Prognosis Of Lung Disease Research Articles

Fuzzy Attention Neural Network to Tackle Discontinuity in Airway Segmentation.

Airway segmentation is crucial for the examination, diagnosis, and prognosis of lung diseases, while its manual delineation is unduly burdensome. To alleviate this time-consuming and potentially subjective manual procedure, researchers have proposed methods to automatically segment airways from computerized tomography (CT) images. However, some small-sized airway branches (e.g., bronchus and terminal bronchioles) significantly aggravate the difficulty of automatic segmentation by machine learning models. In particular, the variance of voxel values and the severe data imbalance in airway branches make the computational module prone to discontinuous and false-negative predictions, especially for cohorts with different lung diseases. The attention mechanism has shown the capacity to segment complex structures, while fuzzy logic can reduce the uncertainty in feature representations. Therefore, the integration of deep attention networks and fuzzy theory, given by the fuzzy attention layer, should be an escalated solution for better generalization and robustness. This article presents an efficient method for airway segmentation, comprising a novel fuzzy attention neural network (FANN) and a comprehensive loss function to enhance the spatial continuity of airway segmentation. The deep fuzzy set is formulated by a set of voxels in the feature map and a learnable Gaussian membership function. Different from the existing attention mechanism, the proposed channel-specific fuzzy attention addresses the issue of heterogeneous features in different channels. Furthermore, a novel evaluation metric is proposed to assess both the continuity and completeness of airway structures. The efficiency, generalization, and robustness of the proposed method have been proved by training on normal lung disease while testing on datasets of lung cancer, COVID-19, and pulmonary fibrosis.

Adversarial Transformer for Repairing Human Airway Segmentation.

Automated airway segmentation models often suffer from discontinuities in peripheral bronchioles, which limits their clinical applicability. Furthermore, data heterogeneity across different centres and pathological abnormalities pose significant challenges to achieving accurate and robust segmentation in distal small airways. Accurate segmentation of airway structures is essential for the diagnosis and prognosis of lung diseases. To address these issues, we propose a patch-scale adversarial-based refinement network that takes in preliminary segmentation and original CT images and outputs a refined mask of the airway structure. Our method is validated on three datasets, including healthy cases, pulmonary fibrosis, and COVID-19 cases, and quantitatively evaluated using seven metrics. Our method achieves more than a 15% increase in the detected length ratio and detected branch ratio compared to previously proposed models, demonstrating its promising performance. The visual results show that our refinement approach, guided by a patch-scale discriminator and centreline objective functions, effectively detects discontinuities and missing bronchioles. We also demonstrate the generalizability of our refinement pipeline on three previous models, significantly improving their segmentation completeness. Our method provides a robust and accurate airway segmentation tool that can help improve diagnosis and treatment planning for lung diseases.

Physical Activity Estimated by the Wearable Device in Lung Disease Patients: Exploratory Analyses of Prospective Observational Study.

Background. Physical activity is a potential parameter to assess the severity or prognosis of lung disease. However, the differences in physical activity between healthy individuals and patients with lung disease remain unclear. Methods. The analyses in this report are a combined analysis of four cohorts, including a healthy control cohort, in a prospective study designed to evaluate wearable device-estimated physical activity in three cohorts: the lung cancer cohort, the interstitial pneumonia cohort, and the COPD cohort (UMIN000047834). In this report, physical activity in the lung disease cohort was compared with that in the healthy cohort. Subgroup analyses were performed based on age, sex, duration of wearable device use, and lung disease subtype. Results. A total of 238 cases were analyzed, including 216 patients with lung disease and 22 healthy cases. Distance walked and number of steps were significantly lower in the patient group compared to the healthy control group. ROC analysis for the diagnostic value of lung disease by mean distance walked and mean number of steps showed AUC of 0.764 (95%CI, 0.673 to 0.856) and 0.822 (95%CI, 0.740 to 0.905), respectively. There was a significant difference in physical activity by age, but not by gender nor by duration based on the threshold of 7 days of wearing the device. Conclusions. Lung disease decreases physical activity compared to healthy subjects, and aging may bias the estimation of physical activity. The distance walked or number of steps is recommended as a measure of physical activity, with a period of approximately one week and adjusted for age for future investigation.

