Lung Area Research Articles

Lung Ultrasonography and Clinical Follow-Up Evaluations in Fattening Bulls Affected by Bovine Respiratory Disease (BRD) during the Restocking Period and after Tulathromycin and Ketoprofen Treatment.

Simple SummaryThe restocking period is a crucial time for fattening bulls: stressors such as transport predispose animals to bovine respiratory disease, reducing animal well-being and causing economic losses. Ultrasonography is a non-invasive, real-time, and portable method frequently employed in farming. The aim of this study was to evaluate the feasibility of the thoracic ultrasound in identifying animals with bovine respiratory disease on a restocking farm, and in assessing the efficacy of tulathromycin and ketoprofen treatment in sick animals. Our findings reveal that lung ultrasound is a useful diagnostic tool for screening respiratory diseases. Moreover, tulathromycin and ketoprofen treatment was effective in reducing both clinical symptoms and lung lesions. Bovine respiratory disease (BRD) is a global infectious disease, causing decreased well-being and economic losses in livestock, frequently during the restocking period. The aim of this study was to evaluate the feasibility of thoracic ultrasonography (TUS) to assess BRD in restocked animals, and the effectiveness of tulathromycin and ketoprofen treatment in sick animals. A total of 60 Limousin fattening bulls were enrolled. On the day of restocking (T0), the animals were divided into two groups based on TUS assessment of six lung areas: group C (ultrasonography score (US score) < 3) and group D (US score ≥ 3). Group D received a single administration of tulathromycin and ketoprofen at T0: this group was revaluated after 1.5, 3, 7, and 14 days. Both groups were revaluated after 21 days. The two groups showed a significant difference both in US score and clinical symptoms (respiratory score, nasal and ocular discharges, and rectal temperature) at T0. In group D, the treatment was effective in improving the clinical symptoms and US score, particularly reducing the severity of lung lesions. TUS represents a non-invasive and cost-effective tool for BRD early diagnosis and for monitoring treatment efficacy in restocked livestock.

Prognostic Significance of Small Pulmonary Vessel Alteration Measured by Chest Computed Tomography in Connective Tissue Diseases With Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is characterized by structural alterations of pulmonary vessels. Few studies have explored the clinical significance of quantitative assessment of pulmonary small vessels by chest computed tomography (CT). Our aim was to assess whether the prognosis of connective tissue diseases (CTD)-PAH patients could be assessed through pulmonary small vessels measured by chest CT. In all, 42 CTD-PAH patients diagnosed based on right heart catheterization were retrospectively investigated. All patients underwent a chest CT within 1 month before and after right heart catheterization examination. Main pulmonary artery (MPA) and the cross-sectional area of small pulmonary vessels <5 mm2 as a percentage of total lung area (%CSA <5) were measured. The primary endpoint was a composite clinical worsening endpoint. After a median follow-up time of 30.5 (interquartile range, 8.5 to 45.25) months, endpoint events occurred in 16 (38.1%) patients after 19.5 (interquartile range, 10.0 to 45.5) months. Cox univariate proportional hazard analysis showed that pulmonary vascular resistance, MPA diameter, and %CSA <5 were associated with the end point. A combination of MPA diameter and %CSA < 5 was the independent risk factor for the prognosis (hazard ratio, 2.180 [95% confidence interval, 1.405-3.383], P=0.001). Kaplan-Meier analysis showed that CTD-PAH patients satisfying %CSA < 5 of <0.382 and MPA >36.75 mm had the highest risk of experiencing the endpoint. Among the pulmonary vascular indicators measured by chest CT, in addition to MPA, %CSA < 5 may be a potential independent risk factor for poor long-term prognosis in Chinese CTD-PAH patients.

