Impact of Emphysema Heterogeneity on Lung Function after Bronchoscopic Lung Volume Reduction
Bibliographic record
Abstract
Current treatments for chronic obstructive pulmonary disease fail to reverse the hyperinflation that impairs patients with a predominant emphysematous phenotype. We report the role of emphysema heterogeneity on lung function after placement of endobronchial one-way valves – Spiration Valve System (SVS). Patients with severe airflow obstruction, hyperinflation, and severe dyspnea without interlobar collateral ventilation were evaluated for enrollment. 113 subjects received SVS valves. Interlobar emphysema heterogeneity was assessed by high resolution computed tomography (HRCT) and categorized as low (10-25%, n=65) or high (>25%, n=48). Lung function was assessed by FEV1, hyperinflation was defined as the ratio of residual volume / total lung capacity and target lobe volume (TLV) was assessed by HRCT. At 6 months, valve treatment improved FEV1 by 99 ±15ml and decreased hyperinflation by -0.035 ±0.08 and TLV by -974 ±736 ml in the overall treatment group. Patients with low heterogeneity (LH), only improved FEV1 by 54 ±136ml, compared to 157 ±158ml (P<0.001). Hyperinflation also showed a smaller change in the LH group, -0.018 ±0.08 compared to -0.056 ±0.08 (P<0.05). TLV showed a similar reduction in both groups, -986 ±661 ml in the LH group compared to -959 ±823 in the high heterogeneity group (P=0.85). Bronchoscopic treatment of severe emphysema patients with the SVS provides statistical and clinically meaningful improvements in lung function and hyperinflation. These improvements are threefold greater in patients with high interlobar emphysema heterogeneity, while TLV reduction is similar despite the degree of heterogeneity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".