Radiographic evaluation of nursing- and healthcare-associated pneumonia.

AIM: Radiographic testing has an important role in the diagnosis and evaluation of pneumonia. The aim of the present study was to evaluate the usefulness of computed tomography (CT), in comparison with chest roentography (CR), in the diagnosis and evaluation of nursing- and healthcare-associated pneumonia (NHCAP) . METHODS: The utility of CT in the diagnosis of NHCAP was compared with that of CR in a prospective study of patients who visited the emergency room in Nissan Tamagawa Hospital, Tokyo, Japan, with clinical symptoms that were indicative of NHCAP. We also evaluated whether particular CT findings were risk factors for NHCAP-associated mortality. RESULTS: A total of 162 patients with suspected NHCAP were included in the study. The 162 patients included 147 (90.6%) patients who were diagnosed with NHCAP based on the detection of pneumonic infiltration on CT. In contrast, CR was not capable of recognizing pneumonic infiltration in 15 of the 147 (10.2%) patients. A multivariable analysis which was carried out to determine the risk factors for NHCAP-associated mortality, showed that oxygen desaturation had the greatest odds ratio, followed by a blood urea nitrogen level of ≥21 mg/dL and the detection of bilateral pneumonic infiltration by CT. CONCLUSIONS: We herein show that CT is superior to CR for the diagnosis and evaluation of NHCAP. The present study will provide a foundation for further studies to clarify whether the use of CT in the diagnosis and evaluation of NHCAP can improve the clinical outcome of patients with NHCAP. Geriatr Gerontol Int 2017; 17: 41-47.

A Prospective Analysis of the Efficacy and Complications Associated With Deep Sedation With Midazolam During Fiberoptic Bronchoscopy.

BACKGROUND: Moderate sedation has been commonly used for fiberoptic bronchoscopy (FB). However, patients may find FB under moderate sedation to be unpleasant. We therefore examined whether deep sedation was a useful premedication for FB. METHODS: We designed a prospective, randomized study using a patient questionnaire to address the perceptions of the procedures and complications of patients who underwent FB with deep sedation (deep sedation group) with midazolam in comparison with those who underwent FB with moderate sedation (moderate sedation group) with the same drug. Patients were asked to grade FB as being easy or difficult to tolerate. The primary endpoint was tolerability and the secondary endpoints included complications associated with the procedure. RESULTS: A total of 80 patients were included in the study. A significantly lower number of patients in the deep sedation group reported that the technique was difficult to tolerate (5.0% vs. 40.0%, moderate sedation group; P<0.001). However, the dose of oxygen required to maintain an oxygen saturation of ≥90% was higher in the deep sedation group (7.3±4.7 vs. 2.7±1.6 L/min; P<0.0001). There were no cases of prolonged oxygen desaturation or deaths related to FB in either group. CONCLUSION: In the present study, deep sedation had a beneficial effect on patient tolerance to FB. Although oxygen desaturation during FB represents a potentially serious complication, deep sedation may be considered to be a useful premedication for FB.

Computed Tomography for the Diagnosis and Evaluation of the Severity of Community-acquired Pneumonia in the Elderly.

OBJECTIVE: We herein assessed the utility of computed tomography (CT) for the diagnosis and ascertainment of the severity of community-acquired pneumonia (CAP) in the elderly. METHODS: The utility of CT compared with chest radiography (CR) for the diagnosis of CAP was prospectively studied among elderly inpatients with clinical symptoms and signs indicative of CAP at the Department of Respiratory Medicine in Nissan Tamagawa Hospital during the one-year period from January 2013 to December 2013. Additionally, we evaluated whether the findings of CT were useful as predictive factors related to the mortality rate associated with CAP. RESULTS: One hundred and forty-two patients, 65 years of age or older, were surveyed upon hospital admission for suspected CAP. Of the 142 patients included, 127 (89.4%) had pneumonic infiltration diagnosed by CT, however, CR could not recognize pneumonic infiltration in 9.4% (12/127) of these patients. In 127 CAP-positive patients, bilateral pneumonic infiltration was more frequently detected by CT in non-survivors than survivors (79.0% vs. 53.7%; p <0.05). By a multivariable analysis to determine the prognostic factors related to mortality from CAP, oxygen desaturation showed the greatest odds ratio among the other predictive factors, followed by comorbid neoplastic disease, blood urea nitrogen ≥21 mg/dL, male gender, and bilateral pneumonic infiltration diagnosed by CT. CONCLUSION: We herein demonstrated that CT was superior to CR for diagnosing and evaluating the severity of CAP in elderly patients.