Driving pressure versus right ventricular echocardiography parameters as a predictive for acute respiratory distress syndrome outcome

Background: Acute respiratory distress syndrome (ARDS) is an inflammatory disease that affects the lung in a heterogeneous manner , so that ,even ideal body weight (IBW) based tidal volume may apply different lung stress and strain according to the available aerated lung areas. Airway driving pressure (DP) is the difference between airway plateau pressure (P plat) and positive endexpiratory pressure (PEEP), it can be used as a bedside surrogate for lung stress in several previous studies. Acute corpulmonale manifested by pulmonary hypertension and right ventricular dysfunction occurs as a consequence for ARDS with a prevalence ( 25% to 61%) in different studies. Objectives : This study was designed to show he clinical value of airway driving pressure and right heart echocardiography parameters in predicting ARDS outcome , and to correlate between airway pressures and right ventricle parameters. Methodology : fifty ARDS patients were diagnosed by Berlin criteria and monitored for airway pressures including DP and Pplat on day 0, day 3 and day 7. transthoracic echocardiography was used to assess RV parameters on day 0 and day 7 . According the ICU mortality patients are divided into survivors and nonsurvivors.

The Percentage of Low Attenuation Area on Computed Tomography to Detect Chronic Lung Allograft Dysfunction After Bilateral Lung Transplantation

<h3>Purpose</h3> Lung emphysematous changes may develop in patients with chronic lung allograft dysfunction (CLAD) after lung transplantation (LT). To evaluate the severity of lung emphysema, the percentage of low attenuation area (LAA%) of the bilateral lungs calculated on computed tomography has been shown to be a useful index. This study aimed to investigate whether the LAA% was associated with the development of CLAD after bilateral LT. <h3>Methods</h3> We conducted a single-center retrospective study of 75 recipients who underwent bilateral LT from May 2008 to August 2015. The LAA% on computed tomography were calculated and compared between the CLAD group (N = 30) and the non-CLAD group (N = 45) from 2 years before to 4 years after the diagnosis of CLAD. The LAA% at 5 years after bilateral LT was designated as the control value in the non-CLAD group. The Pearson product-moment correlation coefficient was calculated between the LAA% and the percent baseline values of the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC), and the total lung capacity (TLC) at the diagnosis of CLAD after bilateral LT. <h3>Results</h3> The median observation period after LT was 3277 (380-7691) days. The LAA% in the CLAD group was significantly higher than that in the non-CLAD group from even 2 years before the diagnosis of CLAD to 2 years after the diagnosis of CLAD (P < 0.05) (Figure 1). The difference in the LAA% between the CLAD group and the non-CLAD group tended to increase after the onset of CLAD. Furthermore, the LAA% was significantly correlated with the percent baseline values of the FEV1, the FVC, and the TLC (FEV1, r = -0.36, P = 0.0031; FVC, r = -0.27, P = 0.027; TLC, r = -0.40, P < 0.001) (Figure 2). <h3>Conclusion</h3> The LAA% was associated with the development of CLAD and increased after the diagnosis of CLAD. Moreover, the LAA% was associated with declines in the FEV1, FVC and TLC at the time of CLAD diagnosis. The LAA% appears to have the potential to predict CLAD after bilateral LT.

Mechanistic analysis of B-line formation in lung ultrasound

The number and distribution of lung ultrasound (LUS) imaging artifacts—B-lines—is correlated with the presence of lung interstitial syndrome such as viral infection and pulmonary edema. The detection and quantification of B-lines is machine and operator dependent, and the mechanisms for B-line formation are not fully understood. The goals of this work were to collect RF data during LUS exams in patients with pulmonary edema and to compare to the signals and corresponding images simulated numerically to elucidate the B-line formation process. Verasonics ultrasound engine (VUE) with a phased array probe (4.5 MHz) was used to perform standard 10-zone LUS in ten patients with confirmed pulmonary edema. The RF data corresponding to each B-mode image and a series of 35 plane wave acquisitions were collected for off-line analyses. Finite element modeling of LUS pulse propagation was performed in COMSOL with fluid-filled inclusions of variable sizes and shapes in air-like medium simulating edematous lung areas. The B-mode image resulting from the simulated RF signals was reconstructed using VUE beamforming. The B-lines similar to those observed experimentally formed in simulated images only under specific conditions of sizes and shapes of water-filled areas relatively to LUS imaging wavelength. [Work supported by NIH R01EB023910.]

