Quantitative assessment of erector spinae muscles and prognosis in elderly patients with pneumonia.

Erector spinae muscle (ESM) size has been reported as a predictor of prognosis in patients with some respiratory diseases. This study aimed to assess the association of ESM size on all-cause in-hospital mortality among elderly patients with pneumonia. We retrospectively included patients (age: ≥ 65 years) admitted to hospital from January 2015 to December 2017 for community-acquired pneumonia who underwent chest computed tomography (CT) on admission. The cross-sectional area of the ESM (ESMcsa) was measured on a single-slice CT image at the end of the 12th thoracic vertebra and adjusted by body surface area (BSA). Cox proportional hazards regression models were used to assess the influence of ESMcsa/BSA on in-hospital mortality. Among 736 patients who were admitted for pneumonia, 702 patients (95%) underwent chest CT. Of those, 689 patients (98%) for whom height and weight were measured to calculate BSA were included in this study. Patients in the non-survivor group were significantly older, had a greater frequency of respiratory failure, loss of consciousness, lower body mass index, hemoglobin, albumin, and ESMcsa/BSA. Multivariate analysis showed that a lower ESMcsa/BSA independently predicted in-hospital mortality after adjusting for these variables. In elderly patients with pneumonia, quantification of ESMcsa/BSA may be associated with in-hospital mortality.

COVID-19 pandemic and the incidence of community-acquired pneumonia in elderly people.

The impact of the COVID-19 pandemic on the incidence of community-acquired pneumonia in elderly people remains uncertain. We compared the number of elderly patients admitted to our hospital for community-acquired pneumonia from January to June 2020 to the numbers from the same period in each of the last three years. The number of patients began decreasing in February 2020, and by April 2020 the number was significantly lower than those from the same period in the three years prior. There is no evidence regarding the impact of general infection control measures, such as wearing a face mask or washing one's hands, on the development of community-acquired pneumonia, because causative bacteria are not believed to be transmitted from human to human. However, these measures might have indirectly contributed to a decreased number of cases through the prevention of common viral infections which could be a trigger of community-acquired pneumonia.

Preparation of liquid crystal nanocapsules by polymerization of oil-in-water emulsion monomer droplets.

Liquid crystal nanocapsules (LC-Nanocapsules) were prepared by miniemulsion polymerization of the oil-in-water emulsion monomer droplets dissolving the liquid crystal (LC) compounds. In order to establish the preparation conditions of LC-Nanocapsules exhibiting the liquid crystallinity, the effects of the capsule wall-forming monomers and the crosslinking agent concentration on the capsule structure were investigated in detail. The monodisperse colloidal products covered with the robust polymer shell wall was successfully prepared by the polymerization of the emulsion monomer droplets obtained through the phase inversion temperature emulsification technique using the amphiphilic block copolymer as an emulsifier. The endothermic peak was observed at the nematic-isotropic phase transition temperature (TNI) of the LC in the differential scanning calorimetry diagram of LC-Nanocapsules. The bright- and dark-field images of the dried thin films of LC-Nanocapsules spread on a glass substrate were found to appear repeatedly by the temperature change below and above TNI by polarized optical microscopic analysis. These results revealed that the LC-Nanocapsules with a complete engulfing morphology were successfully formed by the spontaneous coacervation phenomena between the crosslinked polymer and the LC with a progression of the polymerization, as theoretically predicted from the viewpoint of the spreading coefficients.

Prevalence and prognostic influence of bacterial pyuria in elderly patients with pneumonia: A retrospective study.

AIM: The number of elderly patients with pneumonia is significantly increasing as the populations in many countries age. Although elderly patients with pneumonia are at risk of developing urinary tract infections, no studies have examined the prevalence or the prognostic impact of this complication. The aim of the present study was to investigate the prevalence of comorbid bacterial pyuria and the impact on the prognosis of elderly patients with pneumonia. METHODS: We retrospectively evaluated 132 patients aged >65 years who were hospitalized for pneumonia and who underwent a urinary sediment test on admission. The background characteristics, laboratory results and treatment regimens were documented, and the risk factors for the complication of bacterial pyuria and its association with 90-day mortality in pneumonia patients were elucidated. RESULTS: A total of 37 (28%) of 132 patients were complicated by bacterial pyuria. The patients with bacterial pyuria were more often women, showed a poorer performance status, were more frequently fed by percutaneous endoscopic gastrostomy, and more frequently used diapers and/or a bladder catheter. Regarding first-line drugs, 82.6% of the patients received beta-lactamase inhibitors and extended-spectrum penicillins. The use of a bladder catheter and a poor performance status were associated with bacterial pyuria. A multivariate analysis showed that a poor performance status was the only factor associated with 90-day mortality. CONCLUSIONS: Bacterial pyuria did not affect the prognosis of patients who were treated with penicillin-based regimens. Thus, broad-spectrum antibiotics are not necessarily required for elderly patients with pneumonia complicated by urinary tract infection. Geriatr Gerontol Int 2017; 17: 1076-1080.