[An autopsy case of extraskeletal osteosarcoma arising in the mediastinum].

A 90-year-old woman was admitted to our hospital with dyspnea and palpitation. A chest X-ray film showed an enlarged cardiac outline. An enhanced chest CT scan showed a 35-mm tumor in the superior portion of the mediastinum, a large amount of pericardial effusion, and bilateral lung nodules. She showed progressive deterioration and died 2 weeks after admission. At autopsy, there was a solid tumor measuring 35 mm in the anterior mediastinum between the aortic arch and trachea. The tumor invaded the left subclavian artery. The pathological autopsy finding was extraskeletal osteosarcoma arising from the mediastinum. Although extraskeletal osteosarcoma is uncommon and rarely develops in the mediastinum, it should be included in the differential diagnosis of a mediastinal mass.

ATP-sensitive K+ channel-mediated glucose uptake is independent of IRS-1/phosphatidylinositol 3-kinase signaling.

We previously found that disruption of Kir6.2-containing ATP-sensitive K+ (KATP) channels increases glucose uptake in skeletal muscle, but the mechanism is not clear. In the present study, we generated knockout mice lacking both Kir6.2 and insulin receptor substrate-1 (IRS-1). Because IRS-1 is the major substrate of insulin receptor kinase, we expected disruption of the IRS-1 gene to reduce glucose uptake in Kir6.2 knockout mice. However, the double-knockout mice do not develop insulin resistance or glucose intolerance. An insulin tolerance test reveals the glucose-lowering effect of exogenous insulin in double-knockout mice and in Kir6.2 knockout mice to be similarly enhanced compared with wild-type mice. The basal 2-deoxyglucose uptake rate in skeletal muscle of double-knockout mice is increased similarly to the rate in Kir6.2 knockout mice. Accordingly, disruption of the IRS-1 gene affects neither systemic insulin sensitivity nor glucose uptake in skeletal muscles of Kir6.2-deficient mice. In addition, no significant changes were observed in phosphatidylinositol 3-kinase (PI3K) activity and its downstream signal in skeletal muscle due to lack of the Kir6.2 gene. Disruption of Kir6.2-containing Katp channels clearly protects against IRS-1-associated insulin resistance by increasing glucose uptake in skeletal muscles by a mechanism separate from the IRS-1/PI3K pathway.

ATP-sensitive potassium channels participate in glucose uptake in skeletal muscle and adipose tissue.

ATP-sensitive potassium (K(ATP)) channels are known to be critical in the control of both insulin and glucagon secretion, the major hormones in the maintenance of glucose homeostasis. The involvement of K(ATP) channels in glucose uptake in the target tissues of insulin, however, is not known. We show here that Kir6.2(-/-) mice lacking Kir6.2, the pore-forming subunit of these channels, have no K(ATP) channel activity in their skeletal muscles. A 2-deoxy-[(3)H]glucose uptake experiment in vivo showed that the basal and insulin-stimulated glucose uptake in skeletal muscles and adipose tissues of Kir6.2(-/-) mice is enhanced compared with that in wild-type (WT) mice. In addition, in vitro measurement of glucose uptake indicates that disruption of the channel increases the basal glucose uptake in Kir6.2(-/-) extensor digitorum longus and the insulin-stimulated glucose uptake in Kir6.2(-/-) soleus muscle. In contrast, glucose uptake in adipose tissue, measured in vitro, was similar in Kir6.2(-/-) and WT mice, suggesting that the increase in glucose uptake in Kir6.2(-/-) adipocytes is mediated by altered extracellular hormonal or neuronal signals altered by disruption of the K(ATP) channels.