• 대한영상의학회지
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• 제82권4호
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• pp.808-816
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• 2021

폐기종은 만성 폐쇄성 폐질환을 유발하는 질환으로, CT는 폐기종을 정확하게 진단하는 데 가장 유용한 검사이다. 폐기종의 중증도는 시각적 분류 혹은 정량적 분석 등의 방법으로 평가할 수 있으며, 최근에는 딥러닝을 활용한 폐기종 연구도 다양하게 이루어지고 있다. 이러한 폐기종의 중증도 분류 방법은 다양한 연구에서 그 임상적 유용성을 입증받고 있으며, 한계점으로 지적되고 있는 측정의 신뢰성을 향상시키려는 노력 또한 이어지고 있다.

• Tuberculosis and Respiratory Diseases
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• 제85권2호
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• pp.122-136
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• 2022

Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.

• Tuberculosis and Respiratory Diseases
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• 제78권1호
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• pp.8-17
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• 2015

Background: AMP-activated protein kinase (AMPK) not only functions as an intracellular energy sensor and regulator, but is also a general sensor of oxidative stress. Furthermore, there is recent evidence that it participates in limiting acute inflammatory reactions, apoptosis and cellular senescence. Thus, it may oppose the development of chronic obstructive pulmonary disease. Methods: To investigate the role of AMPK in cigarette smoke-induced lung inflammation and emphysema we first compared cigarette smoking and polyinosinic-polycytidylic acid [poly(I:C)]-induced lung inflammation and emphysema in $AMPK{\alpha}1$-deficient ($AMPK{\alpha}1$-HT) mice and wild-type mice of the same genetic background. We then investigated the role of AMPK in the induction of interleukin-8 (IL-8) by cigarette smoke extract (CSE) in A549 cells. Results: Cigarette smoking and poly(I:C)-induced lung inflammation and emphysema were elevated in $AMPK{\alpha}1$-HT compared to wild-type mice. CSE increased AMPK activation in a CSE concentration- and time-dependent manner. 5-Aminoimidazole-4-carboxamide-1-${\beta}$-4-ribofuranoside (AICAR), an AMPK activator, decreased CSE-induced IL-8 production while Compound C, an AMPK inhibitor, increased it, as did pretreatment with an $AMPK{\alpha}1$-specific small interfering RNA. Conclusion: $AMPK{\alpha}1$-deficient mice have increased susceptibility to lung inflammation and emphysema when exposed to cigarette smoke, and AMPK appears to reduce lung inflammation and emphysema by lowering IL-8 production.

• Tuberculosis and Respiratory Diseases
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• 제72권3호
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• pp.310-317
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• 2012

Background: Airway obstruction and the extent of emphysema are reported to be responsible for reduced bone mineral density (BMD). Corresponding to different phenotypes of a pulmonary disease, different severity in extra pulmonary features may exist. We compared BMDs of subjects with or without airway obstruction and/or emphysema and investigated the relationships among BMD, the severity of airway obstruction, and the extent of emphysema. Methods: Using a university hospital database, we reviewed patients over 40 years old who performed spirometry, computed tomography of chest, and measurement of BMD of the lumbar (L) spine. According to the presence or absence of airway obstruction and/or emphysema, four groups were classified. Results: Among a total of 59 subjects, 33 (56%) had osteoporosis. The prevalence of osteoporosis in subjects with no airway obstruction and no emphysema, those with only emphysema, those with only airway obstruction, and those with both airway obstruction and emphysema were 42%, 57%, 64%, and 73%, respectively (p=0.047 by linear-by-linear association). The mean T-scores of BMD of L1 (p=0.032) and L1-4 spines were different among the four groups (p=0.034). Although the T-score of L1 BMD negatively correlated with the extent of emphysema (r=-0.275, p=0.035) and positively with each of body mass index (BMI) (r=0.520, p<0.001), forced expiratory volume in one second ($FEV_1$) (r=0.330, p=0.011), $FEV_1$/forced vital capacity (r=0.409, p=0.001), and forced expiratory flow at 25~75% of FVC ($FEF_{25-75%}$) (r=0.438, p=0.0001), respectively, multiple linear regression analysis indicated that BMI (p<0.001) and $FEF_{25-75%}$ were predictive of BMD (p=0.012). Conclusion: Low BMI and airway obstruction were strongly associated with reduced bone density rather than the extent of emphysema.