CircRNA hsa_circ_0070659 predicts poor prognosis and promotes non-small cell lung cancer (NSCLC) progression via microRNA-377 (miR-377) / Ras-Associated Binding Protein 3C (RAB3C) pathway

ABSTRACT A large number of circular RNAs (circRNAs) are dysregulated in lung cancer and affect the progression and prognosis of lung disease. Herein, this study selected specific circular RNA (circ_0070659) by bioinformatics analysis and aimed to investigate the role of circ_0070659 in non-small cell lung cancer (NSCLC). The differentially expressed circRNA (hsa_circ_0070659) in NSCLC was screened from public databases (GEO), and real-time quantitative polymerase chain reaction (RT-qPCR) was carried out to identify the circ_0070659 levels in cancer tissues and cells. NSCLC cell proliferation, migration, and invasion abilities after circ_0070659 silencing was detected by colony formation assay, Cell Counting Kit-8 (CCK-8) assay and Transwell assay. Targeted binding between microRNA-377 (miR-377) and circ_0070659 or Ras-Associated Binding Protein 3C (RAB3C) was verified by western blot, dual-luciferase reporter assay, and RNA pull-down assay. Our experimental results showed that circ_0070659 levels were largely increased in tumor tissues and cells. Biologically, knockdown of circ_0070659 obviously inhibited proliferation, migration, and invasion of NSCLC cells. Mechanistically, circ_0070659 promoted RAB3C-mediated proliferation and invasion through sponging miR-377. Furthermore, miR-377 inhibitor reversed the inhibitory ability of circ_0070659 silencing on malignant biological behavior of NSCLC cells. Our study revealed a novel signaling pathway that circ_0070659/miR-377/RAB3C axis regulates tumor progression, and it may become a new therapeutic target for NSCLC.

Temporal changes of quantitative CT findings from 102 patients with COVID-19 in Wuhan, China: A longitudinal study.

BACKGROUND: Computed tomography (CT) imaging combined with artificial intelligence is important in the diagnosis and prognosis of lung diseases.OBJECTIVE: This study aimed to investigate temporal changes of quantitative CT findings in patients with COVID-19 in three clinic types, including moderate, severe, and non-survivors, and to predict severe cases in the early stage from the results.METHODS: One hundred and two patients with confirmed COVID-19 were included in this study. Based on the time interval between onset of symptoms and the CT scan, four stages were defined in this study: Stage-1 (0 7 days); Stage-2 (8 14 days); Stage-3 (15 21days); Stage-4 ( 21 days). Eight parameters, the infection volume and percentage of the whole lung in four different Hounsfield (HU) ranges, ((, 750), [750, 300), [300, 50) and [50, )), were calculated and compared between different groups.RESULTS: The infection volume and percentage of four HU ranges peaked in Stage-2. The highest proportion of HU [750, 50) was found in the infected regions in non-survivors among three groups.CONCLUSIONS: The findings indicate rapid deterioration in the first week since the onset of symptoms in non-survivors. H higher proportion of HU [750, 50) in the lesion area might be a potential bio-marker for poor prognosis in patients with COVID-19.

Calprotectin in Lung Diseases

Calprotectin (CLP) is a heterodimer formed by two S-100 calcium-binding cytosolic proteins, S100A8 and S100A9. It is a multifunctional protein expressed mainly by neutrophils and released extracellularly by activated or damaged cells mediating a broad range of physiological and pathological responses. It has been more than 20 years since the implication of S100A8/A9 in the inflammatory process was shown; however, the evaluation of its role in the pathogenesis of respiratory diseases or its usefulness as a biomarker for the appropriate diagnosis and prognosis of lung diseases have only gained attention in recent years. This review aimed to provide current knowledge regarding the potential role of CLP in the pathophysiology of lung diseases and describe how this knowledge is, up until now, translated into daily clinical practice. CLP is involved in numerous cellular processes in lung health and disease. In addition to its anti-microbial functions, CLP also serves as a molecule with pro- and anti-tumor properties related to cell survival and growth, angiogenesis, DNA damage response, and the remodeling of the extracellular matrix. The findings of this review potentially introduce CLP in daily clinical practice within the spectrum of respiratory diseases.

