Mucus plugs are associated with small airway remodeling in COPD
Bibliographic record
Abstract
Background: Mucus plugs in proximal airways on high-resolution computed tomography (HRCT) are linked to higher mortality and exacerbations in Chronic Obstructive Pulmonary Disease (COPD) patients. However, due to the resolution limits of HRCT, it is not known if the distal small airways (<2mm in diameter) also contain mucus plugs. Objectives: Determine if mucus plugs are present in the distal small airways (terminal bronchioles) and if they are associated with airway wall remodeling. Methods: Lungs from ex-smokers with normal lung function (n=12), or mild (n=12), moderate (n=12), and very-severe COPD (n=12) were inflated and frozen. Systematic uniform random sampling was used to obtain eight samples per case. A total of 384 samples were imaged using micro-CT to assess mucus plugs and airway morphology. Samples were then fixed and sectioned for histology to assess airway wall remodeling using Euclidean distance mapping (EDM). Results: Compared to control lungs, 10% of terminal bronchioles (TBs) in mild/moderate and 15% of TBs in very-severe COPD patients had mucus plugs. Mucus plugs were predominantly stringy and filled over 50% of the TB path length or more in 92% of mild/moderate cases and 60% of very-severe COPD patients. TBs with mucus plugs had thicker airway walls, narrower lumens, and fewer alveolar attachments than non-mucus-plugged airways. EDM analysis identified that mucus-plugged airways had thicker walls due to airway epithelial and basement membrane thickening compared to unplugged airways. Conclusion: Mucus plugs are a feature of distal small airways in COPD and are associated with increased airway remodeling and narrowing, and are a potential target for improving patient outcomes.
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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 | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".