysema progression should be evaluated as part of the outcomes of exacerbations in the management of chronic obstructive pulmonary disease.

  3. Role of Cigarette Smoke-Induced Aggresome Formation in Chronic Obstructive Pulmonary Disease-Emphysema Pathogenesis.

    Science.gov (United States)

    Tran, Ian; Ji, Changhoon; Ni, Inzer; Min, Taehong; Tang, Danni; Vij, Neeraj

    2015-08-01

    Cigarette smoke (CS) exposure is known to induce proteostasis imbalance that can initiate accumulation of ubiquitinated proteins. Therefore, the primary goal of this study was to determine if first- and secondhand CS induces localization of ubiquitinated proteins in perinuclear spaces as aggresome bodies. Furthermore, we sought to determine the mechanism by which smoke-induced aggresome formation contributes to chronic obstructive pulmonary disease (COPD)-emphysema pathogenesis. Hence, Beas2b cells were treated with CS extract (CSE) for in vitro experimental analysis of CS-induced aggresome formation by immunoblotting, microscopy, and reporter assays, whereas chronic CS-exposed murine model and human COPD-emphysema lung tissues were used for validation. In preliminary analysis, we observed a significant (P emphysema murine model to verify that chronic CS significantly (P emphysema pathogenesis. Finally, significantly higher p62 accumulation in smokers and severe COPD-emphysema lungs (Global Initiative for Chronic Obstructive Lung Disease Stage III/IV) as compared with normal nonsmokers (Global Initiative for Chronic Obstructive Lung Disease Stage 0) substantiates the pathogenic role of autophagy impairment in aggresome formation and COPD-emphysema progression. In conclusion, CS-induced aggresome formation is a novel mechanism involved in COPD-emphysema pathogenesis.

  4. Emphysema following vitrectomy with fluid–gas exchange: description of a rare complication

    Directory of Open Access Journals (Sweden)

    Damasceno EF

    2014-02-01

    Full Text Available Eduardo F Damasceno,1 Nadyr Damasceno,2 Soraya Horowitz,2 Marcio Mortera Rodrigues3 1Universidade Federal Fluminense, Niterói, Brazil; 2Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil; 3Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil Purpose: To report a case of subcutaneous emphysema involving the orbit, mediastinum, and face after pars plana vitrectomy with fluid–gas exchange. Methods: Case report of a 55-year-old man who presented with bilateral eyelid and face edema and dysphagia in the immediate postoperative period after pars plana vitrectomy. Orbital and chest computed tomographies were performed, revealing emphysema of the orbit and soft tissue of the face, extending from the neck to the upper chest. Results: The patient with a retinal detachment in the right eye underwent 23-gauge vitrectomy surgery with fluid–gas exchange and an implantation of silicone oil. The patient had a previous history of facial trauma for more than 20 years with an orbital fracture. After surgery, the patient developed emphysema of the orbit, soft tissue of the face and upper chest. Systemic prophylactic antibiotics associated with antibiotics and steroid drops performed a satisfactory evolution. Conclusion: The fluid–gas exchange during pars plana vitrectomy in patients with orbital fracture can lead to emphysema of the face, chest, and soft tissue. Keywords: vitrectomy complications, fluid–gas exchange, orbital emphysema, mediastinal emphysema, face emphysema, orbit fracture

  5. Smoking-related emphysema is associated with idiopathic pulmonary fibrosis and rheumatoid lung.

    Science.gov (United States)

    Antoniou, Katerina M; Walsh, Simon L; Hansell, David M; Rubens, Michael R; Marten, Katharina; Tennant, Rachel; Hansel, Trevor; Desai, Sujal R; Siafakas, Nikolaos M; du Bois, Roland M; Wells, Athol U

    2013-11-01

    A combined pulmonary fibrosis/emphysema syndrome has been proposed, but the basis for this syndrome is currently uncertain. The aim was to evaluate the prevalence of emphysema in idiopathic pulmonary fibrosis (IPF) and rheumatoid lung (rheumatoid arthritis-interstitial lung disease (RA-ILD)), and to compare the morphological features of lung fibrosis between smokers and non-smokers. Using high-resolution computed tomography, the prevalence of emphysema and the pack-year smoking histories associated with emphysema were compared between current/ex-smokers with IPF (n = 186) or RA-ILD (n = 46), and non-chronic obstructive pulmonary disease (COPD) controls (n = 103) and COPD controls (n = 34). The coarseness of fibrosis was compared between smokers and non-smokers. Emphysema, present in 66/186 (35%) patients with IPF and 22/46 (48%) smokers with RA-ILD, was associated with lower pack-year smoking histories than in control groups (P fibrosis was coarser in smokers than in non-smokers on univariate and multivariate analysis (P fibrosis was coarser in patients with emphysema but did not differ significantly between smokers and non-smokers. In IPF and RA-ILD, a high prevalence of concurrent emphysema, in association with low pack-year smoking histories, and an association between coarser pulmonary fibrosis and a history of smoking in IPF together provide support for possible pathogenetic linkage to smoking in both diseases. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

  6. Effect of Emphysema Extent on Serial Lung Function in Patients with Idiopathic Pulmonary Fibrosis.

    Science.gov (United States)

    Cottin, Vincent; Hansell, David M; Sverzellati, Nicola; Weycker, Derek; Antoniou, Katerina M; Atwood, Mark; Oster, Gerry; Kirchgaessler, Klaus-Uwe; Collard, Harold R; Wells, Athol U

    2017-11-01

    Patients with idiopathic pulmonary fibrosis and emphysema may have artificially preserved lung volumes. In this post hoc analysis, we investigated the relationship between baseline emphysema and fibrosis extents, as well as pulmonary function changes, over 48 weeks. Data were pooled from two phase III, randomized, double-blind, placebo-controlled trials of IFN-γ-1b in idiopathic pulmonary fibrosis (GIPF-001 [NCT00047645] and GIPF-007 [NCT00075998]). Patients with Week 48 data, baseline high-resolution computed tomographic images, and FEV 1 /FVC ratios less than 0.8 or greater than 0.9 (0.9 in GIPF-007), as well as randomly selected patients with ratios of 0.8-0.9 and 0.7-0.8, were included. Changes from baseline in pulmonary function at Week 48 were analyzed by emphysema extent. The relationship between emphysema and fibrosis extents and change in pulmonary function was assessed using multivariate linear regression. Emphysema was identified in 38% of patients. A negative correlation was observed between fibrosis and emphysema extents (r = -0.232; P pulmonary fibrosis and emphysema extent greater than or equal to 15%.

  7. Quantitative CT: Associations between Emphysema, Airway Wall Thickness and Body Composition in COPD

    DEFF Research Database (Denmark)

    Rutten, Erica P A; Grydeland, Thomas B; Pillai, Sreekumar G

    2011-01-01

    , CT scans were performed to determine emphysema (%LAA), airway wall thickness (AWT-Pi10), and lung mass. Muscle wasting based on FFMI was assessed by bioelectrical impedance. In both the men and women with COPD, FFMI was negatively associated with %LAA. FMI was positively associated with AWT-Pi10...... in both subjects with and without COPD. Among the subjects with muscle wasting, the percentage emphysema was high, but the predictive value was moderate. In conclusion, the present study strengthens the hypothesis that the subgroup of COPD cases with muscle wasting have emphysema. Airway wall thickness...

  8. Spontaneous subcutaneous emphysema of the scalp following hair coloring/treatment

    Directory of Open Access Journals (Sweden)

    Sanjit O. Tewari, MD

    2017-03-01

    Full Text Available Subcutaneous emphysema of the scalp is a process often attributed to secondary factors such as trauma, infection, or a myriad of iatrogenic etiologies. Here, we are presenting a case report of an adult patient with spontaneous subcutaneous emphysema of the scalp following a hair coloring/treatment. We performed an extensive review of literature on this topic, however, could not find a single case with similar presentation of subcutaneous emphysema. This case demonstrates an unreported etiology for this diagnosis and is thus being reported for its uniqueness and to raise clinical awareness.

  9. Exercise-Induced Asthma

    Science.gov (United States)

    ... Blood Institute. http://www.nhlbi.nih.gov/health-pro/resources/lung/naci/discover/action-plans.htm. Accessed Sept. 12, 2014. Mickleborough TD, et al. Exercise-induced asthma: Nutritional management. Current ...

  10. Reflexology and bronchial asthma

    DEFF Research Database (Denmark)

    Brygge, T; Heinig, J H; Collins, P

    2001-01-01

    Many asthma patients seek alternative or adjunctive therapies. One such modality is reflexology, whereby finger pressure is applied to certain parts of the body. The aim of the study was to examine the popular claim that reflexology treatment benefits bronchial asthma. Ten weeks of active...... or simulated (placebo) reflexology given by an experienced reflexologist, were compared in an otherwise blind, controlled trial of 20+20 outpatients with asthma. Objective lung function tests (peak flow morning and evening, and weekly spirometry at the clinic) did not change. Subjective scores (describing...... diaries was carried out. It was accompanied by a significant pattern compatible with subconscious unblinding, in that patients tended to guess which treatment they had been receiving. No evidence was found that reflexology has a specific effect on asthma beyond placebo influence....

  11. Asthma in elite athletes

    DEFF Research Database (Denmark)

    Elers, Jimmi; Pedersen, Lars; Backer, Vibeke

    2011-01-01

    Asthma is frequently found among elite athletes performing endurance sports such as swimming, rowing and cross-country skiing. Although these athletes often report symptoms while exercising, they seldom have symptoms at rest. Moreover, compared with nonathletic asthmatic individuals, elite athletes...... their physical capacity. Elite athletes should undergo comprehensive assessment to confirm an asthma diagnosis and determine its degree of severity. Treatment should be as for any other asthmatic individual, including the use of ß2-agonist, inhaled steroid as well as leukotriene-antagonist. It should, however......, be noted that daily use of ß-agonists could expose elite athletes to the risk of developing tolerance towards these drugs. Use of ß2-agonist should be replaced with daily inhaled corticosteroid treatment, the most important treatment of exercise-induced asthma. All physicians treating asthma should...

  12. Zoneterapi og asthma

    DEFF Research Database (Denmark)

    Brygge, Thor; Heinig, John Hilligsøe; Collins, Philippa

    2002-01-01

    INTRODUCTION: Many patients with asthma seek alternative or adjunctive therapies. One such modality is reflexology. Our aim was to examine the popular claim that reflexology treatment benefits bronchial asthma. MATERIAL AND METHODS: Ten weeks of either active or simulated (placebo) reflexology were...... compared in an otherwise blind, controlled trial of 40 patients with asthma. RESULTS: Objective lung function tests did not change. Subjective scores and bronchial sensitivity to histamine improved on both regimens, but no differences were found in the groups receiving active or placebo reflexology....... However, a trend in favour of reflexology became significant when a supplementary analysis of symptom diaries was carried out. At the same time a significant pattern compatible with subconscious un-blinding was found. DISCUSSION: We found no evidence that reflexology has a specific effect on asthma beyond...

  13. Asthma in elite athletes

    DEFF Research Database (Denmark)

    Elers, Jimmi; Pedersen, Lars; Backer, Vibeke

    2011-01-01

    Asthma is frequently found among elite athletes performing endurance sports such as swimming, rowing and cross-country skiing. Although these athletes often report symptoms while exercising, they seldom have symptoms at rest. Moreover, compared with nonathletic asthmatic individuals, elite athletes...... their physical capacity. Elite athletes should undergo comprehensive assessment to confirm an asthma diagnosis and determine its degree of severity. Treatment should be as for any other asthmatic individual, including the use of β2-agonist, inhaled steroid as well as leukotriene-antagonist. It should, however......, be noted that daily use of β-agonists could expose elite athletes to the risk of developing tolerance towards these drugs. Use of β2-agonist should be replaced with daily inhaled corticosteroid treatment, the most important treatment of exercise-induced asthma. All physicians treating asthma should...

  14. Vitamin D and asthma

    National Research Council Canada - National Science Library

    Brown, Sheena D; Calvert, H. Hardie; Fitzpatrick, Anne M

    2012-01-01

    .... Vitamin D is of particular interest in asthma since vitamin D concentrations decrease with increased time spent indoors, decreased exposure to sunlight, less exercise, obesity, and inadequate calcium intake...

  15. So You Have Asthma

    Science.gov (United States)

    ... get all the medicine into your lungs . The best way to learn to use these devices correctly is ... bed. • Take your asthma medicine right after you brush your teeth and keep it with your toothbrush as a ...

  16. Inflammation in Asthma

    African Journals Online (AJOL)

    Ashraf

    Systemic hypersensitivity diseases include, among others, asthma, rhinoconjunctivitis, otitis, rhinosinusitis ... hypersensitivity.13 As a medical specialty based on immunology, the allergy specialty (in some countries, called .... In certain countries (the United States, for instance), training in allergy encompasses both pediatrics.

  17. Pediatric asthma in a nutshell.

    Science.gov (United States)

    Link, Holger Werner

    2014-07-01

    On the basis of strong research evidence, asthma is a leading cause of emergency department visits and hospital admissions for children. On the basis of research evidence, implementation of asthma guidelines by medical professionals in not optimal. On the basis of research evidence, the Asthma Predictive Index supports a diagnosis of chronic asthma in children younger than 3 years. On the basis of strong research evidence, premedication with a short-acting β2-agonist is the preferred initial therapy for exercise-induced asthma. On the basis of strong research evidence, anti-inflammatory therapy with inhaled corticosteroids is an effective treatment for asthma. On the basis of research and consensus, assessment of impairment and risk followed by scheduled assessment for asthma control is recommended. On the basis of research and consensus, the establishment of a close cooperative relationship among medical professionals, patients with asthma, and their families is an important component of asthma management.

  18. Stress and asthma

    OpenAIRE

    Shoji Nagata; Masahiro Irie; Norio Mishima

    1999-01-01

    Three factors in recent medical research and treatment (advances in the field of psychoneuroimmunology, epidemiological evidence regarding important interaction between psychosocial factors and development of disease, and the recognition of the importance of patient education for self-management of asthma) have led clinicians and researchers to reconsider the role of psychosocial stress in asthma. There are many reports suggesting that stressful life events, family problems and a behavior pat...

  19. Update in asthma 2008

    National Research Council Canada - National Science Library

    Moore, Wendy C

    2009-01-01

    ... between obesity and asthma (8-10). Articles published in 2008 have advanced our understanding of the influence of genetics (11-18), factors in early life (19-21), and the environment (19, 22-24) on the development of asthma or the modification of disease severity. Basic pathobiologic studies in humans (25-35) and mice (36-46) have added to our underst...

  20. Genetics, atopy asthma

    OpenAIRE

    Cookson, William O. C. M.

    1996-01-01

    Asthma is a complex disease which is due to the interaction of an unknown number of genes with strong environmental factors. Segregation analysis suggests the presence of major genes underlying asthma and atopy. Different genetic effects have been recognized which predispose to generalized atopy, or modify the atopic response to particular allergens, or enhance bronchial inflammation, or modify bronchial tone. These known genes or genetic loci do not account for all of the familial clustering...

  1. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... to learn more about helping people with asthma live healthier lives by gaining control over their asthma. Quick Links ... to learn more about helping people with asthma live healthier lives by gaining control over their asthma. ...

  2. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Recent Asthma Data Most Recent Asthma State or Territory Data Previous Most Recent Asthma Data 2014 National Data Archive 2014 State or Territory Data Archive AsthmaStats Flu Vaccination among Adults with ...

  3. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... page: About CDC.gov . Asthma Learn How to Control Asthma Asthma and Severe Weather Brochures Facts Triggers Indoors In the Workplace Outdoors Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, ...

  4. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Recommend on Facebook Tweet Share Compartir You can control your asthma and avoid an attack by taking ... people with asthma live healthier lives by gaining control over their asthma. Quick Links Asthma Action Plan ...

  5. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Archive 2014 State or Territory Data Archive AsthmaStats Flu Vaccination among Adults with Current Asthma Flu Vaccination among Children with Current Asthma Asthma and Fair ...

  6. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Learn How to Control Asthma Asthma and Severe Weather Brochures Facts Triggers Indoors In the Workplace Outdoors ... CDC Publications on Asthma National Asthma Control Program America Breathing Easier Guide for State Programs Interventions Community ...

  7. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... 1 MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health Know How to Use Your ... 1 MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health File Formats Help: How do ...

  8. Asthma Control Essential in Pregnancy, Study Suggests

    Science.gov (United States)

    ... were born to mothers with active asthma during pregnancy. Those born to mothers who had mild controlled asthma were less likely to be diagnosed with asthma at an early age than those whose moms had mild uncontrolled asthma, ...

  9. Evolving Concepts of Asthma

    Science.gov (United States)

    Ray, Anuradha; Wenzel, Sally E.

    2015-01-01

    Our understanding of asthma has evolved over time from a singular disease to a complex of various phenotypes, with varied natural histories, physiologies, and responses to treatment. Early therapies treated most patients with asthma similarly, with bronchodilators and corticosteroids, but these therapies had varying degrees of success. Similarly, despite initial studies that identified an underlying type 2 inflammation in the airways of patients with asthma, biologic therapies targeted toward these type 2 pathways were unsuccessful in all patients. These observations led to increased interest in phenotyping asthma. Clinical approaches, both biased and later unbiased/statistical approaches to large asthma patient cohorts, identified a variety of patient characteristics, but they also consistently identified the importance of age of onset of disease and the presence of eosinophils in determining clinically relevant phenotypes. These paralleled molecular approaches to phenotyping that developed an understanding that not all patients share a type 2 inflammatory pattern. Using biomarkers to select patients with type 2 inflammation, repeated trials of biologics directed toward type 2 cytokine pathways saw newfound success, confirming the importance of phenotyping in asthma. Further research is needed to clarify additional clinical and molecular phenotypes, validate predictive biomarkers, and identify new areas for possible interventions. PMID:26161792

  10. Asthma is Different in Women

    Science.gov (United States)

    Erzurum, Serpil C.

    2015-01-01

    Gender differences in asthma incidence, prevalence and severity have been reported worldwide. After puberty, asthma becomes more prevalent and severe in women, and is highest in women with early menarche or with multiple gestations, suggesting a role for sex hormones in asthma genesis. However, the impact of sex hormones on the pathophysiology of asthma is confounded by and difficult to differentiate from age, obesity, atopy, and other gender associated environmental exposures. There are also gender discrepancies in the perception of asthma symptoms. Understanding gender differences in asthma is important to provide effective education and personalized management plans for asthmatics across the lifecourse. PMID:26141573

  11. Childhood asthma and physical activity

    DEFF Research Database (Denmark)

    Lochte, Lene; Nielsen, Kim G; Petersen, Poul Erik

    2016-01-01

    BACKGROUND: Childhood asthma is a global problem affecting the respiratory health of children. Physical activity (PA) plays a role in the relationship between asthma and respiratory health. We hypothesized that a low level of PA would be associated with asthma in children and adolescents. The obj......BACKGROUND: Childhood asthma is a global problem affecting the respiratory health of children. Physical activity (PA) plays a role in the relationship between asthma and respiratory health. We hypothesized that a low level of PA would be associated with asthma in children and adolescents...

  12. Clinical Impact of Emphysema Evaluated by High-Resolution Computed Tomography on Idiopathic Pulmonary Fibrosis Diagnosed by Surgical Lung Biopsy.

    Science.gov (United States)

    Kohashi, Yasuo; Arai, Toru; Sugimoto, Chikatoshi; Tachibana, Kazunobu; Akira, Masanori; Kitaichi, Masanori; Hayashi, Seiji; Inoue, Yoshikazu

    2016-01-01

    The prognosis of combined cases of pulmonary fibrosis and emphysema is unresolved partially because radiological differentiation between usual interstitial pneumonia and nonspecific interstitial pneumonia is difficult in coexisting emphysema cases. The purpose of this study was to clarify the clinical impact of emphysema on the survival of patients with idiopathic pulmonary fibrosis (IPF). One hundred and seven patients with interstitial lung diseases were diagnosed by surgical lung biopsies between 2006 and 2012, and 47 patients were diagnosed with IPF through multidisciplinary discussion. Emphysema on high-resolution computed tomography scans was evaluated semiquantitatively by visual scoring. Eight out of the 47 IPF patients showed a higher emphysema score (>3) and were diagnosed to have IPF-emphysema. The median survival time of patients with IPF-emphysema (1,734 days) from the initial diagnosis was significantly shorter than that of patients with IPF alone (2,229 days) by Kaplan-Meier analysis (p = 0.007, log-rank test). Univariate Cox proportional hazard regression analyses revealed that a higher total emphysema score (>3.0) was a significantly poor prognostic factor in addition to Krebs von den Lungen-6, surfactant protein-D, arterial oxygen tension, percent forced vital capacity, and percent diffusing capacity of carbon monoxide (%DLCO). Multivariate Cox proportional hazard regression analyses with the stepwise method showed that higher total emphysema score (>3) and %DLCO were significantly poor prognostic factors. The prognosis of IPF-emphysema was significantly worse than that of IPF alone. © 2016 S. Karger AG, Basel.

  13. Physical training for asthma.

    Science.gov (United States)

    Pereira, Mônica Corso

    2014-01-01

    People with asthma may show less tolerance to exercise due to worsening asthma symptoms during exercise or other reasons such as deconditioning as a consequence of inactivity. Some may restrict activities as per medical advice or family influence and this might result in reduced physical fitness. Physical training programs aim to improve physical fitness, neuromuscular coordination and self confidence. Subjectively, many people with asthma report that they are symptomatically better when fit, but results from trials have varied and have been difficult to compare because of different designs and training protocols. Also, as exercise can induce asthma, the safety of exercise programmes needs to be considered. To gain a better understanding of the effect of physical training on the respiratory and general health of people with asthma, from randomised trials. We searched the Cochrane Airways Group Specialised Register of trials up to January 2013. We included randomised trials of people over eight years of age with asthma who were randomised to undertake physical training or not. Physical training had to be undertaken for at least 20 minutes, two times a week, over a minimum period of four weeks. Two review authors independently assessed eligibility for inclusion and undertook risk of bias assessment for the included studies. Twenty-one studies (772 participants) were included in this review with two additional 2012 studies identified as 'awaiting classification'. Physical training was well tolerated with no adverse effects reported. None of the studies mentioned worsening of asthma symptoms following physical training. Physical training showed marked improvement in cardiopulmonary fitness as measured by a statistically and clinically significant increase in maximum oxygen uptake (mean difference (MD) 4.92 mL/kg/min; 95% confidence interval (CI) 3.98 to 5.87; P physical training may have positive effects on health-related quality of life, with four of five studies

  14. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Breathing Easier [PDF – 1.1 MB] ASL Asthma Film Asthma Clinical Guidelines Asthma & Community Health Know How ... Breathing Easier [PDF – 1.1 MB] ASL Asthma Film Asthma Clinical Guidelines Asthma & Community Health File Formats ...

  15. Towards local progression estimation of pulmonary emphysema using CT

    Energy Technology Data Exchange (ETDEWEB)

    Staring, M., E-mail: m.staring@lumc.nl; Bakker, M. E.; Shamonin, D. P.; Reiber, J. H. C.; Stoel, B. C. [Department of Radiology, Division of Image Processing, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden (Netherlands); Stolk, J. [Department of Pulmonology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden (Netherlands)

    2014-02-15

    Purpose: Whole lung densitometry on chest CT images is an accepted method for measuring tissue destruction in patients with pulmonary emphysema in clinical trials. Progression measurement is required for evaluation of change in health condition and the effect of drug treatment. Information about the location of emphysema progression within the lung may be important for the correct interpretation of drug efficacy, or for determining a treatment plan. The purpose of this study is therefore to develop and validate methods that enable the local measurement of lung density changes, which requires proper modeling of the effect of respiration on density. Methods: Four methods, all based on registration of baseline and follow-up chest CT scans, are compared. The first naïve method subtracts registered images. The second employs the so-called dry sponge model, where volume correction is performed using the determinant of the Jacobian of the transformation. The third and the fourth introduce a novel adaptation of the dry sponge model that circumvents its constant-mass assumption, which is shown to be invalid. The latter two methods require a third CT scan at a different inspiration level to estimate the patient-specific density-volume slope, where one method employs a global and the other a local slope. The methods were validated on CT scans of a phantom mimicking the lung, where mass and volume could be controlled. In addition, validation was performed on data of 21 patients with pulmonary emphysema. Results: The image registration method was optimized leaving a registration error below half the slice increment (median 1.0 mm). The phantom study showed that the locally adapted slope model most accurately measured local progression. The systematic error in estimating progression, as measured on the phantom data, was below 2 gr/l for a 70 ml (6%) volume difference, and 5 gr/l for a 210 ml (19%) difference, if volume correction was applied. On the patient data an underlying

  16. [What place for lung volume reduction surgery for emphysema?

    Science.gov (United States)

    De Wolf, J; Bonnette, P; Sage, É; Hamid, A

    2017-02-01

    Lung volume reduction surgery (LVRS) has been part of the management for the treatment of selected emphysematous patients for two decades. In a large randomized American trial (NETT), lung volume reduction surgery was shown to improve overall survival at 5 years as well as exercise capacity and health-related quality of life, especially in cases of upper-lobe-predominant emphysema and low exercise capacity. Inclusion criteria were pretreatment FEV1≤45 %, TLC≥100 %, RV≥150 %, room air resting PaCO2≤60mmHg and PaO2≥45mmHg. Patients with FEV1≤20 % and either a DLCOlung volume reduction surgery is performed infrequently, competing with lung transplantation and new endoscopic volume reduction techniques. Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  17. COPD, emphysema and the onset of lung cancer. A systematic review.

    Science.gov (United States)

    Mouronte-Roibás, Cecilia; Leiro-Fernández, Virginia; Fernández-Villar, Alberto; Botana-Rial, Maribel; Ramos-Hernández, Cristina; Ruano-Ravina, Alberto

    2016-11-28

    Chronic Obstructive Pulmonary Disease (COPD) and emphysema have been described as possible risk factors for lung cancer. We aim to assess the relationship between COPD, emphysema and the onset of lung cancer. We have developed a systematic review of the published literature in order to systematically analyze the scientific evidence available on this association, applying predefined inclusion and exclusion criteria. 11 Studies were included. Both COPD and emphysema seem to increase the risk of developing lung cancer, being this risk higher for smokers with heavier tobacco consumption. These results emphasize the need for physicians to perform spirometries in current and former smokers and lung image tests when needed in order to identify COPD and emphysema and thus select patients at higher risk of developing lung cancer. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Iatrogenic Lower Extremity Subcutaneous Emphysema after Prolonged Robotic-Assisted Hysterectomy

    Directory of Open Access Journals (Sweden)

    Monica Hagan Vetter

    2015-01-01

    Full Text Available Subcutaneous emphysema is a known complication of carbon dioxide insufflation, an essential component of laparoscopy. The literature contains reports of hypercarbia, pneumothorax, or pneumomediastinum. However, isolated lower extremity subcutaneous emphysema remains a seldom-reported complication. We report a case of unilateral lower extremity subcutaneous emphysema following robotic-assisted hysterectomy, bilateral salpingooophorectomy, staging, and anterior/posterior colporrhaphy for carcinosarcoma and vaginal prolapse. On postoperative day 1, the patient developed tender crepitus and bruising of her right ankle. Radiography confirmed presence of subcutaneous air. Vital signs and laboratory findings were unremarkable. Her symptoms spontaneously improved over time, and she was discharged in good condition on day 2. In stable patients with postoperative extremity swelling or pain with crepitus on exam, the diagnosis of iatrogenic subcutaneous emphysema must be considered.

  19. Advanced anorexia nervosa, associated with pneumomediastinum, pneumothorax, and soft-tissue emphysema without esophageal lesion.