Evaluation of prognostic differences in elderly patients with pneumonia treated by between pulmonologists and non-pulmonologists: a propensity score analysis.

INTRODUCTION: The incidence of pneumonia among elderly people is increasing in aged countries, and both pulmonologists and non-pulmonologists treat such patients. OBJECTIVES: The aim of this study was to assess prognostic differences between elderly patients treated by pulmonologists and those treated by non-pulmonologists. METHODS: This study was a retrospective cohort using a propensity score analysis. Patients 65 years of age or over with pneumonia were consecutively included. The propensity score was estimated based on the patient's background and severity of pneumonia. The difference in 30-day and 90-day mortality depending on the attending physician's specialty was analyzed after adjusting for other variables, including the propensity score. RESULTS: We assessed 68 and 182 patients treated by pulmonologists and non-pulmonologists, respectively. The pulmonologists tended to be in charge of patients with hypoxemia, chronic obstructive pulmonary disease or dementia without aspiration pneumonia or renal dysfunction (area under receiver operating characteristic curve to predict treatment by a pulmonologist according to the propensity score = 0.737, P < 0.001). In the multivariate analysis, white blood count cell (adjusted hazard ratio, 1.000, P = 0.030) and the serum albumin level (0.382, P = 0.001) were associated with 30-day mortality, and a bedridden status (3.000, P = 0.013) and the serum albumin level (0.382, P < 0.001) were associated with 90-day mortality; however, the attending physician's specialty was not associated with these prognoses. CONCLUSIONS: The overall prognosis of pneumonia in elderly patients may not necessarily improve, irrespective of treatment by pulmonologists, and host factors seemed to be associated with mortality.

Bird fancier's lung complicated by pulmonary nocardiosis.

We report the case of an 84-year-old male who was admitted to the hospital with persistent cough and dyspnea. An initial chest X-ray revealed pulmonary infiltrates. Nocardia asteroides was detected in sputum, and the patient was treated with antibiotics. However, his symptoms did not completely resolve. He was admitted multiple times, and his symptoms relapsed after every discharge. He was finally suspected of having hypersensitivity pneumonitis and was diagnosed with bird fancier's lung. Pulmonary nocardiosis is likely to develop in patients with chronic pulmonary disorders, such as COPD, as well as in immunosuppressed hosts. To our knowledge, this is the first report of a case of bird fancier's lung complicated by pulmonary nocardiosis.

Pulmão dos criadores de aves complicado por nocardiose pulmonar / Bird fancier's lung complicated by pulmonary nocardiosis

Relatamos o caso de um paciente de 84 anos que foi hospitalizado devido a tosse persistente e dispneia. A radiografia de tórax inicial revelou infiltrados pulmonares. Nocardia asteroides foi detectada no escarro, e o paciente foi tratado com antibióticos; entretanto, seus sintomas não melhoraram por completo. O paciente foi hospitalizado várias vezes, e os sintomas reapareceram após cada alta. Houve a suspeita de pneumonite de hipersensibilidade, sendo o paciente diagnosticado com pulmão dos criadores de aves. É provável que a nocardiose pulmonar se desenvolva em pacientes com doenças pulmonares crônicas, como DPOC, e em hospedeiros imunossuprimidos. Até onde sabemos, este é o primeiro relato de um caso de pulmão dos criadores de aves complicado por nocardiose pulmonar.

We report the case of an 84-year-old male who was admitted to the hospital with persistent cough and dyspnea. An initial chest X-ray revealed pulmonary infiltrates. Nocardia asteroides was detected in sputum, and the patient was treated with antibiotics. However, his symptoms did not completely resolve. He was admitted multiple times, and his symptoms relapsed after every discharge. He was finally suspected of having hypersensitivity pneumonitis and was diagnosed with bird fancier's lung. Pulmonary nocardiosis is likely to develop in patients with chronic pulmonary disorders, such as COPD, as well as in immunosuppressed hosts. To our knowledge, this is the first report of a case of bird fancier's lung complicated by pulmonary nocardiosis.