Histopathological changes on the pregnant rat's lung induced by sodium nitrite and monosodium glutamate

Food additives and preservatives are widely used globally, which, despite their many benefits, have great harm if they are used without health restrictions or control, as they cause many health problems and tissue lesions. Therefore, the present study aimed to investigate the histopathological effects on the lung of pregnant rats of two types of these substances: Monosodium glutamate (MSG) and Sodium nitrite (NaNO2). Twenty-four pregnant rats used for this study, and they were divided into four groups equally. The control group was dosed with distilled water from the sixth day to the fifteenth day of pregnancy. The second was dosed with MSG at a 12g /kg concentration for the same period in the first group. The third injected with a concentration of 120 mg/kg of NaNO2 for the same period. The fourth was dosed with MSG and NaNO2 together, with the same concentrations and the above period. The results showed that the second group''s lungs showed many histopathological changes, including strong infiltration of inflammatory cells, congestion of blood vessels, necrosis of bronchioles and alveolar septa, and emphysema of some alveoli. In the third group, changes included hyperplasia of the fibroblasts, hemorrhage in the alveoli, desquamation and necrosis in bronchioles, peri-bronchial fibrosis, blood vessel congestion. The fourth group showed infiltration of inflammatory cells, necrosis in multiple lung areas, emphysema, fibrosis in some alveoli, and hypoplasia of the muscle fibers around the blood vessels. The study concluded that MSG and NaNO2 caused much tissue damage in the lungs of pregnant rats.

Ex-Vivo Pulmonary Artery Angioscopy: A Novel Technique for Management of Donor Lung Pulmonary Embolism

<h3>Purpose</h3> Although organ donors have high prevalence of pulmonary embolism (PE), the diagnosis of PE in donor lungs can be challenging and can have a detrimental effect on lung transplantion (LTx) outcomes. The aim of this study was to investigate the feasibility of a novel technique using ex-vivo pulmonary artery (EXPLORE) angioscopy for the diagnosis and treatment of PE in donor lungs post-procurement. <h3>Methods</h3> An adult fiber optic bronchoscope was utilized for the EXPLORE angioscopy technique (off-label use). EXPLORE angioscopy was first tested in donor lungs deemed non-suitable for LTx after ex-vivo lung perfusion (EVLP) (test group). It was then routinely utilized for screening of donor lungs with suspected PE before EVLP (application group). Criteria for PE suspicion included: consistently low P/F ratio during donor management, observed clots during retrograde flushing, and inadequate flushing of donor lungs presented as abnormal coloring of some lung areas. <h3>Results</h3> In the testing group, using EXPLORE angioscopy we were able to identify and remove pulmonary emboli from 4 lungs (<b>Figure 1</b>). In the application group, 16 lungs fulfilled the criteria for PE suspicion and were screened with EXPLORE angioscopy. In 5 cases, pulmonary emboli were identified and removed before EVLP, two of which were deemed suitable for LTx post-EVLP evaluation and were transplanted with good outcomes. Both recipients were extubated on post-transplant day 1 and primary graft dysfunction (PGD) grades at 72 hours post-transplant were 1. In the other 11 cases, PE screening was negative, 6 of which were transplanted. Four recipients had PGD 1 and two had PGD 0 at 72 hours. Median time to extubation was 2 days. <h3>Conclusion</h3> EXPLORE angioscopy can be a useful tool for PE screening in donor lungs post-procurement which can improve the outcomes of LTx. Additionally, it can be utilized for embolectomy prior to EVLP evaluation which can increase the number of initially declined donor lungs treated with EVLP and ultimately transplanted.

Pleurectomy for spontaneous nonspecific pneumothorax

The occurrence of spontaneous nonspecific pneumothorax is associated with degenerative fibrous changes in the interstitial tissue, mainly in the cortical parts of the lung, leading to a violation of the elasticity of the lung tissue with the formation of blisters. The rupture of such a bubble is the cause of spontaneous pneumothorax. The basis for the development of fibrous changes is a violation of the blood supply to the cortical parts of the lung. For the purpose of revascularization of degenerative atrophic parts of the lung in 1954 pleurectomy was performed with simultaneous removal of altered lung areas with spontaneous nonspecific pneumothorax with a good result.