    Science.gov (United States)

    Danzer, Gerhard; Mulzer, Johanna; Weber, Gerrit; Lembke, Alexander; Kocalevent, Rüya; Klapp, Burghard F

    2005-11-01

    We describe the case of a 20-year-old female patient suffering from anorexia nervosa since the age 15 of years. When admitted, she was 168 cm tall with a weight of 35 kg (body mass index [BMI] = 12.4). A week after admission, the patient complained of retrosternal pain, and a few hours later she developed extensive soft-tissue emphysema. The X-ray picture of her thorax showed left-hand supraclavicular and infraclavicular emphysema, extensive emphysema in both sides of the soft tissue of the throat, a left-hand apical pneumothorax (4 mm), and a pneumomediastinum. We discuss the extent to which these symptoms are interrelated in the sense of a causal nexus. We ruled out any other differential-diagnostic etiopathogenic factors and concluded that the cause of our patient's soft-tissue emphysema, pneumothorax, and pneumomediastinum might well be autodestructive behavior.

  20. Quantitative CT: Associations between Emphysema, Airway Wall Thickness and Body Composition in COPD

    DEFF Research Database (Denmark)

    Rutten, Erica P A; Grydeland, Thomas B; Pillai, Sreekumar G

    2011-01-01

    The objective of the present study was to determine the association between CT phenotypes-emphysema by low attenuation area and bronchitis by airway wall thickness-and body composition parameters in a large cohort of subjects with and without COPD. In 452 COPD subjects and 459 subjects without COPD......, CT scans were performed to determine emphysema (%LAA), airway wall thickness (AWT-Pi10), and lung mass. Muscle wasting based on FFMI was assessed by bioelectrical impedance. In both the men and women with COPD, FFMI was negatively associated with %LAA. FMI was positively associated with AWT-Pi10...... in both subjects with and without COPD. Among the subjects with muscle wasting, the percentage emphysema was high, but the predictive value was moderate. In conclusion, the present study strengthens the hypothesis that the subgroup of COPD cases with muscle wasting have emphysema. Airway wall thickness...

  1. Variation compensation and analysis on diaphragm curvature analysis for emphysema quantification on whole lung CT scans

    Science.gov (United States)

    Keller, Brad M.; Reeves, Anthony P.; Barr, R. Graham; Yankelevitz, David F.; Henschke, Claudia I.

    2010-03-01

    CT scans allow for the quantitative evaluation of the anatomical bases of emphysema. Recently, a non-density based geometric measurement of lung diagphragm curvature has been proposed as a method for the quantification of emphysema from CT. This work analyzes variability of diaphragm curvature and evaluates the effectiveness of a compensation methodology for the reduction of this variability as compared to emphysema index. Using a dataset of 43 scan-pairs with less than a 100 day time-interval between scans, we find that the diaphragm curvature had a trend towards lower overall variability over emphysema index (95% CI:-9.7 to + 14.7 vs. -15.8 to +12.0), and that the variation of both measures was reduced after compensation. We conclude that the variation of the new measure can be considered comparable to the established measure and the compensation can reduce the apparent variation of quantitative measures successfully.

  2. Subcutaneous emphysema of the upper extremity following penetrating blackthorn injury to the wrist.

    LENUS (Irish Health Repository)

    Tiong, W H C

    2009-02-01

    SUMMARY: Noninfective subcutaneous emphysema of the upper extremity, albeit rare, has to be borne in mind when treating patients with subcutaneous emphysema. The misdiagnosis of this condition as its serious infective counterpart often leads to unnecessary aggressive treatment. Noninfective subcutaneous emphysema often accompanies a patient who has no systemic symptoms of illness. Unfortunately, the distinction is not always easy especially when history of injury suggests involvement of an infective or reactive element. Penetrating blackthorn injury is common, especially in rural communities, and often occurs from farming or gardening activities. Blackthorn penetration can cause numerous tissue reactions once embedded under the skin and they are often contaminated with soil. Here we present, for the first time, a case where penetrating blackthorn injury to the wrist resulted in noninfective subcutaneous emphysema involving the whole upper limb and neck, and its subsequent management.

  3. Quantifying emphysema extent from weakly labeled CT scans of the lungs using label proportions learning

    DEFF Research Database (Denmark)

    Ørting, Silas Nyboe; Petersen, Jens; Wille, Mathilde

    2016-01-01

    Quantification of emphysema extent is important in diagnosing and monitoring patients with chronic obstructive pulmonary disease (COPD). Several studies have shown that emphysema quantification by supervised texture classification is more robust and accurate than traditional densitometry. Current...... techniques require highly time consuming manual annotations of patches or use only weak labels indicating overall disease status (e.g, COPD or healthy). We show how visual scoring of regional emphysema extent can be exploited in a learning with label proportions (LLP) framework to both predict presence...... of emphysema in smaller patches and estimate regional extent. We evaluate performance on 195 visually scored CT scans and achieve an intraclass correlation of 0.72 (0.65–0.78) between predicted region extent and expert raters. To our knowledge this is the first time that LLP methods have been applied...

  4. Effectiveness and efficacy of minimally invasive lung volume reduction surgery for emphysema

    Directory of Open Access Journals (Sweden)

    Pertl, Daniela

    2014-10-01

    Full Text Available [english] Lung emphysema is a chronic, progressive and irreversible destruction of the lung tissue. Besides non-medical therapies and the well established medical treatment there are surgical and minimally invasive methods for lung volume reduction (LVR to treat severe emphysema. This report deals with the effectiveness and cost-effectiveness of minimally invasive methods compared to other treatments for LVR in patients with lung emphysema. Furthermore, legal and ethical aspects are discussed. No clear benefit of minimally invasive methods compared to surgical methods can be demonstrated based on the identified and included evidence. In order to assess the different methods for LVR regarding their relative effectiveness and safety in patients with lung emphysema direct comparative studies are necessary.

  5. [Pediatric orbital emphysema caused by a compressed-air pistol shot: a case report].

    Science.gov (United States)

    Navarro-Mingorance, A; Reyes-Dominguez, S B; León-León, M C

    2014-09-01

    We report the case of a 2 year-old child with orbital emphysema secondary to a compressed-air gun shot in the malar region, with no evidence of orbital wall fracture. Conservative treatment was applied, and no complications were observed. Orbital emphysema in the absence of an orbital wall fracture is a rare situation. Orbital emphysema is usually seen in facial trauma associated with damage to the adjacent paranasal sinuses or facial bones. To our knowledge there have been very few reports of orbital emphysema caused by a compressed-air injury. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  6. Normalizing computed tomography data reconstructed with different filter kernels: effect on emphysema quantification

    NARCIS (Netherlands)

    Gallardo Estrella, L.; Lynch, D.A.; Prokop, M.; Stinson, D.; Zach, J.; Judy, P.F.; Ginneken, B. van; Rikxoort, E.M. van

    2016-01-01

    OBJECTIVES: To propose and evaluate a method to reduce variability in emphysema quantification among different computed tomography (CT) reconstructions by normalizing CT data reconstructed with varying kernels. METHODS: We included 369 subjects from the COPDGene study. For each subject, spirometry

  7. Volume adjustment of lung density by computed tomography scans in patients with emphysema

    DEFF Research Database (Denmark)

    Shaker, S B; Dirksen, A; Laursen, Lars Christian

    2004-01-01

    PURPOSE: To determine how to adjust lung density measurements for the volume of the lung calculated from computed tomography (CT) scans in patients with emphysema. MATERIAL AND METHODS: Fifty patients with emphysema underwent 3 CT scans at 2-week intervals. The scans were analyzed with a software...... package that detected the lung in contiguous images and subsequently generated a histogram of the pixel attenuation values. The total lung volume (TLV), lung weight, percentile density (PD), and relative area of emphysema (RA) were calculated from this histogram. RA and PD are commonly applied measures...... of pulmonary emphysema derived from CT scans. These parameters are markedly influenced by changes in the level of inspiration. The variability of lung density due to within-subject variation in TLV was explored by plotting TLV against PD and RA. RESULTS: The coefficients for volume adjustment for PD were...

  8. [Prediction of the efficiency of endoscopic lung volume reduction by valves in severe emphysema].

    Science.gov (United States)

    Bocquillon, V; Briault, A; Reymond, E; Arbib, F; Jankowski, A; Ferretti, G; Pison, C

    2016-11-01

    In severe emphysema, endoscopic lung volume reduction with valves is an alternative to surgery with less morbidity and mortality. In 2015, selection of patients who will respond to this technique is based on emphysema heterogeneity, a complete fissure visible on the CT-scan and absence of collateral ventilation between lobes. Our case report highlights that individualized prediction is possible. A 58-year-old woman had severe, disabling pulmonary emphysema. A high resolution thoracic computed tomography scan showed that the emphysema was heterogeneous, predominantly in the upper lobes, integrity of the left greater fissure and no collateral ventilation with the left lower lobe. A valve was inserted in the left upper lobe bronchus. At one year, clinical and functional benefits were significant with complete atelectasis of the treated lobe. The success of endoscopic lung volume reduction with a valve can be predicted, an example of personalized medicine. Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  9. Environmental pollution and asthma.

    Science.gov (United States)

    Di Giampaolo, L; Quecchia, C; Schiavone, C; Cavallucci, E; Renzetti, A; Braga, M; Di Gioacchino, M

    2011-01-01

    Clinical evidences and epidemiological studies show that allergic pathologies of the respiratory tract are increasing in the world areas with high pollution impact, demonstrating how many polluting substances favor both allergic sensitization and the bronchial inflammatory changes characteristic of asthma. It has been shown that asthma, as many other diseases, is a complex interaction between genetic predisposition and environmental stimuli that results in clinical expression of various phenotypes of asthma: allergic, intrinsic etc. Many pollutants have such a potential. Diesel exhaust particles (DEP) can favor allergic sensitization, induce acute asthma attacks and increase bronchial reactivity, acting both on allergen, on bronchial mucosa and on immune cells. In fact, DEP can favor B lymphocytes to shift to a production of IgE and T cells to produce Th2 cytokines. Asthma can be also induced by high exposure to many other substances as NO2 and first of all ozone (O3): strong oxidizing substance that is synthesized, in absence of ventilation, by photochemical reaction due to the combination of ultraviolet sun radiation on exhaust gases as NO2 and hydrocarbons. Ozone is abundant in cities with minimal concentration in the morning gradually increasing during the day until maximal levels in the afternoon and then decreasing during the night. Epidemiological studies show that the number of access to hospital for acute asthma and even the use of bronchodilator by asthmatics increase during the high level periods when Ozone constitute almost 90 percent of the total oxidants in the environment. Particulate matter of very small diameter have a crucial role in favoring asthma attacks, and smaller the substance deeper the penetration in the bronchial tree, with an inflammatory reaction in the peripheral bronchial mucosa characterized by increased vessel permeability, mucosal edema, inflammatory mediator production by damaged epithelium and inflammatory cells that determines

  10. Role of conventional chest radiography in diagnosis and exclusion of emphysema.

    Science.gov (United States)

    Pratt, P C

    1987-05-01

    Although recognizing that the subject is controversial, most authors of textbooks about diagnostic radiology conclude that chest radiography is of little value for either confirmation or exclusion of the diagnosis of emphysema. Yet several reports in the literature show a high degree of accuracy in the interpretation of films for presence of this disease. Some of the controversy results from continuing confusion over the current definition of emphysema in terms of lung structure rather than symptoms or physiologic evidence relating to impaired ventilation. Many autopsy studies have shown that emphysema is often present at postmortem examination and can involve as much as 30 percent of the lung tissue, even in subjects with no respiratory symptoms or impairment during life. Since radiographs deal with structure rather than function, interpreters of chest films should have the intention to recognize the presence of structural emphysema. The correct recognition of emphysema is useful even in a patient without symptoms, and the ability to exclude this diagnosis in symptomatic patients is of equal, if not greater value. The degree of success reported in various studies depends upon the criteria used and the strictness applied by the authors in matching their interpretations to the presence or absence of structural emphysema. This review of existing literature deals solely with papers in which radiographic observations have been related to morphologic evidence of emphysema in inflation-fixed autopsy lung specimens. It identifies reasons for discrepancies among reports and emphasizes the very high predictive value of validated radiographic criteria. Applications of radiographic interpretation both for diagnosis and for exclusion of emphysema in clinical situations are described.

  11. Texture-based segmentation and analysis of emphysema depicted on CT images

    Science.gov (United States)

    Tan, Jun; Zheng, Bin; Wang, Xingwei; Lederman, Dror; Pu, Jiantao; Sciurba, Frank C.; Gur, David; Leader, J. Ken

    2011-03-01

    In this study we present a texture-based method of emphysema segmentation depicted on CT examination consisting of two steps. Step 1, a fractal dimension based texture feature extraction is used to initially detect base regions of emphysema. A threshold is applied to the texture result image to obtain initial base regions. Step 2, the base regions are evaluated pixel-by-pixel using a method that considers the variance change incurred by adding a pixel to the base in an effort to refine the boundary of the base regions. Visual inspection revealed a reasonable segmentation of the emphysema regions. There was a strong correlation between lung function (FEV1%, FEV1/FVC, and DLCO%) and fraction of emphysema computed using the texture based method, which were -0.433, -.629, and -0.527, respectively. The texture-based method produced more homogeneous emphysematous regions compared to simple thresholding, especially for large bulla, which can appear as speckled regions in the threshold approach. In the texture-based method, single isolated pixels may be considered as emphysema only if neighboring pixels meet certain criteria, which support the idea that single isolated pixels may not be sufficient evidence that emphysema is present. One of the strength of our complex texture-based approach to emphysema segmentation is that it goes beyond existing approaches that typically extract a single or groups texture features and individually analyze the features. We focus on first identifying potential regions of emphysema and then refining the boundary of the detected regions based on texture patterns.

  12. It Suddenly Occurred: Extensive Subcutaneous Emphysema after Bipolar Transurethral Resection of Prostate

    Directory of Open Access Journals (Sweden)

    Murat Bagcioglu

    2015-01-01

    Full Text Available Subcutaneous emphysema is a very rare and good-natured complication after transurethral resection of prostate (TURP. It has been reported as colon perforation, diverticulitis, and bladder perforation associated complication previously. We report the first case of a wide subcutaneous emphysema due to microperforations of prostatic capsule, without a bladder perforation after TURP. Any sign of clinic situation should lead to ceasing of the procedure immediately; otherwise, it can cause a life-threatening problem of abdominal compartment syndrome.

  13. Hepatic emphysema associated with ultrasound-guided liver biopsy in a dog

    OpenAIRE

    Westgren, Frida; Hjorth, Tove; Uhlhorn, Margareta; Etterlin, Pernille E; Ley, Charles J.

    2014-01-01

    An eleven-year-old Chinese Crested Powder Puff dog presented with polydipsia/polyuria, inappetence, diarrhea and vomiting underwent an ultrasound-guided percutaneous liver biopsy. Two days post-biopsy the clinical condition of the dog acutely deteriorated with fever, dyspnea, ataxia and subcutaneous emphysema. Radiographs and ultrasound showed focal severe hepatic emphysema in the region of the previous liver biopsy. Post-mortem examination revealed chronic hepatitis with dissecting fibrosis,...

  14. Quantitative CT measures of emphysema and airway wall thickness are related to D(L)CO

    DEFF Research Database (Denmark)

    Grydeland, Thomas B; Thorsen, Einar; Dirksen, Asger

    2011-01-01

    There is limited knowledge on the relationship between diffusing capacity of the lung for carbon monoxide (D(L)CO) and quantitative computed tomography (CT) measures of emphysema and airway wall thickness.......There is limited knowledge on the relationship between diffusing capacity of the lung for carbon monoxide (D(L)CO) and quantitative computed tomography (CT) measures of emphysema and airway wall thickness....

  15. Lung volume reduction surgery for emphysema: What the radiologist needs to know

    Energy Technology Data Exchange (ETDEWEB)

    Screaton, N.J. [Department of Radiology, Papworth Hospital, Papworth Everard, Cambridge (United Kingdom)]. E-mail: nicholas.screaton@papworth.nhs.uk; Reynolds, J.H. [Department of Radiology, Birmingham Heartlands and Solihull NHS Trust, Bordesley Green East, Birmingham (United Kingdom)

    2006-03-15

    Imaging plays a pivotal role in the selection of patients for the surgical treatment of emphysema. In this article, the imaging features of emphysema are reviewed along with the surgical options for treatment. Particular emphasis is given to lung volume reduction surgery as this technique has gained wide acceptance within the thoracic surgical community in recent years. Radiologists need to have an understanding of which patients may be potentially suitable for this technique.

  16. CRTC1 Function During Memory Encoding Is Disrupted in Neurodegeneration.

    Science.gov (United States)

    Parra-Damas, Arnaldo; Chen, Meng; Enriquez-Barreto, Lilian; Ortega, Laura; Acosta, Sara; Perna, Judith Camats; Fullana, M Neus; Aguilera, José; Rodríguez-Alvarez, José; Saura, Carlos A

    2017-01-15

    Associative memory impairment is an early clinical feature of dementia patients, but the molecular and cellular mechanisms underlying these deficits are largely unknown. In this study, we investigated the functional regulation of the cyclic adenosine monophosphate response element binding protein (CREB)-regulated transcription coactivator 1 (CRTC1) by associative learning in physiological and neurodegenerative conditions. We evaluated the activation of CRTC1 in the hippocampus of control mice and mice lacking the Alzheimer's disease-linked presenilin genes (presenilin conditional double knockout [PS cDKO]) after one-trial contextual fear conditioning by using biochemical, immunohistochemical, and gene expression analyses. PS cDKO mice display classical features of neurodegeneration occurring in Alzheimer's disease including age-dependent cortical atrophy, neuron loss, dendritic degeneration, and memory deficits. Context-associative learning, but not single context or unconditioned stimuli, induces rapid dephosphorylation (Ser151) and translocation of CRTC1 from the cytosol/dendrites to the nucleus of hippocampal neurons in the mouse brain. Accordingly, context-associative learning induces differential CRTC1-dependent transcription of c-fos and the nuclear receptor subfamily 4 (Nr4a) genes Nr4a1-3 in the hippocampus through a mechanism that involves CRTC1 recruitment to CRE promoters. Deregulation of CRTC1 dephosphorylation, nuclear translocation, and transcriptional function are associated with long-term contextual memory deficits in PS cDKO mice. Importantly, CRTC1 gene therapy in the hippocampus ameliorates context memory and transcriptional deficits and dendritic degeneration despite ongoing cortical degeneration in this neurodegeneration mouse model. These findings reveal a critical role of CRTC1 in the hippocampus during associative memory, and provide evidence that CRTC1 deregulation underlies memory deficits during neurodegeneration. Copyright © 2016

  17. Innate lymphoid cells and asthma.

    Science.gov (United States)

    Yu, Sanhong; Kim, Hye Young; Chang, Ya-Jen; DeKruyff, Rosemarie H; Umetsu, Dale T

    2014-04-01

    Asthma is a complex and heterogeneous disease with several phenotypes, including an allergic asthma phenotype characterized by TH2 cytokine production and associated with allergen sensitization and adaptive immunity. Asthma also includes nonallergic asthma phenotypes, such as asthma associated with exposure to air pollution, infection, or obesity, that require innate rather than adaptive immunity. These innate pathways that lead to asthma involve macrophages, neutrophils, natural killer T cells, and innate lymphoid cells, newly described cell types that produce a variety of cytokines, including IL-5 and IL-13. We review the recent data regarding innate lymphoid cells and their role in asthma. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  18. Asthma-COPD overlap syndrome

    National Research Council Canada - National Science Library

    Şen, Elif; Oğuzülgen, Kıvılcım; Bavbek, Sevim; Günen, Hakan; Kıyan, Esen; Türktaş, Haluk; Yorgancıoğlu, Arzu; Polatlı, Mehmet; Yıldız, Füsun; Çelik, Gülfem; Demir, Tunçalp; Gemicioğlu, Bilun; Mungan, Dilşad; Saryal, Sevgi; Sayıner, Abdullah; Yıldırım, Nurhayat

    2015-01-01

    .... Among patient with COPD and asthma; there is a group of patients with an overlap between clinical, functional characteristics and airway inflammation patterns, named "Asthma-COPD Overlap Syndrome" (ACOS...

  19. Psychopathology in difficult asthma : Review

    NARCIS (Netherlands)

    Prins, L.C.J.; van Son, M.A.C.; van Keimpema, A.R.J.; van Ranst, D.; Antonissen-Pommer, A.M.; Meijer, J.W.G.; Pop, V.J.M.

    2015-01-01

    Objective: Within the asthma population, difficult asthma (DA) is a severe condition in which patients present with frequent exacerbations, hospitalizations and emergency room visits. The identification and treatment of psychopathology is included in the management of DA. Psychopathology is supposed

  20. Allergy and Asthma Health Magazine

    Science.gov (United States)

    ... Of Age Older Adults Allergy and Asthma Health Magazine Women Infant, Children and Teenagers Living With Lung ... written by Respiratory Experts Like no other health magazine, Allergy & Asthma Health Magazine is published by people ...

  1. Chromosome 13 dementia syndromes as models of neurodegeneration

    DEFF Research Database (Denmark)

    Ghiso, J.; Revesz, T.; Holton, J.

    2001-01-01

    Two hereditary conditions, familial British dementia (FBD) and familial Danish dementia (FDD), are associated with amyloid deposition in the central nervous system and neurodegeneration. The two amyloid proteins, ABri and ADan, are degradation products of the same precursor molecule BriPP bearing....... These issues argue for the primary importance of the amyloid deposits in the mechanism(s) of neuronal cell loss. We propose FBD and FDD, the chromosome 13 dementia syndromes, as models to study the molecular basis of neurofibrillary degeneration, cell death and amyloid formation in the brain....

  2. Calcium Dobesilate Prevents Neurodegeneration and Vascular Leakage in Experimental Diabetes.

    Science.gov (United States)

    Solà-Adell, Cristina; Bogdanov, Patricia; Hernández, Cristina; Sampedro, Joel; Valeri, Marta; Garcia-Ramirez, Marta; Pasquali, Christian; Simó, Rafael

    2017-09-01

    The mechanisms involved in the reported beneficial effects of Calcium dobesilate monohydrate (CaD) for the treatment of diabetic retinopathy (DR) remain to be elucidated. The main aim of the present study is to examine whether CaD prevents early events in the pathogenesis of DR such as neurodegeneration and vascular leakage. In addition, putative mediators of both neurodegeneration (glutamate/GLAST, ET-1/ETB receptor) and early microvascular impairment (ET-1/ETA receptor, oxidative stress, VEGF, and the PKC-delta-p38 MAPK pathway) have been examined. Diabetic (db/db) mice were randomly assigned to daily oral treatment with CaD (200 mg/Kg/day) (n = 12) or vehicle (n = 12) for 14 days. In addition, 12 non-diabetic (db/+) mice matched by age were used as the control group. Functional abnormalities were assessed by electroretinography. Neurodegeneration and microvascular abnormalities were evaluated by immunohistochemistry and Western blot. Glutamate was determined by HPLC. CaD significantly decreased glial activation and apoptosis and produced a significant improvement in the electroretinogram parameters. Mechanistically, CaD prevented the diabetes-induced up-regulation of ET-1 and its cognate receptors (ETA-R and ETB-R), which are involved in microvascular impairment and neurodegeneration, respectively. In addition, treatment with CaD downregulated GLAST, the main glutamate transporter, and accordingly prevented the increase in glutamate. Finally, CaD prevented oxidative stress, and the upregulation of VEGF and PKC delta-p38 MAPK pathway induced by diabetes, thus resulting in a significant reduction in vascular leakage. Our findings demonstrate for the first time that CaD exerts neuroprotection in an experimental model of DR. In addition, we provide first evidence that CaD prevents the overexpression of ET-1 and its receptors in the diabetic retina. These beneficial effects on the neurovascular unit could pave the way for clinical trials addressed to confirm the

  3. Huntingtin interacting proteins are genetic modifiers of neurodegeneration.

    Directory of Open Access Journals (Sweden)

    Linda S Kaltenbach

    2007-05-01

    Full Text Available Huntington's disease (HD is a fatal neurodegenerative condition caused by expansion of the polyglutamine tract in the huntingtin (Htt protein. Neuronal toxicity in HD is thought to be, at least in part, a consequence of protein interactions involving mutant Htt. We therefore hypothesized that genetic modifiers of HD neurodegeneration should be enriched among Htt protein interactors. To test this idea, we identified a comprehensive set of Htt interactors using two complementary approaches: high-throughput yeast two-hybrid screening and affinity pull down followed by mass spectrometry. This effort led to the identification of 234 high-confidence Htt-associated proteins, 104 of which were found with the yeast method and 130 with the pull downs. We then tested an arbitrary set of 60 genes encoding interacting proteins for their ability to behave as genetic modifiers of neurodegeneration in a Drosophila model of HD. This high-content validation assay showed that 27 of 60 orthologs tested were high-confidence genetic modifiers, as modification was observed with more than one allele. The 45% hit rate for genetic modifiers seen among the interactors is an order of magnitude higher than the 1%-4% typically observed in unbiased genetic screens. Genetic modifiers were similarly represented among proteins discovered using yeast two-hybrid and pull-down/mass spectrometry methods, supporting the notion that these complementary technologies are equally useful in identifying biologically relevant proteins. Interacting proteins confirmed as modifiers of the neurodegeneration phenotype represent a diverse array of biological functions, including synaptic transmission, cytoskeletal organization, signal transduction, and transcription. Among the modifiers were 17 loss-of-function suppressors of neurodegeneration, which can be considered potential targets for therapeutic intervention. Finally, we show that seven interacting proteins from among 11 tested were able to

  4. Metabolomics screening identifies reduced L-carnitine to be associated with progressive emphysema.

    Science.gov (United States)

    Conlon, Thomas M; Bartel, Jörg; Ballweg, Korbinian; Günter, Stefanie; Prehn, Cornelia; Krumsiek, Jan; Meiners, Silke; Theis, Fabian J; Adamski, Jerzy; Eickelberg, Oliver; Yildirim, Ali Önder

    2016-02-01

    Chronic obstructive pulmonary disease (COPD) is characterized by chronic bronchitis, small airway remodelling and emphysema. Emphysema is the destruction of alveolar structures, leading to enlarged airspaces and reduced surface area impairing the ability for gaseous exchange. To further understand the pathological mechanisms underlying progressive emphysema, we used MS-based approaches to quantify the lung, bronchoalveolar lavage fluid (BALF) and serum metabolome during emphysema progression in the established murine porcine pancreatic elastase (PPE) model on days 28, 56 and 161, compared with PBS controls. Partial least squares (PLS) analysis revealed greater changes in the metabolome of lung followed by BALF rather than serum during emphysema progression. Furthermore, we demonstrate for the first time that emphysema progression is associated with a reduction in lung-specific L-carnitine, a metabolite critical for transporting long-chain fatty acids into the mitochondria for their subsequent β-oxidation. In vitro, stimulation of the alveolar epithelial type II (ATII)-like LA4 cell line with L-carnitine diminished apoptosis induced by both PPE and H2O2. Moreover, PPE-treated mice demonstrated impaired lung function compared with PBS-treated controls (lung compliance; 0.067±0.008 ml/cmH20 compared with 0.035±0.005 ml/cmH20, PL-carnitine (0.051±0.006, PL-carnitine and, importantly, suggest therapeutic avenues for COPD. © 2016 Authors; published by Portland Press Limited.

  5. Systemic and airway inflammation and the presence of emphysema in patients with COPD.

    Science.gov (United States)

    Papaioannou, Andriana I; Mazioti, Argyro; Kiropoulos, Theodoros; Tsilioni, Irini; Koutsokera, Angela; Tanou, Kalliopi; Nikoulis, Dimitrios J; Georgoulias, Panagiotis; Zakynthinos, Epameinondas; Gourgoulianis, Konstantinos I; Kostikas, Konstantinos

    2010-02-01

    The aim of this study was to determine the impact of HRCT-confirmed emphysema on biomarkers evaluating airway and systemic inflammation in COPD patients. Forty-nine consecutive male COPD outpatients with stable COPD were divided in two groups according to the presence or absence of emphysema on HRCT. Patients underwent pulmonary function tests, plus assessment of exercise capacity, body composition and quality of life. Biomarkers were measured in serum (CRP, interleukin-6, TNF-alpha, leptin, adiponectin, osteocalcin, insulin growth factor-1, and systemic oxidative stress), in plasma (fibrinogen and VEGF) and in whole blood (B-type natriuretic peptide). TNF-alpha, 8-isoprostane and pH were additionally measured in exhaled breath condensate. Patients with emphysema had more severe lung function impairment, lower body-mass index and fat-free mass index, and poorer quality of life. Additionally, they presented increased systemic oxidative stress and plasma fibrinogen and lower BNP compared to patients without emphysema. After proper adjustment for disease severity, all differences remained with the exceptions of body-mass index, fat-free mass index and BNP. COPD patients with HRCT-confirmed emphysema present increased systemic oxidative stress and fibrinogen, suggesting that they may be more prone to the systemic consequences of COPD compared to patients without emphysema.

