Jai Soung Park

Role of Lung Apolipoprotein A-I in Idiopathic Pulmonary Fibrosis Antiinflammatory and Antifibrotic Effect on Experimental Lung Injury and Fibrosis

RATIONALE Idiopathic pulmonary fibrosis (IPF) is caused by alterations in expression of proteins involved in multiple pathways, including matrix deposition, inflammation, injury, and repair. OBJECTIVES To understand the pathogenic changes in lung protein expression in IPF and to evaluate apolipoprotein (Apo) A-I as a candidate therapeutic molecule. METHODS Two-dimensional electrophoresis was adopted for differential display proteomics. Reverse-transcriptase polymerase chain reaction, Western blotting, immunohistochemical staining, and ELISA were performed for identification and quantitative measurement of Apo A-I in bronchoalveolar lavage fluids from subjects with IPF and experimental bleomycin-induced mice. MEASUREMENTS AND MAIN RESULTS Sixteen protein spots showed differences in relative intensity between IPF (n = 14) and healthy control subjects (n = 8). Nano liquid chromatography-tandem mass spectrometry (LC-MS/MS) revealed increase of haptoglobulin and decrease of alpha(1)-antitrypsin, alpha(1)-antichymotrypsin, macrophage capping protein, angiotensinogen, hemoglobin chain B, Apo A-I, clusterin, protein disulfide isomerase A3, immunoglobulin, and complement C4A in IPF compared with normal control subjects (P = 0.006-0.044). Apo A-I concentrations were lower in bronchoalveolar lavage fluids from subjects with IPF (n = 28) than in normal control subjects (n = 18; P < 0.01). In bleomycin-treated mice, Apo A-I protein in BALF was lower than that in sham-treated control animals. Immunohistochemical analysis showed positive staining on intraalveolar macrophages and epithelial cells of the lungs. Intranasal treatment with Apo A-I protein reduced the bleomycin-induced increases in number of inflammatory cells and collagen deposition in sham-treated mice in a dose-dependent manner. CONCLUSIONS Alterations of several inflammatory and antiinflammatory proteins in the lungs may be related to the pathogenesis of IPF, and local treatment with Apo A-I is very effective against the development of experimental lung injury and fibrosis.

Interleukin-13 and Its Receptors in Idiopathic Interstitial Pneumonia: Clinical Implications for Lung Function

Idiopathic interstitial pneumonia (IIP) is characterized by varying degrees of interstitial fibrosis. IL-13 and IL-4 are strong inducers of tissue fibrosis, whereas IFN-γ has antifibrotic potential. However, the roles of these substances in IIP remain unknown. IL-13, IL-4, and IFN-γ were measured in the BAL fluid of 16 idiopathic pulmonary fibrosis (IPF) patients, 10 nonspecific interstitial pneumonia (NSIP) patients, and 8 normal controls. The expression of IL-13 and IL-13Rα1/α2 in lung tissues was analyzed using ELISA and immunohistochemistry. IL-13 levels were significantly higher in IPF patients than the others (P<0.05). IL-4 levels were higher in both IPF and NSIP patients than in normal controls (P<0.05), and IFN-γ levels were lower in NSIP patients than in normal controls (P=0.047). IL-13 levels correlated inversely with FVC% (r=-0.47, P=0.043) and DLCO% (r=-0.58, P=0.014) in IPF and NSIP patients. IL-13 was strongly expressed in the smooth muscle, bronchial epithelium, alveolar macrophages and endothelium of IPF patients. IL-13Rα1, rather than IL-13Rα2, was strongly expressed in the smooth muscle, bronchial epithelium, and endothelium of IPF patients. IL-13 and its receptors may contribute to the pathogenesis of fibrosis in IIP and appear to be related to the severity of the disease.

Association of interleukin-5 and eotaxin with acute exacerbation of asthma.