Risk factors for unexpected death from suffocation in elderly patients hospitalized for pneumonia.

AIM: Unexpected death from suffocation as a result of ortholaryngeal mucinous secretions or vomitus during recovery from pneumonia is devastating for patients, their families and medical professionals. This study aimed to determine the risk factors for unexpected death from suffocation in elderly patients hospitalized for pneumonia. METHODS: This study was carried out with patients aged 65 years and older that were hospitalized for pneumonia and died of any cause. Unexpected death from suffocation was defined as: (i) being in the recovery stage of pneumonia; (ii) presenting stable vital signs a week before death; (iii) dying within 24 h after suffocation; and (iv) aspiration confirmed by transtracheal suction. The clinical features and courses, and methods of feeding were retrospectively analyzed. RESULTS: A total of 11 patients that had an unexpected death from suffocation and 62 patients who died of other causes were enrolled. There were significantly more patients that received tube feeding after admission (continuation and introduction) among the patients who had died of suffocation (63.6%) than in those who had died of other causes (12.9%; P < 0.001). A multiple logistic regression analysis showed that tube feeding after admission was strongly associated with unexpected death from suffocation (adjusted odds ratio 9.536, P = 0.047) after adjusting for sex, age, level of serum albumin, PaO2 /FIO2 ratio, the pneumonia severity score and performance status. CONCLUSION: A continuation of tube feeding after admission is thus considered to be a significant predictor of unexpected death from suffocation in elderly patients with pneumonia.

Computed tomography findings of aspiration pneumonia in 53 patients.

AIM: No large case series has so far shown the chest computed tomography (CT) features in patients with aspiration pneumonia, despite the fact that aspiration pneumonia is the most common pulmonary disease in the elderly and is regarded as gravity-dependent pneumonia. The aim of the present study was to elucidate the CT features based on the patients' status in patients with dysphagia-associated aspiration pneumonia. METHODS: A total of 53 patients, who were hospitalized because of pneumonia and subsequently confirmed to have dysphagia by videofluorography, were entered into this study. The CT findings were independently evaluated by two radiologists who were unaware of the patients' clinical information. The relationships between the patients' status and the CT patterns of pneumonia or their distributions were analyzed. RESULTS: There were eight patients (15%) with lobar pneumonia, 36 patients (68%) with bronchopneumonia and nine patients (17%) with bronchiolitis. Posterior lung predominance was seen in 49 patients (92%). In the craniocaudal observation, lower lung predominance was found in 25 patients (47%) and diffuse distribution was seen in 28 patients (53%). A decreased performance status was significantly associated with a diffuse distribution (P=0.039). CONCLUSIONS: Aspiration pneumonia more frequently presented as a bronchopneumonia pattern followed by a bronchiolitis pattern on CT. Their distributions were characterized by gravity dependence, and anterior- or upper lung-limited pneumonia might not be due to dysphagia-associated pneumonia.

Physicians' attitudes toward the definition of "death from age-related physical debility" in deceased elderly with aspiration pneumonia.

AIM: Deaths from aspiration pneumonia in elderly patients are occasionally considered to be "death from age-related physical debility", because most aspiration pneumonias are a result of aging and lead to death without any definitive therapy. The aim of the present study was to assess physicians' attitudes toward the diagnosis of and actual description of "death from age-related physical debility" on death certificates for deceased patients with aspiration pneumonia. METHODS: This study surveyed 62 Japanese physicians including 36 pulmonologists and 26 other physicians who treat patients with pneumonia. Their attitudes regarding consideration and actually recorded "death from age-related physical debility" for deceased patients with aspiration pneumonia were assessed by using anonymous questionnaires, which included the decision-making process and the necessity of detailed diagnostic criteria. RESULTS: A total of 32 (52%) respondents had considered deceased patients with aspiration pneumonia to be "death from age-related physical debility", and 10 (16%) have actually stated this on the death certificate. Advanced age, bedridden status, inability of oral intake and disturbance of consciousness including dementia were major factors in their decision-making. A total of 34 (55%) of the respondent physicians wanted detailed criteria to be established. CONCLUSIONS: Physicians' attitudes toward the definition of "death from age-related physical debility" vary a great deal depending on the respondent. The description in death certificates therefore might inaccurately reflect the results of current mortality statistics in Japan.

Sai-rei-to-induced lung injury: a case report and brief review of the literature.

