Purpose: To investigate important factors affecting the frequency of air trapping through observation of normal lung attenuation, and propose a cause of heterogeneous attenuation. Materials and Methods: In this ethica...Purpose: To investigate important factors affecting the frequency of air trapping through observation of normal lung attenuation, and propose a cause of heterogeneous attenuation. Materials and Methods: In this ethical committee-approved study, a total of 109 patients (30 males, 79 females;mean age, 58.2 years;range, 27 - 81 years) were included. All patients had undergone inspiratory and expiratory chest thin-section computed tomography (CT) examinations and pulmonary function tests. Air trapping on CT images was graded subjectively. Hounsfield units (HU) lung attenuation value and lung volume were measured on CT images. All variables (age, sex, indices of pulmonary function test results, air trapping score, HU value, and rate of change in lung volume) were compared by diagnoses and air trap- ping findings cohorts. The correlation between lung function test results and expiratory HU attenuation were analyzed. Results: Interstitial pneumonia showed higher and bronchiolitis obliterans showed lower HU attenuation at normal and air trapping regions. The variables affecting air trapping findings were age, a ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1.0/FVC), maximal expiratory flow at 50% of forced vital capacity (MEF50), HU attenuation at normal regions, and rate of change in lung volume. Compared with expiratory HU attenuation, significant positive correlation was shown to FEV1.0/FVC and negative correlation to single-breath diffusion capacity for carbon monoxide, which was confirmed by a simple regression analysis. Conclusion: It can be suggested that lung attenuation can increase when fibrosis is advanced, and this is exaggerated when lungs are compressed.展开更多
Objective: The purpose of this study was to evaluate the effect of radiation dose reduction on the quantification of air trapping on expiratory CT. Materials and methods: This study was conducted as a retrospective ev...Objective: The purpose of this study was to evaluate the effect of radiation dose reduction on the quantification of air trapping on expiratory CT. Materials and methods: This study was conducted as a retrospective evaluation of inspiratory and expiratory CT studies performed in routine clinical practice before and after alteration of the scanning protocol for expiratory CT at our institute. Eighty-six patients who had a clinical diagnosis of chronic obstructive pulmonary disease (COPD) and underwent inspiratory and expiratory CT and pulmonary function testing (PFT) were included. For the quantitative analysis, CT scans were obtained at six evenly spaced levels from the lung apices to the bases. The area of segmented lung without emphysema between -500 to -950 HU was obtained from the summation of six slices. The relative area between -900 and -950 HU for the area of the segmented lung (RA900-950) was calculated on both the inspiratory and expiratory scans. Comparisons of the RA-change between the standard-dose group (200 mA) and the low-dose group (80 mA) were performed by Mann-Whitney U test. Results: There was no significant difference between the standard-dose group and the low-dose group in the mean RA-change, and RA-change in both the standard-dose and low-dose groups correlated significantly with the results of PFT. In addition, there were no prominent differences in the correlation coefficients between the two groups. Conclusions: Low-dose CT could evaluate air trapping objectively and was not inferior to standard-dose CT for this purpose.展开更多
Background Evidence has demonstrated that the distal lung,which includes airways of 〈2 mm in diameter and lung parenchyma,constitutes an important component of asthma pathology.Cysteinyl leukotrienes (CysLTs) are p...Background Evidence has demonstrated that the distal lung,which includes airways of 〈2 mm in diameter and lung parenchyma,constitutes an important component of asthma pathology.Cysteinyl leukotrienes (CysLTs) are potent proinflammatory mediators and bronchoconstrictors involved in the asthmatic process.Guidelines recommend the leukotriene-modifying agents for asthma treatment.We hypothesized that a leukotriene receptor antagonist with an inhaled corticosteroid (ICS) and long-acting β2 agonist (LABA) combination would improve small airways function in moderate-tosevere asthmatics evaluated by physiological tests and high-resolution computed tomography (HRCT) analysis.This study was performed at a tertiary university hospital in Beijing.Methods This was a randomized,double-blind,parallel study performed in 38 patients with moderate-to-severe asthma treated with salmeterol/fluticasone (SFC) plus montelukast (SFC+M) or SFC plus placebo over 24 weeks.Small airway function was assessed by physiological studies and HRCT image analysis.Results Montelukast significantly improved air trapping as expressed by the residual volume (RV)/total lung capacity (TLC).Over 24 weeks of treatment,RV/TLC was improved by (15.41±6.67)% in patients receiving SFC+M while RV/TLC was decreased by (8.57±10.26)% in patients receiving SFC alone,the difference between the two groups was significant (P=0.02).There was a trend towards a significant difference in forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) in the SFC+M group compared to that in the SFC group ((17.87±8.17)% vs.(12.28±9.20)%,P=0.056).There was no significant change in percentage wall area (WA%) after 24 weeks of add-on treatment with montelukast.Patients receiving SFC+M showed significant improvement in the ratio of CT-determined values at full expiration to those at full inspiration (E/I ratio) (0.894±0.005 vs.0.871±0.003,P=0.002).Conclusion We have shown,using lung function tests and HRCT image technique,that add-on therapy with montelukast improves distal lung function reflected by air trapping,but not airway wall thickness in moderate-to-severe asthma.(ClinicalTrials.gov number,NCT00699062)展开更多
