Diffusion-Controlled Recrystallization of Water Sorbed into Poly(meth)acrylates Revealed by Variable-Temperature Mid-Infrared Spectroscopy and Molecular Dynamics Simulation.

Recrystallization behaviors of water sorbed into four poly(meth)acrylates, poly(2-methoxyethyl acrylate), poly(tetrahydrofurfuryl acrylate), poly(methyl acrylate), and poly(methyl methacrylate), are investigated by variable-temperature mid-infrared (VT-MIR) spectroscopy and molecular dynamics (MD) simulation. VT-MIR spectra demonstrate that recrystallization temperatures of water sorbed into the polymers are positively correlated with their glass-transition temperatures reported previously. The present MD simulation shows that a lower-limit temperature of the diffusion for the sorbed water and the glass-transition temperatures of the polymers also have a positive correlation, indicating that the recrystallization is controlled by diffusion mechanism rather than reorientation mechanism. Detailed molecular processes of not only recrystallization during rewarming but also crystallization during cooling and hydrogen-bonding states of water in the polymers are systematically analyzed and discussed.

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.

Clinical characteristics of catamenial and non-catamenial thoracic endometriosis-related pneumothorax.

BACKGROUND AND OBJECTIVE: A major pathogenic factor for catamenial pneumothorax is thoracic endometriosis. However, thoracic endometriosis-related pneumothorax (TERP) can develop as either catamenial or non-catamenial pneumothorax (CP). Therefore, the aim of this study was to elucidate the clinical differences between catamenial and non-catamenial TERP. METHODS: The clinical and pathological data in female patients who underwent video-assisted thoracoscopic surgery at the Pneumothorax Research Center during an 8-year period were retrospectively reviewed. This study included 150 female patients with surgico-pathologically confirmed TERP. The subjects were divided into two groups, those having all of the pneumothorax episodes in the catamenial period (CP group) and those who did not (non-CP group). We compared the clinical characteristics and surgico-pathological findings between these two groups. RESULTS: Of the 150 TERP patients, 55 (36.7%) were classified in the CP group, and 95 (63.3%) in the non-CP group. In regard to the locations of endometriosis, all TERP patients had diaphragmatic endometriosis, while pleural implantation was recognized in 34 of the 55 (61.8%) patients in the CP group and 42 of the 95 (44.2%) patients in the non-CP group (P < 0.05). CONCLUSIONS: A significant difference in the proportion of patients with pleural endometriosis was observed between catamenial and non-catamenial TERP. The ectopic sites of the endometriosis may be responsible for the timing of the pneumothorax episodes.

[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.