Pulmonary Arterial Pruning and Longitudinal Change in Percent Emphysema and Lung Function: The Genetic Epidemiology of COPD Study.

BACKGROUND: Pulmonary endothelial damage has been shown to precede the development of emphysema in animals, and vascular changes in humans have been observed in COPD and emphysema. RESEARCH QUESTION: Is intraparenchymal vascular pruning associated with longitudinal progression of emphysema on CT imaging or decline in lung function over 5 years? STUDY DESIGN AND METHODS: The Genetic Epidemiology of COPD Study enrolled ever smokers with and without COPD from 2008 through 2011. The percentage of emphysema-like lung, or "percent emphysema," was assessed at baseline and after 5 years on noncontrast CT imaging as the percentage of lung voxels < -950 Hounsfield units. An automated CT imaging-based tool assessed and classified intrapulmonary arteries and veins. Spirometry measures are postbronchodilator. Pulmonary arterial pruning was defined as a lower ratio of small artery volume (< 5 mm2 cross-sectional area) to total lung artery volume. Mixed linear models included demographics, anthropomorphics, smoking, and COPD, with emphysema models also adjusting for CT imaging scanner and lung function models adjusting for clinical center and baseline percent emphysema. RESULTS: At baseline, the 4,227 participants were 60 ± 9 years of age, 50% were women, 28% were Black, 47% were current smokers, and 41% had COPD. Median percent emphysema was 2.1 (interquartile range, 0.6-6.3) and progressed 0.24 percentage points/y (95% CI, 0.22-0.26 percentage points/y) over 5.6 years. Mean FEV1 to FVC ratio was 68.5 ± 14.2% and declined 0.26%/y (95% CI, -0.30 to -0.23%/y). Greater pulmonary arterial pruning was associated with more rapid progression of percent emphysema (0.11 percentage points/y per 1-SD increase in arterial pruning; 95% CI, 0.09-0.16 percentage points/y), including after adjusting for baseline percent emphysema and FEV1. Arterial pruning also was associated with a faster decline in FEV1 to FVC ratio (-0.04%/y per 1-SD increase in arterial pruning; 95% CI, -0.008 to -0.001%/y). INTERPRETATION: Pulmonary arterial pruning was associated with faster progression of percent emphysema and more rapid decline in FEV1 to FVC ratio over 5 years in ever smokers, suggesting that pulmonary vascular differences may be relevant in disease progression. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.

Synthesis of zeolite membranes on calcium silicate support and their bioactive response.

The synthesis of calcium silicate supported zeolite membrane was carried out by second growth method. The chemical nature of the functionalizing agent on the formation of homogenous zeolite membrane was evaluated. One monomer and two cationic polymers were used: 3-aminopropyltriethoxysilane (APS), polyethylenimine (PEI) and polydiallyldimethylammonium chloride (PDDA). The support was subjected to chemical functionalization and then it was rubbed with zeolite crystals. The W zeolite was used as zeolite seed in two different Si/Al ratios. The functionalized and rubbed supports were submitted to hydrothermal treatment at 150 °C for 48 h. The bioactivity of the homogeneous zeolite membranes was evaluated by the biomimetic method through the membranes soaking in a simulated body fluid (SBF) at 37 °C for 21 days. Two immersion methods were evaluated. The products were characterized by XRD and SEM techniques. The results indicated that the supported functionalization with PDDA and the Si/Al ratio (higher than 1.8) of zeolite enhanced the interaction between the support and the zeolite precursor enhancing the formation of homogeneous zeolite membrane on the surface. The presence of the functional groups of PDDA on the membrane was detected by FTIR. After immersion in SBF, the zeolite membrane was stable and led to the formation of Ca-P layer on its surface. The re-immersion method led to the formation of richer Ca/P layer (1.36). These findings allowed generating a zeolite membrane with combined properties of calcium silicate and the controllable porosity of zeolitic material making it potentially useful for bone regeneration and drug releasing.

Pulmonary vascular morphology as an imaging biomarker in chronic thromboembolic pulmonary hypertension.