  6. Emphysema and pulmonary impairment in coal miners: Quantitative relationship with dust exposure and cigarette smoking

    Science.gov (United States)

    Kuempel, E. D.; Vallyathan, V.; Green, F. H. Y.

    2009-02-01

    Coal miners have been shown to be at increased risk of developing chronic obstructive pulmonary diseases including emphysema. The objective of this study was to determine whether lifetime cumulative exposure to respirable coal mine dust is a significant predictor of developing emphysema at a clinically-relevant level of severity by the end of life, after controlling for cigarette smoking and other covariates. Clinically-relevant emphysema severity was determined from the association between individuals' lung function during life (forced expiratory volume in one second, FEV1, as a percentage of predicted normal values) and emphysema severity at autopsy (as the proportion of lung tissue affected). In a logistic regression model, cumulative exposure to respirable coal mine dust was a statistically significant predictor of developing clinically-relevant emphysema severity, among both ever-smokers and never-smokers. The odds ratio for developing emphysema associated with FEV1 <80% at the cohort mean cumulative coal dust exposure (87 mg/m3 x yr) was 2.30 (1.46-3.64, 95% confidence limits), and at the cohort mean cigarette smoking (among smokers: 42 pack-years) was 1.95 (1.39-2.79).

  7. Distinct Quantitative Computed Tomography Emphysema Patterns Are Associated with Physiology and Function in Smokers

    Science.gov (United States)

    San José Estépar, Raúl; Mendoza, Carlos S.; Hersh, Craig P.; Laird, Nan; Crapo, James D.; Lynch, David A.; Silverman, Edwin K.; Washko, George R.

    2013-01-01

    Rationale: Emphysema occurs in distinct pathologic patterns, but little is known about the epidemiologic associations of these patterns. Standard quantitative measures of emphysema from computed tomography (CT) do not distinguish between distinct patterns of parenchymal destruction. Objectives: To study the epidemiologic associations of distinct emphysema patterns with measures of lung-related physiology, function, and health care use in smokers. Methods: Using a local histogram-based assessment of lung density, we quantified distinct patterns of low attenuation in 9,313 smokers in the COPDGene Study. To determine if such patterns provide novel insights into chronic obstructive pulmonary disease epidemiology, we tested for their association with measures of physiology, function, and health care use. Measurements and Main Results: Compared with percentage of low-attenuation area less than −950 Hounsfield units (%LAA-950), local histogram-based measures of distinct CT low-attenuation patterns are more predictive of measures of lung function, dyspnea, quality of life, and health care use. These patterns are strongly associated with a wide array of measures of respiratory physiology and function, and most of these associations remain highly significant (P emphysema patterns provide novel information about the relationship between emphysema and key measures of physiology, physical function, and health care use. Measures of mild emphysema in smokers with preserved lung function can be extracted from CT scans and are significantly associated with functional measures. PMID:23980521

  8. Influence of emphysema distribution on pulmonary function parameters in COPD patients

    Science.gov (United States)

    Bastos, Helder Novais e; Neves, Inês; Redondo, Margarida; Cunha, Rui; Pereira, José Miguel; Magalhães, Adriana; Fernandes, Gabriela

    2015-01-01

    ABSTRACT OBJECTIVE: To evaluate the impact that the distribution of emphysema has on clinical and functional severity in patients with COPD. METHODS: The distribution of the emphysema was analyzed in COPD patients, who were classified according to a 5-point visual classification system of lung CT findings. We assessed the influence of emphysema distribution type on the clinical and functional presentation of COPD. We also evaluated hypoxemia after the six-minute walk test (6MWT) and determined the six-minute walk distance (6MWD). RESULTS: Eighty-six patients were included. The mean age was 65.2 ± 12.2 years, 91.9% were male, and all but one were smokers (mean smoking history, 62.7 ± 38.4 pack-years). The emphysema distribution was categorized as obviously upper lung-predominant (type 1), in 36.0% of the patients; slightly upper lung-predominant (type 2), in 25.6%; homogeneous between the upper and lower lung (type 3), in 16.3%; and slightly lower lung-predominant (type 4), in 22.1%. Type 2 emphysema distribution was associated with lower FEV1, FVC, FEV1/FVC ratio, and DLCO. In comparison with the type 1 patients, the type 4 patients were more likely to have an FEV1 emphysema could have a major impact on functional parameters and should be considered in the evaluation of COPD patients. PMID:26785956

  9. Classification of pulmonary emphysema from chest CT scans using integral geometry descriptors

    Science.gov (United States)

    van Rikxoort, E. M.; Goldin, J. G.; Galperin-Aizenberg, M.; Brown, M. S.

    2011-03-01

    To gain insight into the underlying pathways of emphysema and monitor the effect of treatment, methods to quantify and phenotype the different types of emphysema from chest CT scans are of crucial importance. Current standard measures rely on density thresholds for individual voxels, which is influenced by inspiration level and does not take into account the spatial relationship between voxels. Measures based on texture analysis do take the interrelation between voxels into account and therefore might be useful for distinguishing different types of emphysema. In this study, we propose to use Minkowski functionals combined with rotation invariant Gaussian features to distinguish between healthy and emphysematous tissue and classify three different types of emphysema. Minkowski functionals characterize binary images in terms of geometry and topology. In 3D, four Minkowski functionals are defined. By varying the threshold and size of neighborhood around a voxel, a set of Minkowski functionals can be defined for each voxel. Ten chest CT scans with 1810 annotated regions were used to train the method. A set of 108 features was calculated for each training sample from which 10 features were selected to be most informative. A linear discriminant classifier was trained to classify each voxel in the lungs into a subtype of emphysema or normal lung. The method was applied to an independent test set of 30 chest CT scans with varying amounts and types of emphysema with 4347 annotated regions of interest. The method is shown to perform well, with an overall accuracy of 95%.

  10. Quantifying Heterogeneity in Emphysema from High Resolution Computed Tomography: A Lung Tissue Research Consortium Study

    Science.gov (United States)

    Yilmaz, Cuneyt; Dane, Dan M.; Patel, Nova C.; Hsia, Connie C.W.

    2012-01-01

    Rationale and Objective To quantify spatial distribution of emphysema using high-resolution computed tomography (HRCT), we applied semi-automated analysis with internal attenuation calibration to measure regional air volume, tissue volume, and fractional tissue volume (FTV=tissue/[air+tissue] volume) in well-characterized patients studied by the Lung Tissue Research Consortium (LTRC). Methods HRCT was obtained at supine end-inspiration and end-expiration, and prone end-inspiration from 31 patients with mild, moderate, severe, or very severe emphysema (stages II–V, FEV1>75%, 51–75%, 21–50% and ≤20% predicted, respectively). Control data were from 20 healthy non-smokers (stage I). Each lobe was analyzed separately. Heterogeneity of FTV was assessed from coefficients of variation (CV) within and among lobes, and the kurtosis and skewness of FTV histograms. Results In emphysema, lobar air volume increased up to 177% except in the right middle lobe. Lobar tissue volume increased up to 107% in mild-moderate stages then normalized in advanced stages. Normally, FTV was up to 82% higher in lower than upper lobes. In mild-moderate emphysema, lobar FTV increased by up to 74% above normal at supine inspiration. In severe emphysema FTV declined below normal in all lobes and positions in correlation with pulmonary function (pemphysema distribution and heterogeneity from that in ILD. Early emphysema is associated with elevated tissue volume and FTV, consistent with hyperemia, inflammation or atelectasis. PMID:23122057

  11. The impact of emphysema on dosimetric parameters for stereotactic body radiotherapy of the lung.

    Science.gov (United States)

    Ochiai, Satoru; Nomoto, Yoshihito; Yamashita, Yasufumi; Inoue, Tomoki; Murashima, Shuuichi; Hasegawa, Daisuke; Kurita, Yoshie; Watanabe, Yui; Toyomasu, Yutaka; Kawamura, Tomoko; Takada, Akinori; Noriko; Kobayashi, Shigeki; Sakuma, Hajime

    2016-09-01

    The purpose of this study was to evaluate the impact of emphysematous changes in lung on dosimetric parameters in stereotactic body radiation therapy (SBRT) for lung tumor. A total of 72 treatment plans were reviewed, and dosimetric factors [including homogeneity index (HI) and conformity index (CI)] were evaluated. Emphysematous changes in lung were observed in 43 patients (60%). Patients were divided into three groups according to the severity of emphysema: no emphysema (n = 29), mild emphysema (n = 22) and moderate to severe emphysema groups (n = 21). The HI (P material density of the lung within the PTV (P < 0.001) were significant factors for HI, and the mean density of the lung within the PTV (P = 0.005) was the only significant factor for CI. The mean density of the lung within the PTV was significantly different in accordance with the severity of emphysema (one-way ANOVA, P = 0.008) and the severity of emphysema (P < 0.001) was one of the significant factors for the density of the lung within the PTV in multiple linear regression analysis. Our results suggest that emphysematous changes in the lung significantly impact on several dosimetric parameters in SBRT, and they should be carefully evaluated before treatment planning. © The Author 2016. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

  12. Emphysema and pulmonary impairment in coal miners: Quantitative relationship with dust exposure and cigarette smoking

    Energy Technology Data Exchange (ETDEWEB)

    Kuempel, E D [National Institute for Occupational Safety and Health, Education and Information Division, Risk Evaluation Branch, Cincinnati, Ohio (United States); Vallyathan, V [National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Pathology and Physiology Research Branch, Morgantown, West Virginia (United States); Green, F H Y, E-mail: ekuempel@cdc.go [Department of Pathology, Faculty of Medicine, University of Calgary, Calgary, Alberta (Canada)

    2009-02-01

    Coal miners have been shown to be at increased risk of developing chronic obstructive pulmonary diseases including emphysema. The objective of this study was to determine whether lifetime cumulative exposure to respirable coal mine dust is a significant predictor of developing emphysema at a clinically-relevant level of severity by the end of life, after controlling for cigarette smoking and other covariates. Clinically-relevant emphysema severity was determined from the association between individuals' lung function during life (forced expiratory volume in one second, FEV{sub 1}, as a percentage of predicted normal values) and emphysema severity at autopsy (as the proportion of lung tissue affected). In a logistic regression model, cumulative exposure to respirable coal mine dust was a statistically significant predictor of developing clinically-relevant emphysema severity, among both ever-smokers and never-smokers. The odds ratio for developing emphysema associated with FEV{sub 1} <80% at the cohort mean cumulative coal dust exposure (87 mg/m{sup 3} x yr) was 2.30 (1.46-3.64, 95% confidence limits), and at the cohort mean cigarette smoking (among smokers: 42 pack-years) was 1.95 (1.39-2.79).

  13. Adaptive quantification and longitudinal analysis of pulmonary emphysema with a hidden Markov measure field model.

    Science.gov (United States)

    Hame, Yrjo; Angelini, Elsa D; Hoffman, Eric A; Barr, R Graham; Laine, Andrew F

    2014-07-01

    The extent of pulmonary emphysema is commonly estimated from CT scans by computing the proportional area of voxels below a predefined attenuation threshold. However, the reliability of this approach is limited by several factors that affect the CT intensity distributions in the lung. This work presents a novel method for emphysema quantification, based on parametric modeling of intensity distributions and a hidden Markov measure field model to segment emphysematous regions. The framework adapts to the characteristics of an image to ensure a robust quantification of emphysema under varying CT imaging protocols, and differences in parenchymal intensity distributions due to factors such as inspiration level. Compared to standard approaches, the presented model involves a larger number of parameters, most of which can be estimated from data, to handle the variability encountered in lung CT scans. The method was applied on a longitudinal data set with 87 subjects and a total of 365 scans acquired with varying imaging protocols. The resulting emphysema estimates had very high intra-subject correlation values. By reducing sensitivity to changes in imaging protocol, the method provides a more robust estimate than standard approaches. The generated emphysema delineations promise advantages for regional analysis of emphysema extent and progression.

  14. [Anesthetic management of a patient with severe subcutaneous and mediastinal emphysema due to pertussis infection].

    Science.gov (United States)

    Ideno, Satoshi; Miyazawa, Noriko; Ishikawa, Saki; Wakamiya, Rie; Shinto, Atsushi; Mikasa, Hiromi; Yamamoto, Shinichi

    2014-06-01

    A 20-month-old girl, with respiratory failure due to severe subcutaneous and mediastinal emphysema, was scheduled to undergo percutaneous drainage of emphysema and induction of extracorporeal membrane oxygenation. Paroxysm, a symptom of the infection of Bordetella pertussis, was the cause of emphysema. In patients with severe neck subcutaneous emphysema, management of difficult airway is the most important safety issue in the practice of anesthesia. Following the American Society of Anesthesiologist (ASA) guidelines for management of difficult airway, we prepared various types of equipment to facilitate intubation and surgeons were beside the patient during induction of anesthesia for emergency invasive airway access. To prevent the progression of emphysema, preservation of spontaneous breathing during the perioperative period was also important. Combined with propofol and midazolam, pethidine was an effective agent for safe anesthetic induction because it produces less respiratory depression compared to other opiate analgesics. In conclusion, this case demonstrates the importance of prediction of and preparation for difficult airway. Furthermore, anesthesiologists should consider the optimization of anesthesia to avoid progression of emphysema.

  15. Emphysema and pulmonary impairment in coal miners: quantitative relationship with dust exposure and cigarette smoking

    Energy Technology Data Exchange (ETDEWEB)

    E.D. Kuempel; V. Vallyathan; F.H.Y. Green [National Institute for Occupational Safety and Health, Cincinnati, OH (United States)

    2009-07-01

    Coal miners have been shown to be at increased risk of developing chronic obstructive pulmonary diseases including emphysema. The objective of this study was to determine whether lifetime cumulative exposure to respirable coal mine dust is a significant predictor of developing emphysema at a clinically-relevant level of severity by the end of life, after controlling for cigarette smoking and other covariates. Clinically-relevant emphysema severity was determined from the association between individuals' lung function during life (forced expiratory volume in one second, FEV{sub 1}, as a percentage of predicted normal values) and emphysema severity at autopsy (as the proportion of lung tissue affected). In a logistic regression model, cumulative exposure to respirable coal mine dust was a statistically significant predictor of developing clinically-relevant emphysema severity, among both ever-smokers and never-smokers. The odds ratio for developing emphysema associated with FEV1 <80% at the cohort mean cumulative coal dust exposure (87 mg/m{sup 3} x yr) was 2.30 (1.46-3.64, 95% confidence limits), and at the cohort mean cigarette smoking (among smokers: 42 pack-years) was 1.95 (1.39-2.79). 20 refs., 2 figs., 2 tabs.

  16. Quantitative analysis of pulmonary emphysema using local binary patterns

    DEFF Research Database (Denmark)

    Sørensen, Lauge Emil Borch Laurs; Shaker, S.B.; de Bruijne, Marleen

    2010-01-01

    We aim at improving quantitative measures of emphysema in computed tomography (CT) images of the lungs. Current standard measures, such as the relative area of emphysema (RA), rely on a single intensity threshold on individual pixels, thus ignoring any interrelations between pixels. Texture analy......| = 0.79 in 39 subjects. The results were compared to RA and to a Gaussian filter bank, and the texture-based measures correlated significantly better with PFT than did RA.......We aim at improving quantitative measures of emphysema in computed tomography (CT) images of the lungs. Current standard measures, such as the relative area of emphysema (RA), rely on a single intensity threshold on individual pixels, thus ignoring any interrelations between pixels. Texture...... analysis allows for a much richer representation that also takes the local structure around pixels into account. This paper presents a texture classification-based system for emphysema quantification in CT images. Measures of emphysema severity are obtained by fusing pixel posterior probabilities output...

  17. A Belgian survey on the diagnosis of asthma-COPD overlap syndrome.

    Science.gov (United States)

    Cataldo, Didier; Corhay, Jean-Louis; Derom, Eric; Louis, Renaud; Marchand, Eric; Michils, Alain; Ninane, Vincent; Peché, Rudi; Pilette, Charles; Vincken, Walter; Janssens, Wim

    2017-01-01

    Patients with chronic airway disease may present features of both asthma and COPD, commonly referred to as asthma-COPD overlap syndrome (ACOS). Recommendations on their diagnosis are diffuse and inconsistent. This survey aimed to identify consensus on criteria for diagnosing ACOS. A Belgian expert panel developed a survey on ACOS diagnosis, which was completed by 87 pulmonologists. Answers chosen by ≥70% of survey respondents were considered as useful criteria for ACOS diagnosis. The two most frequently selected answers were considered as major criteria, others as minor criteria. The expert panel proposed a minimal requirement of two major criteria and one minor criterion for ACOS diagnosis. Respondents were also asked which criteria are important for considering inhaled corticosteroids prescription in a COPD patient. To diagnose ACOS in COPD patients, major criteria were "high degree of variability in airway obstruction over time (change in forced expiratory volume in 1 second ≥400 mL)" and "high degree of response to bronchodilators (>200 mL and ≥12% predicted above baseline)". Minor criteria were "personal/family history of atopy and/or IgE sensitivity to ≥1 airborne allergen", "elevated blood/sputum eosinophil levels and/or increased fractional exhaled nitric oxide", "diagnosis of asthma 40 years"; "emphysema on chest computed tomography scan". Specific criteria were identified that may guide physicians to a more uniform diagnostic approach for ACOS in COPD or asthma patients. These criteria are largely similar to those used to prescribe inhaled corticosteroids in COPD.

  18. Aspirin-Exacerbated Asthma

    Directory of Open Access Journals (Sweden)

    Varghese Mathew

    2008-06-01

    Full Text Available This review focuses on aspirin-exacerbated asthma (AEA. The review includes historical perspective of aspirin, prevalence, pathogenesis, clinical features and treatment of AEA. The pathogenesis of AEA involves the cyclooxygenase and lipooxygenase pathway. Aspirin affects both of these pathways by inhibiting the enzyme cycooxygenase-1 (COX-1. Inhibition of COX-1 leads to a decrease in prostaglandin E2 (PGE2. The decrease in PGE2 results in an increase in cysteinyl leukotrienes by the lipooxygenase pathway involving the enzyme 5-lipooxygenase (5-LO. Leukotriene C4 (LTC4 synthase is the enzyme responsible for the production of leukotriene C4, the chief cysteinyl leukotriene responsible for AEA. There have been familial occurences of AEA. An allele of the LTC4 synthase gene in AEA is known as allele C. Allele C has a higher frequency in AEA. Clinical presentation includes a history of asthma after ingestion of aspirin, nasal congestion, watery rhinorrhea and nasal polyposis. Treatment includes leukotriene receptor antagonists, leukotriene inhibitors, aspirin desinsitaztion and surgery. AEA is the most well-defined phenotype of asthma. Although AEA affects adults and children with physician-diagnosed asthma, in some cases there is no history of asthma and AEA often goes unrecognized and underdiagnosed.

  19. Allergens, germs and asthma.

    Science.gov (United States)

    Scadding, Glenis Kathleen

    2015-04-01

    To explore asthma pathogenesis using data from upper and lower airways. English-language papers on human asthma and nasal polyp subjects from 1990 onwards. High-quality studies in established journals. The recognition of its inflammatory nature led to a quantum leap in the understanding and treatment of asthma, with lives saved by inhaled corticosteroids. Further work at genetic, molecular, histological and clinical levels has shown that asthma is polymorphic and rarely involves isolated Th2 bronchial inflammation. Viral infections may act as an initiating event in children and adults, showing synergy with atopy. Chronic staphylococcal colonization of the mucosa may act as a promoter, as in atopic dermatitis. These two observations may be linked, with viruses providing an entry for bacteria into the mucosal epithelium. Most asthma begins in the nose and involves allergy and infection: both viral and bacterial. The combination of atopy and infection suggests new possibilities for therapy. © 2014 The Author. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.

  20. Asthma and dental caries.

    Science.gov (United States)

    Matthews, Joseph

    2012-06-01

    Medline, government reports and conference proceedings were searched. Case-control, cohort or cross sectional studies were included if they provided relevant and applicable quantitative information on the relation between asthma and caries, had an independent study population and adequate definitions of asthma and caries and appropriate measurement of caries. Data were extracted independently by two reviewers and quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Fixed- and random-effects models were used for the analyses. Heterogeneity and publication bias were evaluated. Eighteen articles were included; 11 provided information on primary dentition and 15 on permanent dentition. Random-effects models showed a significant association between asthma and caries for both primary and permanent dentition, the odds ratios being 2.73 (95% CI: 1.61, 4.64) and 2.04 (95% CI: 1.44, 2.89), respectively. Evidence from this analysis suggests that asthma doubles the risk of caries in both primary and permanent dentition. Publication bias diagnostics and simulation suggested possible overestimation of the summary odds ratio for permanent dentition but not for primary dentition. Physicians and dentists should recommend preventive measures against caries for people with asthma.

  1. [Epigenetics, environment and asthma].

    Science.gov (United States)

    Rico-Rosillo, Guadalupe; Vega-Robledo, Gloria Bertha; Silva-García, Raúl; Oliva-Rico, Diego

    2014-01-01

    Asthma is a chronic inflammatory disease of the respiratory tract with a complex genetic background influenced by the exposition to a series of environmental factors. Genetic studies can only elucidate part of the heritability and susceptibility of asthma and even though several diseases have an evident genetic etiology, only a fraction of the genes involved in their pathogenicity have been identified. The epigenetic regulation of the latter is a fact one should bear in mind in order to explain the major triggers of diseases whose understanding is complicated, such as allergies and asthma. External stimulus such as nourishment, stress, physical activity, atmospheric pollution, tobacco smoking and alcohol drinking can induce either gene silencing or gene expression. In this regard, epigenetics can explain how these environmental factors influence our genetic inheritance. There is growing evidence that backs-up the fact that DNA methylation, histone post-translational modification and microRNA expression are influenced by the environment. This helps explaining how several of the risk factors mentioned contribute to the development and inheritance of asthma. In this review, different environmental factors and their relation with the main epigenetic regulatory mechanisms will be analyzed, as well as their possible role in the development of asthma.

  2. The pharmacotherapy of the asthma

    OpenAIRE

    BROŽOVÁ, Lenka

    2008-01-01

    Asthma bronchiale is a very common chronic disorder of airways with not fully elucidated pathology, which is not fully curable at the moment. It is estimated that 300 millions of persons suffer from asthma. About 8% of adult population and 10% of children are affected in the Czech republic. The aim of this thesis is to give an overview of contemporary modern pharmacotherapy of asthma. Firstly, this work describes asthma from pathophysiological and epidemiological point of view, among others: ...

  3. Obesity, Asthma, and the Microbiome.

    Science.gov (United States)

    Cho, Youngji; Shore, Stephanie A

    2016-03-01

    Obesity is a risk factor for asthma, but standard asthma drugs have reduced efficacy in the obese. Obesity alters the gastrointestinal microbial community structure. This change in structure contributes to some obesity-related conditions and also could be contributing to obesity-related asthma. Although currently unexplored, obesity may also be altering lung microbiota. Understanding the role of microbiota in obesity-related asthma could lead to novel treatments for these patients. ©2016 Int. Union Physiol. Sci./Am. Physiol. Soc.

  4. Obesity, Asthma, and the Microbiome

    OpenAIRE

    Cho, Youngji; Shore, Stephanie A.

    2016-01-01

    Obesity is a risk factor for asthma, but standard asthma drugs have reduced efficacy in the obese. Obesity alters the gastrointestinal microbial community structure. This change in structure contributes to some obesity-related conditions and also could be contributing to obesity-related asthma. Although currently unexplored, obesity may also be altering lung microbiota. Understanding the role of microbiota in obesity-related asthma could lead to novel treatments for these patients.

  5. Obesity, Asthma, and the Microbiome

    Science.gov (United States)

    Cho, Youngji

    2016-01-01

    Obesity is a risk factor for asthma, but standard asthma drugs have reduced efficacy in the obese. Obesity alters the gastrointestinal microbial community structure. This change in structure contributes to some obesity-related conditions and also could be contributing to obesity-related asthma. Although currently unexplored, obesity may also be altering lung microbiota. Understanding the role of microbiota in obesity-related asthma could lead to novel treatments for these patients. PMID:26889016

  6. Emphysema progression is visually detectable in low-dose CT in continuous but not in former smokers

    DEFF Research Database (Denmark)

    Wille, Mathilde Marie Winkler; Thomsen, Laura H.; Dirksen, Asger

    2014-01-01

    OBJECTIVES: To evaluate interobserver agreement and time-trend in chest CT assessment of emphysema, airways, and interstitial abnormalities in a lung cancer screening cohort. METHODS: Visual assessment of baseline and fifth-year examination of 1990 participants was performed independently by two...... observers. Results were standardised by means of an electronic score sheet; kappa and time-trend analyses were performed. RESULTS: Interobserver agreement was substantial in early emphysema diagnosis; highly significant (p emphysema presence and grading were found (higher...... prevalence and grade of emphysema in late CT examinations). Significant progression in emphysema was seen in continuous smokers, but not in former smokers. Agreement on centrilobular emphysema subtype was substantial; agreement on paraseptal subtype, moderate. Agreement on panlobular and mixed subtypes...

  7. Japanese Guideline for Adult Asthma

    Directory of Open Access Journals (Sweden)

    Ken Ohta

    2011-01-01

    Full Text Available Adult bronchial asthma (hereinafter, asthma is characterized by chronic airway inflammation, reversible airway narrowing, and airway hyperresponsiveness. Long-standing asthma induces airway remodeling to cause an intractable asthma. The number of patients with asthma has increased, while the number of patients who die from asthma has decreased (1.7 per 100,000 patients in 2009. The aim of asthma treatment is to enable patients with asthma to lead a healthy life without any symptoms. A partnership between physicians and patients is indispensable for appropriate treatment. Long-term management with agents and elimination of causes and risk factors are fundamental to asthma treatment. Four steps in pharmacotherapy differentiate mild to intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid (ICS, varying from low to high doses. Long-acting β2 agonists (LABA, leukotriene receptor antagonists, and theophylline sustained-release preparation are recommended as concomitant drugs, while anti-IgE antibody therapy is a new choice for the most severe and persistent asthma. Inhaled β2 agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, etc., are used as needed against acute exacerbations. Allergic rhinitis, chronic obstructive pulmonary disease (COPD, aspirin induced asthma, pregnancy, and cough variant asthma are also important factors that need to be considered.

  8. Defining asthma in genetic studies

    NARCIS (Netherlands)

    Koppelman, GH; Postma, DS; Meijer, G.

    1999-01-01

    Genetic studies have been hampered by the lack of a gold standard to diagnose asthma. The complex nature of asthma makes it more difficult to identify asthma genes. Therefore, approaches to define phenotypes, which have been successful in other genetically complex diseases, may be applied to define

  9. Rhinitis: a complication to asthma

    DEFF Research Database (Denmark)

    Hansen, J W; Thomsen, S F; Nolte, H

    2010-01-01

    Asthma and rhinitis often co-occur, and this potentially increases the disease severity and impacts negatively on the quality of life. We studied disease severity, airway responsiveness, atopy, quality of life and treatment in subjects with both asthma and rhinitis compared to patients with asthma...