A Soft Labeling Approach to Develop Automated Algorithms that Incorporate Uncertainty in Pulmonary Opacification on Chest CT using COVID-19 Pneumonia

Hard data labels for automated algorithm training are binary and cannot incorporate uncertainty between labels. We proposed and evaluated a soft labeling methodology to quantify opacification and percent well-aerated lung (%WAL) on chest CT, that considers uncertainty in segmenting pulmonary opacifications and reduces labeling burden. We retrospectively sourced 760 COVID-19 chest CT scans from five international centers between January and June 2020. We created pixel-wise labels for >27,000 axial slices that classify three pulmonary opacification patterns: pure ground-glass, crazy-paving, consolidation. We also quantified %WAL as the total area of lung without opacifications. Inter-user hard label variability was quantified using Shannon entropy (range=0-1.39, low-high entropy/variability). We incorporated a soft labeling and modeling cycle following an initial model with hard labels and compared performance using point-wise accuracy and intersection-over-union of opacity labels with ground-truth, and correlation with ground-truth %WAL. Hard labels annotated by 12 radiologists demonstrated large inter-user variability (3.37% of pixels achieved complete agreement). Our soft labeling approach increased point-wise accuracy from 60.0% to 84.3% (p=0.01) compared to hard labeling at predicting opacification type and area involvement. The soft label model accurately predicted %WAL (R=0.900) compared to the hard label model (R=0.856), but the improvement was not statistically significant (p=0.349). Our soft labeling approach increased accuracy for automated quantification and classification of pulmonary opacification on chest CT. Although we developed the model on COVID-19, our intent is broad application for pulmonary opacification contexts and to provide a foundation for future development using soft labeling methods.

Prenatal Ultrasound Markers: A Comparative Study for Prediction of Respiratory Distress in Early Preterm Newborns.

This study aimed to compare the prenatal ultrasound parameters- fetal lung biometry and pulmonary artery Doppler in preterm newborns for prediction of respiratory distress (RD). A prospective analytic study was conducted in Department of Obstetrics and Gynecology in collaboration with Department of Neonatalogy. Fetal ultrasound and Doppler parameters were evaluated in women predisposed to have preterm delivery at or before 34weeks. The neonates were followed for occurrence of RD. Out of 100 study population, neonates who developed RD were taken as cases (n = 36) and rest were grouped as controls (n = 64). The gestational age at delivery, mean birth weight and Apgar score were significantly less in cases than controls. All the fetal lung biometric parameters were significantly less in cases than controls (p value < 0.001). The fetal lung volume had highest sensitivity (72.22%) and negative predictive value (83%). The right lung area had highest specificity (89%) and positive predictive value (72%). Among the Doppler parameters, the At/Et ratio showed high degree of accuracy (68%). The sensitivity and specificity were 55.56% and 75%, respectively. The positive and negative predictive values were 72% and 60%, respectively. Both fetal lung biometry and pulmonary artery Doppler offer an excellent noninvasive approach for assessment of fetal lung maturity, clinically assessed by RD. On comparison of all the ultrasound parameters, fetal lung volume and At/Et ratio showed highest degree of accuracy in prediction of RD.

RNA Sequencing of Epithelial Cell/Fibroblastic Foci Sandwich in Idiopathic Pulmonary Fibrosis: New Insights on the Signaling Pathway.

Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease characterized by irreversible scarring of the distal lung. IPF is best described by its histopathological pattern of usual interstitial pneumonia (UIP), characterized by spatial heterogeneity with alternating interstitial fibrosis and areas of normal lung, and temporal heterogeneity of fibrosis characterized by scattered fibroblastic foci (FF), dense acellular collagen and honeycomb changes. FF, comprising aggregated fibroblasts/myofibroblasts surrounded by metaplastic epithelial cells (EC), are the cardinal pathological lesion and their presence strongly correlates with disease progression and mortality. We hypothesized that the EC/FF sandwich from patients with UIP/IPF has a distinct molecular signature which could offer new insights into the crosstalk of these two crucial actors in the disease. Laser capture microdissection with RNAseq was used to investigate the transcriptome of the EC/FF sandwich from IPF patients versus controls (primary spontaneous pneumothorax). Differentially expressed gene analysis identified 23 up-regulated genes mainly related to epithelial dysfunction. Gene ontology analysis highlighted the activation of different pathways, mainly related to EC, immune response and programmed cell death. This study provides novel insights into the IPF pathogenetic pathways and suggests that targeting some of these up-regulated pathways (particularly those related to secreto-protein/mucin dysfunction) may be beneficial in IPF. Further studies in a larger number of lung samples, ideally from patients with early and advanced disease, are needed to validate these findings.

Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

BackgroundDriving pressure (ΔP = Plateau pressure-PEEP) is highly correlated with postoperative pulmonary complications (PPCs) and appears to be a promising indicator for optimizing ventilator settings. We hypothesized that dynamic, individualized positive end-expiratory pressure (PEEP) guided by ΔP could reduce postoperative atelectasis and improve intraoperative oxygenation, respiratory mechanics, and reduce the incidence of PPCs on elderly patients undergoing laparoscopic surgery.MethodsFifty-one elderly patients who were subject to laparoscopic surgery participated in this randomized trial. In the PEEP titration group (DV group), the PEEP titration was decremented to the lowest ΔP and repeated every 1 h. Additional procedures were also performed when performing predefined events that may be associated with lung collapse. In the constant PEEP group (PV group), a PEEP of 6 cmH2O was used throughout the surgery. Moreover, zero PEEP was applied during the entire procedure in the conventional ventilation group (CV group). The primary objective of this study was lung ultrasound score noted at the end of surgery and 15 min after admission to the post-anesthesia care unit (PACU) at 12 lung areas bilaterally. The secondary endpoints were perioperative oxygenation function, expiratory mechanics, and the incidence of the PPCs.ResultsThe lung ultrasound scores of the DV group were significantly lower than those in the PV group and CV group (P < 0.05), whereas there was no significant difference between the PV group and CV group (P > 0.05). The lung static compliance (Cstat) and ΔP at all the intraoperative time points in the DV group were significantly better compared to the PV group and the CV group (p < 0.05).ConclusionsIntraoperative titrated PEEP reduced postoperative lung atelectasis and improved respiratory mechanics in elderly patients undergoing laparoscopic surgery. Meanwhile, standard PEEP strategy is not superior to conventional ventilation in reducing postoperative pulmonary atelectasis in laparoscopic surgery.

Comparison of prone position effectiveness with percentage of injured lung area in awake non - intubated COVID-19 patients

Aim: Prone position plays a key role in the treatment of both non-intubated and intubated patients because COVID-19 associated respiratory failure is gas exchange abnormalities based on shunt and dead-space ventilation. In this study, we aimed to compare the effect of prone position applied in awake non-intubated COVID-19 patients with percentage of injured lung area. &#x0D; Material and Method: 65 patients with awake, non-intubated were included in this prospective, single-center study. Percentage of injured lung area was calculated using chest computer tomography taken during diagnosis of patients. The prone position cycle was applied as 6 hours prone, 4-6 hours supine position. &#x0D; Results: The mean of percentage of injured lung area was 25.16±13.81. When percentage of injured lung area groups were compared with the 0th, 6th, 24th and 48th hour SpO2/FIO2 ratio and respiratory frequency; while the SpO2/FIO2 ratio increased in all hours with prone position in the 0-10% and 10-30% groups, a decrease was observed in the SpO2/FIO2 ratio over time in the ≥ 30% group. &#x0D; Conclusions: The prone position is a safe and effective application that causes improvement in SpO2/FIO2 ratio and RR in awake non-intubated COVID-19 patients with less damage to the lung. However, it should be kept in mind that as the damage to the lung increases, the expected recovery might not be possible.

Use of Dynamic Chest Radiography to Assess Treatment of Pulmonary Exacerbations in Cystic Fibrosis.

