[Death in geriatric pneumonia patients]

AIM

Pneumonia-associated deaths are the 4th leading cause of death in elderly people, and fatality tends to increase with age, especially after the age of 65. We aimed to further define convalescence in this patient population by examining the clinical characteristics of elderly pneumonia patients.

METHODS

We retrospectively examined the data of 292 patients aged 65 years or older who had died of pneumonia. Analysis was performed according to the guidelines for the management of pneumonia of the Japanese Respiratory Society (JRSGMP), which retrospectively classifies pneumonia into a community-acquired type (c type) and hospital-acquired type (h type). In the present study, there were 110 cases of c type and 182 cases of h type.

RESULTS

Among the factors that accurately predicted disease severity in the c type group, age was associated with the highest frequency (104; 94.5%). Furthermore, age was most frequently associated with a convalescence prediction factor in the h type group (150; 82.4%). The remaining factors collectively comprised approximately 50%. Except in mild cases in the c type group, deaths occurred in each of the disease severity groups for both pneumonia types. Dysphagia occurred in many cases in both groups, and in both pneumonia types the most common complication was dementia. In the h type group, cerebrovascular diseases were the second most common complication.

CONCLUSION

When assessing disease severity in elderly pneumonia patients, the JRSGMP may not allow accurate judgment of convalescence. It is very likely that dementia and cerebrovascular diseases cause dysphagia. Furthermore, very elderly patients are frequently at risk of developing aspiration pneumonia during treatment. For these reasons, it may be necessary to add the condition of a patient with these complications to the disease severity rating or convalescence prediction factor when considering the outcome of pneumonia in very elderly patients. It is necessary to consider all these factors when treating such episodes.

[Laser therapy for endobronchial malignancies]

Photodynamic therapy (PDT), neodymium yttrium aluminum garnet (Nd-YAG) laser therapy, electrocautery and microwave coagulation therapy are therapeutic options available for management of endobronchial malignancies. All of these treatment modalities have been used for both palliation of late obstructing cancers, and more recently have been used as primary treatment of early stage lung cancers. Only PDT has the curative potential for patients with early superficial squamous cell carcinoma. Nd-YAG laser therapy is used for direct thermal ablation of tissue in endobronchial malignancy. This equipment is the most widely used type of laser for bronchoscopic interventions because it has sufficient power to vaporize tissues and produces an excellent coagulation effect. But the risks of perforation and bleeding are high. Endobronchial electrocautery is the use of high-frequency electrical current that generates heat due to tissue resistance, resulting in destruction of tissue. Argon plasma coagulation (APC) is a form of noncontact electrocoagulation. The risks of perforation and igniting are much lower than with the Nd-YAG laser therapy. Microwave coagulation therapy refers to the use of all electromagnetic methods for inducing tumor destruction by using devices with frequencies of 2450 MHz. It is important to select these treatment methods appropriately according to each case.

Impact of number of resected and involved lymph nodes (LN) at the time of surgical resection on the survival of non-small cell lung cancer (NSCLC)

7514

Background: Total number of lymph-nodes has recently proven prognostic in early breast and colorectal cancer. In this study we retrospectively evaluated the prognostic impact of the number of resected and involved lymph-nodes on the survival of stage I-III NSCLC. Methods: A series of 928 consecutive NSCLC pts who underwent complete lobectomy, bilobectomy or pneumonectomy with lymph-nodes dissection from 1/2000 to 11/2007 at Tokyo Medical University was eligible. Log rank and Cox proportional hazard model was used to estimate survival rates and relative risks. Results: Demographics are as follows: median age: 65.0 (22–87yrs), sex: 547 males and 381 females, median follow-up time: 2.5 yrs, clinical stage: 765 stage I, 84 stage II and 76 stage III, histology: 684 adenocarcinoma, 182 squamous cell carcinoma, and 62 others, operation: 870 lobectomy, 42 bilobectomy and 16 pneumonectomy, mean number of resected LN: 15 (1–49), mean number of involved LN: 0.9 (0–22). We observed a statistically significant increasing trend in overall survival (OS) between 0–3 and 4 and more of number of involved LN (P<0.001). Although a significant increasing in OS of 0–9 of number of resected LN cases compared with 10 and more was observed in all stages (P=0.024), no significant differentiation was observed in clinical stage I cases. Conclusions: This data suggests that there is a significant decrease in OS with 10 and more number of resected LN examined at surgery in NSCLC pts. However, there is no significant different in stage I pts, which implies that selected LN sampling is enough in clinical stage I cases. Further study such as LN dissection vs LN sampling in clinical stage I will be needed.

No significant financial relationships to disclose.