The Correlation of Neutralizing Antibody Responses with SARS-CoV-2 Virus Clearance and Lung Disease Prognosis: Implication from a Family Cluster Study

Background: A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing pneumonia-associated respiratory disease pandemic across the world. Until now, the viral prevalence patterns, radiological characters, and antibody responses at initial stage of SARS-CoV-2 infection have been reported. The prolonged viral RNA shedding and coexistence with viral specific IgG antibody in discharged patients have also been reported recently. To date, however, correlations among viral specific RNA shedding, radiological pattern shift, and serum neutralizing antibody response covering the whole acute- and convalescent- phase in patients infected with SARS-CoV-2 are unknown. Focusing on a family cluster, present study is aim to give a bird view on the correlation of neutralizing antibody responses with viral clearance and lung disease prognosis from acute to convalescent phases. Methods: We conducted a surveillance study on a familial cluster of COVID-19 patients from Jan 17 to Apr 27 (99 days), 2020, in Guangzhou, Guangdong province, China. Epidemiological study was performed to clarify the virus transmission inside a family. NPAs, stool, and serum samples were collected and conducted RT-PCR to test the presence of SARS-CoV-2. Serum was used to perform neutralizing antibody tests to determine dynamic levels of neutralizing antibody. Radiological images as well as high-resolution CT scans for each patients were continually recorded to monitor outcomes of lung recovery. Findings: In this family cluster, three members (P2, P3, P4) in Guangzhou were infected by SARS-CoV-2 due to a close contact with P1 (index), who came back Guangzhou from Wuhan on Jan, 17, 2020, while another two members (H1 and H2) were unsusceptible and negative to SARS-CoV-2 test. The patients (P1, P2, P3) presented varying degrees of clinical symptoms on admission including recurrent fever, cough, and dyspnea, while P4 was asymptomatic. CT images showed ground-glass opacities in lungs of P1-3. The median length from illness onset to discharge for four-confirmed cases was 21.3 (4.7) days (range from 15 to 26). However, all patients returned positive for SARS-CoV-2 in follow-up investigation. The mean time for RNA shedding was 36.5 (3.2) days in P1, P2, and P4. The neutralizing antibody of P1, P2, and P4 was detectable during illness day 16 to 22. Then, the level was apparently ascent to a relative high titer and remained stable during 34-40, 31-41, and 35 days of illness onset for P1, P2, and P4, respectively, while declined gradually with time. The last positive time for SARS-CoV-2 test for P1, P2, and P4 was 40, 35, and 34 days of illness onset, respectively. Follow-up chest CT showed good prognosis in lung disease of P1 and P2, and CT scan was normal for P4. P3 was an exceptional case in this family cluster, who experienced the longest RNA shedding time (up to 68 days) as well as lung disease. In particular, radiological worsen was observed at day 34 of illness onset, high-resolution CT image revealed a glass-ground opacity in middle segment of right lung since day 45 to 99 of illness onset. The neutralizing antibody level in P3 was low during the entire study and significantly lower than that in other patients. Interpretation: The efficiency of SARS-CoV-2 virus clearance and lung disease prognosis were closely related to the levels of neutralizing antibody in COVID-19 patients. Viral clearance was observed along with high level of neutralizing antibody in P1, P2, and P4. However, the level of neutralizing antibody in P3 was not high enough to clear the virus completely, leading a prolong RNA shedding and lung disease. We proposed that high level of neutralizing antibody was essential for viral clearance and lung recovery, and virus was thoroughly eliminated during the period when neutralizing antibody reached high level in serum. Funding Statement: This work was supported by grants from the Guangzhou Science and Technology Program (201904010012), Guangdong Provincial Science and Technology Program (2018B020207006), Guangdong Provincial Novel Coronavirus Scientific and Technological Project (2020111107001). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the Institutional Review Board of the Guangdong Second Provincial General Hospital. All patients involved in this study signed the clinical research informed consent.