• Tuberculosis and Respiratory Diseases
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• 제85권4호
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• pp.302-312
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• 2022

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease. Not all patients with COPD respond to available drugs. Identifying respondents to therapy is critical to delivering the most appropriate treatment and avoiding unnecessary medication. Recognition of individual patients' dominant characteristics by phenotype is a useful tool to better understand their disease and tailor treatment accordingly. To look for a suitable phenotype, it is important to understand what makes COPD complex and heterogeneous. The pathology of COPD includes small airway disease and/or emphysema. Thus, COPD is not a single disease entity. In addition, there are two types (panlobular and centrilobular) of emphysema in COPD. The coexistence of different pathological subtypes could be the reason for the complexity and heterogeneity of COPD. Thus, it is necessary to look for the phenotype based on the difference in the underlying pathology. Review of the literature has shown that clinical manifestation and therapeutic response to pharmacological therapy are different depending on the presence of computed tomography-defined airway wall thickening in COPD patients. Defining the phenotype of COPD based on the underlying pathology is encouraging as most clinical manifestations can be distinguished by the presence of increased airway wall thickness. Pharmacological therapy has shown significant effect on COPD with airway wall thickening. However, it has limited use in COPD without an airway disease. The phenotype of COPD based on the underlying pathology can be a useful tool to better understand the disease and adjust treatment accordingly.

• Tuberculosis and Respiratory Diseases
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• 제82권2호
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• pp.158-165
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• 2019

Background: A recent study reported that mesenchymal stem cells possess potential cellular therapeutic properties for treating patients with chronic obstructive pulmonary disease, which is characterized by emphysema. We examined the potential therapeutic effect of Wharton's Jelly-derived mesenchymal stem cells (WJMSCs), following pretreatment with pioglitazone, in lung regeneration mouse emphysema models. Methods: We used two mouse emphysema models, an elastase-induced model and a cigarette smoke-induced model. We intravenously injected WJMSCs ($1{\times}10^4/mouse$) to mice, pretreated or not, with pioglitazone for 7 days. We measured the emphysema severity by mean linear intercepts (MLI) analysis using lung histology. Results: Pioglitazone pretreated WJMSCs (pioWJMSCs) were associated with greater lung regeneration than non-augmented WJMSCs in the two mouse emphysema models. In the elastase-induced emphysema model, the MLIs were $59.02{\pm}2.42{\mu}m$ (n=6), $72.80{\pm}2.87{\mu}m$ (n=6), for pioWJMSCs injected mice, and non-augmented WJMSCs injected mice, respectively (p<0.01). Both pioWJMSCs and non-augmented WJMSCs showed regenerative effects in the cigarette smoke emphysema model (MLIs were $41.25{\pm}0.98$ [n=6] for WJMSCs and $38.97{\pm}0.61{\mu}m$ [n=6] for pioWJMSCs) compared to smoking control mice ($51.65{\pm}1.36{\mu}m$, n=6). The mean improvement of MLI appeared numerically better in pioWJMSCs than in non-augmented WJMSCs injected mice, but the difference did not reach the level of statistical significance (p=0.071). Conclusion: PioWJMSCs may produce greater lung regeneration, compared to non-augmented WJMSCs, in a mouse emphysema model.

• 한국동물위생학회지
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• 제26권1호
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• pp.81-88
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• 2003

A cross-sectional epidemiological study using a multistage sampling strategy in slaughter cattle in Mymensingh, Bangladesh was conducted during September 2001 to April 2002 to study distributions and risk factors of specific pulmonary lesions and diseases. The pulmonary lesions and diseases were diagnosed on the basis of macroscopic and microscopic pathological and parasitological findings. The frequency distribution of pulmonary lesions and diseases in slaughter cattle was found to vary among categories of the study variables. The risk factors identified on statistical basis were male cattle and ${\leq}3$ years old cattle and summer in congestion, slightly thin physical condition and summer season in pulmonary emphysema, slightly thin physical condition in parasitic bronchitis as well as female cattle, autumn and rainy seasons in pulmonary hydatidosis. The population impact and etiologic significance of summer season on pulmonary congestion and emphysema was more important than that of adult male cattle. The population impact and etiologic significance of autumn season on pulmonary hydatidosis was more important than that of female cattle during rainy season. Population impact of slightly thin cattle on parasitic bronchitis was poor.

• 한국방사선학회논문지
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• 제16권4호
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• pp.411-417
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• 2022