  10. Neurodegeneration Induced by Clustering of Sialylated Glycosylphosphatidylinositols of Prion Proteins*

    Science.gov (United States)

    Bate, Clive; Williams, Alun

    2012-01-01

    The transmissible spongiform encephalopathies, more commonly known as the prion diseases, are associated with the production and aggregation of disease-related isoforms of the prion protein (PrPSc). The mechanisms by which PrPSc accumulation causes neurodegeneration in these diseases are poorly understood. In cultured neurons, the addition of PrPSc alters cell membranes, increasing cholesterol, activating cytoplasmic phospholipase A2 (cPLA2), and triggering synapse damage. These effects of PrPSc are dependent upon its glycosylphosphatidylinositol (GPI) anchor, suggesting that it is the increased density of GPIs that occurs following the aggregation of PrPSc molecules that triggers neurodegeneration. This hypothesis was supported by observations that cross-linkage of the normal cellular prion protein (PrPC) also increased membrane cholesterol, activated cPLA2, and triggered synapse damage. These effects were not seen after cross-linkage of Thy-1, another GPI-anchored protein, and were dependent on the GPI anchor attached to PrPC containing two acyl chains and sialic acid. We propose that the aggregation of PrPSc, or the cross-linkage of PrPC, causes the clustering of sialic acid-containing GPI anchors at high densities, resulting in altered membrane composition, the pathological activation of cPLA2, and synapse damage. PMID:22262833

  11. Impact of aging immune system on neurodegeneration and potential immunotherapies.

    Science.gov (United States)

    Liang, Zhanfeng; Zhao, Yang; Ruan, Linhui; Zhu, Linnan; Jin, Kunlin; Zhuge, Qichuan; Su, Dong-Ming; Zhao, Yong

    2017-10-01

    The interaction between the nervous and immune systems during aging is an area of avid interest, but many aspects remain unclear. This is due, not only to the complexity of the aging process, but also to a mutual dependency and reciprocal causation of alterations and diseases between both the nervous and immune systems. Aging of the brain drives whole body systemic aging, including aging-related changes of the immune system. In turn, the immune system aging, particularly immunosenescence and T cell aging initiated by thymic involution that are sources of chronic inflammation in the elderly (termed inflammaging), potentially induces brain aging and memory loss in a reciprocal manner. Therefore, immunotherapeutics including modulation of inflammation, vaccination, cellular immune therapies and "protective autoimmunity" provide promising approaches to rejuvenate neuroinflammatory disorders and repair brain injury. In this review, we summarize recent discoveries linking the aging immune system with the development of neurodegeneration. Additionally, we discuss potential rejuvenation strategies, focusing aimed at targeting the aging immune system in an effort to prevent acute brain injury and chronic neurodegeneration during aging. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. The influence of cannabinoids on generic traits of neurodegeneration.

    Science.gov (United States)

    Fagan, S G; Campbell, V A

    2014-03-01

    In an increasingly ageing population, the incidence of neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease and Huntington's disease are rising. While the aetiologies of these disorders are different, a number of common mechanisms that underlie their neurodegenerative components have been elucidated; namely neuroinflammation, excitotoxicity, mitochondrial dysfunction and reduced trophic support. Current therapies focus on treatment of the symptoms and attempt to delay the progression of these diseases but there is currently no cure. Modulation of the endogenous cannabinoid system is emerging as a potentially viable option in the treatment of neurodegeneration. Endocannabinoid signalling has been found to be altered in many neurodegenerative disorders. To this end, pharmacological manipulation of the endogenous cannabinoid system, as well as application of phytocannabinoids and synthetic cannabinoids have been investigated. Signalling from the CB1 and CB2 receptors are known to be involved in the regulation of Ca(2+) homeostasis, mitochondrial function, trophic support and inflammatory status, respectively, while other receptors gated by cannabinoids such as PPARγ, are gaining interest in their anti-inflammatory properties. Through multiple lines of evidence, this evolutionarily conserved neurosignalling system has shown neuroprotective capabilities and is therefore a potential target for neurodegenerative disorders. This review details the mechanisms of neurodegeneration and highlights the beneficial effects of cannabinoid treatment. This article is part of a themed section on Cannabinoids 2013. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2014.171.issue-6. © 2013 The British Pharmacological Society.

  13. Astrocyte dysfunction triggers neurodegeneration in a lysosomal storage disorder.

    Science.gov (United States)

    Di Malta, Chiara; Fryer, John D; Settembre, Carmine; Ballabio, Andrea

    2012-08-28

    The role of astrocytes in neurodegenerative processes is increasingly appreciated. Here we investigated the contribution of astrocytes to neurodegeneration in multiple sulfatase deficiency (MSD), a severe lysosomal storage disorder caused by mutations in the sulfatase modifying factor 1 (SUMF1) gene. Using Cre/Lox mouse models, we found that astrocyte-specific deletion of Sumf1 in vivo induced severe lysosomal storage and autophagy dysfunction with consequential cytoplasmic accumulation of autophagic substrates. Lysosomal storage in astrocytes was sufficient to induce degeneration of cortical neurons in vivo. Furthermore, in an ex vivo coculture assay, we observed that Sumf1(-/-) astrocytes failed to support the survival and function of wild-type cortical neurons, suggesting a non-cell autonomous mechanism for neurodegeneration. Compared with the astrocyte-specific deletion of Sumf1, the concomitant removal of Sumf1 in both neurons and glia in vivo induced a widespread neuronal loss and robust neuroinflammation. Finally, behavioral analysis of mice with astrocyte-specific deletion of Sumf1 compared with mice with Sumf1 deletion in both astrocytes and neurons allowed us to link a subset of neurological manifestations of MSD to astrocyte dysfunction. This study indicates that astrocytes are integral components of the neuropathology in MSD and that modulation of astrocyte function may impact disease course.

  14. Flavonoids and Asthma

    Science.gov (United States)

    Tanaka, Toshio; Takahashi, Ryo

    2013-01-01

    Asthma is a chronic disease, characterized by airway inflammation, airflow limitation, hyper-reactivity and airway remodeling. It is believed that asthma is caused by the interaction between genetic and environmental factors. The prevalence of allergic diseases, including asthma, has increased worldwide during the past two decades. Although the precise reasons that have caused this increase remain unknown, dietary change is thought to be one of the environmental factors. Flavonoids, which are polyphenolic plant secondary metabolites ubiquitously present in vegetables, fruits and beverages, possess antioxidant and anti-allergic traits, as well as immune-modulating activities. Flavonoids are powerful antioxidants and anti-allergic nutrients that inhibit the release of chemical mediators, synthesis of Th2 type cytokines, such as interleukin (IL)-4 and IL-13, and CD40 ligand expression by high-affinity immunoglobulin E (IgE) receptor-expressing cells, such as mast cells and basophils. They also inhibit IL-4-induced signal transduction and affect the differentiation of naïve CD4+ T cells into effector T-cells through their inhibitory effect on the activation of the aryl hydrocarbon receptor. Various studies of flavonoids in asthmatic animal models have demonstrated their beneficial effects. The results of several epidemiological studies suggest that an increase in flavonoid intake is beneficial for asthma. Moreover, clinical trials of flavonoids have shown their ameliorative effects on symptoms related to asthma. However, these human studies are currently limited; further validation is required to clarify whether an appropriate intake of flavonoids may constitute dietary treatment and for part of a preventive strategy for asthma. PMID:23752494

  15. Obesity and asthma

    OpenAIRE

    Pranab Baruwa; Kripesh Ranjan Sarmah

    2013-01-01

    Asthma is a chronic disorder affecting millions of people worldwide. The prevalence of asthma is around 300 million and is expected to increase another 100 million by 2025. Obesity, on the other hand, also affects a large number of individuals. Overweight in adults is defined when body mass index (BMI) is between 25 to 30 kg/m 2 and obesity when the BMI >30 kg/m 2 . It has been a matter of interest for researchers to find a relation between these two conditions. This knowledge will provide a ...

  16. Management of infantile asthma.

    Science.gov (United States)

    Brasher, G W

    1977-09-01

    Infantile asthama is an important pediatric problem and may cause substantial morbidity and mortality in this age group. The pathophysiology of allergic asthma involves a type I hypersensitivity reaction that is mediated by reaginic antibodies of the IgE class. Various factors predisposing to infantile asthma have been suggested but not confirmed. The differential diagnosis of infantile wheezing is of particular importance in this very young age group. An appreciation of the natural history and clinical characteristics of the disease, and of the important causative factors (foods, environmental inhalants, and respiratory infections), will aid the physician in the management of this problem.

  17. Relvar Ellipta for asthma.

    Science.gov (United States)

    2014-08-01

    ▼Relvar Ellipta (GSK) is a dry powder inhaler that contains a corticosteroid (fluticasone furoate) and a long-acting beta2 agonist (vilanterol trifenatate). It is licensed for once-daily use as maintenance therapy for chronic obstructive pulmonary disease (COPD) and asthma. In a previous article we considered its use in the management of COPD.1 Here we review the evidence for Relvar Ellipta in the treatment of patients with asthma. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. The coexistence of asthma and chronic obstructive pulmonary disease (COPD: prevalence and risk factors in young, middle-aged and elderly people from the general population.

    Directory of Open Access Journals (Sweden)

    Roberto de Marco

    Full Text Available BACKGROUND: The joint distribution of asthma and chronic obstructive pulmonary disease (COPD has not been well described. This study aims at determining the prevalence of self-reported physician diagnoses of asthma, COPD and of the asthma-COPD overlap syndrome and to assess whether these conditions share a common set of risk factors. METHODS: A screening questionnaire on respiratory symptoms, diagnoses and risk factors was administered by mail or phone to random samples of the general Italian population aged 20-44 (n = 5163 45-64 (n = 2167 and 65-84 (n = 1030 in the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD study. RESULTS: A physician diagnosis of asthma or COPD (emphysema/chronic bronchitis/COPD was reported by 13% and 21% of subjects aged <65 and 65-84 years respectively. Aging was associated with a marked decrease in the prevalence of diagnosed asthma (from 8.2% to 1.6% and with a marked increase in the prevalence of diagnosed COPD (from 3.3% to 13.3%. The prevalence of the overlap of asthma and COPD was 1.6% (1.3%-2.0%, 2.1% (1.5%-2.8% and 4.5% (3.2%-5.9% in the 20-44, 45-64 and 65-84 age groups. Subjects with both asthma and COPD diagnoses were more likely to have respiratory symptoms, physical impairment, and to report hospital admissions compared to asthma or COPD alone (p<0.01. Age, sex, education and smoking showed different and sometimes opposite associations with the three conditions. CONCLUSION: Asthma and COPD are common in the general population, and they coexist in a substantial proportion of subjects. The asthma-COPD overlap syndrome represents an important clinical phenotype that deserves more medical attention and further research.

  19. Temporal Tracking of Microglia Activation in Neurodegeneration at Single-Cell Resolution

    Directory of Open Access Journals (Sweden)

    Hansruedi Mathys

    2017-10-01

    Full Text Available Microglia, the tissue-resident macrophages in the brain, are damage sensors that react to nearly any perturbation, including neurodegenerative diseases such as Alzheimer’s disease (AD. Here, using single-cell RNA sequencing, we determined the transcriptome of more than 1,600 individual microglia cells isolated from the hippocampus of a mouse model of severe neurodegeneration with AD-like phenotypes and of control mice at multiple time points during progression of neurodegeneration. In this neurodegeneration model, we discovered two molecularly distinct reactive microglia phenotypes that are typified by modules of co-regulated type I and type II interferon response genes, respectively. Furthermore, our work identified previously unobserved heterogeneity in the response of microglia to neurodegeneration, discovered disease stage-specific microglia cell states, revealed the trajectory of cellular reprogramming of microglia in response to neurodegeneration, and uncovered the underlying transcriptional programs.

  20. Quantifying heterogeneity in emphysema from high-resolution computed tomography: a lung tissue research consortium study.

    Science.gov (United States)

    Yilmaz, Cuneyt; Dane, Dan M; Patel, Nova C; Hsia, Connie C W

    2013-02-01

    To quantify spatial distribution of emphysema using high-resolution computed tomography (HRCT), we applied semiautomated analysis with internal attenuation calibration to measure regional air volume, tissue volume, and fractional tissue volume (FTV = tissue/[air + tissue] volume) in well-characterized patients studied by the Lung Tissue Research Consortium (LTRC). HRCT was obtained at supine end-inspiration and end-expiration, and prone end-inspiration from 31 patients with mild, moderate, severe, or very severe emphysema (stages II-V, forced expiratory volume at 1 second >75%, 51%-75%, 21%-50% and ≤20% predicted, respectively). Control data were from 20 healthy non-smokers (stage I). Each lobe was analyzed separately. Heterogeneity of FTV was assessed from coefficients of variation (CV) within and among lobes, and the kurtosis and skewness of FTV histograms. In emphysema, lobar air volume increased up to 177% above normal except in the right middle lobe. Lobar tissue volume increased up to 107% in mild-moderate stages then normalized in advanced stages. Normally, FTV was up to 82% higher in lower than upper lobes. In mild-moderate emphysema, lobar FTV increased by up to 74% above normal at supine inspiration. In severe emphysema, FTV declined below normal in all lobes and positions in correlation with pulmonary function (P < .05). Markers of FTV heterogeneity increased steadily with disease stage in correlation with pulmonary function (P < .05); the pattern is distinct from that seen in interstitial lung disease (ILD). CT-derived biomarkers differentiate the spatial patterns of emphysema distribution and heterogeneity from that in ILD. Early emphysema is associated with elevated tissue volume and FTV, consistent with hyperemia, inflammation or atelectasis. Published by Elsevier Inc.

  1. The Relationship of Educational Attainment with Pulmonary Emphysema and Airway Wall Thickness.

    Science.gov (United States)

    Gjerdevik, Miriam; Grydeland, Thomas B; Washko, George R; Coxson, Harvey O; Silverman, Edwin K; Gulsvik, Amund; Bakke, Per S

    2015-06-01

    Low educational attainment is a risk factor of chronic obstructive pulmonary disease (COPD). There is limited knowledge on the relationship between educational level and computed tomography measures of emphysema and airway wall thickness (AWT). We hypothesized that low educational attainment is associated with increased emphysema and AWT in ever-smokers with and without COPD. We included 462 and 485 ever-smokers with and without COPD in a cross-sectional study, aged 40-86 years. The sample was divided into groups reflecting educational attainment: primary, secondary, and university. We performed linear regression to examine associations between educational attainment and both emphysema and AWT separately for those with and without COPD. We adjusted for sex, age, smoking status, age of onset of smoking, pack-years, height, and body mass index. Compared with university education, in subjects with COPD, primary education was associated with a 68.1% (95% confidence interval = 14.2-147.6%; P = 0.01) relative increase in emphysema and secondary education was associated with a 50.6% (95% confidence interval = 5.7-114.6%; P = 0.02) relative increase. There was a nonsignificant trend toward an association between lower educational attainment and increased emphysema among those without COPD (P = 0.18), yet greater age appeared to modify this association (P = 0.01). We did not detect significant linear relationships between educational attainment and AWT in subjects with or without COPD. Lower educational attainment was associated with increased emphysema among adults with COPD. Among those without COPD, this association was more pronounced with increasing age. No significant linear relationship between educational attainment and AWT was found. Clinicians treating adults with emphysema should keep in mind that factors related to low education beyond that of smoking and occupational dust exposure might be of importance to the disease.

  2. Emphysema distribution and annual changes in pulmonary function in male patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Tanabe, Naoya; Muro, Shigeo; Tanaka, Shiro; Sato, Susumu; Oguma, Tsuyoshi; Kiyokawa, Hirofumi; Takahashi, Tamaki; Kinose, Daisuke; Hoshino, Yuma; Kubo, Takeshi; Ogawa, Emiko; Hirai, Toyohiro; Mishima, Michiaki

    2012-04-18

    The progression of chronic obstructive pulmonary disease (COPD) considerably varies among patients. Those with emphysema identified by quantitative computed tomography (CT) are associated with the rapid progression assessed by forced expiratory volume in one second (FEV1). However, whether the rate of the decline in lung function is independently affected by the regional distribution or the severity of emphysema in the whole lung is unclear. We followed up 131 male patients with COPD for a median of 3.7 years. We measured wall area percent (WA%) in right apical segmental bronchus, total lung volume, percent low attenuation volume (LAV%), and the standard deviation (SD) of LAV% values from CT images of 10 isovolumetric partitions (SD-LAV) as an index of cranial-caudal emphysema heterogeneity. Annual changes in FEV1 were then determined using a random coefficient model and relative contribution of baseline clinical parameters, pulmonary function, and CT indexes including LAV%, SD-LAV, and WA% to annual changes in FEV1 were examined. The mean (SD) annual change in FEV1 was -44.4 (10.8) mL. Multivariate random coefficient model showed that higher baseline FEV1, higher LAV%, current smoking, and lower SD-LAV independently contributed to an excessive decline in FEV1, whereas ratio of residual volume to total lung capacity, ratio of diffusing capacity to alveolar ventilation, and WA% did not, after adjusting for age, height, weight, and ratio of CT-measured total lung volume to physiologically-measured total lung capacity. A more homogeneous distribution of emphysema contributed to an accelerated decline in FEV1 independently of baseline pulmonary function, whole-lung emphysema severity, and smoking status. In addition to whole-lung analysis of emphysema, CT assessment of the cranial-caudal distribution of emphysema might be useful for predicting rapid, progressive disease and for developing a targeted strategy with which to prevent disease progression.

  3. Normalizing computed tomography data reconstructed with different filter kernels: effect on emphysema quantification.

    Science.gov (United States)

    Gallardo-Estrella, Leticia; Lynch, David A; Prokop, Mathias; Stinson, Douglas; Zach, Jordan; Judy, Philip F; van Ginneken, Bram; van Rikxoort, Eva M

    2016-02-01

    To propose and evaluate a method to reduce variability in emphysema quantification among different computed tomography (CT) reconstructions by normalizing CT data reconstructed with varying kernels. We included 369 subjects from the COPDGene study. For each subject, spirometry and a chest CT reconstructed with two kernels were obtained using two different scanners. Normalization was performed by frequency band decomposition with hierarchical unsharp masking to standardize the energy in each band to a reference value. Emphysema scores (ES), the percentage of lung voxels below -950 HU, were computed before and after normalization. Bland-Altman analysis and correlation between ES and spirometry before and after normalization were compared. Two mixed cohorts, containing data from all scanners and kernels, were created to simulate heterogeneous acquisition parameters. The average difference in ES between kernels decreased for the scans obtained with both scanners after normalization (7.7 ± 2.7 to 0.3 ± 0.7; 7.2 ± 3.8 to -0.1 ± 0.5). Correlation coefficients between ES and FEV1, and FEV1/FVC increased significantly for the mixed cohorts. Normalization of chest CT data reduces variation in emphysema quantification due to reconstruction filters and improves correlation between ES and spirometry. • Emphysema quantification is sensitive to the reconstruction kernel used. • Normalization allows comparison of emphysema quantification from images reconstructed with varying kernels. • Normalization allows comparison of emphysema quantification obtained with scanners from different manufacturers. • Normalization improves correlation of emphysema quantification with spirometry. • Normalization can be used to compare data from different studies and centers.

  4. Emphysema distribution and annual changes in pulmonary function in male patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Tanabe Naoya

    2012-04-01

    Full Text Available Abstract Background The progression of chronic obstructive pulmonary disease (COPD considerably varies among patients. Those with emphysema identified by quantitative computed tomography (CT are associated with the rapid progression assessed by forced expiratory volume in one second (FEV1. However, whether the rate of the decline in lung function is independently affected by the regional distribution or the severity of emphysema in the whole lung is unclear. Methods We followed up 131 male patients with COPD for a median of 3.7 years. We measured wall area percent (WA% in right apical segmental bronchus, total lung volume, percent low attenuation volume (LAV%, and the standard deviation (SD of LAV% values from CT images of 10 isovolumetric partitions (SD-LAV as an index of cranial-caudal emphysema heterogeneity. Annual changes in FEV1 were then determined using a random coefficient model and relative contribution of baseline clinical parameters, pulmonary function, and CT indexes including LAV%, SD-LAV, and WA% to annual changes in FEV1 were examined. Results The mean (SD annual change in FEV1 was −44.4 (10.8 mL. Multivariate random coefficient model showed that higher baseline FEV1, higher LAV%, current smoking, and lower SD-LAV independently contributed to an excessive decline in FEV1, whereas ratio of residual volume to total lung capacity, ratio of diffusing capacity to alveolar ventilation, and WA% did not, after adjusting for age, height, weight, and ratio of CT-measured total lung volume to physiologically-measured total lung capacity. Conclusions A more homogeneous distribution of emphysema contributed to an accelerated decline in FEV1 independently of baseline pulmonary function, whole-lung emphysema severity, and smoking status. In addition to whole-lung analysis of emphysema, CT assessment of the cranial-caudal distribution of emphysema might be useful for predicting rapid, progressive disease and for developing a targeted

  5. Work-related asthma

    African Journals Online (AJOL)

    grain dust, welding fumes and wood dust. (Table III).1 Exposure to animal epithelia, hairs and secretions is commonly reported among laboratory animal workers and agricultural workers. Latex allergy-related asthma appears to be less common due to the introduction of latex-free gloves in most health care settings.

  6. Treating childhood asthma

    African Journals Online (AJOL)

    played by additional factors, such as patient adherence and administration of medication technique. It is always necessary to treat the child as an individual, but some measures apply in all cases. It is important to allay anxiety about the diagnosis. This is best done by carefully explaining the nature and causes of asthma, ...

  7. Asthma Home Environment Checklist

    Science.gov (United States)

    This checklist guides home care visitors in identifying environmental asthma triggers most commonly found in homes. It includes sections on the building, home interior and room interior and provides low-cost action steps for remediation. EPA 402-F-03-030.

  8. School and Asthma

    Science.gov (United States)

    ... or dad to speak to the teacher, school nurse, or principal. Most teachers are glad to help. After all, if you can't breathe, you can't learn! What About Sports? You might think that because you have asthma ...

  9. Asthma and Hispanic Americans

    Science.gov (United States)

    ... to non-Hispanic whites. While all of the causes of asthma remain unclear, children exposed to secondhand tobacco smoke exposure are at increased risk for acute lower respiratory tract infections, such as bronchitis. Children living below or near the poverty level are more likely to have high levels ...

  10. Stress and asthma

    Directory of Open Access Journals (Sweden)

    Shoji Nagata

    1999-01-01

    Full Text Available Three factors in recent medical research and treatment (advances in the field of psychoneuroimmunology, epidemiological evidence regarding important interaction between psychosocial factors and development of disease, and the recognition of the importance of patient education for self-management of asthma have led clinicians and researchers to reconsider the role of psychosocial stress in asthma. There are many reports suggesting that stressful life events, family problems and a behavior pattern that increases psychological conflict may influence the development or relapse of asthma and influence its clinical course. Depression is known as one of the risk factors of fatal asthmatic attack. In laboratory studies, about 20% of asthmatics were considered reactors who showed an airway change after exposure to emotional stress. Studies regarding the pathway of stress effect on allergy and asthma are reviewed and discussed from the standpoint of psychoneuroimmunology; for example, the enhancement of IgE production and increased susceptibility to respiratory infection by stress, conditioned anaphylaxis and nerve/mast cell interaction, the effect of stress on various bronchial responses and the inhibition of the immediate and late asthmatic response by anterior hypothalamic lesioning.

  11. Vascular remodelling in asthma.

    Science.gov (United States)

    Walters, Eugene Haydn; Soltani, Amir; Reid, David William; Ward, Chris

    2008-02-01

    We review the recent literature, focusing on 2006 and 2007, to produce an update on the patho-biology of angiogenesis and vascular endothelial growth factor in the asthmatic airway. In terms of conceptual development in asthma research, airway inflammation and remodelling have been regarded as separate processes or perhaps as sequential, with early inflammation leading later to remodelling. Recent insights identify a central role for vascular endothelial growth factor in stimulating both inflammation and vascular remodelling coincidentally, with the full panoply of vascular endothelial growth factor mediated events being complex and wide. Both nitric oxide and matrix metalloproteinase-9 induction may be important downstream pathogenic mechanisms. Virus-mediated exacerbations are a prime manifestation of the oscillating trajectory of clinical asthma. The early stimulation of vascular endothelial growth factor production is probably a central aetiological mechanism, with secondary inflammation and angiogenesis. The time scale of the latter, especially, fits with the time scale of clinico-physiological changes after exacerbation. These vascular endothelial growth factor induced changes are potentially modifiable with therapy. Insights into the importance of vascular endothelial growth factor and angiogenesis in asthma pathogenesis now lead to potential new therapeutic possibilities and elucidate why recent advances in asthma therapeutics have been so successful.

  12. Decreasing asthma morbidity

    African Journals Online (AJOL)

    1994-12-12

    Dec 12, 1994 ... Apart from the optimal use of drugs, various supplementary methods have been tested to decrease asthma morbidity, usually in patients from reiatively affluent socio-economic backgrounds. A study of additional measures taken in a group of moderate to severe adult asthmatics from very poor socio- ...

  13. Allergy, asthma and the environment; Allergie, Asthma und Umwelt

    Energy Technology Data Exchange (ETDEWEB)

    Ring, J. [Klinik und Poliklinik fuer Dermatologie und Allergologie am Biederstein, Technische Univ. Muenchen (Germany); Gfesser, M. [Klinik und Poliklinik fuer Dermatologie und Allergologie am Biederstein, Technische Univ. Muenchen (Germany)

    1996-10-11

    Asthma is a chronic inflammatory disease of the airways. Asthma and other allergic diseases have increased in prevalence during the last decades in many industrialized countries. Among other hypotheses, the possible role of environmental pollutants has received much public and scientific attention. Some pollutants may modulate the different phases of allergic reactions. Inflammation is a critical feature in the pathogenesis of asthma and therefore, beside allergen avoidance, anti-inflammatory treatment is the first line therapy of asthma. Cysteinyl-leukotrienes are lipid mediators which appear to play a major role in the pathophysiology of asthma. Based on current data, it appears that leukotrience receptor antagonists have bronchodilative and anti-inflammatory effects and may therefore enrich the pharmacotherapeutic spectrum within the therapeutic concept of patient management in asthma. (orig.) [Deutsch] Asthma bronchiale ist eine entzuendliche Erkrankung der Atemwege. Epidemiologische Studien konnten eine deutliche Zunahme der Erkrankung in den letzten zwei Jahrzehnten aufzeigen. In der Entstehung von Allergien und Asthma bronchiale spielen Umwelteinfluesse eine grosse Rolle. Luftschadstoffe scheinen mit verschiedenen Allergie-Parametern bei der Sensibilisierung, Symptombildung und Chronifizierung zu interferieren. Da beim Asthma bronchiale neben der Bronchokonstriktion die Entzuendung der Bronchialschleimhaut eine besondere Rolle spielt, wird heute neben Allergenkarenz und prophylaktischen Massnahmen eine fruehzeitige antientzuendliche Asthmatherapie angestrebt. Cysteinyl-Leukotriene gehoeren zu den wirksamsten Entzuendungsmediatoren beim Asthma bronchiale. Leukotrien-Rezeptorantagonisten scheinen sowohl bronchodilatatorische als auch antientzuendliche Wirkungen zu haben und koennten so innerhalb eines Gesamtkonzeptes von antiallergischer und antiasthmatischer Therapie das pharmakotherapeutische Spektrum bereichern. (orig.)