Patients with chronic thromboembolic pulmonary hypertension (CTEPH) have morphologic changes to the pulmonary vasculature. These include pruning of the distal vessels, dilation of the proximal vessels, and increased vascular tortuosity. Advances in image processing and computer vision enable objective detection and quantification of these processes in clinically acquired computed tomographic (CT) scans. Three-dimensional reconstructions of the pulmonary vasculature were created from the CT angiograms of 18 patients with CTEPH diagnosed using imaging and hemodynamics as well as 15 control patients referred to our Dyspnea Clinic and found to have no evidence of pulmonary vascular disease. Compared to controls, CTEPH patients exhibited greater pruning of the distal vasculature (median density of small-vessel volume: 2.7 [interquartile range (IQR): 2.5-3.0] vs. 3.2 [3.0-3.8]; P = 0.008), greater dilation of proximal arteries (median fraction of blood in large arteries: 0.35 [IQR: 0.30-0.41] vs. 0.23 [0.21-0.31]; P = 0.0005), and increased tortuosity in the pulmonary arterial tree (median: 4.92% [IQR: 4.85%-5.21%] vs. 4.63% [4.39%-4.92%]; P = 0.004). CTEPH was not associated with dilation of proximal veins or increased tortuosity in the venous system. Distal pruning of the vasculature was correlated with the cardiac index (R = 0.51, P = 0.04). Quantitative models derived from CT scans can be used to measure changes in vascular morphology previously described subjectively in CTEPH. These measurements are also correlated with invasive metrics of pulmonary hemodynamics, suggesting that they may be used to assess disease severity. Further work in a larger cohort may enable the use of such measures as a biomarker for diagnostic, phenotyping, and prognostic purposes.

Computed tomographic measures of airway morphology in smokers and never-smoking normals.

Bronchial wall area percent (WA% = 100 × wall area/total bronchial cross sectional area) is a standard computed tomographic (CT) measure of central airway morphology utilized in smokers with chronic obstructive pulmonary disease (COPD). Although it provides significant clinical correlations, the range of reported WA% is narrow. This suggests limited macroscopic change in response to smoking or that remodeling proportionally affects the airway wall and lumen dimensions such that their ratio is preserved. The objective of this study is to assess central airway wall area (WA), lumen area (Ai), and total bronchial area (Ao) from CT scans of 5,179 smokers and 92 never smoking normal subjects. In smokers, WA, Ai, and Ao were positively correlated with forced expiratory volume in 1 s (FEV1) expressed as a percent of predicted (FEV1%), and the WA% was negatively correlated with FEV1% (P < 0.0001 for all comparisons). Importantly, smokers with lower FEV1% tended to have airways of smaller cross-sectional area with lower WA. The increases in the WA% across GOLD stages of chronic obstructive pulmonary disease (COPD) can therefore not be due to increases in WA. The data suggest two possible origins for the WA% increases: 1) central airway remodeling resulting in overall reductions in airway caliber in excess of the decreased WA or 2) those with COPD had smaller native airways before they began smoking. In both cases, these observations provide an explanation for the limited range of values of WA% across stages of COPD.

EMPHYSEMA QUANTIFICATION IN A MULTI-SCANNER HRCT COHORT USING LOCAL INTENSITY DISTRIBUTIONS.

This article investigates the suitability of local intensity distributions to analyze six emphysema classes in 342 CT scans obtained from 16 sites hosting scanners by 3 vendors and a total of 9 specific models in subjects with Chronic Obstructive Pulmonary Disease (COPD). We propose using kernel density estimation to deal with the inherent sparsity of local intensity histograms obtained from scarcely populated regions of interest. We validate our approach by leave-one-subject-out classification experiments and full-lung analyses. We compare our results with recently published LBP texture-based methodology. We demonstrate the efficacy of using intensity information alone in multi-scanner cohorts, which is a simpler, more intuitive approach.

Benign rectal ulcer: an underground cause of inpatient lower gastrointestinal bleeding.