Classic respiratory mechanics is a branch of vectorial mechanics, which aims to recognize all forces acting on the respiratory system. Another branch of mechanics, analytical mechanics, has been used for analyzing the...Classic respiratory mechanics is a branch of vectorial mechanics, which aims to recognize all forces acting on the respiratory system. Another branch of mechanics, analytical mechanics, has been used for analyzing the motions of complicated systems with constraints through equilibrium among scalar quantities such as kinetic energy and potential energy. However, until now, there have not been any studies concerning about analytical respiratory mechanics. In this paper, the author has obtained two types of motion equations (linear and nonlinear) for the airflow limitation from formulation of the analytical respiratory mechanics. Reconstructed flow-volume trajectories of the linear equation revealed a new relationship among the slope of the linear portion of trajectory, the coefficient of the dissipation function and the coefficient of the potential function. Reconstructed trajectories of the nonlinear equation suggested that a curved flow-volume trajectory would be caused by the emergence of regional hypoventilated clusters with airtrapped lobules. In conclusion, analytical respiratory mechanics will provide the basis for analyzing the mechanical properties of the respiratory system con cerning pulmonary functional images made by newly developed technologies.展开更多
<b><span style="font-family:Verdana;">Introduction: </span></b><span style="font-family:""><span style="font-family:Verdana;">Urban Air pollution ...<b><span style="font-family:Verdana;">Introduction: </span></b><span style="font-family:""><span style="font-family:Verdana;">Urban Air pollution is increasingly becoming a major health and sustainable development issue. Several studies showed that Traffic-related air pollution (TRAP) is one of the main sources of urban air pollution and has serious consequences on respiratory health. As no systematic review focused on the traffic-related air pollution and respiratory health in the target population of individuals working in a shop or in an office or individuals living along the trunk road, the authors conducted the current study to try to fill this gap. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: A systematic review search was conducted using MEDLINE (PubMed), Scientific Research Publishing: SCIRP, Web of Science, Google scholar. Studies were included if they meet the following selection criteria: </span></span><span style="font-family:Verdana;">1</span><span style="font-family:Verdana;">) focus on population working or living along a major/trunk road</span><span style="font-family:Verdana;">;</span><span style="font-family:""> </span><span style="font-family:Verdana;">2</span><span style="font-family:Verdana;">) studies had reported clearly at least on the exposure variables related to TRAP</span><span style="font-family:Verdana;">;</span><span style="font-family:""> </span><span style="font-family:Verdana;">3</span><span style="font-family:""><span style="font-family:Verdana;">) the association between TRAP and development of respiratory symptoms or respiratory diseases was established. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">13 articles were selected on the 192 articles that were retrieved in the initial research. Exposure to traffic-related air pollution was determined by using distance to road, traffic intensity and pollutants measured. The main respiratory health problems found were cough, wheeze, asthma and bronchitis. No article discussed about roundabouts in characterizing exposure to traffic-related air pollution. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Distance to road, traffic density and pollutants measured are the usual methods to characterize the exposure to traffic-related air pollution and its consequences on respiratory health. Regarding the context of area occupations in African cities, it is necessary to focus on population around roundabouts and see if they are not more exposed to TRAP.展开更多
Visual and pressurized pipeline systems with single- and multi-undulation layouts were used to study experimentally and analyze theoretically the transient characteristics of water-air two-phase flow during water fill...Visual and pressurized pipeline systems with single- and multi-undulation layouts were used to study experimentally and analyze theoretically the transient characteristics of water-air two-phase flow during water fillings in undulation pipelines based on the combination action analyses of both the communicating pipe and the gravity of the water-air two-phase flows in the descending pipe. For the single undulation pipeline, the complex two-phase flow-pattern evolutions including full pipe flow and stratified flow for low, medium, high water-filling velocity cases, respectively, lead to a great difference in transient pressure, flow pattern and the water-filling duration. Especially for low and medium water-filling velocity cases, the hydraulic theories related to hydraulic drop and hydraulic jump were employed to investigate the entrapped air pocket evolutions in the descending pipe, and the mechanism of negative pressure at the top of the undulation pipes was analyzed. For the same multi-undulation pipeline, due to the different elevations of the three undulation points along flow direction, namely three different types of pipeline layout, high-medium-low case (high elevation undulation point, medium one, and low one), low-medium-high and high-low-medium ones, their water-filling durations are significantly different, i.e., approximately 80.02 s, 227.34 s and 617.78 s. Meanwhile, there are significant differences in flow patterns in water filling, namely larger entrapped air pockets in three descending pipes for the high-medium-low case, entrapped air pockets in the first two descending pipes and open channel stratified flow in the last one for low-medium-high case, some bubbles in three descending pipes for the high-low-medium case.展开更多