  14. Redox homeostasis and cellular stress response in aging and neurodegeneration.

    Science.gov (United States)

    Calabrese, Vittorio; Cornelius, Carolin; Mancuso, Cesare; Lentile, Riccardo; Stella, A M Giuffrida; Butterfield, D Allan

    2010-01-01

    Decreased expression and/or activity of antioxidant proteins leads to oxidative stress, accelerated aging, and neurodegeneration. While overwhelming levels and uncontrolled/dysregulated actions of reactive oxygen species (ROS) lead to deleterious effects, tighter regulation of those plays an important role in cell signaling. Mutations causing protein misfolding and the overload of toxic products derived from the free radical oxidation of polyunsaturated fatty acids, cholesterol, and glucose contribute to the disruption of the cellular redox homeostasis. Collectively or individually, these effects create pro-oxidant conditions in cells. Oxidative stress can induce neuronal damage, modulate intracellular signaling, and can ultimately lead to neuronal death by apoptosis or necrosis. Emerging evidence indicates that homocysteine (Hcy), a non-protein amino acid naturally present in the plasma, is implicated as a risk factor for numerous diseases. In particular, increased levels of circulating Hcy have been recognized as an independent risk factor for the development of vascular disease(s). Recent findings emphasize a relationship between elevated Hcy levels and neurodegeneration, which can be observed in Alzheimer's and Parkinson's diseases. An integrated response exists in the brain to detect and control diverse forms of stress. This is accomplished by a complex network of the so-called longevity assurance processes, which are controlled by several genes termed "vitagenes." Among these, the heat-shock proteins (HSPs) form a highly conserved system that is responsible for the preservation and repair of the correct protein conformation. Recent studies have shown that the heat-shock response (HSR) contributes to cytoprotection in a number of human diseases including inflammation, cancer, aging, and neurodegenerative disorders. Given the broad cytoprotective properties of the HSR, interest mounts currently among investigators toward discovering and developing

  15. Physical training for asthma

    Directory of Open Access Journals (Sweden)

    Kristin V. Carson

    Full Text Available BACKGROUND: People with asthma may show less tolerance to exercise due to worsening asthma symptoms during exercise or other reasons such as deconditioning as a consequence of inactivity. Some may restrict activities as per medical advice or family influence and this might result in reduced physical fitness. Physical training programs aim to improve physical fitness, neuromuscular coordination and self confidence. Subjectively, many people with asthma report that they are symptomatically better when fit, but results from trials have varied and have been difficult to compare because of different designs and training protocols. Also, as exercise can induce asthma, the safety of exercise programmes needs to be considered.OBJECTIVE: To gain a better understanding of the effect of physical training on the respiratory and general health of people with asthma, from randomised trials.METHODS:Search methods: We searched the Cochrane Airways Group Specialised Register of trials up to January 2013. Selection criteria: We included randomised trials of people over eight years of age with asthma who were randomised to undertake physical training or not. Physical training had to be undertaken for at least 20 minutes, two times a week, over a minimum period of four weeks. Data collection and analysis:Two review authors independently assessed eligibility for inclusion and undertook risk of bias assessment for the included studies.MAIN RESULTS: Twenty-one studies (772 participants were included in this review with two additional 2012 studies identified as 'awaiting classification'. Physical training was well tolerated with no adverse effects reported. None of the studies mentioned worsening of asthma symptoms following physical training. Physical training showed marked improvement in cardiopulmonary fitness as measured by a statistically and clinically significant increase in maximum oxygen uptake (mean difference (MD 4.92 mL/kg/min; 95% confidence interval (CI 3

  16. Understanding mild persistent asthma in children

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Szefler, Stanley J

    2005-01-01

    Limitations in asthma prevalence studies and difficulties in diagnosing pediatric asthma lead to uncertainty over the full extent of mild persistent asthma in children and adolescents. Although recent surveys have reported that the majority of pediatric patients with asthma in the United States...... and Europe have symptoms consistent with mild disease, these surveys have limitations in design. Thus, the true prevalence of mild asthma remains unknown. It is unclear whether children with mild persistent asthma progress to more severe asthma, but the risk of severe asthma exacerbations seems...... into the true prevalence of mild persistent asthma in children and adolescents, and optimal treatment....

  17. Endothelial Microparticles in Mild Chronic Obstructive Pulmonary Disease and Emphysema. The Multi-Ethnic Study of Atherosclerosis Chronic Obstructive Pulmonary Disease Study

    OpenAIRE

    Thomashow, Michael A.; Shimbo, Daichi; Parikh, Megha A.; Hoffman, Eric A.; Vogel-Claussen, Jens; Hueper, Katja; Fu, Jessie; Liu, Chia-Ying; Bluemke, David A.; Ventetuolo, Corey E.; Doyle, Margaret F.; Barr, R. Graham

    2013-01-01

    Rationale: Basic research implicates alveolar endothelial cell apoptosis in the pathogenesis of chronic obstructive pulmonary disease (COPD) and emphysema. However, information on endothelial microparticles (EMPs) in mild COPD and emphysema is lacking.

  18. Asthma outcomes: Biomarkers

    Science.gov (United States)

    Szefler, Stanley J.; Wenzel, Sally; Brown, Robert; Erzurum, Serpil C.; Fahy, John V.; Hamilton, Robert G.; Hunt, John F.; Kita, Hirohito; Liu, Andrew H.; Panettieri, Reynold A.; Schleimer, Robert P.; Minnicozzi, Michael

    2012-01-01

    Background Measurement of biomarkers has been incorporated within clinical research studies of asthma to characterize the population and associate the disease with environmental and therapeutic effects. Objective National Institutes of Health institutes and federal agencies convened an expert group to propose which biomarkers should be assessed as standardized asthma outcomes in future clinical research studies. Methods We conducted a comprehensive search of the literature to identify studies that developed and/or tested asthma biomarkers. We identified biomarkers relevant to the underlying disease process progression and response to treatment. We classified the biomarkers as either core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at an National Institutes of Health–organized workshop convened in March 2010 and finalized in September 2011. Results Ten measures were identified; only 1, multiallergen screening to define atopy, is recommended as a core asthma outcome. Complete blood counts to measure total eosinophils, fractional exhaled nitric oxide (Feno), sputum eosinophils, urinary leukotrienes, and total and allergen-specific IgE are recommended as supplemental measures. Measurement of sputum polymorphonuclear leukocytes and other analytes, cortisol measures, airway imaging, breath markers, and system-wide studies (eg, genomics, proteomics) are considered as emerging outcome measures. Conclusion The working group participants propose the use of multiallergen screening in all asthma clinical trials to characterize study populations with respect to atopic status. Blood, sputum, and urine specimens should be stored in biobanks, and standard procedures should be developed to harmonize sample collection for clinical trial biorepositories. PMID:22386512

  19. Active relearning for robust supervised classification of pulmonary emphysema

    Science.gov (United States)

    Raghunath, Sushravya; Rajagopalan, Srinivasan; Karwoski, Ronald A.; Bartholmai, Brian J.; Robb, Richard A.

    2012-03-01

    Radiologists are adept at recognizing the appearance of lung parenchymal abnormalities in CT scans. However, the inconsistent differential diagnosis, due to subjective aggregation, mandates supervised classification. Towards optimizing Emphysema classification, we introduce a physician-in-the-loop feedback approach in order to minimize uncertainty in the selected training samples. Using multi-view inductive learning with the training samples, an ensemble of Support Vector Machine (SVM) models, each based on a specific pair-wise dissimilarity metric, was constructed in less than six seconds. In the active relearning phase, the ensemble-expert label conflicts were resolved by an expert. This just-in-time feedback with unoptimized SVMs yielded 15% increase in classification accuracy and 25% reduction in the number of support vectors. The generality of relearning was assessed in the optimized parameter space of six different classifiers across seven dissimilarity metrics. The resultant average accuracy improved to 21%. The co-operative feedback method proposed here could enhance both diagnostic and staging throughput efficiency in chest radiology practice.

  20. Subcutaneous Emphysema, Pneumomediastinum, and Pneumorrhachis after Cocaine Inhalation

    Directory of Open Access Journals (Sweden)

    Tuğba Atmaca Temrel

    2015-01-01

    Full Text Available Introduction. The most prominent complications of cocaine use are adverse effects in the cardiovascular and central nervous systems. Free air in the mediastinum and subcutaneous tissue may be observed less frequently, whereas free air in the spinal canal (pneumorrhachis is a very rare complication of cocaine abuse. In this report we present a case of pneumorrhachis that developed after cocaine use. Case. A 28-year-old male patient was admitted to the emergency department with shortness of breath, chest pain, and swelling in the neck and face which started four hours after he had sniffed cocaine. On physical examination, subcutaneous crepitations were felt with palpation of the jaw, neck, and upper chest area. Diffuse subcutaneous emphysema, pneumomediastinum, and pneumorrhachis were detected in the computed tomography imaging. The patient was treated conservatively and discharged uneventfully. Discussion. Complications such as pneumothorax, pneumomediastinum, and pneumoperitoneum that are associated with cocaine use may be seen due to increased intrathoracic pressure. The air then may flow into the spinal canal resulting in pneumorrhachis. Emergency physicians should know the possible complications of cocaine use and be prepared for rare complications such as pneumorrhachis.

  1. Mast cell-nerve interactions in asthma

    NARCIS (Netherlands)

    Kleij, Hanneke Paulina Maria van der

    2002-01-01

    Asthma is characterized by a chronic inflammatory reaction in the airways. Roughly, asthma can be subdivided into atopic asthma involving elevated levels of serum IgE and a less familiar form, non-atopic asthma. Non-atopic asthma is an increasing problem in the developed world. The mechanisms

  2. Do Written Asthma Action Plans Improve Outcomes?

    Science.gov (United States)

    Kelso, John M

    2016-03-01

    With appropriate management, children with asthma should expect few symptoms, no limits on activity, rare exacerbations, and normal lung function. Appropriate education of parents and other caregivers of children with asthma has clearly been shown to help achieve these goals. Although recommended in asthma guidelines, providing written asthma action plans does not improve outcomes beyond asthma education alone.

  3. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... 1 MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health Know How to Use Your Asthma Inhaler Recommend ... 1 MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health File Formats Help: How do I view different ...

  4. An autopsy study of combined pulmonary fibrosis and emphysema: correlations among clinical, radiological, and pathological features

    Science.gov (United States)

    2014-01-01

    Background Clinical evaluation to differentiate the characteristic features of pulmonary fibrosis and emphysema is often difficult in patients with combined pulmonary fibrosis and emphysema (CPFE), but diagnosis of pulmonary fibrosis is important for evaluating treatment options and the risk of acute exacerbation of interstitial pneumonia of such patients. As far as we know, it is the first report describing a correlation among clinical, radiological, and whole-lung pathological features in an autopsy cases of CPFE patients. Methods Experts retrospectively reviewed the clinical charts and examined chest computed tomography (CT) images and pathological findings of an autopsy series of 22 CPFE patients, and compared these with findings from 8 idiopathic pulmonary fibrosis (IPF) patients and 17 emphysema-alone patients. Results All patients had a history of heavy smoking. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC%) was significantly lower in the emphysema-alone group than the CPFE and IPF-alone groups. The percent predicted diffusing capacity of the lung for carbon monoxide (DLCO%) was significantly lower in the CPFE group than the IPF- and emphysema-alone groups. Usual interstitial pneumonia (UIP) pattern was observed radiologically in 15 (68.2%) CPFE and 8 (100%) IPF-alone patients and was pathologically observed in all patients from both groups. Pathologically thick-cystic lesions involving one or more acini with dense wall fibrosis and occasional fibroblastic foci surrounded by honeycombing and normal alveoli were confirmed by post-mortem observation as thick-walled cystic lesions (TWCLs). Emphysematous destruction and enlargement of membranous and respiratory bronchioles with fibrosis were observed in the TWCLs. The cystic lesions were always larger than the cysts of honeycombing. The prevalence of both radiological and pathological TWCLs was 72.7% among CPFE patients, but no such lesions were observed in patients with IPF or emphysema

  5. Association of incidental emphysema with annual lung function decline and future development of airflow limitation

    Directory of Open Access Journals (Sweden)

    Koo HK

    2016-01-01

    Full Text Available Hyeon-Kyoung Koo,1 Kwang Nam Jin,2 Deog Kyeom Kim,3 Hee Soon Chung,3 Chang-Hoon Lee3,4 1Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, College of Medicine, Ilsan Paik Hospital, Inje University, Goyang-si, Gyeonggi-Do, 2Department of Radiology, Seoul Metropolitan Government – Seoul National University Boramae Medical Center, 3Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 4Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea Objectives: Emphysema is one of the prognostic factors for rapid lung function decline in patients with COPD, but the impact of incidentally detected emphysema on population without spirometric abnormalities has not been evaluated. This study aimed to determine whether emphysema detected upon computed tomography (CT screening would accelerate the rate of lung function decline and influence the possibility of future development of airflow limitation in a population without spirometric abnormalities.Materials and methods: Subjects who participated in a routine screening for health checkup and follow-up pulmonary function tests for at least 3 years between 2004 and 2010 were retrospectively enrolled. The percentage of low-attenuation area below −950 Hounsfield units (%LAA−950 was calculated automatically. A calculated value of %LAA−950 that exceeded 10% was defined as emphysema. Adjusted annual lung function decline was analyzed using random-slope, random-intercept mixed linear regression models.Results: A total of 628 healthy subjects within the normal range of spriometric values were included. Multivariable analysis showed that the emphysema group exhibited a faster decline in forced vital capacity (−33.9 versus −18.8

  6. Emphysema and bronchiectasis in COPD patients with previous pulmonary tuberculosis: computed tomography features and clinical implications

    Directory of Open Access Journals (Sweden)

    Jin J

    2018-01-01

    Full Text Available Jianmin Jin,1 Shuling Li,2 Wenling Yu,2 Xiaofang Liu,1 Yongchang Sun1,3 1Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 2Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 3Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China Background: Pulmonary tuberculosis (PTB is a risk factor for COPD, but the clinical characteristics and the chest imaging features (emphysema and bronchiectasis of COPD with previous PTB have not been studied well.Methods: The presence, distribution, and severity of emphysema and bronchiectasis in COPD patients with and without previous PTB were evaluated by high-resolution computed tomography (HRCT and compared. Demographic data, respiratory symptoms, lung function, and sputum culture of Pseudomonas aeruginosa were also compared between patients with and without previous PTB.Results: A total of 231 COPD patients (82.2% ex- or current smokers, 67.5% male were consecutively enrolled. Patients with previous PTB (45.0% had more severe (p=0.045 and longer history (p=0.008 of dyspnea, more exacerbations in the previous year (p=0.011, and more positive culture of P. aeruginosa (p=0.001, compared with those without PTB. Patients with previous PTB showed a higher prevalence of bronchiectasis (p<0.001, which was more significant in lungs with tuberculosis (TB lesions, and a higher percentage of more severe bronchiectasis (Bhalla score ≥2, p=0.031, compared with those without previous PTB. The overall prevalence of emphysema was not different between patients with and without previous PTB, but in those with previous PTB, a higher number of subjects with middle (p=0.001 and lower (p=0.019 lobe emphysema, higher severity score (p=0.028, higher prevalence of panlobular emphysema (p=0.013, and more extensive centrilobular emphysema (p=0.039 were observed. Notably, in patients with

  7. Nitric oxide mediates glial-induced neurodegeneration in Alexander disease.

    Science.gov (United States)

    Wang, Liqun; Hagemann, Tracy L; Kalwa, Hermann; Michel, Thomas; Messing, Albee; Feany, Mel B

    2015-11-26

    Glia play critical roles in maintaining the structure and function of the nervous system; however, the specific contribution that astroglia make to neurodegeneration in human disease states remains largely undefined. Here we use Alexander disease, a serious degenerative neurological disorder caused by astrocyte dysfunction, to identify glial-derived NO as a signalling molecule triggering astrocyte-mediated neuronal degeneration. We further find that NO acts through cGMP signalling in neurons to promote cell death. Glial cells themselves also degenerate, via the DNA damage response and p53. Our findings thus define a specific mechanism for glial-induced non-cell autonomous neuronal cell death, and identify a potential therapeutic target for reducing cellular toxicity in Alexander disease, and possibly other neurodegenerative disorders with glial dysfunction.

  8. Deep Brain Stimulation for Pantothenate Kinase-Associated Neurodegeneration

    Directory of Open Access Journals (Sweden)

    Pedro J. Garcia-Ruiz

    2015-01-01

    Full Text Available Pantothenate kinase-associated neurodegeneration (PKAN is usually associated with dystonia, which is typically severe and progressive over time. Pallidal stimulation (GPi DBS has been carried out in selected cases of PKAN with drug-resistant dystonia with variable results. We report a 30-month follow-up study of a 30-year-old woman with PKAN-related dystonia treated with GPi DBS. Postoperatively, the benefit quickly became evident, as the patient exhibited a marked improvement in her dystonia, including her writing difficulty. This result has been maintained up to the present. GPi DBS should be considered in dystonic PKAN patients provided fixed contractures and/or pyramidal symptoms are not present.

  9. SDHAF4 promotes mitochondrial succinate dehydrogenase activity and prevents neurodegeneration

    Science.gov (United States)

    Van Vranken, Jonathan G.; Bricker, Daniel K.; Dephoure, Noah; Gygi, Steven P.; Cox, James E.; Thummel, Carl S.; Rutter, Jared

    2014-01-01

    SUMMARY Succinate dehydrogenase (SDH) occupies a central place in cellular energy production, linking the tricarboxylic cycle with the electron transport chain. As a result, a subset of cancers and neuromuscular disorders result from mutations affecting any of the four SDH structural subunits or either of two known SDH assembly factors. Herein we characterize a novel evolutionarily conserved SDH assembly factor designated Sdh8/SDHAF4, using yeast, Drosophila, and mammalian cells. Sdh8 interacts specifically with the catalytic Sdh1 subunit in the mitochondrial matrix, facilitating its association with Sdh2 and the subsequent assembly of the SDH holocomplex. These roles for Sdh8 are critical for preventing motility defects and neurodegeneration in Drosophila as well as the excess ROS generated by free Sdh1. These studies provide insights into the mechanisms by which SDH is assembled and raise the possibility that some forms of neuromuscular disease may be associated with mutations that affect this SDH assembly factor. PMID:24954416

  10. Age-Related Neurodegeneration and Memory Loss in Down Syndrome

    Directory of Open Access Journals (Sweden)

    Jason P. Lockrow

    2012-01-01

    Full Text Available Down syndrome (DS is a condition where a complete or segmental chromosome 21 trisomy causes variable intellectual disability, and progressive memory loss and neurodegeneration with age. Many research groups have examined development of the brain in DS individuals, but studies on age-related changes should also be considered, with the increased lifespan observed in DS. DS leads to pathological hallmarks of Alzheimer's disease (AD by 40 or 50 years of age. Progressive age-related memory deficits occurring in both AD and in DS have been connected to degeneration of several neuronal populations, but mechanisms are not fully elucidated. Inflammation and oxidative stress are early events in DS pathology, and focusing on these pathways may lead to development of successful intervention strategies for AD associated with DS. Here we discuss recent findings and potential treatment avenues regarding development of AD neuropathology and memory loss in DS.

  11. Tryptophan, Neurodegeneration and HIV-Associated Neurocognitive Disorder

    Directory of Open Access Journals (Sweden)

    Nicholas W.S. Davies

    2010-06-01

    Full Text Available This review presents an up-to-date assessment of the role of the tryptophan metabolic and catabolic pathways in neurodegenerative disease and HIV-associated neurocognitive disorder. The kynurenine pathway and the effects of each of its enzymes and products are reviewed. The differential expression of the kynurenine pathway in cells within the brain, including inflammatory cells, is explored given the increasing recognition of the importance of inflammation in neurodegenerative disease. An overview of common mechanisms of neurodegeneration is presented before a review and discussion of the evidence for a pathogenetic role of the kynurenine pathway in Alzheimer’s disease, HIV-associated neurocognitive disorder, Huntington’s disease, motor neurone disease, and Parkinson’s disease.

  12. Tryptophan, Neurodegeneration and HIV-Associated Neurocognitive Disorder

    Directory of Open Access Journals (Sweden)

    Nicholas W.S. Davies

    2010-01-01

    Full Text Available This review presents an up-to-date assessment of the role of the tryptophan metabolic and catabolic pathways in neurodegenerative disease and HIV-associated neurocognitive disorder. The kynurenine pathway and the effects of each of its enzymes and products are reviewed. The differential expression of the kynurenine pathway in cells within the brain, including inflammatory cells, is explored given the increasing recognition of the importance of inflammation in neurodegenerative disease. An overview of common mechanisms of neurodegeneration is presented before a review and discussion of the evidence for a pathogenetic role of the kynurenine pathway in Alzheimer's disease, HIV-associated neurocognitive disorder, Huntington's disease, motor neurone disease, and Parkinson's disease.

  13. Autophagy and Neurodegeneration: Pathogenic Mechanisms and Therapeutic Opportunities.

    Science.gov (United States)

    Menzies, Fiona M; Fleming, Angeleen; Caricasole, Andrea; Bento, Carla F; Andrews, Stephen P; Ashkenazi, Avraham; Füllgrabe, Jens; Jackson, Anne; Jimenez Sanchez, Maria; Karabiyik, Cansu; Licitra, Floriana; Lopez Ramirez, Ana; Pavel, Mariana; Puri, Claudia; Renna, Maurizio; Ricketts, Thomas; Schlotawa, Lars; Vicinanza, Mariella; Won, Hyeran; Zhu, Ye; Skidmore, John; Rubinsztein, David C

    2017-03-08

    Autophagy is a conserved pathway that delivers cytoplasmic contents to the lysosome for degradation. Here we consider its roles in neuronal health and disease. We review evidence from mouse knockout studies demonstrating the normal functions of autophagy as a protective factor against neurodegeneration associated with intracytoplasmic aggregate-prone protein accumulation as well as other roles, including in neuronal stem cell differentiation. We then describe how autophagy may be affected in a range of neurodegenerative diseases. Finally, we describe how autophagy upregulation may be a therapeutic strategy in a wide range of neurodegenerative conditions and consider possible pathways and druggable targets that may be suitable for this objective. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Self-Mutilation in Neurodegeneration with Brain Iron Accumulation.

    Science.gov (United States)

    Chandra, Sadanandavalli Retnaswami; Raj, Pawan; Issac, Thomas Gregor

    2015-01-01

    Neurodegeneration with brain iron accumulation (NBIA) is the term applied to a heterogeneous group of disorders resulting in iron deposition in the basal ganglia. Well-known phenotypic features are progressive regression with extra pyramidal involvement and a variable course. A 10-year-old child born to consanguineous parents presented with progressive generalized opisthotonic dystonia, retrocollis, oromandibular dyskinesias, apraxia for swallowing, optic atrophy and severe self-mutilation of lips. MR imaging showed brain iron accumulation. Other causes of self-mutilation were excluded. Early infantile onset, ophisthotonic dystonia with oromandibular dyskinesias and characteristic MR images are suggestive of NBIA. There is only one case reported in the literature of self-mutilation in this condition.

  15. Self-mutilation in neurodegeneration with brain iron accumulation

    Directory of Open Access Journals (Sweden)

    Sadanandavalli Retnaswami Chandra

    2015-01-01

    Full Text Available Neurodegeneration with brain iron accumulation (NBIA is the term applied to a heterogeneous group of disorders resulting in iron deposition in the basal ganglia. Well-known phenotypic features are progressive regression with extra pyramidal involvement and a variable course. A 10-year-old child born to consanguineous parents presented with progressive generalized opisthotonic dystonia, retrocollis, oromandibular dyskinesias, apraxia for swallowing, optic atrophy and severe self-mutilation of lips. MR imaging showed brain iron accumulation. Other causes of self-mutilation were excluded. Early infantile onset, ophisthotonic dystonia with oromandibular dyskinesias and characteristic MR images are suggestive of NBIA. There is only one case reported in the literature of self-mutilation in this condition.

  16. Implications of mitochondrial dynamics on neurodegeneration and on hypothalamic dysfunction

    Directory of Open Access Journals (Sweden)

    Antonio eZorzano

    2015-06-01

    Full Text Available Mitochondrial dynamics is a term that encompasses the movement of mitochondria along the cytoskeleton, regulation of their architecture, and connectivity mediated by tethering and fusion/fission. The importance of these events in cell physiology and pathology has been partially unraveled with the identification of the genes responsible for the catalysis of mitochondrial fusion and fission. Mutations in two mitochondrial fusion genes (MFN2 and OPA1 cause neurodegenerative diseases, namely Charcot-Marie Tooth type 2A and autosomal dominant optic atrophy. Alterations in mitochondrial dynamics may be involved in the pathophysiology of prevalent neurodegenerative conditions. Moreover, impairment of the activity of mitochondrial fusion proteins dysregulates the function of hypothalamic neurons, leading to alterations in food intake and in energy homeostasis. Here we review selected findings in the field of mitochondrial dynamics and their relevance for neurodegeneration and hypothalamic dysfunction.

  17. Detecting airway remodeling in COPD and emphysema using low-dose CT imaging

    Science.gov (United States)

    Rudyanto, R.; Ceresa, M.; Muñoz-Barrutia, A.; Ortiz-de-Solorzano, C.

    2012-03-01

    In this study, we quantitatively characterize lung airway remodeling caused by smoking-related emphysema and Chronic Obstructive Pulmonary Disease (COPD), in low-dose CT scans. To that end, we established three groups of individuals: subjects with COPD (n=35), subjects with emphysema (n=38) and healthy smokers (n=28). All individuals underwent a low-dose CT scan, and the images were analyzed as described next. First the lung airways were segmented using a fast marching method and labeled according to its generation. Along each airway segment, cross-section images were resampled orthogonal to the airway axis. Next 128 rays were cast from the center of the airway lumen in each crosssection slice. Finally, we used an integral-based method, to measure lumen radius, wall thickness, mean wall percentage and mean peak wall attenuation on every cast ray. Our analysis shows that both the mean global wall thickness and the lumen radius of the airways of both COPD and emphysema groups were significantly different from those of the healthy group. In addition, the wall thickness change starts at the 3rd airway generation in the COPD patients compared with emphysema patients, who display the first significant changes starting in the 2nd generation. In conclusion, it is shown that airway remodeling happens in individuals suffering from either COPD or emphysema, with some local difference between both groups, and that we are able to detect and accurately quantify this process using images of low-dose CT scans.

  18. Pulmonary emphysema classification based on an improved texton learning model by sparse representation

    Science.gov (United States)

    Zhang, Min; Zhou, Xiangrong; Goshima, Satoshi; Chen, Huayue; Muramatsu, Chisako; Hara, Takeshi; Yokoyama, Ryujiro; Kanematsu, Masayuki; Fujita, Hiroshi

    2013-03-01

    In this paper, we present a texture classification method based on texton learned via sparse representation (SR) with new feature histogram maps in the classification of emphysema. First, an overcomplete dictionary of textons is learned via KSVD learning on every class image patches in the training dataset. In this stage, high-pass filter is introduced to exclude patches in smooth area to speed up the dictionary learning process. Second, 3D joint-SR coefficients and intensity histograms of the test images are used for characterizing regions of interest (ROIs) instead of conventional feature histograms constructed from SR coefficients of the test images over the dictionary. Classification is then performed using a classifier with distance as a histogram dissimilarity measure. Four hundreds and seventy annotated ROIs extracted from 14 test subjects, including 6 paraseptal emphysema (PSE) subjects, 5 centrilobular emphysema (CLE) subjects and 3 panlobular emphysema (PLE) subjects, are used to evaluate the effectiveness and robustness of the proposed method. The proposed method is tested on 167 PSE, 240 CLE and 63 PLE ROIs consisting of mild, moderate and severe pulmonary emphysema. The accuracy of the proposed system is around 74%, 88% and 89% for PSE, CLE and PLE, respectively.

  19. Pulmonary Emphysema in Cystic Fibrosis Detected by Densitometry on Chest Multidetector Computed Tomography

    Science.gov (United States)

    Wielpütz, Mark O.; Weinheimer, Oliver; Eichinger, Monika; Wiebel, Matthias; Biederer, Jürgen; Kauczor, Hans-Ulrich; Heußel, Claus P.