Background: Airway eosinophilia is frequently observed during acute exacerbation of asthma. Interleukin-5 (IL-5) and eotaxin are directly involved in the airway eosinophilia found in persistent asthma. Interrelation between these cytokines is expected to occur in acute exacerbation of asthma. Thus, we evaluated the relevance of interaction between eotaxin and IL-5 in the airway inflammation of acute exacerbation. Methods: We measured the number of inflammatory cells and the amount of eotaxin and IL-5 in sputum from 22 healthy subjects, 21 asthmatics with acute exacerbation and 16 patients with mild persistent asthma, and reassessed these values in 7 subjects with acute exacerbation after 7 days’ treatment with systemic steroid (2 mg/kg/day). Sources of IL-5 and eotaxin were investigated by immunohistochemical staining of sputum cells of 4 cases from each group. Results: Both IL-5 and eotaxin levels were higher in patients with acute exacerbation of asthma than in patients with persistent asthma and normal subjects. IL-5 and eotaxin levels were significantly correlated with eosinophil percentages in mild persistent asthma. Eotaxin staining was found mainly on macrophages and occasionally on eosinophils. Steroid treatment markedly decreased eosinophil percentages and IL-5 levels within 7 days but did not alter eotaxin levels. Conclusions: Both IL-5 and eotaxin are associated with acute exacerbation of asthma. IL-5 rather than eotaxin is effectively decreased by the inhibitory effect of steroid in acute exacerbation.

High-Resolution Sonography for Nasal Fracture in Children

OBJECTIVE We describe the sonographic findings of nasal fracture in children, and we evaluate the diagnostic value of sonography as compared with conventional radiography and clinical findings to determine whether sonography can be a primary technique for evaluating nasal fracture in children. MATERIALS AND METHODS Conventional radiographs and sonographic scans were obtained in 26 consecutive children with nasal trauma who were seen at our hospital from March 2003 to March 2005. There were five girls and 21 boys, and their ages ranged from 1 year 9 months to 15 years 11 months (mean age, 9.9 years). The following sonographic scans (HDI-5000 unit with a 7-15-MHz linear array transducer) were used to evaluate the nasal bone at different levels: a midline longitudinal image; axial scans of the nasal bones at the upper, middle, and lower levels; images of the nasal septum; and transverse and longitudinal scans of both lateral walls. Ten children also underwent CT. RESULTS Conventional radiographs depicted 14 (54%) of 26 fractures. Sonographic scans were able to show all the fracture lines. One case was diagnosed as an old nasal fracture on the basis of a physical examination, even though a visible fracture line was seen on sonography. The sonographic findings of nasal fracture were disruption of the bone continuity with or without separation of the fractured segment (7/26), displacement of the bone segment as being depressed or overriding (20/26), associated septal deviation (7/26), and separation of the pyriform aperture of the maxilla and nasal bone (2/26). The associated findings were soft-tissue edema and hypoechoic hematoma near the fracture lines in 25 cases. The fractures involved both sides of the nasal bones in 11 of 26 cases, the midline part of the bones in six of 26 cases, and the unilateral paramedian or lateral part of the bones in 12 of 26 cases. Among the 10 CT scans, one CT scan did not depict the fracture, showing only soft-tissue swelling, and one scan showed fractures of the orbital floor and maxilla. CONCLUSION Sonography can be a primary diagnostic technique for evaluating nasal fracture in children. It inflicts no radiation, provides various imaging planes without positional change, and can be used to evaluate the cartilaginous septum. Potential pitfalls are the nasofrontal suture, the junction between the nasal bone and the pyriform aperture of the maxilla, the vascular groove, and the presence of an old fracture. CT can be used in addition to sonography in cases of suspected complex facial bone trauma.