An 81-year-old man was admitted to our hospital due to persistent fever and dyspnea with pulmonary infiltrates. He was treated successfully by discontinuing his current medications, including Sai-rei-to, and administering glucocorticoids. Drug lymphocyte stimulation tests showed a positive result for Sai-rei-to alone, and the resumption of other regular drugs did not re-induce the lung injury. Therefore, we diagnosed the patient with Sai-rei-to-induced lung injury. Sai-rei-to is a combination drug that consists of Sho-saiko-to and Gorei-san. This paper briefly reviews drug-induced lung injury caused by Sai-rei-to or its components with a case report.

Glutathione depletion as a mechanism of 3,4-dideoxyglucosone-3-ene-induced cytotoxicity in human peritoneal mesothelial cells: role in biocompatibility of peritoneal dialysis fluids.

BACKGROUND: The potential detrimental effects of glucose degradation products (GDPs) contained in peritoneal dialysis fluids (PDFs) on peritoneal mesothelial cells (PMCs) may impair intraperitoneal homeostasis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). A recent study showed that 3,4-dideoxyglucosone-3-ene (3,4-DGE) was the most strongly cytotoxic among all identified GDPs in PDFs. The present study examined the effects of clinically relevant concentrations of 3,4-DGE on the proliferative capacity of PMCs and oxidative injury to them. METHOD: The concentrations of eight GDPs in commercially available PDFs were determined by HPLC. The effect of cell growth media spiked with GDPs on the proliferation capacity of PMCs was evaluated. As a marker of the cellular redox status, total cellular glutathione (tGSH) was determined in PMCs incubated with GDPs. The reaction of 3,4-DGE with GSH under nonenzymatic conditions was analysed by liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS). RESULT: The concentrations of 3,4-DGE in a heat-sterilized single-compartment standard-type PDF (S-PDF) and in a heat-sterilized dual-chamber-type PDF (N-PDF) were 16 microM and 1.7 microM, respectively. The most cytotoxic GDP was 3,4-DGE, and the concentration at which it causes 50% inhibition of cell growth was 35 microM. A significant decrease in the cellular tGSH levels was observed in the cells treated with 10 microM 3,4-DGE. 3,4-DGE disappeared on incubation with GSH under nonenzymatic conditions for 1 h, and the 3,4-DGE-GSH conjugate was confirmed by accurate mass measurement using LC-ESI-MS. These data demonstrated that the change in the cellular redox status by GSH depletion might be a contributory factor in 3,4-DGE-induced cytotoxicity. CONCLUSION: 3,4-DGE is a highly reactive GDP and is responsible for the depletion of the total intracellular glutathione. 3,4-DGE has an intense impact on PMC growth at concentrations found in standard PDFs. It is desired that the amount of 3,4-DGE in PDFs should be minimized.

Impact of 3,4-dideoxyglucosone-3-ene (3,4-DGE) on cytotoxicity of acidic heat-sterilized peritoneal dialysis fluid.

Of the glucose degradation products (GDPs) in glucose-rich peritoneal dialysate, we investigated the influence of 3,4-dideoxyglucosone-3-ene (3,4-DGE) on the cytotoxicity of acidic heat-sterilized peritoneal dialysis fluid (L-H PDF) using human peritoneal mesothelial cells (HPMC). We prepared acidified filtration-sterilized PDF (glucose concentration 3.86%) containing eight types of added GDP [3,4-DGE, glyoxal (GO), methylglyoxal (MGO), 3-deoxyglucosone (3-DG), formaldehyde (FA), acetaldehyde (AA), 5-hydroxymethyl-2-furaldehyde (5-HMF), and furfural (FF)] or seven types of GDP (GO, MGO, 3-DG, FA, AA, 5-HMF, and FF). HPMC were exposed to these two types of solution and acidic heat-sterilized PDF (glucose concentration 3.86%, L-H 3.86) for 4 h. Cell viability was determined by 3,(4,5-dimethythiazol-2-yl)2,5-diphenyl-terazolium bromide (MTT) assay. MTT viability was decreased significantly compared with the control when treated with L-H 3.86 or acidified neutral filtration-sterilized PDF (glucose concentration 3.86%) containing eight GDPs. However, no significant decrease in MTT viability was observed when HPMC were treated with acidified neutral filtration-sterilized PDF (glucose concentration 3.86%) containing seven GDPs. Thus, 3,4-DGE strongly affects the cytotoxicity of L-H PDF. It is suggested that the cytotoxicity of L-H PDF is based on the presence of 3,4-DGE.