Background Although spirometry is an important marker in the management of pulmonary exacerbations in cystic fibrosis (CF), it is a forced maneuver and can generate aerosol. Therefore, it may be difficult to perform in some individuals. Dynamic chest radiography (DCR) provides real-time information regarding pulmonary dynamics alongside fluoroscopic-style thoracic imaging. Purpose To assess the effect of pulmonary exacerbation treatment by using both spirometry and DCR and assess the clinical utility of DCR in participants with CF experiencing pulmonary exacerbations. Materials and Methods In this prospective, observational, single-center pilot study, spirometry and DCR were performed before and after treatment of pulmonary exacerbations in participants with CF between December 2019 and August 2020. Spirometry measured forced expiratory volume in 1 second (FEV1) and forced vital capacity. DCR helped to measure projected lung area (PLA), hemidiaphragm midpoint position, and speed during tidal and deep breathing. Data were analyzed by using the paired t test or Wilcoxon signed-rank test. Correlation was assessed by using the Spearman rank correlation coefficient. Results Twenty participants with CF (mean age, 25 years ± 7 [standard deviation]; 14 women) were evaluated. Spirometry showed that percentage predicted FEV1 improved from a median of 44% (interquartile range [IQR], 17%) before treatment to 55% (IQR, 16%) after treatment (P = .004). DCR showed improvement in median deep breathing excursion for left and right hemidiaphragms (from 18 [IQR, 11] to 25 [IQR, 16] mm [P = .03] and from 13 [IQR, 6] to 19 [IQR, 14] mm [P = .03], respectively) and in median expiratory speed following deep breathing for left and right hemidiaphragms (from 7 [IQR, 2] to 11 [IQR, 5] mm/sec [P = .004] and 6 [IQR, 3] to 9 [IQR, 6] mm/sec [P = .004], respectively). PLA rate of change during full expiration and change in PLA during tidal breathing improved (from a mean of 42 cm2/sec ± 16 to 56 cm2/sec ± 24 [P = .03] and from a mean of 29 cm2 ± 14 to 35 cm2 ± 10 [P = .03], respectively). Conclusion Dynamic chest radiography demonstrated improvement in diaphragm speed and range of chest wall movement during respiration aftere treatment for pulmonary exacerbations in cystic fibrosis and showed potential as a tool to investigate the effect of pulmonary exacerbations on lung mechanics. Clinical trials registration no. NCT01234567 Published under a CC BY 4.0 license. Online supplemental material is available for this article.

Stereotactic radiotherapy for lung oligometastases.

30–60% of cancer patients develop lung metastases, mostly from primary tumors in the colon-rectum, lung, head and neck area, breast and kidney. Nowadays, stereotactic radiotherapy (SRT ) is considered the ideal modality for treating pulmonary metastases.When lung metastases are suspected, complete disease staging includes a total body computed tomography (CT ) and/or positron emission tomography-computed tomography (PET -CT ) scan. PET -CT has higher specificity and sensitivity than a CT scan when investigating mediastinal lymph nodes, diagnosing a solitary lung lesion and detecting distant metastases. For treatment planning, a multi-detector planning CT scan of the entire chest is usually performed, with or without intravenous contrast media or esophageal lumen opacification, especially when central lesions have to be irradiated. Respiratory management is recommended in lung SRT, taking the breath cycle into account in planning and delivery. For contouring, co-registration and/or matching planning CT and diagnostic images (as provided by contrast enhanced CT or PET-CT ) are useful, particularly for central tumors. Doses and fractionation schedules are heterogeneous, ranging from 33 to 60 Gy in 3–6 fractions. Independently of fractionation schedule, a BED10 > 100 Gy is recommended for high local control rates. Single fraction SRT (ranges 15–30 Gy) is occasionally administered, particularly for small lesions. SRT provides tumor control rates of up to 91% at 3 years, with limited toxicities.The present overview focuses on technical and clinical aspects related to treatment planning, dose constraints, outcome and toxicity of SRT for lung metastases.