Utility of Sonographic Measurement of the Common Tensor Tendon in Patients With Lateral Epicondylitis

OBJECTIVE The purpose of this article is to evaluate prospectively the utility of sonographic measurements of the common extensor tendon for diagnosing lateral epicondylitis. SUBJECTS AND METHODS Forty-eight patients with documented lateral epicondylitis and 63 healthy volunteers were enrolled and underwent ultrasound of the elbow joint. The common extensor tendon overlying the bony landmark was scanned transversely, and the cross-section area and the maximum thickness were measured. Clinical examination was used as the reference standard in the diagnosis of lateral epicondylitis. Data from the patient and control groups were compared with established optimal diagnostic criteria for lateral epicondylitis using receiver operating characteristic curves. Qualitative evaluation with grayscale ultrasound was also performed on patients and healthy volunteers. RESULTS The common extensor tendon was significantly thicker in patients with lateral epicondylitis than in control subjects (p < 0.01). Tendon thickness greater than 4.2 mm (sensitivity, 78.4%; specificity, 95.2%; accuracy, 87.7%) and area larger than or equal to 32 mm(2) (sensitivity, 86.3%; specificity, 82.5%; accuracy, 84.2%) were highly predictive of lateral epicondylitis. For qualitative evaluation with gray-scale ultrasound, overall sensitivity, specificity, and accuracy values in the diagnosis of lateral epicondylitis were 76.5%, 76.2%, and 76.3%, respectively. CONCLUSION The quantitative sonographic measurements had an excellent diagnostic performance for lateral epicondylitis, as well as good or excellent interreader agreement. A common extensor tendon cross-section area greater than or equal to 32 mm(2) and a thickness of 4.2 mm correlated well with the presence of lateral epicondylitis. However, further prospective study is necessary to determine whether quantitative ultrasound with these cutoff values can improve the accuracy of the diagnosis of lateral epicondylitis.

Nonspecific Interstitial Pneumonia/Fibrosis: Clinical Manifestations, Histologic and Radiologic Features

Objectives Customarily used classification of IPF did not satisfy a sizable group of patients with IPF that in the past had been lumped with UIP and now currently has begun to be recognized as nonspecific interstitial pneumonia/fibrosis (NIP). There are few reports about the clinical features of NIP. Methods The pathologic slides of 66 patients having open lung biopsy (OLB) for the differential diagnosis of interstitial lung diseases (ILD) from 1984 to 1995 were reviewed. Seven cases were confirmed as NIP. The clinical record, pulmonay function tests (PFT), chest PA and HRCT were reviewed and analysed retrospectively. Results Six patients with NIP were female. The median age was 56 years. Mean duration of symptoms was 4 months. Five patients had systemic flu-like symptoms. the most common respiratory symptom was gradual dyspnea Two patients revealed a mild degree of anemia Four cases had leukocytois of more than 10,000/mm3. ESR and CRP O.K. elevated in all measured cases. Anti-nuclear antibody (ANA) was positive in three of six patients and ds-DNA antibody was positive in one of six patients Restrictive pattern of PFT was predominant. Diffusion capacity of carbonmonoxide (DLCO) decreased markedly. In bronchoalveolar lavage (BAL), total cell counts elevated about three times of normal value. On differntial counts of BAL cells, lymphocytes, neutrophils and eosinophils were higher than those of normal controls. The prominent finding of chest radiology was bilaterally patchy opacifications in parenchyme of lower lung zones. On HRCT, bilaterally patchy areas of ground-glass attenuation and/or areas of alveolar consolidation were commonly shown. The number of pathologic type was one case of group I, four cases of group II and two cases of group III. The average period from diagnosis to the last follow-up was 24.8 months. Five patients were clinically recovered to the previously well-being state. Conclusion Patients with NIP had different clinical features from UIP, AIP and DIP. They also had characteristic findings of radiology and their prognosis seems to be better than UIP.