BACKGROUND: Although it is uncommon, significant bleeding per rectum presents one of the most difficult emergency problems. Bleeding from a rectal ulcer is not well recognized as a cause of such bleeding. METHODS: From July 2000 through December 2000, 195 consecutive patients with significant blood loss per rectum were reviewed. RESULTS: Forty-eight cases in whom significant gastrointestinal (GI) bleeding occurred following prior hospitalization were identified. Sources of bleeding were gastroduodenal in 38 cases (79%) and colorectal in 10 cases (21%). The causes of inpatient colorectal bleeding were benign rectal ulcer (n = 4), ischemic colitis (n = 3), neoplasia (n = 2), and diversion colitis (n = 1). CONCLUSION: The differential diagnosis for inpatients who develop new inpatient GI bleeding differs from that of patients who develop outpatient GI bleeding. Careful examination of the rectum following rectal instrumentation is critical. In addition to the standard resuscitative measures, the identification and treatment of rectal ulcers in this group of patients is of paramount importance. The treatment options for bleeding rectal ulcer include conservative therapy, cauterization, embolization, banding, and local excision.

Biological activity of complexes derived from pyridine-2-carbaldehyde thiosemicarbazone. Structure of.

Biological studies on [Fe(L)2](NO3).0.5H2O (1), [Fe(L)2][PF6] (2), [Co(L)2](NCS) (3), [Ni(HL)2]Cl2.3H2O (4) and Cu(L)(NO3) (5), where HL=C7H8N4S, pyridine-2-carbaldehyde thiosemicarbazone, have been carried out. The crystal structure of compound 3 has been solved. It consists of discrete monomeric cationic entities containing cobalt(III) ions in a distorted octahedral environment. The metal ion is bonded to one sulfur and two nitrogen atoms of each thiosemicarbazone molecule. The thiocyanate molecules act as counterions. The copper(II) and iron(III) complexes react with reduced glutathione and 2-mercaptoethanol. The reaction of compound 1 with the above thiols causes the reduction of the metal ion and bis(thiosemicarbazonato)iron(II) species are obtained. The redox activity, and in particular the reaction with cell thiols, seems to be related to the cytotoxicity of these complexes against Friend erithroleukemia cells and melanoma B16F10 cells.

Measurements of density and viscosity of one- and two-phase fluids with torsional waveguides.

The continuing need for in-situ measurements of physical properties of wastes contained within many high level radioactive waste tanks within the Hanford Site has initiated experimental and theoretical investigations of candidate measurement methods. This paper describes experiments performed with acoustic waveguide sensors. This technology has potential application at the Hanford Site for in-situ measurements of density, viscosity, and temperature of liquid wastes. Waveguides of both circular and rectangular geometry were used in these studies for determination of the densities and viscosities of various fluids. The flight time of a torsional pulse through the sensing region of the waveguide forms the measured quantity. The flight time depends on the velocity of the wave through the sensing region of the waveguide, and this velocity in turn depends upon the properties of the fluid in contact with the waveguide. We performed experiments with 15 different fluids, most of which were single-phase Newtonian fluids. However, three of the fluids were particle-liquid mixtures, and one of these Newtonian in behavior. Most of the wastes held in Hanford tanks contain high solids content. The results of our experiments showed that acoustic waveguides were well suited for measurements in most Newtonian fluids, in agreement with earlier research presented in the literature. However, results for two-phase Newtonian fluids containing particles indicate that, in our case, the waveguides responded primarily to the background fluid rather than the mixture. Very poor results were obtained with the non-Newtonian fluid. In addition, there was a class of fluids, which serve the community as viscosity standards, for which viscosities determined with torsional waveguides were in disagreement with viscosities obtained with standard viscometers.

Comparison of fingernail ridge patterns of monozygotic twins.

The ridge patterns on the fingernails of corresponding fingers of a pair of twins were compared microscopically and found to be readily distinguishable from one another. Based on blood grouping in six blood group systems (ABO, Rhesus, Ss, Duffy, Kidd, and Kell), the probability that the twins were monozygotic was calculated to be 89.1%.

Spanish norms for the Harvard Group Scale of Hypnotic Susceptibility, Form A.

The results of administering the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A) of Shor and E. Orne (1962) to a Spanish sample are on the whole consistent with those results obtained in other normative studies, especially Bongartz's work with a German sample, and they confirm HGSHS:A's usefulness in non-Anglophone countries. The Spanish HGSHS:A's reliability and validity remain within the limits reported for other locales, but there are certain discrepancies with respect to the difficulty of two HGSHS:A items.