文摘Purpose: To investigate important factors affecting the frequency of air trapping through observation of normal lung attenuation, and propose a cause of heterogeneous attenuation. Materials and Methods: In this ethical committee-approved study, a total of 109 patients (30 males, 79 females;mean age, 58.2 years;range, 27 - 81 years) were included. All patients had undergone inspiratory and expiratory chest thin-section computed tomography (CT) examinations and pulmonary function tests. Air trapping on CT images was graded subjectively. Hounsfield units (HU) lung attenuation value and lung volume were measured on CT images. All variables (age, sex, indices of pulmonary function test results, air trapping score, HU value, and rate of change in lung volume) were compared by diagnoses and air trap- ping findings cohorts. The correlation between lung function test results and expiratory HU attenuation were analyzed. Results: Interstitial pneumonia showed higher and bronchiolitis obliterans showed lower HU attenuation at normal and air trapping regions. The variables affecting air trapping findings were age, a ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1.0/FVC), maximal expiratory flow at 50% of forced vital capacity (MEF50), HU attenuation at normal regions, and rate of change in lung volume. Compared with expiratory HU attenuation, significant positive correlation was shown to FEV1.0/FVC and negative correlation to single-breath diffusion capacity for carbon monoxide, which was confirmed by a simple regression analysis. Conclusion: It can be suggested that lung attenuation can increase when fibrosis is advanced, and this is exaggerated when lungs are compressed.
文摘Objective: The purpose of this study was to evaluate the effect of radiation dose reduction on the quantification of air trapping on expiratory CT. Materials and methods: This study was conducted as a retrospective evaluation of inspiratory and expiratory CT studies performed in routine clinical practice before and after alteration of the scanning protocol for expiratory CT at our institute. Eighty-six patients who had a clinical diagnosis of chronic obstructive pulmonary disease (COPD) and underwent inspiratory and expiratory CT and pulmonary function testing (PFT) were included. For the quantitative analysis, CT scans were obtained at six evenly spaced levels from the lung apices to the bases. The area of segmented lung without emphysema between -500 to -950 HU was obtained from the summation of six slices. The relative area between -900 and -950 HU for the area of the segmented lung (RA900-950) was calculated on both the inspiratory and expiratory scans. Comparisons of the RA-change between the standard-dose group (200 mA) and the low-dose group (80 mA) were performed by Mann-Whitney U test. Results: There was no significant difference between the standard-dose group and the low-dose group in the mean RA-change, and RA-change in both the standard-dose and low-dose groups correlated significantly with the results of PFT. In addition, there were no prominent differences in the correlation coefficients between the two groups. Conclusions: Low-dose CT could evaluate air trapping objectively and was not inferior to standard-dose CT for this purpose.
文摘Background Evidence has demonstrated that the distal lung,which includes airways of 〈2 mm in diameter and lung parenchyma,constitutes an important component of asthma pathology.Cysteinyl leukotrienes (CysLTs) are potent proinflammatory mediators and bronchoconstrictors involved in the asthmatic process.Guidelines recommend the leukotriene-modifying agents for asthma treatment.We hypothesized that a leukotriene receptor antagonist with an inhaled corticosteroid (ICS) and long-acting β2 agonist (LABA) combination would improve small airways function in moderate-tosevere asthmatics evaluated by physiological tests and high-resolution computed tomography (HRCT) analysis.This study was performed at a tertiary university hospital in Beijing.Methods This was a randomized,double-blind,parallel study performed in 38 patients with moderate-to-severe asthma treated with salmeterol/fluticasone (SFC) plus montelukast (SFC+M) or SFC plus placebo over 24 weeks.Small airway function was assessed by physiological studies and HRCT image analysis.Results Montelukast significantly improved air trapping as expressed by the residual volume (RV)/total lung capacity (TLC).Over 24 weeks of treatment,RV/TLC was improved by (15.41±6.67)% in patients receiving SFC+M while RV/TLC was decreased by (8.57±10.26)% in patients receiving SFC alone,the difference between the two groups was significant (P=0.02).There was a trend towards a significant difference in forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) in the SFC+M group compared to that in the SFC group ((17.87±8.17)% vs.(12.28±9.20)%,P=0.056).There was no significant change in percentage wall area (WA%) after 24 weeks of add-on treatment with montelukast.Patients receiving SFC+M showed significant improvement in the ratio of CT-determined values at full expiration to those at full inspiration (E/I ratio) (0.894±0.005 vs.0.871±0.003,P=0.002).Conclusion We have shown,using lung function tests and HRCT image technique,that add-on therapy with montelukast improves distal lung function reflected by air trapping,but not airway wall thickness in moderate-to-severe asthma.(ClinicalTrials.gov number,NCT00699062)