Reducing Metallic Artifacts in Postoperative Spinal Imaging: Usefulness of IDEAL Contrast-enhanced T1- and T2-weighted MR Imaging—Phantom and Clinical Studies

PURPOSE To prospectively compare the effectiveness of iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) T2-weighted and contrast material-enhanced T1-weighted magnetic resonance (MR) imaging with that of a conventional MR imaging protocol in minimizing metallic artifacts in phantoms and in patients with metallic hardware after spinal surgery. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained for this study. Coronal T1- and T2-weighted MR images of six titanium alloy pedicle screws in an oil bath containing tubes filled with diluted gadolinium contrast medium were obtained with frequency-selective fat saturation (FSFS) and IDEAL. Axial T2-weighted and contrast-enhanced T1-weighted MR imaging of the spine was performed with FSFS and IDEAL at 22 lumbar levels in 19 patients. Two musculoskeletal radiologists qualitatively analyzed the images in terms of the visualization of paravertebral muscle and the spinal canal region, uniformity of fat saturation, and noise. The paired images were rated by using a five-point scale. For the quantitative study with phantoms, the short- and long-axis lengths of metallic artifacts were determined on signal intensity profiles. RESULTS In the phantom study, metallic artifact size was markedly decreased in the IDEAL T2-weighted and contrast-enhanced T1-weighted images (P < .001). In the clinical study, IDEAL T2-weighted and contrast-enhanced T1-weighted images enabled significantly improved visualization of the dural sac (P < .001), spinal muscles (P < .05), uniformity of fat saturation (P < .001), and noise (P < .05). CONCLUSION IDEAL T2-weighted and contrast-enhanced T1-weighted MR imaging examinations effectively reduce the degree of tissue-obscuring artifacts produced by spinal fixation hardware and improve image quality compared with FSFS T2-weighted and contrast-enhanced T1-weighted MR imaging. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101856/-/DC1.

Role of neutrophils in persistent airway obstruction due to refractory asthma.

Background and objective:  One of the clinical manifestations of refractory asthma (RA) in a certain group of patients is persistent airway obstruction (PAO), despite treatment with high doses of inhaled and/or systemic corticosteroids. Airway neutrophilic inflammation is frequently observed in RA; however, the relationship between neutrophilic inflammation and PAO has not been evaluated in this group of patients. The aim of this study was to compare the clinical parameters and patterns of inflammatory cells between patients with or without PAO due to RA, and to identify the factors associated with PAO.

Systemic arterial supply to the normal basal segments of the left lower lobe: Radiographic and CT findings in 11 patients

To assess the radiologic findings of systemic arterial supply to the normal basal segments of the left lower lobe, chest radiographs and CT scans of all 11 patients were reviewed retrospectively by two chest radiologists. On posteroanterior chest radiographs (n = 11), the anomalous systemic artery arising from the descending thoracic aorta was shown as a retrocardiac mass (n = 11). Absence of normal lower lobar pulmonary artery shadow (n = 11), partial obliteration of the descending aortic interface (n = 9), and increased interstitial markings in left lower lung zone (n = 8) were also noted. On contrast-enhanced scans (n = 11), abrupt tapering of the normal left lower lobar pulmonary artery distal to the origin of superior segmental artery (n = 11), aberrant systemic artery originating from the descending aorta (n = 11), mild volume loss in the left lower lobe (n = 11), diffuse dilatation of the intrapulmonary peripheral vasculature (n = 11) and areas of ground-glass opacity (n = 10) in the basal segments of the left lower lobe were seen. Because chest radiography and CT consistently demonstrate several combinations of characteristic findings, conventional aortography may not be necessary for proper diagnosis of this anomaly.

Practical Application of Iterative Decomposition of Water and Fat with Echo Asymmetry and Least-Squares Estimation (IDEAL) Imaging in Minimizing Metallic Artifacts

Iterative decomposition of water and fat with echo asymmetry and the least-squares estimation (IDEAL) is a recently developed method for robust separation of fat and water with very high signal-to-noise-ratio (SNR) efficiency. In contrast to conventional fat-saturation methods, IDEAL is insensitive to magnetic field (B0 and B1) inhomogeneity. The aim of this study was to illustrate the practical application of the IDEAL technique in reducing metallic artifacts in postoperative patients with metallic hardware. The IDEAL technique can help musculoskeletal radiologists make an accurate diagnosis particularly in musculoskeletal imaging by reducing metallic artifacts, enabling the use of contrast enhancement, improving SNR performance, and providing various modes of MR images with one scan parameter.