본 연구에서는 저선량 흉부 CT 영상을 이용하여 VGGNet을 학습시키고 폐기종 검출 모델을 구현하고 성능을 확인하고자 한다. 연구에 사용된 저선량 흉부 CT 영상은 정상 진단 8000장, 폐기종 진단 3189장이며, 모델 학습을 위해 정상 데이터와 폐기종 데이터를 train, validation, test dataset으로 각각 60%, 24%, 16%로 무작위 추출하여 구분하였다. 학습을 위한 인공신경망은 VGGNet 중 VGG16과 VGG19를 사용하였으며, 학습이 완료된 모델 평가를 위해 정확도, 손실율, 오차 행렬, 정밀도, 재현율, 특이도, F1-score의 평가지표를 사용하였다. 폐기종 검출 정확도와 손실율은 VGG16과 VGG19 각각 92.35%, 95.88%, 0.21%, 0.09%, 정밀도는 91.60%, 96.55%, 재현율은 98.36%, 97.39%, 특이도는 77.08%, 92.72%, F1-score는 94.86%, 96.97%였다. 위의 평가지표를 통해 VGG19 모델의 폐기종 검출 성능이 VGG16 모델에 비해 우수하다고 판단된다. 본 연구를 통해 VGGNet과 인공신경망을 이용한 폐기종 검출 모델 연구에 기초자료로 사용할 수 있을 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제51권2호
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• pp.97-107
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• 2001

연구배경 : 결핵에 의해 폐실질의 손상과 혈관 자체의 손상이 발생하고, 폐결핵의 만성 후유증으로 병발하는 이차성 폐기종에 의해 추가적인 폐혈관상의 손상이 초래된다. 그러므로 폐의 관류장애는 원발성 폐기종보다 결핵후 폐기종에서 더 심한 경향을 보인다. 따라서 결핵후 폐기종에서 우심의 기능이 중요한 역할을 할 것으로 추정되나, 이에 대한 연구는 부족한 실정이다. 본 연구는 결핵후 폐기종과 원발성 폐기종에서 우심 기능의 차이를 알아보고, 유의한 차이가 있다면 그 의의를 알아보고자 하였다. 방 법 : 병력 및 HRCT 결과, 폐기능검사 소견을 종합하여, 결핵후 폐기종 또는 원발성 폐기종을 진단하였다. 1초시 강제호기량과 노력성폐활량이 서로 비슷한 결핵 후 폐기종 환자와 원발성 폐기종 환자 20명을 선정하였다. 이들 환자를 대상으로 안정 시와 증상한계 운동부하 후 동맥혈가스분석과 심초음파검사들 시행하였다. 우심의 기능은 변형된 Simpson씨 법으로 박출계수를 산정하여 평가하였다. 결 과:대상환자들의 임상적 특성이나 폐기능검사 지표 상 두군간에 유의한 차이는 없었다. 동맥혈 가스분석 상 결핵후 폐기종군에서 안정 시와 운동 후 모두 이산화탄소압이 높고(안정 시 $42.9{\pm}4.7$ vs $38.8{\pm}3.1\;mmHg$, p<0.05 ; 운동 후 $47.9{\pm}7.0$ vs $41.1{\pm}5.9$, p<0.01) 우심실기능은 낮았다(안정 시 $57.6{\pm}6.5$ vs $61.4{\pm}4.7\;%$, p<0.01 ; 운동 후 $51.1{\pm}10.8$ vs $59.8{\pm}6.6\;%$, p<0.01). 또 운동 후 산소분압 역시 낮았으며($65.7{\pm}12.6$ vs $80.2{\pm}14.4\;mmHg$, p<0.01), 안정 시 산소분압은 낮은 경향을 보였다($82.9{\pm}12.0$ vs $87{\pm}7.5$, p>0.05). 양군 모두에서 우심의 박출계수는 운동 후의 산소분압(결핵후 폐기종 r=0.536, 원발성 폐기종 r=0.557), 그리고 안정 시(결핵후 폐기종 r=-0.576, 원발생 폐기종 r=-0.588) 및 운동 후(결핵후 폐기종 r=-0.764, 원발성 폐기종 r=-0.619)의 이산화탄소분압과 유의한 상관관계를 보였다. 결 론 : 환기기능이 비슷한 경우 결핵후 폐기종에서는 원발성 폐기종에 비해 우심의 기능과 가스교환능이 현저히 떨어져 있어, 결핵후 폐기종에서 폐의 가스교환은 우심실 기능의 영향을 받을 것으로 사료된다.

• BMB Reports
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• 제50권2호
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• pp.79-84
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• 2017

Emphysema, a pathologic component of the chronic obstructive pulmonary disease, causes irreversible destruction of lung. Many researchers have reported that mesenchymal stem cells can regenerate lung tissue after emphysema. We evaluated if spheroid human adipose-derived mesenchymal stem cells (ASCs) showed greater regenerative effects than dissociated ASCs in mice with elastase-induced emphysema. ASCs were administered via an intrapleural route. Mice injected with spheroid ASCs showed improved regeneration of lung tissues, increased expression of growth factors such as fibroblast growth factor-2 (FGF2) and hepatocyte growth factor (HGF), and a reduction in proteases with an induction of protease inhibitors when compared with mice injected with dissociated ASCs. Our findings indicate that spheroid ASCs show better regeneration of lung tissues than dissociated ACSs in mice with elastase-induced emphysema.