文摘Classic respiratory mechanics is a branch of vectorial mechanics, which aims to recognize all forces acting on the respiratory system. Another branch of mechanics, analytical mechanics, has been used for analyzing the motions of complicated systems with constraints through equilibrium among scalar quantities such as kinetic energy and potential energy. However, until now, there have not been any studies concerning about analytical respiratory mechanics. In this paper, the author has obtained two types of motion equations (linear and nonlinear) for the airflow limitation from formulation of the analytical respiratory mechanics. Reconstructed flow-volume trajectories of the linear equation revealed a new relationship among the slope of the linear portion of trajectory, the coefficient of the dissipation function and the coefficient of the potential function. Reconstructed trajectories of the nonlinear equation suggested that a curved flow-volume trajectory would be caused by the emergence of regional hypoventilated clusters with airtrapped lobules. In conclusion, analytical respiratory mechanics will provide the basis for analyzing the mechanical properties of the respiratory system con cerning pulmonary functional images made by newly developed technologies.
文摘<b><span style="font-family:Verdana;">Introduction: </span></b><span style="font-family:""><span style="font-family:Verdana;">Urban Air pollution is increasingly becoming a major health and sustainable development issue. Several studies showed that Traffic-related air pollution (TRAP) is one of the main sources of urban air pollution and has serious consequences on respiratory health. As no systematic review focused on the traffic-related air pollution and respiratory health in the target population of individuals working in a shop or in an office or individuals living along the trunk road, the authors conducted the current study to try to fill this gap. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: A systematic review search was conducted using MEDLINE (PubMed), Scientific Research Publishing: SCIRP, Web of Science, Google scholar. Studies were included if they meet the following selection criteria: </span></span><span style="font-family:Verdana;">1</span><span style="font-family:Verdana;">) focus on population working or living along a major/trunk road</span><span style="font-family:Verdana;">;</span><span style="font-family:""> </span><span style="font-family:Verdana;">2</span><span style="font-family:Verdana;">) studies had reported clearly at least on the exposure variables related to TRAP</span><span style="font-family:Verdana;">;</span><span style="font-family:""> </span><span style="font-family:Verdana;">3</span><span style="font-family:""><span style="font-family:Verdana;">) the association between TRAP and development of respiratory symptoms or respiratory diseases was established. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">13 articles were selected on the 192 articles that were retrieved in the initial research. Exposure to traffic-related air pollution was determined by using distance to road, traffic intensity and pollutants measured. The main respiratory health problems found were cough, wheeze, asthma and bronchitis. No article discussed about roundabouts in characterizing exposure to traffic-related air pollution. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Distance to road, traffic density and pollutants measured are the usual methods to characterize the exposure to traffic-related air pollution and its consequences on respiratory health. Regarding the context of area occupations in African cities, it is necessary to focus on population around roundabouts and see if they are not more exposed to TRAP.
基金Project supported by the National Natural Science Foundation of China(Grant Nos.52079140,51779257).
文摘Visual and pressurized pipeline systems with single- and multi-undulation layouts were used to study experimentally and analyze theoretically the transient characteristics of water-air two-phase flow during water fillings in undulation pipelines based on the combination action analyses of both the communicating pipe and the gravity of the water-air two-phase flows in the descending pipe. For the single undulation pipeline, the complex two-phase flow-pattern evolutions including full pipe flow and stratified flow for low, medium, high water-filling velocity cases, respectively, lead to a great difference in transient pressure, flow pattern and the water-filling duration. Especially for low and medium water-filling velocity cases, the hydraulic theories related to hydraulic drop and hydraulic jump were employed to investigate the entrapped air pocket evolutions in the descending pipe, and the mechanism of negative pressure at the top of the undulation pipes was analyzed. For the same multi-undulation pipeline, due to the different elevations of the three undulation points along flow direction, namely three different types of pipeline layout, high-medium-low case (high elevation undulation point, medium one, and low one), low-medium-high and high-low-medium ones, their water-filling durations are significantly different, i.e., approximately 80.02 s, 227.34 s and 617.78 s. Meanwhile, there are significant differences in flow patterns in water filling, namely larger entrapped air pockets in three descending pipes for the high-medium-low case, entrapped air pockets in the first two descending pipes and open channel stratified flow in the last one for low-medium-high case, some bubbles in three descending pipes for the high-low-medium case.