    2013-01-01

    Background Histopathological studies on lung specimens from patients with cystic fibrosis (CF) and recent results from a mouse model indicate that emphysema may contribute to CF lung disease. However, little is known about the relevance of emphysema in patients with CF. In the present study, we used computationally generated density masks based on multidetector computed tomography (MDCT) of the chest for non-invasive characterization and quantification of emphysema in CF. Methods Volumetric MDCT scans were acquired in parallel to pulmonary function testing in 41 patients with CF (median age 20.1 years; range 7-66 years) and 21 non-CF controls (median age 30.4 years; range 4-68 years), and subjected to dedicated software. The lung was segmented, low attenuation volumes below a threshold of -950 Hounsfield units were assigned to emphysema volume (EV), and the emphysema index was computed (EI). Results were correlated with forced expiratory volume in 1 s percent predicted (FEV1%), residual volume (RV), and RV/total lung capacity (RV/TLC). Results We show that EV was increased in CF (457±530 ml) compared to non-CF controls (78±90 ml) (PEmphysema in CF was detected from early adolescence (~13 years) and increased with age (rs=0.67, Pemphysema detected by densitometry on chest MDCT is a characteristic pathology that contributes to airflow limitation and may serve as a novel endpoint for monitoring lung disease in CF. PMID:23991177

  20. Impact of iterative reconstructions on objective and subjective emphysema assessment with computed tomography: a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Steve P.; Gariani, Joanna; Hachulla, Anne-Lise; Botsikas, Diomidis; Becker, Christoph D.; Montet, Xavier [Geneva University Hospitals, Division of Radiology, Department of Imaging and Medical Information Sciences, Geneva (Switzerland); Adler, Dan [Geneva University Hospitals, Division of Pneumology, Department of Internal Medicine, Geneva (Switzerland); Karenovics, Wolfram [Geneva University Hospitals, Division of Thoracic Surgery, Department of Surgery, Geneva (Switzerland)

    2017-07-15

    To prospectively evaluate the impact of iterative reconstruction (IR) algorithms on pulmonary emphysema assessment as compared to filtered back projection (FBP). One hundred ten unenhanced chest CT examinations were obtained on two different scanners. Image reconstructions from a single acquisition were done with different levels of IR and compared with FBP on the basis of the emphysema index (EI), lung volume and voxel densities. Objective emphysema assessment was performed with 3D software provided by each manufacturer. Subjective assessment of emphysema was performed as a blinded evaluation. Quantitative and subjective values were compared using repeated ANOVA analysis, Bland-Altman analysis and Kendall's coefficient of concordance (W). Lung volumes are stable on both units, throughout all IR levels (P ≥ 0.057). EI significantly decreases on both units with the use of any level of IR (P < 0.001). The highest levels of IR are responsible for a decrease of 33-36 % of EI. Significant differences in minimal lung density are found between the different algorithms (P < 0.003). Intra- and inter-reader concordance for emphysema characterisation is generally good (W ≥ 0.77 and W ≥ 0.86, respectively). Both commercially available IR algorithms used in this study significantly changed EI but did not alter visual assessment compared to standard FBP reconstruction at identical radiation exposure. (orig.)

  1. Emphysema on Thoracic CT and Exercise Ventilatory Inefficiency in Mild-to-Moderate COPD.

    Science.gov (United States)

    Jones, Joshua H; Zelt, Joel T; Hirai, Daniel M; Diniz, Camilla V; Zaza, Aida; O'Donnell, Denis E; Neder, J Alberto

    2017-04-01

    There is growing evidence that emphysema on thoracic computed tomography (CT) is associated with poor exercise tolerance in COPD patients with only mild-to-moderate airflow obstruction. We hypothesized that an excessive ventilatory response to exercise (ventilatory inefficiency) would underlie these abnormalities. In a prospective study, 19 patients (FEV1 = 82 ± 13%, 12 Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1) and 26 controls underwent an incremental exercise test. Ventilatory inefficiency was assessed by the ventilation ([Formula: see text]E)/CO2 output ([Formula: see text]CO2) nadir. Pulmonary blood flow (PBF) in a submaximal test was calculated by inert gas rebreathing. Emphysema was quantified as % of attenuation areas below 950 HU. Patients typically presented with centrilobular emphysema (76.8 ± 10.1% of total emphysema) in the upper lobes (upper/total lung ratio = 0.82 ± 0.04). They had lower peak oxygen uptake ([Formula: see text]O2), higher [Formula: see text]E/[Formula: see text]CO2 nadir, and greater dyspnea scores than controls (p exercise (p exercise (r = -0.69) (p exercise ventilatory efficiency in mild-to-moderate COPD. Exercise ventilatory inefficiency links structure (emphysema) and function (DLCO) to a key clinical outcome (poor exercise tolerance) in COPD patients with only modest spirometric abnormalities.

  2. Mechanisms of obesity in asthma.

    Science.gov (United States)

    Rasmussen, Finn; Hancox, Robert J

    2014-02-01

    Obesity and asthma are chronic conditions affecting millions of people worldwide. The two conditions also appear to be linked with an increased risk of asthma in people who are obese. The purpose of this review is to describe mechanism(s) that may explain the association between asthma and obesity. Current evidence suggests that the association between asthma and obesity is linked by two major phenotypes and three important pathways of obesity-related asthma: one phenotype with primary (often atopic) asthma that is aggravated by obesity and a second phenotype with late-onset nonatopic asthma, which predominantly affects women and primarily seems to be associated with neutrophilic inflammation. Proposed pathways include the mechanical effects of obesity (fewer deep inspirations leading to increased airway hyperresponsiveness), an inflammatory pathway driven by obesity-related cytokines (adipokines), and finally environment and lifestyle changes that have led to an increasing prevalence of obesity over the past 50 years (including exposures in utero, physical activity, and diet) may also result in asthma in predisposed individuals. How these environmental changes influence the occurrence and expression of asthma may depend on the age of exposure and on interactions with genetic susceptibilities. Future research should be directed to shed light on the associations between obesity and asthma phenotypes, modern lifestyles and environmental exposures and genetic susceptibilities. http://links.lww.com/COAI/A6.

  3. Children with Asthma and Sports

    Directory of Open Access Journals (Sweden)

    Selda Yuzer

    2014-06-01

    Full Text Available Asthma is one of the chronic diseases which have are widely seen among the children. The disease has recently been in the increase all over the world and affects many children. In a study conducted with International Study of Asthma and Allergies in Childhood (ISAAC method, it was found out that prevalence of childhood asthma was 17.1%. Participation in sportive activities by the children with asthma, which is today considered as a part of asthma treatment program, makes contributions to their physical, mental and psychological development and increases their quality of life. The most recommended sports for the children with asthma are swimming and water sports. Sports like tennis and volleyball are too advised. Choice of sports depends on severity of asthma, child and #8217;s choice and whether or not asthma is kept under control. Nursing approaches for the children with asthma include correction of symptoms, training of children and their families, assistance with disease adaptation, continuing asthma care at home and interventions to make children lead healthy activities of daily life of children. With protective measures to be taken by families and children; children should be encourage for sportive activities. [TAF Prev Med Bull 2014; 13(3.000: 241-244

  4. Rhinoviruses, Allergic Inflammation, and Asthma

    Science.gov (United States)

    Gavala, Monica; Bertics, Paul J.; Gern, James E.

    2011-01-01

    Summary Viral infections affect wheezing and asthma in children and adults of all ages. In infancy, wheezing illnesses are usually viral in origin, and children with more severe wheezing episodes are more likely to develop recurrent episodes of asthma and to develop asthma later in childhood. Children who develop allergen-specific immunoglobulin E (allergic sensitization), and those who wheeze with rhinoviruses (HRV) are at especially high risk for asthma. In older children and adults, HRV infections generally cause relatively mild respiratory illnesses and yet contribute to acute and potentially severe exacerbations in patients with asthma. These findings underline the importance of understanding the synergistic nature of allergic sensitization and infections with HRV in infants relative to the onset of asthma and in children and adults with respect to exacerbations of asthma. This review discusses clinical and experimental evidence of virus/allergen interactions and evaluates theories which relate immunologic responses to respiratory viruses and allergens to the pathogenesis and disease activity of asthma. Greater understanding of the relationship between viral respiratory infections, allergic inflammation, and asthma is likely to suggest new strategies for the prevention and treatment of asthma. PMID:21682739

  5. The multiple sclerosis visual pathway cohort: understanding neurodegeneration in MS.

    Science.gov (United States)

    Martínez-Lapiscina, Elena H; Fraga-Pumar, Elena; Gabilondo, Iñigo; Martínez-Heras, Eloy; Torres-Torres, Ruben; Ortiz-Pérez, Santiago; Llufriu, Sara; Tercero, Ana; Andorra, Magi; Roca, Marc Figueras; Lampert, Erika; Zubizarreta, Irati; Saiz, Albert; Sanchez-Dalmau, Bernardo; Villoslada, Pablo

    2014-12-15

    Multiple Sclerosis (MS) is an immune-mediated disease of the Central Nervous System with two major underlying etiopathogenic processes: inflammation and neurodegeneration. The latter determines the prognosis of this disease. MS is the main cause of non-traumatic disability in middle-aged populations. The MS-VisualPath Cohort was set up to study the neurodegenerative component of MS using advanced imaging techniques by focusing on analysis of the visual pathway in a middle-aged MS population in Barcelona, Spain. We started the recruitment of patients in the early phase of MS in 2010 and it remains permanently open. All patients undergo a complete neurological and ophthalmological examination including measurements of physical and disability (Expanded Disability Status Scale; Multiple Sclerosis Functional Composite and neuropsychological tests), disease activity (relapses) and visual function testing (visual acuity, color vision and visual field). The MS-VisualPath protocol also assesses the presence of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), general quality of life (SF-36) and visual quality of life (25-Item National Eye Institute Visual Function Questionnaire with the 10-Item Neuro-Ophthalmic Supplement). In addition, the imaging protocol includes both retinal (Optical Coherence Tomography and Wide-Field Fundus Imaging) and brain imaging (Magnetic Resonance Imaging). Finally, multifocal Visual Evoked Potentials are used to perform neurophysiological assessment of the visual pathway. The analysis of the visual pathway with advance imaging and electrophysilogical tools in parallel with clinical information will provide significant and new knowledge regarding neurodegeneration in MS and provide new clinical and imaging biomarkers to help monitor disease progression in these patients.

  6. 4R-cembranoid protects against diisopropylfluorophosphate-mediated neurodegeneration.

    Science.gov (United States)

    Ferchmin, P A; Andino, Myrna; Reyes Salaman, Rebeca; Alves, Janaina; Velez-Roman, Joyce; Cuadrado, Brenda; Carrasco, Marimeé; Torres-Rivera, Wilmarie; Segarra, Annabell; Martins, Antonio Henrique; Lee, Jae Eun; Eterovic, Vesna A

    2014-09-01

    Many organophosphorous esters synthesized for applications in industry, agriculture, or warfare irreversibly inhibit acetylcholinesterase, and acute poisoning with these compounds causes life-threatening cholinergic overstimulation. Following classical emergency treatment with atropine, an oxime, and a benzodiazepine, surviving victims often suffer brain neurodegeneration. Currently, there is no pharmacological treatment to prevent this brain injury. Here we show that a cyclic diterpenoid, (1S,2E,4R,6R,7E,11E)-cembra-2,7,11-triene-4,6-diol (4R) ameliorates the damage caused by diisopropylfluorophosphate (DFP) in the hippocampal area CA1. DFP has been frequently used as a surrogate for the warfare nerve agent sarin. In rats, DFP is lethal at the dose used to cause brain damage. Therefore, to observe brain damage in survivors, the death rate was reduced by pre-administration of the peripherally acting antidotes pyridostigmine and methyl atropine or its analog ipratropium. Pyridostigmine bromide, methyl atropine nitrate, and ipratropium bromide were dissolved in saline and injected intramuscularly at 0.1mg/kg, 20mg/kg, and 23mg/kg, respectively. DFP (9mg/kg) dissolved in cold water was injected intraperitoneally. 4R (6mg/kg) dissolved in DMSO was injected subcutaneously, either 1h before or 5 or 24h after DFP. Neurodegeneration was assessed with Fluoro-Jade B and amino cupric silver staining; neuroinflammation was measured by the expression of nestin, a marker of activated astrocytes. Forty-eight hours after DFP administration, 4R decreased the number of dead neurons by half when injected before or after DFP. 4R also significantly decreased the number of activated astrocytes. These data suggest that 4R is a promising new drug that could change the therapeutic paradigm for acute poisoning with organophosphorous compounds by the implementation of a second-stage intervention after the classical countermeasure treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Protection of MPTP-induced neuroinflammation and neurodegeneration by Pycnogenol

    Science.gov (United States)

    Khan, Mohammad Moshahid; Kempuraj, Duraisamy; Thangavel, Ramasamy; Zaheer, Asgar

    2013-01-01

    Oxidative stress and inflammation play a crucial role in Parkinson’s disease (PD) pathogenesis and may represent a target for treatment. Current PD drugs provide only symptomatic relief and have limitations in terms of adverse effects and inability to prevent neurodegeneration. Flavonoids have been suggested to exert human health benefits by its anti-oxidant and anti-inflammatory properties. Therefore, in the present study, using 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydro pyridine (MPTP)-induced mouse model of Parkinsonism, we investigated the neuroprotective potential of bioflavonoid compound Pycnogenol® (PYC), an extract of Pinus maritime bark. MPTP injected mice developed significantly severe oxidative stress and impaired motor coordination at day 1 and day 7 postinjection. This was associated with significantly increased inflammatory responses of astrocyte and microglia as assessed by ionized calcium binding adaptor molecule 1 (Iba 1) and glial fibrillary acidic protein (GFAP) immunohistochemistry, and nuclear transcription factor-κB (NF-kB), inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) expression in the striata by Western blot. Additionally, there was significant upregulation of tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) expression in the striata of MPTP injected mice compared to saline controls. The MPTP-induced neuroinflammation, neurodegeneration and behavioral impairments were markedly repudiated by treatment with PYC. These results suggest that PYC protects dopaminergic neurons from MPTP toxicity in the mouse model of PD. Thus, the present finding of PYC-induced adaptation to oxidative stress and inflammation could suggest a novel avenue for clinical intervention in neurodegenerative diseases including PD. PMID:23391521

  8. Microglial cell dysregulation in Brain Aging and Neurodegeneration.

    Directory of Open Access Journals (Sweden)

    Rommy eVon Bernhardi

    2015-07-01

    Full Text Available Aging is the main risk factor for neurodegenerative diseases. In aging, microglia undergo phenotypic changes compatible with their activation. Glial activation can lead to neuroinflammation, which is increasingly accepted as part of the pathogenesis of neurodegenerative diseases, including Alzheimer’s disease (AD. We hypothesize that in aging, aberrant microglia activation leads to a deleterious environment and neurodegeneration. In aged mice, microglia exhibit an increased expression of cytokines and an exacerbated inflammatory response to pathological changes. Whereas LPS increases nitric oxide secretion in microglia from young mice, induction of reactive oxygen species (ROS predominates in older mice. Furthermore, there is accumulation of DNA oxidative damage in mitochondria of microglia during aging, and also an increased intracellular ROS production. Increased ROS activates the redox-sensitive nuclear factor kappa B, which promotes more neuroinflammation, and can be translated in functional deficits, such as cognitive impairment. Mitochondria-derived ROS and cathepsin B, are also necessary for the microglial cell production of interleukin-1β, a key inflammatory cytokine. Interestingly, whereas the regulatory cytokine TGFβ1 is also increased in the aged brain, neuroinflammation persists. Assessing this apparent contradiction, we have reported that TGFβ1 induction and activation of Smad3 signaling after inflammatory stimulation are reduced in adult mice. Other protective functions, such as phagocytosis, although observed in aged animals, become not inducible by inflammatory stimuli and TGFβ1. Here, we discuss data suggesting that mitochondrial and endolysosomal dysfunction could at least partially mediate age-associated microglial cell changes, and, together with the impairment of the TGFβ1-Smad3 pathway, could result in a reduction of protective activation and a facilitation of cytotoxic activation of microglia, resulting in the

  9. AsthmaVent – Effect of Ventilation on Asthma Control

    DEFF Research Database (Denmark)

    Hogaard, Nina Viskum; Rubak, Sune Leisgaard Mørck; Halken, Susanne

    sensitive towards. Reducing this exposure may improve the asthma control in these children. Previous studies give conflicting information on the effect of mechanical ventilation on asthma control in children. Objectives We aim at investigating whether mechanical ventilation is capable of improving indoor...... and design of housing. Indoor environment factors that trigger the disease must be controlled as well as possible. The results of this project will be a significant contribution to the potential recommendations regarding the effect of ventilation on indoor air quality and asthma control of HDM allergic...... air quality and thereby asthma symptoms and quality of life, in children with house dust mite allergy and asthma. Materials and Methods Randomized double-blind placebo-controlled intervention study, including 80 children from 3 Danish Pediatric outpatient clinics, with: Verified asthma, requiring...

  10. Yoga for asthma

    Directory of Open Access Journals (Sweden)

    Zu-Yao Yang

    Full Text Available ABSTRACT BACKGROUND: Asthma is a common chronic inflammatory disorder affecting about 300 million people worldwide. As a holistic therapy, yoga has the potential to relieve both the physical and psychological suffering of people with asthma, and its popularity has expanded globally. A number of clinical trials have been carried out to evaluate the effects of yoga practice, with inconsistent results. OBJECTIVES: To assess the effects of yoga in people with asthma. METHODS: Search methods: We systematically searched the Cochrane Airways Group Register of Trials, which is derived from systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, and handsearching of respiratory journals and meeting abstracts. We also searched PEDro. We searched ClinicalTrials.gov and the WHO ICTRP search portal. We searched all databases from their inception to 22 July 2015, and used no restriction on language of publication. We checked the reference lists of eligible studies and relevant review articles for additional studies. We attempted to contact investigators of eligible studies and experts in the field to learn of other published and unpublished studies. Selection criteria: We included randomized controlled trials (RCTs that compared yoga with usual care (or no intervention or sham intervention in people with asthma and reported at least one of the following outcomes: quality of life, asthma symptom score, asthma control, lung function measures, asthma medication usage, and adverse events. Data collection and analysis: We extracted bibliographic information, characteristics of participants, characteristics of interventions and controls, characteristics of methodology, and results for the outcomes of our interest from eligible studies. For continuous outcomes, we used mean difference (MD with 95% confidence interval (CI to denote the treatment effects, if the

  11. Contributions of dust exposure and cigarette smoking to emphysema severity in coal miners in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Kuempel, E.D.; Wheeler, M.W.; Smith, R.J.; Vallyathan, V.; Green, F.H.Y. [NIOSH, Cincinnati, OH (United States)

    2009-08-15

    Previous studies have shown associations between dust exposure or lung burden and emphysema in coal miners, although the separate contributions of various predictors have not been clearly demonstrated. The objective was to quantitatively evaluate the relationship between cumulative exposure to respirable coal mine dust, cigarette smoking, and other factors on emphysema severity. The study group included 722 autopsied coal miners and nonminers in the United States. Data on work history, smoking, race, and age at death were obtained from medical records and questionnaire completed by next-of-kin. Emphysema was classified and graded using a standardized schema. Job-specific mean concentrations of respirable coal mine dust were matched with work histories to estimate cumulative exposure. Relationships between various metrics of dust exposure (including cumulative exposure and lung dust burden) and emphysema severity were investigated in weighted least squares regression models. Emphysema severity was significantly elevated in coal miners compared with nonminers among ever- and never-smokers (P < 0.0001). Cumulative exposure to respirable coal mine dust or coal dust retained in the lungs were significant predictors of emphysema severity (P < 0.0001) after accounting for cigarette smoking, age at death, and race. The contributions of coal mine dust exposure and cigarette smoking were similar in predicting emphysema severity averaged over this cohort. Coal dust exposure, cigarette smoking, age, and race are significant and additive predictors of emphysema severity in this study.

  12. Association of the transfer coefficient of the lung for carbon monoxide with emphysema progression in male smokers

    NARCIS (Netherlands)

    Mohamed Hoesein, F.A.; Zanen, P.; Ginneken, B. van; Klaveren, R.J. van; Lammers, J.W.

    2011-01-01

    A decreased transfer coefficient of the lung for carbon monoxide (K(CO)) is associated with emphysema. We evaluated whether in heavy smokers, baseline K(CO) was associated with the progression of computed tomography (CT)-detected emphysema, and the progression of airflow limitation. Heavy smokers,

  13. INVITRO RELEASE OF NEUTROPHIL ELASTASE, MYELOPEROXIDASE AND BETA-GLUCURONIDASE IN PATIENTS WITH EMPHYSEMA AND HEALTHY-SUBJECTS

    NARCIS (Netherlands)

    RENKEMA, TEJ; POSTMA, DS; NOORDHOEK, JA; SLUITER, HJ; KAUFFMAN, HF

    1991-01-01

    Evidence is accumulating that cigarette smoking plays an important role in the protease-antiprotease imbalance in alpha-1-antitrypsin-sufficient emphysema. Since most smokers, however, do not develop emphysema, it has to be presumed that other factors in addition to smoking contribute to the origin

  14. Morphological quantification of emphysema in small human lung specimens: comparison of methods and relation with clinical data.

    NARCIS (Netherlands)

    Robbesom, A.A.J.P.; Versteeg, E.M.M.; Veerkamp, J.H.; Krieken, J.H.J.M. van; Bulten, J.; Smits, H.T.J.; Willems, L.N.; Herwaarden, C.L.A. van; Dekhuijzen, P.N.R.; Kuppevelt, A.H.M.S.M. van

    2003-01-01

    Small human lung specimens are frequently used for cell biological studies of the pathogenesis of emphysema. In general, lung function and other clinical parameters are used to establish the presence and severity of emphysema/chronic obstructive pulmonary disease without morphological analysis of

  15. Randomised controlled trial for emphysema with a selective agonist of the γ-type retinoic acid receptor

    DEFF Research Database (Denmark)

    Stolk, Jan; Stockley, Robert A; Stoel, Berend C

    2012-01-01

    Palovarotene is an oral γ-selective retinoid agonist. In animal emphysema models, palovarotene reduced inflammation, promoted structural repair and functional improvement. REPAIR (Retinoid treatment of Emphysema in Patients on the α(1)-antitrypsin International Registry), was an investigator-init...

  16. The coexistence of asthma and chronic obstructive pulmonary disease (COPD): prevalence and risk factors in young, middle-aged and elderly people from the general population.

    Science.gov (United States)

    de Marco, Roberto; Pesce, Giancarlo; Marcon, Alessandro; Accordini, Simone; Antonicelli, Leonardo; Bugiani, Massimiliano; Casali, Lucio; Ferrari, Marcello; Nicolini, Gabriele; Panico, Maria Grazia; Pirina, Pietro; Zanolin, Maria Elisabetta; Cerveri, Isa; Verlato, Giuseppe

    2013-01-01

    The joint distribution of asthma and chronic obstructive pulmonary disease (COPD) has not been well described. This study aims at determining the prevalence of self-reported physician diagnoses of asthma, COPD and of the asthma-COPD overlap syndrome and to assess whether these conditions share a common set of risk factors. A screening questionnaire on respiratory symptoms, diagnoses and risk factors was administered by mail or phone to random samples of the general Italian population aged 20-44 (n = 5163) 45-64 (n = 2167) and 65-84 (n = 1030) in the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD) study. A physician diagnosis of asthma or COPD (emphysema/chronic bronchitis/COPD) was reported by 13% and 21% of subjects aged prevalence of diagnosed asthma (from 8.2% to 1.6%) and with a marked increase in the prevalence of diagnosed COPD (from 3.3% to 13.3%). The prevalence of the overlap of asthma and COPD was 1.6% (1.3%-2.0%), 2.1% (1.5%-2.8%) and 4.5% (3.2%-5.9%) in the 20-44, 45-64 and 65-84 age groups. Subjects with both asthma and COPD diagnoses were more likely to have respiratory symptoms, physical impairment, and to report hospital admissions compared to asthma or COPD alone (pCOPD are common in the general population, and they coexist in a substantial proportion of subjects. The asthma-COPD overlap syndrome represents an important clinical phenotype that deserves more medical attention and further research.

  17. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Quick Links Asthma Action Plan America Breathing Easier [PDF – 1.1 MB] ASL Asthma Film Asthma Clinical ... Using a metered dose inhaler with a spacer [ PDF - 377 KB] Your browser does not support iframes ...

  18. Can the Weather Affect My Child's Asthma?

    Science.gov (United States)

    ... Giving Teens a Voice in Health Care Decisions Can the Weather Affect My Child's Asthma? KidsHealth > For ... Affect My Child's Asthma? Print A A A Can the Weather Affect My Child's Asthma? Yes. Weather ...

  19. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... In the Workplace Outdoors Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, and Surveillance Most Recent ... Archive 2014 State or Territory Data Archive AsthmaStats Flu Vaccination among Adults with Current Asthma Flu Vaccination ...

  20. Treating Asthma in Children under 5

    Science.gov (United States)

    ... laughing Gastrointestinal reflux Changes or extremes in weather Asthma emergencies Severe asthma attacks can be life-threatening ... Changes in activity levels or sleep patterns Control asthma triggers Depending on the triggers for your child's ...

  1. Managing Asthma: Learning to Breathe Easier

    Science.gov (United States)

    ... Issues Subscribe June 2014 Print this issue Managing Asthma Learn To Breathe Easier En español Send us ... Allergy Therapy Seeking Allergy Relief Wise Choices Controlling Asthma Get regular checkups for your asthma. Make a ...

  2. Allergies and Asthma: They Often Occur Together

    Science.gov (United States)

    ... A family history of allergies is a major risk factor for allergic asthma. Having hay fever or other allergies yourself also increases your risk of getting asthma. Though allergic asthma is very common, there are other types ...

  3. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... among Adults with Current Asthma Flu Vaccination among Children with Current Asthma Asthma and Fair or Poor Health Usual Place for Medical Care among Children Number of Visits to a Health Care Provider(s) ...

  4. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... and Publications Related Articles, Publications, and Links Asthma’s Impact on the Nation Fact Sheet State Data Profiles ( ... MB] ASL Asthma Film Asthma Clinical Guidelines Air Pollution & Respiratory Health Know How to Use Your Asthma ...

  5. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Obesity Percentage of People with Asthma who Smoke Insurance coverage and barriers to care for people with ... Asthma NCHS Asthma FastStats Survey Questions Resources for Health Professionals and Schools Healthcare Professionals Public Health Professionals ...

  6. Asthma & Physical Activity in the School

    Science.gov (United States)

    ... of Education) How Asthma-Friendly Is Your School? (checklist in English and in Spanish) Is the Asthma ... gov/ asthma/ publications. html U.S. Department of Education Office for Civil Rights Lyndon Baines Johnson Department of ...

  7. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Messages Agencies Working on Asthma Follow @CDCasthma on Twitter to learn more about helping people with asthma ... de boca) [PDF - 276 KB] Follow @CDCasthma on Twitter to learn more about helping people with asthma ...

  8. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Brochures Facts Triggers Indoors In the Workplace Outdoors Management Asthma Action Plan Flu Shots Inhalers Data, Statistics, ... Work-related Asthma NCHS Asthma FastStats Survey Questions Resources for Health Professionals and Schools Healthcare Professionals Public ...

  9. Violence and Asthma: A Review

    Directory of Open Access Journals (Sweden)

    Takeo Fujiwara

    2008-01-01

    Full Text Available Recent research shows that exposure to community violence is, directly and indirectly, associated with asthma. This article reviews the findings on the impact of violence on asthma, and the pathways for the association of violence and asthma are suggested: 1 exposure to violence is directly associated with asthma, mainly through dysregulation of sympathetic-adrenal-medullary (SAM and hypothalamic-pituitary-adrenal (HPA axis, 2 exposure to violence is associated with the change of susceptibility of outdoor air pollution on asthma, probably through the change of an immune response, and 3 behavioral change due to exposure to violence (e.g. keeping children indoors leads to more exposure to indoor pollutants. The suggested framework may be useful to develop health policy on asthma in high-violence communities.

  10. Asthma in Children: MedlinePlus Health Topic

    Science.gov (United States)

    ... PDF School and Asthma (Nemours Foundation) Also in Spanish Teaching Your Child about Asthma (American Academy of Allergy, Asthma, and Immunology) What's an Asthma Action Plan? (Nemours Foundation) ... Also in Spanish Related Issues Asthma & Physical Activity in the School ( ...

  11. Localized persistent pulmonary interstitial emphysema in a preterm infant in the absence of mechanical ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Berk, David R. [Stanford University School of Medicine, Division of Pediatric Radiology, CA (United States); Lucile Packard Children' s Hospital, Stanford, CA (United States); Varich, Laura J. [Stanford University School of Medicine, Division of Pediatric Radiology, CA (United States); Stanford University School of Medicine, Department of Radiology, CA (United States); Lucile Packard Children' s Hospital, Stanford, CA (United States)

    2005-12-01

    Localized persistent pulmonary interstitial emphysema has rarely been reported in preterm infants in the absence of utilization of mechanical ventilation or continuous positive airway pressure. The relative rarity of this condition might preclude rendering of the correct diagnosis, making patients susceptible to unnecessary surgery and increased morbidity and mortality associated with such intervention. We present a preterm infant who developed respiratory distress and radiographic findings of pulmonary interstitial emphysema on the first day after birth, prior to receiving continuous positive airway pressure or mechanical ventilation. It is important for radiologists to consider localized persistent pulmonary interstitial emphysema in the differential diagnosis of cystic lung lesions in preterm infants, even in the absence of mechanical ventilation. In cases where there is uncertainty, CT imaging can be useful in making the correct diagnosis. (orig.)