Near-infrared fluorescence imaging during ex vivo lung perfusion: Noninvasive real-time evaluation of regional lung perfusion and edema

ObjectiveEx vivo lung perfusion (EVLP) is an excellent platform to evaluate donor lung function before transplantation, but novel methods are needed to accurately confirm transplant quality. Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) has been used in various clinical perioperative applications to evaluate tissue perfusion. We used NIRF imaging during pig and human EVLP to evaluate donor lung perfusion and edema. MethodsPig lungs with various degrees of lung injury (n = 10) and human lungs rejected from clinical transplantation (n = 3) were imaged during EVLP using intravascular ICG and a SPY Elite (Stryker) NIRF imaging unit. Optimal ICG and imaging conditions, and perfusion and edema quantification methods, were established. Pig lung transplants with extended graft preservation (n = 5) and control native lungs (n = 6) were also imaged. ResultsA single ICG dose resulted in sustained donor lung NIRF throughout the EVLP. Even and homogenous ICG signal was demonstrated in areas of normal lung. Low NIRF was present in regions with poor tissue perfusion, and rapid, intense ICG accumulation occurred in damaged and edematous areas. Segmental perfusion defects were common in the peripheral and elevated regions of the lungs, and serial imaging showed gradual perfusion recovery during EVLP. Impaired microvascular reperfusion, indicated by a decreased NIRF ingress rate, was detected in transplanted pig lungs early after reperfusion. ConclusionsNIRF imaging enables noninvasive real-time evaluation of lung perfusion and edema during EVLP. Prospective clinical studies are needed to determine the role of NIRF imaging in donor lung assessment and selection, and prediction of posttransplant outcomes.

Phenotypic and Histological Distribution Analysis Identify Mast Cell Heterogeneity in Non-Small Cell Lung Cancer.

Simple SummaryDuring the fight against tumor, some cells of the immune system such as cytotoxic lymphocytes eliminate tumoral cells while others such as tumor-associated macrophages favor tumor development. Mast cells (MCs) are multifaceted immune cells whose role in cancer is still poorly understood. Moreover, MCs are poorly characterized in the context of cancer and their presence in the tumor microenvironment has been reported to be either associated with good or bad prognosis. In this pilot study we characterized tumor-associated MCs (TAMCs) in lung cancer. We showed that TAMCs exhibited a typical phenotype and can be classified in two subsets according to alphaE integrin (CD103) expression. CD103+ TAMCs appeared more mature, more prone to interact with CD4+ T cells, and located closer to cancer cells than their CD103− counterpart. This study revealed that a high frequency of total TAMC correlated with better overall survival and progression free survival in patients and underlined MC heterogeneity in cancer.Mast cells (MCs) are multifaceted innate immune cells often present in the tumor microenvironment (TME). However, MCs have been only barely characterized in studies focusing on global immune infiltrate phenotyping. Consequently, their role in cancer is still poorly understood. Furthermore, their prognosis value is confusing since MCs have been associated with good and bad (or both) prognosis depending on the cancer type. In this pilot study performed on a surgical cohort of 48 patients with Non-Small Cell Lung Cancer (NSCLC), we characterized MC population within the TME and in matching non-lesional lung areas, by multicolor flow cytometry and confocal microscopy. Our results showed that tumor-associated MCs (TAMCs) harbor a distinct phenotype as compared with MCs present in non-lesional counterpart of the lung. Moreover, we found two TAMCs subsets based on the expression of CD103 (also named alphaE integrin). CD103+ TAMCs appeared more mature, more prone to interact with CD4+ T cells, and located closer to cancer cells than their CD103− counterpart. In spite of these characteristics, we did not observe a prognosis advantage of a high frequency of CD103+ TAMCs, while a high frequency of total TAMC correlated with better overall survival and progression free survival. Together, this study reveals that TAMCs constitute a heterogeneous population and indicates that MC subsets should be considered for patients’ stratification and management in future research.

A multilevel self‐attention based segmentation and classification technique using Directional Hexagonal Mixed Pattern algorithm for lung nodule detection in thoracic CT image

AbstractPulmonic nodules are unusual growing of tissues; originate on one lung or both lungs. They are the round, trifling mass of soft tissues in the lung area. Habitually, pulmonic nodules are indications of lung tumors, but they may be nonthreatening. When identified earlier and treated in time, the patient's life expectancy increases. The anatomy of the lung is highly interconnected in nature, which makes it difficult to diagnose pulmonic nodules by diverse clinical imaging practices. A network model is presented in this paper for accurate classification of pulmonic nodules from computed tomography scans images. The lung images are subjected to semantic segmentation using Attention U‐Net to isolate the pulmonary nodules. The proposed Directional Hexagonal Mixed Pattern is applied to generate a new texture pattern. Then, the nodules are classified by combining the proposed multilevel network model with the self‐attention network. This paper also demonstrates an experimental arrangement called tenfold cross‐validation without a segmentation mask, in which the nodules that had been marked as less than 3 mm by radiologists are discarded. This has obtained an improved result. The experimental results show that with and without segmentation masks the proposed classifier scores an accuracy of 90.48% and 91.83%. In addition, it has efficiently produced the measure of area under curve as 98.08%.