Xenopus W-linked DM-W induces Foxl2 and Cyp19 expression during ovary formation

The molecular mechanisms of vertebrate ZZ/ZW-type sex-determining systems remain unclear. We recently indicated that a W-linked gene, DM-W is a likely ovary-determining gene in Xenopus laevis. We first examined whether Cyp19 for estrogen-synthesizing enzyme P450 aromatase and Foxl2 showed female-specific expression in developing gonads. Both genes showed much higher expression in ZW than in ZZ gonads during and after sex determination. Importantly, transgenic ZZ gonads expressing exogenous DM-W at the sex-determining stage showed a ZW-type pattern of Cyp19 and Foxl2 expression. These results suggest that DM-W up-regulates Cyp19 and Foxl2 expression to guide primary ovary development in X. laevis.

Electronic ferroelectricity from charge ordering in RFe(2)O(4)

We report our recent discovery of novel ferroelectricity arising from the polar ordering of Fe(3)+ and Fe(2)+ in a mixed valence triangular lattice oxide LuFe(2)O(4), where the electric polarization is not a result of ionic displacement. The polar ordering of Fe(3)+ and Fe(2)+ was confirmed with a resonant x-ray scattering study in SPring-8. The origin of such ordering is the competitive interaction between Fe(3)+ and Fe(2)+ in the triangular lattice, i.e., the charge frustration. The polar superlattice of Fe(3)+ and Fe(2)+ develops below 350 K, where the electric polarization appears. The ferroelectricity arising from the polar charge ordering or the polar electron distribution may have great potential for the future application of ferroelectrics.

[Safety management of bronchoscopic examination and treatment]

Safety management of bronchoscopic examination and treatment is devided into 3 phases. Patient information should be provided before the procedure. Also written informed conscent should be obtained after the information of advantage and disadvantage of examination/treatment. Bronchoscopists and well-trained nurses should manage both the procedure itself and patient condition. Through check up of patient is necessary to avoid late complications after the procedure. Due to the increase in the number of interventional bronchoscopies, the management of patients is getting more important. Safety management should be developed by wide-range of medical team including bronchoscopists, nurses and technical staff.

Isolated limb sensory disturbance accompanied with sudden deafness from vertebral artery dissection: a case report

A 52-year-old male presented with right sudden deafness and left isolated limb sensory disturbance following posterior neck pain. An examination revealed a mild degree of right sensory neural hearing loss and decreased pain and thermal sensation in the left side below the L3 level. Brain MRI showed a small lesion in the midlateral portion of the right middle-rostral medulla. The combination of the image findings suggests a right lateral medullary infarction caused by a vertebral artery (VA) dissection. In our case, the fibers carrying the modalities of the lateral spinothalamic tract restricted to below the L3 level, sparing other sensations, suggest a selective involvement. This finding suggests that sensory dermatomal representation in the modality may be preserved at least up to the level of the medulla oblongata. Moreover, in our case, the small emboli originating from the dissected VA possibly caused a small selective cochlear infarction. This type of embolism may give rise to various combinations of symptoms depending on the branches involved. For patients with an acute onset of headache or neck pain who present with isolated limb sensory disturbance accompanied by sudden deafness, even without the classical brainstem signs, a VA dissection and medullary infarction should therefore be considered.

Adsorption and micelle formation of alkylammonium chloride–alkyltrimethylammonium chloride mixtures

The surface tension of the aqueous solutions of binary cationic surfactant mixtures of (1) dodecylammnonium chloride (DAC)-tetradecyltrimethylammonium chloride (TTAC), (2) decylammonium chloride (DeAC)-dodecyltrimethylammonium chloride (DTAC), and (3) DAC-DTAC was measured as a function of the total molality and composition of surfactants at 298.15 K. The compositions of surfactants in the adsorbed film and micelle were evaluated and the phase diagram of adsorption and that of micelle formation were constructed. Furthermore the excess Gibbs energies of adsorption and micelle formation were calculated to estimate the deviation from the corresponding ideal mixing. It was found that the surface and micelle are enriched in trimethylammonium salts in (1) and (2), while in ammonium salt in (3) compared to the bulk solution. On the other hand, the micelle is enriched in trimethylammonium salts compared to the surface at the critical micelle concentration (CMC) in all the systems. The miscibility of the surfactants was clarified from the standpoints of the structure of the head group and of the matching between the size of polar head group of surfactants and the difference in hydrocarbon chain length.

[Clinical usage of parallel imaging of head three-dimensional MR image for analysis of VSRAD: a comparison of imaging statistical analytic results in SENSE acquisition method shortening acquisition time versus conventional acquisition method]

Voxel-based Specific Regional Analysis System for Alzheimer's Disease (VSRAD) has developed recently as an adjunctive diagnostic tool for early Alzheimer-type dementia (ATD), using three-dimensional (3D) MRI with statistical parametric mapping (SPM), and for the objective evaluation of brain atrophy. However, it takes more than five minutes to acquire MRI data by the 3D gradient echo method (3D FFE), resulting in low-throughput performance and motion artifact. These problems interrupt the application of daily MRI study. In this study, we recruited 20 patients suspected of having ATD who then underwent continuous 3D FFE MRI studies with and without the SENSE method. It was found that the VSRAD results of MRI data with SENSE were nearly to equal to those without SENSE, in spite of the prediction of a decline in source-to-noise ratio due to the reduction factor in the SENSE method.