Antimicrobial Treatment of Staphylococcus aureus in Patients With Cystic Fibrosis.

Staphylococcus aureus is a ubiquitous human commensal pathogen. It is commonly isolated in cystic fibrosis (CF) patients and is considered one of the main causes of the recurrent acute pulmonary infections and progressive decline in lung function that characterize this inherited life-threatening multisystem disorder. However, the true role of S. aureus in CF patients is not completely understood. The main aim of this narrative review is to discuss the present knowledge of the role of S. aureus in CF patients. Literature review showed that despite the fact that the availability and use of drugs effective against S. aureus have coincided with a significant improvement in the prognosis of lung disease in CF patients, clearly evidencing the importance of S. aureus therapy, how to use old and new drugs to obtain the maximal effectiveness has not been precisely defined. The most important problem remains that the high frequency with which S. aureus is carried in healthy subjects prevents the differentiation of simple colonization from infection. Moreover, although experts recommend antibiotic administration in CF patients with symptoms and in those with persistent detection of S. aureus, the best antibiotic approach has not been defined. All these problems are complicated by the evidence that the most effective antibiotic against methicillin-resistant S. aureus (MRSA) cannot be used in patients with CF with the same schedules used in patients without CF. Further studies are needed to solve these problems and to assure CF patients the highest level of care.

Impaired cardiac autonomic response in lung transplant patients: A retrospective cohort study.

Cardiac autonomic dysfunction (AD) is associated with adverse prognosis in lung disease; however, its implications in lung transplantation have not been previously described. This study evaluated the prevalence of AD in lung transplant (LTx) candidates, its determinants, prognostic implications, and prevalence post-transplant. Retrospective one-year study of 103 LTx candidates with AD assessed using heart rate (HR) from the six-minute walk test (6MWT). Impaired chronotropic response index (CRI) was defined as <80% age-adjusted HR during 6MWT. Abnormal HR recovery (HRR) was categorized as reduction in HR≤12 beats/minute after the first minute of 6MWT cessation. Abnormal CRI and HRR were observed in 94% and 76% of patients, respectively. A lower CRI was associated with obstructive lung disease and lower estimated aerobic capacity. CRI was independently associated with 6MW distance [12m per 10% CRI, P=0.03], but not with post-transplant cardiovascular events, hospital stay, or one-year mortality. At 3months post-transplant, no improvement was observed in CRI (99%, n=66/67, P=0.25) or HRR (88%, n=36/41, P=0.12). Cardiac AD was prevalent in LTx candidates and recipients, with chronotropic incompetence a modest contributor to exercise intolerance pretransplant. Further study may help determine whether direct autonomic measures such as HR variability may be more prognostic of LTx outcomes.

Extracellular vesicles in lung health, disease, and therapy.

Both physiological homeostasis and pathological disease processes in the lung typically result from complex, yet coordinated multicellular responses that are synchronized via paracrine and endocrine intercellular communication pathways. Of late, extracellular vesicles have emerged as important information shuttles that can coordinate and disseminate homeostatic and disease signals. In parallel, extracellular vesicles in biological fluids such as sputum, mucus, epithelial lining fluid, edema fluid, the pulmonary circulation, pleural fluid, and lymphatics have emerged as promising candidate biomarkers for diagnosis and prognosis in lung disease. Extracellular vesicles are small, subcellular, membrane-bound vesicles containing cargos from parent cells such as lipids, proteins, genetic information, or entire organelles. These cargos endow extracellular vesicles with biologically active information or functions by which they can reprogram their respective target cells. Recent studies show that extracellular vesicles found in lung-associated biological fluids play key roles as biomarkers and effectors of disease. Conversely, administration of naïve or engineered extracellular vesicles with homeostatic or reparative effects may provide a promising novel protective and regenerative strategy to treat lung disease. To highlight this rapidly developing field, the American Journal of Physiology-Lung Cellular and Molecular Physiology is now launching a special Call for Papers on extracellular vesicles in lung health, disease, and therapy. This review aims to set the stage for this call by introducing extracellular vesicles and their emerging roles in lung physiology and pathobiology.