Assessment of lung density in pediatric patients using three-dimensional ultrashort echo-time and four-dimensional zero echo-time sequences

PurposeLung magnetic resonance imaging (MRI) using conventional sequences is limited due to strong signal loss by susceptibility effects of aerated lung. Our aim is to assess lung signal intensity in children on ultrashort echo-time (UTE) and zero echo-time (ZTE) sequences. We hypothesize that lung signal intensity can be correlated to lung physical density.Materials and methodsLung MRI was performed in 17 children with morphologically normal lungs (median age: 4.7 years, range 15 days to 17 years). Both lungs were manually segmented in UTE and ZTE images and the average signal intensities were extracted. Lung-to-background signal ratios (LBR) were compared for both sequences and between both patient groups using non-parametric tests and correlation analysis. Anatomical region-of-interest (ROI) analysis was performed for the normal cohort for assessment of the anteroposterior lung gradient.ResultsThere was no significant difference between LBR of normal lungs using UTE and ZTE (p < 0.05). Both sequences revealed a LBR age-dependency with a high negative correlation for UTE (Rs = – 0.77; range 2.98–1.41) and ZTE (Rs = – 0.82; range 2.66–1.38)). Signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were age-dependent for both sequences. SNR was higher for children up to 2 years old with 3D UTE Cones while for the rest it was higher with 4D ZTE. CNR was similar for both sequences. Posterior lung areas exhibited higher signal intensity compared to anterior ones (UTE 9.4% and ZTE 12% higher), both with high correlation coefficients (R2UTE = 0.94, R2ZTE = 0.97).ConclusionThe ZTE sequence can measure signal intensity similarly to UTE in pediatric patients. Both sequences reveal an age- and gravity-dependency of LBR.

Spectral Detector CT-Derived Pulmonary Perfusion Maps and Pulmonary Parenchyma Characteristics for the Semiautomated Classification of Pulmonary Hypertension

ObjectivesTo evaluate the usefulness of spectral detector CT (SDCT)-derived pulmonary perfusion maps and pulmonary parenchyma characteristics for the semiautomated classification of pulmonary hypertension (PH).MethodsA total of 162 consecutive patients with right heart catheter (RHC)-proven PH of different aetiologies as defined by the current ESC/ERS guidelines who underwent CT pulmonary angiography (CTPA) on SDCT and 20 patients with an invasive rule-out of PH were included in this retrospective study. Semiautomatic lung segmentation into normal and malperfused areas based on iodine density (ID) as well as automatic, virtual non-contrast-based emphysema quantification were performed. Corresponding volumes, histogram features and the ID SkewnessPerfDef-Emphysema-Index (δ-index) accounting for the ratio of ID distribution in malperfused lung areas and the proportion of emphysematous lung parenchyma were computed and compared between groups.ResultsPatients with PH showed a significantly greater extent of malperfused lung areas as well as stronger and more homogenous perfusion defects. In group 3 and 4 patients, ID skewness revealed a significantly more homogenous ID distribution in perfusion defects than in all other subgroups. The δ-index allowed for further subclassification of subgroups 3 and 4 (p < 0.001), identifying patients with chronic thromboembolic PH (CTEPH, subgroup 4) with high accuracy (AUC: 0.92, 95%-CI, 0.85–0.99).ConclusionAbnormal pulmonary perfusion in PH can be detected and quantified by semiautomated SDCT-based pulmonary perfusion maps. ID skewness in malperfused lung areas, and the δ-index allow for a classification of PH subgroups, identifying groups 3 and 4 patients with high accuracy, independent of reader expertise.