  12. Hepatic emphysema associated with ultrasound-guided liver biopsy in a dog.

    Science.gov (United States)

    Westgren, Frida; Hjorth, Tove; Uhlhorn, Margareta; Etterlin, Pernille E; Ley, Charles J

    2014-04-23

    An eleven-year-old Chinese Crested Powder Puff dog presented with polydipsia/polyuria, inappetence, diarrhea and vomiting underwent an ultrasound-guided percutaneous liver biopsy. Two days post-biopsy the clinical condition of the dog acutely deteriorated with fever, dyspnea, ataxia and subcutaneous emphysema. Radiographs and ultrasound showed focal severe hepatic emphysema in the region of the previous liver biopsy. Post-mortem examination revealed chronic hepatitis with dissecting fibrosis, acute hepatitis with hemorrhage and in the hindlimb musculature extensive hemorrhage and necrosis. Pure cultures of the gas producing bacteria Clostridium perfringens were isolated in samples from the hind limb musculature. We propose that the hepatic emphysema in the region of the biopsy site was a result of a clostridial infection.

  13. Gastric Emphysema a Spectrum of Pneumatosis Intestinalis: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Guillermo López-Medina

    2014-01-01

    Full Text Available The finding of gas within the gastric wall is not a disease by itself, rather than a sign of an underlying condition which could be systemic or gastric. We present the case of a woman identified with gastric emphysema secondary to the administration of high doses of steroids, with the purpose of differentiating emphysematous gastritis versus gastric emphysema due to the divergent prognostic implications. Gastric emphysema entails a more benign course, opposed to emphysematous gastritis which often presents as an acute abdomen and carries a worse prognosis. Owing to the lack of established diagnostic criteria, computed tomography is the assessment method of choice. Currently no guidelines are available for the management of this entity, since the evidence is limited to a few case series and a considerable number of single case reports.

  14. Gastric Emphysema a Spectrum of Pneumatosis Intestinalis: A Case Report and Literature Review

    Science.gov (United States)

    López-Medina, Guillermo; Castillo Díaz de León, Roxana; Heredia-Salazar, Alberto Carlos; Hernández-Salcedo, Daniel Ramón

    2014-01-01

    The finding of gas within the gastric wall is not a disease by itself, rather than a sign of an underlying condition which could be systemic or gastric. We present the case of a woman identified with gastric emphysema secondary to the administration of high doses of steroids, with the purpose of differentiating emphysematous gastritis versus gastric emphysema due to the divergent prognostic implications. Gastric emphysema entails a more benign course, opposed to emphysematous gastritis which often presents as an acute abdomen and carries a worse prognosis. Owing to the lack of established diagnostic criteria, computed tomography is the assessment method of choice. Currently no guidelines are available for the management of this entity, since the evidence is limited to a few case series and a considerable number of single case reports. PMID:25093129

  15. Role for Cela1 in Postnatal Lung Remodeling and AAT-deficient Emphysema

    DEFF Research Database (Denmark)

    Joshi, Rashika; Heinz, Andrea; Fan, Qiang

    2018-01-01

    Cela1 mRNA and reduction in ~70kDa Cela1 consistent with covalent binding of Cela1 by AAT. Cela1-/- mice were completely protected against emphysema in this model. Cela1 was increased in human AAT-deficient emphysema. CONCLUSIONS: Cela1 is important in physiologic and pathologic stretch......RATIONALE: α1-antitrypsin (AAT) deficiency-related emphysema is the fourth leading indication for lung transplantation. Chymotrypsin-like elastase 1 (Cela1) is a digestive protease that is expressed during lung development in association with regions of elastin remodeling, exhibits stretch......-dependent expression during lung regeneration, and binds lung elastin in a stretch-dependent manner. AAT covalently neutralizes Cela1 in vitro. OBJECTIVES: We sought to determine the role of Cela1 in postnatal lung physiology, whether it interacted with AAT in vivo, and any effects it may have in the context of AAT...

  16. Cotinine Concentration in Serum Correlates with Tobacco Smoke-Induced Emphysema in Mice

    Science.gov (United States)

    Xu, Xin; Su, Yunchao; Fan, Z. Hugh

    2014-01-01

    Secondhand smoke (SHS) has been associated with a variety of adverse health outcomes in nonsmokers, including emphysema (a chronic obstructive pulmonary disease). One way to detect SHS exposure is to measure the concentration of cotinine, the primary metabolite of nicotine, in bodily fluids. We have developed a method for cotinine analysis by combining micellar electrokinetic chromatography with enrichment techniques. We employed the method to measure cotinine concentrations in serum samples of mice exposed to tobacco smoke for 12 or 24 weeks and found that it was 3.1-fold or 4.8-fold higher than those exposed to room air for the same period. Further, we investigated the morphological changes in lungs of mice and observed tobacco smoke induced emphysema. Our results indicate that the method can be used to measure cotinine and there is an association between the serum cotinine concentration and tobacco smoke-induced emphysema in mice.

  17. Lung volume reduction for severe emphysema: do we need a scalpel or a scope?

    Directory of Open Access Journals (Sweden)

    D. Van Raemdonck

    2010-09-01

    Full Text Available Resectional lung volume reduction has proven to be superior to medical treatment in reducing dyspnoea and in increasing lung function, survival and quality of life in a very well selected, low risk group of hyperinflated patients with heterogeneous emphysema predominantly in the upper lobe. Nevertheless, this intervention is hampered by an important pulmonary (30% and cardiovascular (20% morbidity, mainly as a result of prolonged (>7 days air leak, and a 5% risk of death as a result of the surgical intervention. Results from ongoing randomised trials are awaited in order to determine whether less invasive, non-resectional lung volume treatment of emphysema via the bronchoscope using endobronchial valves, airway bypass stents or biological adhesives/heated water vapour will yield similar improvement with less morbidity and reduced mortality, compared with surgical resection. Furthermore, it is hoped that endoscopic lung volume reduction techniques may help patients with homogeneous emphysema currently excluded by most teams for the resectional procedure.

  18. Nitric oxide prevents alveolar senescence and emphysema in a mouse model.

    Directory of Open Access Journals (Sweden)

    Amanda E Boe

    Full Text Available Nω-nitro-L-arginine methyl ester (L-NAME treatment induces arteriosclerosis and vascular senescence. Here, we report that the systemic inhibition of nitric oxide (NO production by L-NAME causes pulmonary emphysema. L-NAME-treated lungs exhibited both the structural (alveolar tissue destruction and functional (increased compliance and reduced elastance characteristics of emphysema development. Furthermore, we found that L-NAME-induced emphysema could be attenuated through both genetic deficiency and pharmacological inhibition of plasminogen activator inhibitor-1 (PAI-1. Because PAI-1 is an important contributor to the development of senescence both in vitro and in vivo, we investigated whether L-NAME-induced senescence led to the observed emphysematous changes. We found that L-NAME treatment was associated with molecular and cellular evidence of premature senescence in mice, and that PAI-1 inhibition attenuated these increases. These findings indicate that NO serves to protect and defend lung tissue from physiological aging.

  19. The lung volume reduction coil for the treatment of emphysema: a new therapy in development.

    Science.gov (United States)

    Klooster, Karin; Ten Hacken, Nick H T; Slebos, Dirk-Jan

    2014-09-01

    Lung volume reduction (LVR) coil treatment is a novel therapy for patients with severe emphysema. In this bilateral bronchoscopic treatment, approximately 10 LVR coils per lobe are delivered under fluoroscopic guidance in two sequential procedures. The LVR coil reduces lung volume by compressing the most destructed areas of the lung parenchyma and restores the lung elastic recoil. Both patients with upper- and lower-lobe predominant emphysema as well as a homogeneous emphysema distribution can be treated. LVR coil treatment results in an improvement of pulmonary function, exercise tolerance and quality of life. The LVR-coil treatment has been evaluated in several European clinical trials since 2008 and received CE mark approval in 2010. Currently, two large multicenter randomized controlled trials are underway in Europe and North America to assess the efficacy and safety of the LVR-coil treatment at 12 months compared with usual care. In this review, we share our experience with the LVR-coil treatment.

  20. Incidental lung volume reduction following fulminant pulmonary hemorrhage in a patient with severe emphysema.

    Science.gov (United States)

    Hetzel, Juergen; Spengler, Werner; Horger, Marius; Boeckeler, Michael

    2015-06-01

    Endoscopic lung volume reduction is an emerging technique meant to improve lung function parameters, quality of life, and exercise tolerance in patients with severe lung emphysema. This is the first report of lung volume reduction by autologous blood in a patient with non-bullous lung emphysema. A 74-year-old woman with heterogeneous lung emphysema developed accidentally diffuse lobar bleeding immediately after valve placement. Due to persistent hemorrhage, the valves had to be removed shortly thereafter. Despite extraction of the valves, respiratory function of the patient improved rapidly indicated also by a drop in the COPD assessment test questionnaire, 3 months later. This was consistent with both improvement of lung function tests and six-minute walking test.

  1. Nasal disease and asthma.

    Science.gov (United States)

    Marseglia, G L; Merli, P; Caimmi, D; Licari, A; Labó, E; Marseglia, A; Ciprandi, G; La Rosa, M

    2011-10-01

    The nose plays a primary role within the airways, working as a filter and air-conditioner, together with other important functions. Thus, it is not surprising that nasal diseases are associated with several other comorbidities, including both upper and lower airways, such as bronchial hyperresponsiveness (BHR) and asthma. Several studies have investigated the relationship existing between the upper and the lower airways and new insights are rising. Nevertheless, some uncertainties still remain, mainly because nasal disorders are quite heterogeneous, overlapping (i.e. rhinitis-rhinosinusitis-sinusitis, acute or chronic, allergic or non-allergic) and difficult to diagnose, so that, frequently, many studies don’t differentiate between the various conditions. For this reason, the purpose of this review is to systematically analyze present epidemiological, pathophysiological and clinical data on the relationship between nasal diseases and asthma, splitting up three main conditions: allergic rhinitis, chronic rhinosinusitis and nasal polyposis.

  2. Asthma management: important issues

    Directory of Open Access Journals (Sweden)

    P. Barnes

    2005-12-01

    Full Text Available Although most attention has been focused on the drugs used to control asthma, it is increasingly recognised that effective delivery of these drugs to the lungs is just as important. The most effective drugs, beta2-agonists and corticosteroids, are given by inhalation so there has been a search for more efficient inhaler devices that are easier for patients to use. A symposium at the European Respiratory Society Annual Meeting in 2005 discussed some of the important issues in inhaler therapy in adults and children. This article summarises the major points of discussion that arose out of this symposium. New more effective inhaler devices are now becoming available and are likely to have an important impact on asthma management.

  3. MANIFEST ANXIETY IN BRONCHIAL ASTHMA

    OpenAIRE

    Sreedhar, Krishna Prasad

    1989-01-01

    SUMMARY Using a vernacular adaptation of MAS 50 bronchial asthma patients were compared with 102 normals, 60 hospital general out-patients and 50 neurotics to determine the level of anxiety in asthma. The manifest anxiety scores of the bronchial asthma patients were found to be significantly high showing that their level of anxiety was abnormally higher in comparison with that of the normals and the hospital general out-patients. The bronchial asthmatics and the neurotics did not differ in an...

  4. CT-derived Biomechanical Metrics Improve Agreement Between Spirometry and Emphysema.

    Science.gov (United States)

    Bhatt, Surya P; Bodduluri, Sandeep; Newell, John D; Hoffman, Eric A; Sieren, Jessica C; Han, Meilan K; Dransfield, Mark T; Reinhardt, Joseph M

    2016-10-01

    Many patients with chronic obstructive pulmonary disease (COPD) have marked discordance between forced expiratory volume in 1 second (FEV1) and degree of emphysema on computed tomography (CT). Biomechanical differences between these patients have not been studied. We aimed to identify reasons for the discordance between CT and spirometry in some patients with COPD. Subjects with Global initiative for chronic Obstructive Lung Disease stages I-IV from a large multicenter study (The Genetic Epidemiology of COPD) were arranged by percentiles of %predicted FEV1 and emphysema on CT. Three categories were created using differences in percentiles: Catspir with predominant airflow obstruction/minimal emphysema, CatCT with predominant emphysema/minimal airflow obstruction, and Catmatched with matched FEV1 and emphysema. Image registration was used to derive Jacobian determinants, a measure of lung elasticity, anisotropy, and strain tensors, to assess biomechanical differences between groups. Regression models were created with the previously mentioned categories as outcome variable, adjusting for demographics, scanner type, quantitative CT-derived emphysema, gas trapping, and airway thickness (model 1), and after adding biomechanical CT metrics (model 2). Jacobian determinants, anisotropy, and strain tensors were strongly associated with FEV1. With Catmatched as control, model 2 predicted Catspir and CatCT better than model 1 (Akaike information criterion 255.8 vs. 320.8). In addition to demographics, the strongest independent predictors of FEV1 were Jacobian mean (β = 1.60,95%confidence intervals [CI] = 1.16 to 1.98; P spirometry, offering the potential for new insights into the linkage between regional parenchymal destruction and global decrement in lung function in patients with COPD. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  5. Low agreement of visual rating for detailed quantification of pulmonary emphysema in whole-lung CT

    Energy Technology Data Exchange (ETDEWEB)

    Mascalchi, Mario; Diciotti, Stefano (Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence (Italy)), Email: m.mascalchi@dfc.unifi.it; Sverzellati, Nicola (Department of Radiology, University of Parma, Parma (Italy)); Camiciottoli, Gianna (Department of Critical Care, University of Florence, Florence (Italy)); Ciccotosto, Cesareo (Division of Radiology, Arezzo Hospital, Arezzo (Italy)); Falaschi, Fabio (Second Division of Radiology, Cisanello Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa (Italy)); Zompatori, Maurizio (Department of Radiology, S Orsola Hospital of Bologna, University of Bologna, Bologna (Italy))

    2012-02-15

    Background. Multidetector spiral computed tomography (CT) has opened the possibility of quantitative evaluation of emphysema extent in the whole lung. Visual assessment can be used for such a purpose, but its reproducibility has not been established. Purpose. To assess agreement of detailed assessment of pulmonary emphysema on whole-lung CT using a visual scale. Material and Methods. Thirty patients with chronic obstructive pulmonary disease underwent whole-lung inspiratory CT. Four chest radiologists rated the same 22 +- 2 thin sections using a visual scale which defines a range of emphysema extent between 0 and 100. Two of them repeated the rating two months later. Inter- and intra-operator agreement was evaluated with the Bland and Altman method. In addition, the percentage of emphysema at -950 Hounsfield units in the whole lung was determined using fully automated commercially available software for 3D densitometry. Results. In three of six operator pairs and in one of two intra-operator pairs the Kendall t test showed a significant correlation between the difference and the average magnitude of visual scores. Among different operators the half-width of 95% limits of agreement (95% LoA) was wide ranging between a score of 14.2-27.7 for an average visual score of 20 and between 18.5-36.8 for an average visual score of 80. Within the same operator the half-width of 95% LoA ranged between a score of 10.9-21.0 for an average visual score of 20 and between 25.1-30.1 for an average visual score of 80. The visual scores of the four radiologists were correlated with the results of densitometry (P < 0.001; r = 0.65-0.81). Conclusion. The inter- and intra-operator agreement of detailed assessment of emphysema in the whole lung using a visual scale is low and decreases with increasing emphysema extent

  6. Serum Proteins Associated with Emphysema Progression in Severe Alpha-1 Antitrypsin Deficiency.

    Science.gov (United States)

    Beiko, Tatsiana; Janech, Michael G; Alekseyenko, Alexander V; Atkinson, Carl; Coxson, Harvey O; Barth, Jeremy L; Stephenson, Sarah E; Wilson, Carole L; Schnapp, Lynn M; Barker, Alan; Brantly, Mark; Sandhaus, Robert A; Silverman, Edwin K; Stoller, James K; Trapnell, Bruce; Charlie, Strange

    2017-07-15

    Computed tomography (CT) lung density is an accepted biomarker for emphysema in alpha-1 antitrypsin deficiency (AATD), although concerns for radiation exposure limit its longitudinal use. Serum proteins associated with emphysema, particularly in early disease, may provide additional pathogenic insights. We investigated whether distinct proteomic signatures characterize the presence and progression of emphysema in individuals with severe AATD and normal forced expiratory volume in 1 second (FEV 1 ). QUANT itative lung CT U n M asking emphysema progression in AATD (QUANTUM-1) is a multicenter, prospective 3-year study of 49 adults with severe AATD and FEV 1 post-bronchodilator values (Post-BD) ≥ 80% predicted. All participants received chest CT, serial spirometry, and contributed to the serum biobank. Volumetric imaging display and analysis (VIDA) software defined the baseline 15 th percentile density (PD15) which was indexed to CT-derived total lung capacity (TLC). We measured 317 proteins using a multiplexed immunoassay (Myriad Discovery MAP ® panel) in 31 individuals with a complete dataset. We analyzed associations between initial PD15/TLC, PD15/TLC annual decline, body mass index (BMI), and protein levels using Pearson's product moment correlation. C-reactive protein (CRP), adipocyte fatty acid-binding protein (AFBP), leptin, and tissue plasminogen activator (tPA) were found to be associated with baseline emphysema and all but leptin were associated with emphysema progression after adjustments were made for age and sex. All 4 proteins were associated with BMI after further adjustment for multiple comparisons was made. The relationship between these proteins and BMI, and further validation of these findings in replicative cohorts require additional studies.

  7. Serum Levels of Surfactant Proteins in Patients with Combined Pulmonary Fibrosis and Emphysema (CPFE.

    Directory of Open Access Journals (Sweden)

    Andriana I Papaioannou

    Full Text Available Emphysema and idiopathic pulmonary fibrosis (IPF present either per se or coexist in combined pulmonary fibrosis and emphysema (CPFE. Serum surfactant proteins (SPs A, B, C and D levels may reflect lung damage. We evaluated serum SP levels in healthy controls, emphysema, IPF, and CPFE patients and their associations to disease severity and survival.122 consecutive patients (31 emphysema, 62 IPF, and 29 CPFE and 25 healthy controls underwent PFTs, ABG-measurements, 6MWT and chest HRCT. Serum levels of SPs were measured. Patients were followed-up for 1-year.SP-A and SP-D levels differed between groups (p = 0.006 and p<0.001 respectively. In post-hoc analysis, SP-A levels differed only between controls and CPFE (p<0.05 and CPFE and emphysema (p<0.05. SP-D differed between controls and IPF or CPFE (p<0.001 for both comparisons. In IPF SP-B correlated to pulmonary function while SP-A, correlated to the Composite Physiological Index (CPI. Controls current smokers had higher SP-A and SP-D levels compared to non-smokers (p = 0.026 and p = 0.023 respectively. SP-D levels were higher in CPFE patients with extended emphysema (p = 0.042. In patients with IPF, SP-B levels at the upper quartile of its range (≥26 ng/mL presented a weak association with reduced survival (p = 0.05.In conclusion, serum SP-A and SP-D levels were higher where fibrosis exists or coexists and related to disease severity, suggesting that serum SPs relate to alveolar damage in fibrotic lungs and may reflect either local overproduction or overleakage. The weak association between high levels of SP-B and survival needs further validation in clinical trials.

  8. Pulmonary Microvascular Blood Flow in Mild Chronic Obstructive Pulmonary Disease and Emphysema. The MESA COPD Study

    Science.gov (United States)

    Hueper, Katja; Vogel-Claussen, Jens; Parikh, Megha A.; Austin, John H. M.; Bluemke, David A.; Carr, James; Choi, Jiwoong; Goldstein, Thomas A.; Gomes, Antoinette S.; Hoffman, Eric A.; Kawut, Steven M.; Lima, Joao; Michos, Erin D.; Post, Wendy S.; Po, Ming Jack; Prince, Martin R.; Liu, Kiang; Rabinowitz, Dan; Skrok, Jan; Smith, Ben M.; Watson, Karol; Yin, Youbing; Zambeli-Ljepovic, Alan M.

    2015-01-01

    Rationale: Smoking-related microvascular loss causes end-organ damage in the kidneys, heart, and brain. Basic research suggests a similar process in the lungs, but no large studies have assessed pulmonary microvascular blood flow (PMBF) in early chronic lung disease. Objectives: To investigate whether PMBF is reduced in mild as well as more severe chronic obstructive pulmonary disease (COPD) and emphysema. Methods: PMBF was measured using gadolinium-enhanced magnetic resonance imaging (MRI) among smokers with COPD and control subjects age 50 to 79 years without clinical cardiovascular disease. COPD severity was defined by standard criteria. Emphysema on computed tomography (CT) was defined by the percentage of lung regions below −950 Hounsfield units (−950 HU) and by radiologists using a standard protocol. We adjusted for potential confounders, including smoking, oxygenation, and left ventricular cardiac output. Measurements and Main Results: Among 144 participants, PMBF was reduced by 30% in mild COPD, by 29% in moderate COPD, and by 52% in severe COPD (all P emphysema−950HU and radiologist-defined emphysema, particularly panlobular and centrilobular emphysema (all P ≤ 0.01). Registration of MRI and CT images revealed that PMBF was reduced in mild COPD in both nonemphysematous and emphysematous lung regions. Associations for PMBF were independent of measures of small airways disease on CT and gas trapping largely because emphysema and small airways disease occurred in different smokers. Conclusions: PMBF was reduced in mild COPD, including in regions of lung without frank emphysema, and may represent a distinct pathological process from small airways disease. PMBF may provide an imaging biomarker for therapeutic strategies targeting the pulmonary microvasculature. PMID:26067761

  9. Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: the MESA COPD study.

    Science.gov (United States)

    Kawut, Steven M; Poor, Hooman D; Parikh, Megha A; Hueper, Katja; Smith, Benjamin M; Bluemke, David A; Lima, João A C; Prince, Martin R; Hoffman, Eric A; Austin, John H M; Vogel-Claussen, Jens; Barr, R Graham

    2014-11-11

    The classic cardiovascular complication of chronic obstructive pulmonary disease (COPD) is cor pulmonale or right ventricular (RV) enlargement. Most studies of cor pulmonale were conducted decades ago. This study sought to examine RV changes in contemporary COPD and emphysema using cardiac magnetic resonance (CMR) imaging. We performed a case-control study nested predominantly in 2 general population studies of 310 participants with COPD and control subjects 50 to 79 years of age with ≥10 pack-years of smoking who were free of clinical cardiovascular disease. RV volumes and mass were assessed using magnetic resonance imaging. COPD and COPD severity were defined according to standard spirometric criteria. The percentage of emphysema was defined as the percentage of lung regions emphysema subtypes were scored by radiologists. Results were adjusted for age, race/ethnicity, sex, height, weight, smoking status, pack-years, systemic hypertension, and sleep apnea. Right ventricular end-diastolic volume (RVEDV) was reduced in COPD compared with control subjects (-7.8 ml; 95% confidence interval: -15.0 to -0.5 ml; p = 0.04). Increasing severity of COPD was associated with lower RVEDV (p = 0.004) and lower RV stroke volume (p emphysema also was associated with lower RVEDV (p = 0.005) and stroke volume (p emphysema. RV volumes are lower without significant alterations in RV mass and ejection fraction in contemporary COPD, and this reduction is related to the greater percentage of emphysema on computed tomography. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  10. A combined pulmonary function and emphysema score prognostic index for staging in Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Boutou, Afroditi K; Nair, Arjun; Douraghi-Zadeh, Dariush; Sandhu, Ranbir; Hansell, David M; Wells, Athol U; Polkey, Michael I; Hopkinson, Nicholas S

    2014-01-01

    Chronic Obstructive Pulmonary Disease (COPD) is characterized by high morbidity and mortality. Lung computed tomography parameters, individually or as part of a composite index, may provide more prognostic information than pulmonary function tests alone. To investigate the prognostic value of emphysema score and pulmonary artery measurements compared with lung function parameters in COPD and construct a prognostic index using a contingent staging approach. Predictors of mortality were assessed in COPD outpatients whose lung computed tomography, spirometry, lung volumes and gas transfer data were collected prospectively in a clinical database. Univariate and multivariate Cox proportional hazard analysis models with bootstrap techniques were used. 169 patients were included (59.8% male, 61.1 years old; Forced Expiratory Volume in 1 second % predicted: 40.5±19.2). 20.1% died; mean survival was 115.4 months. Age (HR = 1.098, 95% Cl = 1.04-1.252) and emphysema score (HR = 1.034, 95% CI = 1.007-1.07) were the only independent predictors of mortality. Pulmonary artery dimensions were not associated with survival. An emphysema score of 55% was chosen as the optimal threshold and 30% and 65% as suboptimals. Where emphysema score was between 30% and 65% (intermediate risk) the optimal lung volume threshold, a functional residual capacity of 210% predicted, was applied. This contingent staging approach separated patients with an intermediate risk based on emphysema score alone into high risk (Functional Residual Capacity ≥210% predicted) or low risk (Functional Residual Capacity Emphysema score-Functional Residual Capacity index might provide a better separation of high and low risk patients with COPD, than other individual predictors alone.

  11. CT screening for lung cancer: Importance of emphysema for never smokers and smokers.

    Science.gov (United States)

    Henschke, Claudia I; Yip, Rowena; Boffetta, Paolo; Markowitz, Steven; Miller, Albert; Hanaoka, Takaomi; Wu, Ning; Zulueta, Javier J; Yankelevitz, David F

    2015-04-01

    To address the prevalence of lung cancer in high and low-risk people according to their smoking history, age, and CT findings of emphysema. We reviewed the baseline low-dose CT scans of 62,124 current, former and never smokers, aged 40-90 to determine the prevalence of lung cancer. We performed logistic regression analysis of the prevalence of lung cancer to determine the odds ratio (OR) for emphysema, conditionally on age, female gender, and ethnicity. The prevalence of lung cancer was 1.4% (95% CI: 1.3-1.6) for current smokers, 1.1% (95% CI: 1.0-1.2) for former smokers, and 0.4% (95% CI: 0.3-0.6) for never smokers. Emphysema was identified in 28.5% (6,684), 20.6% (5,422), and 1.6% (194) of current, former, and never smokers, respectively. The prevalence of lung cancer among current smokers was 1.1% for those without emphysema vs. 2.3% for those with emphysema (odds ratio [OR] 1.8; 95% confidence interval [CI]: 1.4-2.2) and the corresponding difference for former smokers was 0.9% vs. 1.8% (OR: 1.7; 95% CI: 1.3-2.2), and for never smokers, it was 0.4% vs. 2.6% (OR: 6.3; 95% CI: 2.4-16.9). Identification of emphysema in low-dose CT scans increases the risk of lung cancer and is important in determining follow-up of current, former, and never smokers. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Prevalence and characteristics of paratracheal air cysts and their association with emphysema in a general population

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Hua-Ming, E-mail: moyercheng@gmail.com [Department of Medical Imaging, Chi-Mei Medical Center, No. 901, Chung Hwa Road, Yong-Kang, Tainan 710, Taiwan (China); Chang, Pau-Yang, E-mail: pausheng@gmail.com [Department of Medical Imaging, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Chung Yang Road, Hualien, Taiwan (China); Tzu Chi University, Hualien, Taiwan (China); Chiang, Kuo-Hsien, E-mail: moyer20361@yahoo.com.tw [Department of Medical Imaging, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Chung Yang Road, Hualien, Taiwan (China); Tzu Chi University, Hualien, Taiwan (China); Huang, Hsin-Wen, E-mail: hwhuang660@gmail.com [Department of Diagnostic Radiology, Mennonite Christian Hospital, 44 Min-chuan Road, Hualien 970, Taiwan (China); Lee, Chau-Chin, E-mail: moyermiming@yahoo.com.tw [Department of Medical Imaging, Buddhist Tzu Chi General Hospital, No. 707, Section 3, Chung Yang Road, Hualien, Taiwan (China); Tzu Chi University, Hualien, Taiwan (China)

    2012-10-15

    Background: To evaluate the prevalence and characteristics of paratracheal air cysts and their association with emphysema and gender in a general population using low-dose computed tomography scanning of the chest. Materials and methods: We retrospectively enrolled a total of 924 patients (584 women, 340 men; mean age, 59.73 years; range, 37–89 years) who had received low-dose computed tomography scanning for health examination during the period January 1, 2010 to June 30, 2010. Computed tomographic images were evaluated for the presence of paratracheal air cysts. If paratracheal air cysts were identified, the lungs were reconstructed as a three-dimensional model on a commercial workstation. An emphysema index, an objective quantification of the extent of emphysematous changes on CT imaging, was defined as the percentage area of lung with attenuation values below −950 Hounsfield units. Results: A total of 60 patients with paratracheal air cysts were included in this study (estimated prevalence, 6.5%; 12 men, 48 women; mean age, 59.85; range 45–89 years). Emphysema index differed significantly between genders (P < 0.0001). The prevalence of paratracheal air cysts in men was significantly lower than that in women (P = 0.005); however, the emphysema index in patients of both genders showed no evidence of emphysema. The majority (95%) of paratracheal air cysts were at the level of the seventh cervical to the second thoracic vertebrae. Conclusion: The presence of paratracheal air cysts is a common condition in general populations and should not be misdiagnosed as abnormal paratracheal free air. Paratracheal air cysts are more common in woman than in man. In our study, there is no patient with paratracheal air cysts has CT evidence of emphysema.