The effect of peritoneal rest in combination therapy of peritoneal dialysis and hemodialysis: using the cultured human peritoneal mesothelial cell model.

The effects of peritoneal rest for 24 h during peritoneal dialysis and hemodialysis combination therapy were investigated using cultured human peritoneal mesothelial cell (HPMC) models. Cell activity was investigated by 3-[4,5-dimethylthiazol-2-yl]-2, 5-diphenylterazolium bromide (MTT) assay after exposing HPMCs to peritoneal dialysis fluids (PDFs) with different pH levels. The following PDFs (50 microl/well) were used for exposure durations of 30 or 240 min: acidic heat-sterilized PDFs (L-H PDF, pH 5.5) and neutral heat-sterilized PDFs (N-H PDF, pH 6.7). Control wells were exposed to M-199 Hanks medium containing 20% fetal bovine serum (FBS) for 30 or 240 min. Supernatants were then aspirated from each well and M-199 culture medium containing 20% FBS (50 microl) was added to each well to rest HPMCs for 24 h before investigation of MTT activity. The activity of HPMCs exposed to L-H PDF for 240 min decreased to approximately 20% and 15% when compared with controls (glucose concentrations of 1.36% and 3.86%, respectively; P < 0.01 versus control, Tukey-Kramer test), and to approximately 60% and 40% after exposure to N-H PDF for 240 min (glucose: 1.36% and 3.86%; P < 0.01). The activity of HPMCs exposed to L-H PDF for 240 min followed by rest was approximately 20% and 4% when compared with controls (glucose: 1.36% and 3.86%; P < 0.01) and was 93% and 96% when compared with controls after exposure to N-H PDF for 240 min followed by rest (glucose: 1.36% and 3.86%). These findings suggest that rest for 24 h after exposure to N-H PDF improves the activity of HPMCs.

Synergistic cytotoxicity of acidity and 3,4-Dideoxyglucosone-3-ene under the existence of lactate in peritoneal dialysis fluid.

Of the non-physiological compounds in glucose-rich peritoneal dialysis fluid, we investigated the synergistic cytotoxicity of acidity and 3,4-Dideoxyglucosone-3-ene(3,4-DGE) under the existence of lactate using human peritoneal mesothelial cells (HPMC). The effect of pH on cell viability at various levels of pH (5.5, 6.7, 7.15), with or without lactate was examined by adding 1N-HCl to phosphate buffer solution. We also examined the cytotoxic effects of 3,4-DGE and pH (5.5, 6.7 or 7.15). Additionally, we compared the cytotoxic effects of 3,4-DGE and pH (5.5, 6.7 or 7.15) under existence of lactate (40 meq/L) or absence of lactate. The cells were exposed to these solutions for 2 or 4 h. Cell viability was determined by MTT (3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenylterazolium bromide) assay. 3,4-DGE or acidic solution alone had no significant effects on MTT viability under the absence of lactate. However, acidic solutions containing 3,4-DGE significantly decreased MTT viability under the existence of lactate. The MTT viability of HPMC was not decreased by 3,4-DGE or acidity alone under the absence of lactate. However, the combination of acidity and 3,4-DGE markedly decreased MTT viability under the existence of lactate, strongly suggesting the synergistic cytotoxicity of 3,4-DGE and acidity under the existence of lactate.

Synergistic cytotoxicity of acidity and glucose degradation products in peritoneal dialysis fluid.

Of the nonphysiological compounds in glucose-rich peritoneal dialysate, we investigated the cytotoxicity and synergistic cytotoxicity of acidity and glucose degradation products (GDPs) using human peritoneal mesothelial cells (HPMC). The effect of pH on cell viability was examined by adding 1N HCl to a phosphate-buffered solution (pH > or = 5.5). We also examined the cytotoxic effects of various GDPs [glyoxal (GO), methylglyoxal (MGO), and 3-deoxyglucosone (3DG), alone or in combination] and pH (5.5 or 6.7). The cells were exposed to these solutions for 2 or 4 h. Cell viability was determined by 3,(4,5-dimethylthiazol-2-yl)2,5-diphenyl-tetrazolium bromide (MTT) assay. Although the MTT viability of HPMC was not decreased by GDP or acidity alone, the combination of acidity and GDP markedly decreased MTT viability, strongly suggesting the synergistic cytotoxicity of GDP and acidity.