Advances in relationship between plexinC1 and lung diseases

PlexinC1 is a large transmembrane protein widely distributed, which belongs to receptor system.PlexinC1 is expressed by monocyte, T-cells, B-cells, dendritic cells, neutrophils, and platelets.Recent researches showed that plexinC1 was intensely associated with lung injury, asthma and pulmonary fibrosis.PlexinC1 binded to its corresponding ligand and activated cellular signal pathway, which then participating in pathophysiologic processes of diseases mentioned above.Reasonably, PlexinC1 influences the development, prognosis of lung diseases and would provide a new target in control and treatment of lung diseases.This paper reviewed simply the formation, distribution, function of plexinC1 and the role of it playing in the associated lung diseases. Key words: PlexinC1; Semaphorin 7A; Lung diseases

Nocardia Colonization: A Risk Factor for Lung Deterioration in Cystic Fibrosis Patients?

BackgroundCystic fibrosis (CF) patients are predisposed to infection and colonization with different microbes. Some cause deterioration of lung functions, while others are colonizers without clear pathogenic effects. Our aim was to understand the effects of Nocardia species in sputum cultures on the course of lung disease in CF patients.Material/MethodsA retrospective study analyzing the impact of positive Nocardia spp. in sputum of 19 CF patients over a period of 10 years, comparing them with similar status patients without Nocardia growth. Pulmonary function tests (PFTs) are used as indicators of lung disease severity and decline rate in functions per year is calculated.ResultsNo significant difference in PFTs of CF patients with positive Nocardia in sputum was found in different sub-groups according to number of episodes of growth, background variables, or treatment plans. The yearly decline in PFTs was similar to that recognized in CF patients. The control group patients showed similar background data. However, a small difference was found in the rate of decline of their PFTs, which implies a possibly slower rate of progression of lung disease.ConclusionsThe prognosis of lung disease in CF patients colonized with Nocardia does not seem to differ based on the persistence of growth on cultures, different treatment plans or risk factors. Apparently, Nocardia does not cause a deterioration of lung functions with time. However, it may show a trend to faster decline in PFTs compared to similar status CF patients without isolation of this microorganism in their sputum.

Computed tomography aids scleroderma lung disease prognosis

Computed tomography aids scleroderma lung disease prognosis

Prognosis of lung disease in cystic fibrosis children based on genotype modelling and lung function longitudinal data

Prognosis of lung disease in cystic fibrosis children based on genotype modelling and lung function longitudinal data

First pass evaluation of blood velocity in the pulmonary artery.

Studying the kinetics of blood flow in the pulmonary artery using non-invasive techniques may be an important tool in assessing the prognosis of lung diseases. The aim of this study was to ascertain dynamic parameters of pulmonary blood flow, particularly the velocity of a small bolus of a radioactive tracer after intravenous injection. Since the shape and distribution pattern of the bolus changes substantially from frame to frame, common image processing techniques for motion detection or other techniques, such as accumulation of subtracted images, segmentation and spectral analysis with temporal/spatial filtering, are unable to properly evaluate the motion of the bolus. However, the passage of the bolus from the arm to the lungs was visualized with good contrast through acquisition of a first pass sequence of scintigraphic images. The wave form of the bolus becomes increasingly complex as it progresses towards the pulmonary artery. In the proposed method the time-activity curves for each pixel are displayed. It is assumed that the peaks of the maximum counts in these curves correlate with the time after injection that the bolus takes to cross each pixel (bolus head). The bolus head contains information on time, space and activity, and allows the velocity of the studied fluid to be calculated. We demonstrated a mean velocity through the pulmonary artery trunk in resting patients of approximately 11 cm/s, with a mean residence time of 0.5 s.