  13. Aspirin-Exacerbated Asthma

    OpenAIRE

    Varghese, Mathew; Lockey, Richard F

    2008-01-01

    This review focuses on aspirin-exacerbated asthma (AEA). The review includes historical perspective of aspirin, prevalence, pathogenesis, clinical features and treatment of AEA. The pathogenesis of AEA involves the cyclooxygenase and lipooxygenase pathway. Aspirin affects both of these pathways by inhibiting the enzyme cycooxygenase-1 (COX-1). Inhibition of COX-1 leads to a decrease in prostaglandin E2 (PGE2). The decrease in PGE2 results in an increase in cysteinyl leukotrienes by the lipoo...

  14. High-resolution computed tomography findings in elderly patients with asthma

    Energy Technology Data Exchange (ETDEWEB)

    Yilmaz, Sevda [Department of Radiology, School of Medicine, University of Kirikkale, 71100 Kirikkale (Turkey)]. E-mail: dryilmazsevda@yahoo.com; Ekici, Aydanur [Department of Pulmonary Medicine, School of Medicine, University of Kirikkale, 71100 Kirikkale (Turkey); Ekici, Mehmet [Department of Pulmonary Medicine, School of Medicine, University of Kirikkale, 71100 Kirikkale (Turkey); Keles, Hatice [Department of Internal Medicine, School of Medicine, University of Kirikkale, 71100 Kirikkale (Turkey)

    2006-08-15

    Objective: Based on the hypothesis that airway remodelling is related to the duration of asthma, HRCT scanning should show greater abnormalities in the early-onset than the late-onset asthmatics. It was, therefore, intended to assess the presence and the frequency of airway and parenchymal abnormalities with high-resolution computed tomography (HRCT) in elderly asthmatic patients, and to determine whether these abnormalities are related to the duration of asthma. Patients and methods: Sixty-eight clinically stable asthmatic patients aged {>=}60 yr were included in this prospective study. The patients were separated into two groups according to the duration of symptoms as late-onset asthma (n = 31) with disease duration of <5 yr, and early-onset asthma (n = 37) with disease duration of {>=}5 yr. All patients were lifelong non-smoker and had been using inhaled beta agonists and inhaled steroids. HRCT-scanning and histamine inhalation test were performed on all patients. Results: In comparison with late-onset asthmatic patients, those with early-onset asthma had significantly higher frequency of emphysema (21.6% versus 0.0%, p = 0.006), bronchial dilatation (13.9% versus 0.0%, p 0.03) and bronchial wall thickness (41.7% versus 12.9%, p = 0.01). Multiple logistic regression analysis identified that early-onset of disease was an independent risk factor for the presence of irreversible HRCT-scan abnormalities in elderly asthmatics [odds ratio (OR): 9.4 (2.7-32.7), p 0.00001]. Conclusion: Present data suggest that HRCT abnormalities in early-onset elderly asthmatics reflect parenchymal and airway changes that become irreversible throughout the long course of the disease.

  15. Japanese Guideline for Childhood Asthma

    Directory of Open Access Journals (Sweden)

    Toshiyuki Nishimuta

    2011-01-01

    JAGL differs from the Global Initiative for Asthma Guideline (GINA in that the former emphasizes long-term management of childhood asthma based on asthma severity and early diagnosis and intervention at <2 years and 2–5 years of age. However, a management method, including step-up or step-down of long-term management agents based on the status of asthma symptoms, is easy to understand and thus JAGL is suitable for routine medical treatment. JAGL also introduced treatment and management using a control test for children, recommending treatment and management aimed at complete control through avoiding exacerbation factors and appropriate use of antiinflammatory agents.

  16. Acute bronchial asthma

    Directory of Open Access Journals (Sweden)

    Susanna Ramuscello

    2007-04-01

    Full Text Available Asthma is one of the main causes of morbidity worldwide. It affects some 300 million individuals and has risen over the past 20 years, especially in the paediatric population. Asthma is a chronic inflammation of the airways, subject to periodic exacerbations, characterised by coughing and progressive dyspnoea. Clinical conditions may vary greatly, ranging from moderate exacerbation with an increase in nocturnal awakening and a less than 20% reduction in the flow peak, through to severe respiratory insufficiency that requires immediate intubation of the airways. Pharmacological treatment envisages a step approach that aims to obtain and maintain control over the symptoms, taking into consideration the effectiveness of the treatment available, potential side effects and cost. β2-agonists and corticosteroids are the drugs of election for both maintenance therapy and for treating exacerbations. Other therapeutic devices may prove useful in particular cases. One fundamental key point in treatment over time is the cooperation between patient and attending doctor. The latest review of the Global Initiative for Asthma (GINA guidelines was published in 2006.

  17. [Asthma and cyclic neutropenia].

    Science.gov (United States)

    Salazar Cabrera, A N; Berrón Pérez, R; Ortega Martell, J A; Onuma Takane, E

    1996-01-01

    We report a male with history of recurrent infections (recurrent oral aphtous disease [ROAD], middle ear infections and pharyngo amigdalitis) every 3 weeks since he was 7 months old. At the age of 3 years cyclic neutropenia was diagnosed with cyclic fall in the total neutrophil count in blood smear every 21 days and prophylactic antimicrobial therapy was indicated. Episodic events every 3 weeks of acute asthma and allergic rhinitis were detected at the age of 6 years old and specific immunotherapy to Bermuda grass was given during 3 years with markedly improvement in his allergic condition but not in the ROAD. He came back until the age of 16 with episodic acute asthma and ROAD. The total neutrophil count failed to 0 every 21 days and surprisingly the total eosinophil count increased up to 2,000 at the same time, with elevation of serum IgE (412 Ul/mL). Specific immunotherapy to D.pt. and Aller.a. and therapy with timomodulin was indicated. After 3 months we observed clinical improvement in the asthmatic condition and the ROAD disappeared, but the total neutrophil count did not improve. We present this case as a rare association between 2 diseases with probably no etiological relationship but may be physiopatological that could help to understand more the pathogenesis of asthma.

  18. Quantitative computed tomography: emphysema and airway wall thickness by sex, age and smoking

    DEFF Research Database (Denmark)

    Grydeland, T B; Dirksen, A; Coxson, H O

    2009-01-01

    We investigated how quantitative high-resolution computed tomography (HRCT) measures of emphysema and airway wall thickness (AWT) vary with sex, age and smoking history. We included 463 chronic obstructive pulmonary disease (COPD) cases and 431 controls. All included subjects were current or ex...... cases, respectively, and 0.488+/-0.028 and 0.463+/-0.025 in male and female controls, respectively. AWT decreased with increasing age in cases, and increased with the degree of current smoking in all subjects. We found significant differences in quantitative HRCT measures of emphysema and AWT between...

  19. Influence of radiological emphysema on lung function test in idiopathic pulmonary fibrosis.

    Science.gov (United States)

    Bodlet, Aline; Maury, Gisèle; Jamart, Jacques; Dahlqvist, Caroline

    2013-11-01

    Idiopathic pulmonary fibrosis (IPF) is one of the most frequent interstitial lung disease. Emphysema can be associated with IPF as described in the «Combined pulmonary fibrosis and emphysema» syndrome. The primary endpoint of this retrospective cohort study was to evaluate the impact of the association of IPF and emphysema on lung function tests parameters (FVC, TLC, FEV1, FEV1/FVC and DLCO). The secondary endpoint was to assess the impact of the associated radiological emphysema on lung function parameters used in the du Bois prognostic score recently developed by Ron du Bois et al. We retrospectively reviewed the medical files of 98 patients with lung fibrosis who were followed in our University Hospital with access to pharmacological studies and lung transplantation from 1981 to 2011. Fifty six patients were considered for analysis. The collected data included gender, age, smoking history and respiratory hospitalizations. We also analysed their pulmonary functional parameters along with radiological characteristics, in particular the presence of emphysema which was assessed on thoracic high resolution CT scan. The du Bois score was retrospectively calculated from these data. TLC and FVC at diagnosis were significantly higher in the IPF-E group compared to the IPF group (respectively 86.6 ± 17.2% pv versus 72.0 ± 15.0% pv; p: 0.004 and 86.8 ± 18.4% pv versus 72.6 ± 20.6% pv; p: 0.020). The [Formula: see text] used in the calculation of the du Bois prognostic score was significantly higher in the IPF-E group. By cons, [Formula: see text] was not statistically different between the two groups. Radiological emphysema associated with IPF had an impact on pulmonary function tests. Despite this difference, the du Bois score was not statistically different between these two groups. Nevertheless, after one year of follow up, the patients with emphysema were in a subclass with a lower mortality rate than those without emphysema. Copyright © 2013 Elsevier

  20. Is neutrophil elastase the missing link between emphysema and fibrosis? Evidence from two mouse models

    Directory of Open Access Journals (Sweden)

    Martorana Piero A

    2005-07-01

    Full Text Available Abstract Background The separation of emphysema from fibrosis is not as clear-cut as it was thought in early studies. These two pathologies may be present at the same time in human lungs and in mice either instilled with elastolytic enzymes or bleomycin or exposed to cigarette-smoke. According to a current view, emphysema originates from a protease/antiprotease imbalance, and a role for antiproteases has also been suggested in the modulation of the fibrotic process. In this study we investigate in experimental animal models of emphysema and fibrosis whether neutrophil elastase may constitute a pathogenic link between these two pathologies. Methods This study was done in two animal models in which emphysema and fibrosis were induced either by bleomycin (BLM or by chronic exposure to cigarette-smoke. In order to assess the protease-dependence of the BLM-induced lesion, a group mice was treated with 4-(2-aminoethyl-benzenesulfonyl fluoride hydrochloride, a serine proteinase inhibitor active toward neutrophil elastase. Lungs from each experimental group were used for the immunohistochemical assessment of transforming growth factor-β (TGF-β and transforming growth factor-α (TGF-α and for determination of the mean linear intercept as well as the percent volume densities of fibrosis and of emphysematous changes. Additionally, the lungs were also assessed for desmosine content and for the determination of elastase levels in the pulmonary interstitium by means of immunoelectron microscopy. Results We demonstrate that in BLM-treated mice (i the development of elastolytic emphysema precedes that of fibrosis; (ii significant amount of elastase in alveolar interstitium is associated with an increased expression of TGF-β and TGF-α; and finally, (iii emphysematous and fibrotic lesions can be significantly attenuated by using a protease inhibitor active against neutrophil elastase. Also, in a strain of mice that develop both emphysema and fibrosis after

  1. Pneumoscrotum With Extensive Penile and Abdominal Subcutaneous Emphysema: A Case Report of Uncertain Etiology

    Directory of Open Access Journals (Sweden)

    Eric Raffin

    2017-02-01

    Full Text Available Pneumoscrotum and subcutaneous emphysema make for impressive findings on examination and imaging. With ranging etiologies, thorough investigation into the source is essential to rule out potentially life threatening situations. We present a 31-year-old man with pneumoscrotum and extensive subcutaneous emphysema of his penis, abdomen, and perineum. History and physical exam didn't reveal a clear cause and he subsequently underwent surgical exploration showing no soft tissue infection. On post-operative day 1, he remained clinically stable and was discharged. Despite the usual benign nature of pneumoscrotum, full assessment is necessary to identify possible underlying conditions of significant morbidity and mortality.

  2. Know How to Use Your Asthma Inhaler

    Medline Plus

    Full Text Available ... Providers CDC Publications on Asthma National Asthma Control Program America Breathing Easier Guide for State Programs Interventions Community Guide—Evidence-based Potentially Effective Interventions ...

  3. Early and lethal neurodegeneration with myasthenic and myopathic features: A new ALG14-CDG

    NARCIS (Netherlands)

    Schorling, D.C.; Rost, S.; Lefeber, D.J.; Brady, L.; Muller, C.R.; Korinthenberg, R.; Tarnopolsky, M.; Bonnemann, C.G.; Rodenburg, R.J.T.; Bugiani, M.; Beytia, M.; Kruger, M.; Knaap, M. van der; Kirschner, J.

    2017-01-01

    OBJECTIVE: To describe the presentation and identify the cause of a new clinical phenotype, characterized by early severe neurodegeneration with myopathic and myasthenic features. METHODS: This case study of 5 patients from 3 families includes clinical phenotype, serial MRI, electrophysiologic

  4. Dystonia in neurodegeneration with brain iron accumulation : outcome of bilateral pallidal stimulation

    NARCIS (Netherlands)

    Timmermann, L.; Pauls, K. A. M.; Wieland, K.; Jech, R.; Kurlemann, G.; Sharma, N.; Gill, S. S.; Haenggeli, C. A.; Hayflick, S. J.; Hogarth, P.; Leenders, K. L.; Limousin, P.; Malanga, C. J.; Moro, E.; Ostrem, J. L.; Revilla, F. J.; Santens, P.; Schnitzler, A.; Tisch, S.; Valldeoriola, F.; Vesper, J.; Volkmann, J.; Woitalla, D.; Peker, S.

    Neurodegeneration with brain iron accumulation encompasses a heterogeneous group of rare neurodegenerative disorders that are characterized by iron accumulation in the brain. Severe generalized dystonia is frequently a prominent symptom and can be very disabling, causing gait impairment, difficulty

  5. Comparison of distinctive models for calculating an interlobar emphysema heterogeneity index in patients prior to endoscopic lung volume reduction

    Directory of Open Access Journals (Sweden)

    Theilig D

    2017-06-01

    Full Text Available Dorothea Theilig,1 Felix Doellinger,1 Alexander Poellinger,1 Vera Schreiter,1 Konrad Neumann,2 Ralf-Harto Hubner31Department of Radiology, Charité Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Berlin, Germany; 2Institute of Biometrics and Clinical Epidemiology, Charité Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Berlin, Germany; 3Department of Pneumology, Charité Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Berlin, GermanyBackground: The degree of interlobar emphysema heterogeneity is thought to play an important role in the outcome of endoscopic lung volume reduction (ELVR therapy of patients with advanced COPD. There are multiple ways one could possibly define interlobar emphysema heterogeneity, and there is no standardized definition.Purpose: The aim of this study was to derive a formula for calculating an interlobar emphysema heterogeneity index (HI when evaluating a patient for ELVR. Furthermore, an attempt was made to identify a threshold for relevant interlobar emphysema heterogeneity with regard to ELVR.Patients and methods: We retrospectively analyzed 50 patients who had undergone technically successful ELVR with placement of one-way valves at our institution and had received lung function tests and computed tomography scans before and after treatment. Predictive accuracy of the different methods for HI calculation was assessed with receiver-operating characteristic curve analysis, assuming a minimum difference in forced expiratory volume in 1 second of 100 mL to indicate a clinically important change.Results: The HI defined as emphysema score of the targeted lobe (TL minus emphysema score of the ipsilateral nontargeted lobe disregarding the middle lobe yielded the best predicative accuracy (AUC =0.73, P=0.008. The HI defined as emphysema score of the TL minus emphysema score of the lung without the TL showed a similarly good predictive accuracy (AUC =0.72, P=0.009. Subgroup

  6. Novel Mechanism for Reducing Acute and Chronic Neurodegeneration After Traumatic Brain Injury

    Science.gov (United States)

    2015-07-01

    chronic neuronal cell loss, glial activation, and chronic traumatic encephalopathy (CTE) measure of β-amyloid and hyper-phosphorylated tau protein...Award Number: W81XWH-14-1-0195 TITLE: Novel Mechanism for Reducing Acute and Chronic Neurodegeneration After Traumatic Brain Injury...30 Jun 2015 4. TITLE AND SUBTITLE Novel Mechanism for Reducing Acute and Chronic Neurodegeneration After TBI 5a. CONTRACT NUMBER W81XWH-14-1

  7. Ethanol-Induced Neurodegeneration and Glial Activation in the Developing Brain

    Directory of Open Access Journals (Sweden)

    Mariko Saito

    2016-08-01

    Full Text Available Ethanol induces neurodegeneration in the developing brain, which may partially explain the long-lasting adverse effects of prenatal ethanol exposure in fetal alcohol spectrum disorders (FASD. While animal models of FASD show that ethanol-induced neurodegeneration is associated with glial activation, the relationship between glial activation and neurodegeneration has not been clarified. This review focuses on the roles of activated microglia and astrocytes in neurodegeneration triggered by ethanol in rodents during the early postnatal period (equivalent to the third trimester of human pregnancy. Previous literature indicates that acute binge-like ethanol exposure in postnatal day 7 (P7 mice induces apoptotic neurodegeneration, transient activation of microglia resulting in phagocytosis of degenerating neurons, and a prolonged increase in glial fibrillary acidic protein-positive astrocytes. In our present study, systemic administration of a moderate dose of lipopolysaccharides, which causes glial activation, attenuates ethanol-induced neurodegeneration. These studies suggest that activation of microglia and astrocytes by acute ethanol in the neonatal brain may provide neuroprotection. However, repeated or chronic ethanol can induce significant proinflammatory glial reaction and neurotoxicity. Further studies are necessary to elucidate whether acute or sustained glial activation caused by ethanol exposure in the developing brain can affect long-lasting cellular and behavioral abnormalities observed in the adult brain.

  8. Peak flow as predictor of overall mortality in asthma and chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Hansen, Ejvind Frausing; Vestbo, Jørgen; Phanareth, K

    2001-01-01

    Lung function is a strong predictor of overall mortality in asthma and chronic obstructive pulmonary disease (COPD). FEV1 is considered to be the "gold standard," whereas peak expiratory flow (PEF) is mostly used in absence of FEV1 measurements. We compared the predictive power of PEF and FEV1...... reflecting different components of COPD, i.e., chronic bronchitis, small airways disease, and emphysema. Furthermore, extrapulmonary components such as muscle mass and general "vigour" probably affect PEF to a greater extent than they affect FEV1......., measured after maximal bronchodilation, which included a short course of oral corticosteroids. The study population comprised 491 asthmatics and 1,095 subjects with COPD. Pulmonary function tests were performed between 1983 and 1988, and survival data were obtained by September 1997, when 127 asthmatics...

  9. The Future of Asthma Treatment

    Directory of Open Access Journals (Sweden)

    Louis-Philippe Boulet

    1995-01-01

    identification and possible correction of genetic abnormalities responsible for the tendency to develop asthma and atopy, and prevention or functional and structural airway changes. This last goal will be achieved by improved environmental control, earlier use of more powerful and safe anti-inflammatory agents, as well as an increased involvement on the part of the asthma patient in treatment.

  10. The Saudi Initiative for asthma

    Directory of Open Access Journals (Sweden)

    Al-Moamary Mohamed

    2009-01-01

    Full Text Available The Saudi Initiative for Asthma (SINA provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system.

  11. How Do Asthma Medicines Work?

    Science.gov (United States)

    ... a Kid Who's Bullied? How Do Asthma Medicines Work? KidsHealth > For Kids > How Do Asthma Medicines Work? Print A A A en español ¿Cómo funcionan ... control medicines (also called controller or maintenance medicines) work over a long period of time by keeping ...

  12. Smoking and Asthma (For Parents)

    Science.gov (United States)

    ... Giving Teens a Voice in Health Care Decisions Smoking and Asthma KidsHealth > For Parents > Smoking and Asthma Print A A A What's in ... Antismoking Message en español Fumar y el asma Smoking is an unhealthy habit for anyone, but it's ...

  13. Adolescents and Exercise Induced Asthma

    Science.gov (United States)

    Hansen, Pamela; Bickanse, Shanna; Bogenreif, Mike; VanSickle, Kyle

    2008-01-01

    This article defines asthma and exercise induced asthma, and provides information on the triggers, signs, and symptoms of an attack. It also gives treatments for these conditions, along with prevention guidelines on how to handle an attack in the classroom or on the practice field. (Contains 2 tables and 1 figure.)

  14. Adult-onset eosinophilic asthma

    NARCIS (Netherlands)

    de Groot, J.C.

    2017-01-01

    In the last decades, it has been recognized that asthma is not a single disease, but comprises several clinical syndromes, which all share respiratory symptoms and lung function abnormalities, associated with different types of airway inflammation. These syndromes are now known as different asthma

  15. Asthma in patients with psoriasis

    DEFF Research Database (Denmark)

    Lønnberg, A S; Skov, L; Skytthe, A

    2015-01-01

    We read with interest the report by Fang and colleagues of the relationship between psoriasis and asthma in a large retrospective case-control study from Taiwan [1]. The study found a 1.38-fold increased risk of asthma among patients with psoriasis, and with an increasing risk according to higher...

  16. Neurodegeneration in ataxia-telangiectasia is caused by horror autotoxicus.

    Science.gov (United States)

    Kuljis, R O; Aguila, M C

    1999-05-01

    Ataxia-telangiectasia (A-T) is a pleiotropic, multi-system disorder with manifestations that include immune deficiency, sensitivity to ionizing radiation and neoplasms. Many of these manifestations are understood in principle since the identification in A-T patients of mutations in a gene encoding a protein kinase that plays a key role in signaling and repair of DNA damage. However, the cause of the neurodegeneration that afflicts patients with A-T for at least a decade before they succumb to overwhelming infections or malignancy remains mysterious. Based on our work in a mouse model of A-T and previous evidence of extra-neural autoimmune disorders in A-T, we postulate that the neurodegenerative process in A-T is not due to a function for A-T mutated (ATM) essential for the postnatal brain, but to an autoimmune process (hence 'horror autotoxicus', Paul Ehrlich's term for autoimmune disorder). This hypothetical mechanism may be analogous to that in the so-called 'paraneoplastic' neurodegenerative syndromes in patients with various malignancies. Thus, alterations in the balance between cellular and humoral immunity in A-T probably result in autoantibodies to cerebral epitopes shared with cells of the immune system. This hypothesis has important implications for the understanding and development of effective palliative and even preventative strategies for A-T, and probably for other so far relentlessly progressive neurodegenerative disorders.

  17. Brain aging and neurodegeneration: from a mitochondrial point of view.

    Science.gov (United States)

    Grimm, Amandine; Eckert, Anne

    2017-11-01

    Aging is defined as a progressive time-related accumulation of changes responsible for or at least involved in the increased susceptibility to disease and death. The brain seems to be particularly sensitive to the aging process since the appearance of neurodegenerative diseases, including Alzheimer's disease, is exponential with the increasing age. Mitochondria were placed at the center of the 'free-radical theory of aging', because these paramount organelles are not only the main producers of energy in the cells, but also to main source of reactive oxygen species. Thus, in this review, we aim to look at brain aging processes from a mitochondrial point of view by asking: (i) What happens to brain mitochondrial bioenergetics and dynamics during aging? (ii) Why is the brain so sensitive to the age-related mitochondrial impairments? (iii) Is there a sex difference in the age-induced mitochondrial dysfunction? Understanding mitochondrial physiology in the context of brain aging may help identify therapeutic targets against neurodegeneration. This article is part of a series "Beyond Amyloid". © 2017 The Authors. Journal of Neurochemistry published by John Wiley & Sons Ltd on behalf of International Society for Neurochemistry.

  18. Neurodegeneration and microtubule dynamics: Death by a thousand cuts

    Directory of Open Access Journals (Sweden)

    Jyoti eDubey

    2015-09-01

    Full Text Available Microtubules form important cytoskeletal structures that play a role in establishing and maintaining neuronal polarity, regulating neuronal morphology, transporting cargo and scaffolding signaling molecules to form signaling hubs. Within a neuronal cell, microtubules are found to have variable lengths and can be both stable and dynamic. Microtubule associated proteins, post-translational modifications of tubulin subunits, microtubule severing enzymes, and signaling molecules are all known to influence both stable and dynamic pools of microtubules. Microtubule dynamics, the process of interconversion between stable and dynamic pools, and the proportions of these two pools have the potential to influence a wide variety of cellular processes. Reduced microtubule stability has been observed in several neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s disease, Amyotrophic Lateral Sclerosis and tauopathies like Progressive Supranuclear Palsy. Hyperstable microtubules, as seen in Hereditary Spastic Paraplegia, also lead to neurodegeneration. Therefore, the ratio of stable and dynamic microtubules is likely to be important for neuronal function and perturbation in microtubule dynamics might contribute to disease progression.

  19. LINGO-1 and Neurodegeneration: Pathophysiologic Clues for Essential Tremor?

    Directory of Open Access Journals (Sweden)

    Zhou Zhi-dong

    2012-03-01

    Full Text Available Essential tremor (ET, one of the most common adult-onset movement disorders, has been associated with cerebellar Purkinje cell degeneration and formation of brainstem Lewy bodies. Recent findings suggest that genetic variants of the leucine-rich repeat and Ig domain containing 1 (LINGO-1 gene could be risk factors for ET. The LINGO-1 protein contains both leucine-rich repeat (LRR and immunoglobulin (Ig-like domains in its extracellular region, as well as a transmembrane domain and a short cytoplasmic tail. LINGO-1 can form a ternary complex with Nogo-66 receptor (NgR1 and p75. Binding of LINGO-1 with NgR1 can activate the NgR1 signaling pathway, leading to inhibition of oligodendrocyte differentiation and myelination in the central nervous system. LINGO-1 has also been found to bind with epidermal growth factor receptor (EGFR and induce downregulation of the activity of EGFR–PI3K–Akt signaling, which might decrease Purkinje cell survival. Therefore, it is possible that genetic variants of LINGO-1, either alone or in combination with other genetic or environmental factors, act to increase LINGO-1 expression levels in Purkinje cells and confer a risk to Purkinje cell survival in the cerebellum. Here, we provide a concise summary of the link between LINGO-1 and neurodegeneration and discuss various hypotheses as to how this could be potentially relevant to ET pathogenesis.

  20. Application of medical cannabis in patients with the neurodegeneration disorders

    Directory of Open Access Journals (Sweden)

    Lidia Kotuła

    2014-04-01

    Full Text Available Medical cannabis is the dried flowers of the female Cannabis sativa L. plant. Cannabis contains a number of active elements, including dronabinol (THC and cannabidiol (CBD. Dronabinol is usually the main ingredient. The body’s own cannabinoid system has been identified. The discovery of this system, which comprises endocannabinoids and receptors, confirmed that cannabis has a positive effect on certain illnesses and conditions. Two types of cannabinoid receptors have been identified: CB1 and CB2 receptors. The first type CB1 is mostly found in the central nervous system, modulate pain. It also has an anti-emetic effect, and has influence on the memory and the motor system. The second type of receptors CB2 is peripheral, and it is primarily found in immune system cells and it is responsible for the immunomodulatory effects of cannabinoids. Medical cannabis can help in cases of the neurodegeneration disorders, for example Parkinson’s disease, Huntington’s Disease, Amyotrophic Lateral Sclerosis. Patients generally tolerate medical cannabis well.