Correlation between α-SMA and ß-catenin levels in bronchoalveolar lavage fluid and severity of pneumonia

Objectives: To assess the association of bronchoalveolar lavage fluid (BALF) α-SMA and ß-catenin levels and the severity of pneumonia. Methods: The records of patients with severe pneumonia treated in our hospital from June 2019 to June 2020 were selected. The clinical outcome was observed within 10 days. For the purpose of analysis, patients were divided into two groups according to the outcome, 47 cases in the improvement group and 39 cases in the deterioration group. The intubation time, mechanical ventilation time and APACHE II score 10 days after admission were compared between the two groups; We assessed pulmonary infections using the clinical pulmonary infection score(CPIS). The levels of α-SMA and ß-catenin in bronchoalveolar lavage fluid at different time points were compared and analyzed, to analyze the association between the levels and the CPIS. Results: The APACHE II score in the improvement group were lower than those in the deterioration group (P<0.05). The expressions of α-SMA and ß-catenin in the BALF of patients in the improvement group were significantly lower than those of patients in the deterioration group on day 1, 3, and 7 (P<0.05); and the expressions of α-SMA and ß-catenin in the BALF of patients in the improvement group decreased with time, while those of patients in the deterioration group increased gradually with time(P<0.05). The expressions of α-SMA and ß-catenin in patients with CPIS>6 was significantly higher than those in patients with CPI≤6(P<0.05). Pearson correlation analysis showed that the levels of α-SMA and ß-catenin in BALF were positively correlated with the CPIS. Conclusion: The levels of α-SMA and ß-catenin in BALF are closely associated with the clinical condition of patients with severe pneumonia; the levels are positively associated with the severity of the disease and they increase with symptomatic worsening. doi: https://doi.org/10.12669/pjms.38.3.5329 How to cite this:Li X, Jiang Z. Correlation between α-SMA and ß-catenin levels in bronchoalveolar lavage fluid and severity of pneumonia. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5329 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Diagnosis of Early Neurological Deterioration after Intravenous Thrombolysis for Patients with Cerebral Ischemic Stroke Using Compressed Sensing-Magnetic Resonance Imaging Algorithm

This study was to explore the risk factors and prognosis of early neurological deterioration (END) after intravenous thrombolysis in patients with cerebral ischemic stroke (CIS) with the guidance of magnetic resonance imaging (MRI) under the compressed sensing-MRI (CSMRI) algorithm. 187 patients with CIS in the hospital were selected and grouped into a deterioration group and a control group according to whether they had END. The CSMRI algorithm was constructed and compared with digital television (DTV) algorithm and Bayesian compressed sensing (BCS) algorithm. It was found that the reconstruction time of CSMRI algorithm in platform I (1134.9 s) and platform II (2615.8 s) was visibly lower than that of DTV algorithm (2634.6 s, 3963.4 s) and BCS algorithm (5631.5 s, 7412.3 s), showing statistically obvious differences ( P < 0.05 ). In addition, the reconstruction efficiency of the CSMRI algorithm was the best. After 4 hours of intravenous thrombolysis, the stroke scale score (12.3 scores) of the deterioration group was much higher than that of the control group (8.4 scores) ( P < 0.05 ). The occlusion of responsible great vessel in the deterioration group (30 cases, 83.33%) was obviously higher in contrast to that in the control group (74 cases, 49%) ( P < 0.05 ). Stroke scale score and occlusion of responsible great vessel were risk factors for EBD after intravenous thrombolysis.

Alternate In-Brace and Out-of-Brace Radiographs Are Recommended to Assess Brace Fitting and Curve Progression With Adolescent Idiopathic Scoliosis Follow-Up

Study Design: Retrospective cohort study. Objective: To determine the prevalence of missed curve progression in patients with adolescent idiopathic scoliosis (AIS) undergoing brace treatment with only in-brace follow-up radiographs, and to provide recommendations on when in-brace and out-of-brace should be obtained during follow-up. Methods: 133 patients who had documented clinically significant curve progression during brace treatment or only when an out-of-brace radiograph were studied. Of these, 95 patients (71.4%) had curve progression noted on in-brace radiographs while 38 patients (28.6%) showed curve progression only after brace removal. We analyzed differences in age, sex, curve types, Risser stage, months after menarche, standing out-of-brace Cobb angle, correction rate, and flexibility rate between the groups. Multivariate logistic regression was performed to determine factors contributing to curve progression missed during brace treatment. Results: There were no differences in initial Cobb angle between out-of-brace and in-brace deterioration groups. However, the correction rate was higher (32.7% vs 25.0%; P = .004) in the in-brace deterioration group as compared to the out-of-brace deterioration group. A lower correction rate was more likely to result in out-of-brace deterioration (OR 0.970; P = .019). For thoracic curves, higher flexibility in the curves was more likely to result in out-of-brace deterioration (OR 1.055; P = .045). For double/triple curves, patients with in-brace deterioration had higher correction rate (OR 0.944; P = .034). Conclusions: Patients may develop curve progression despite good correction on in-brace radiographs. Those with higher flexibility and suboptimal brace fitting are at-risk. In-brace and out-of-brace radiographs should be taken alternately for brace treatment follow-up.

The association between hospital length of stay before rapid response system activation and clinical outcomes: a retrospective multicenter cohort study

Background Rapid response system (RRS) is being increasingly adopted to improve patient safety in hospitals worldwide. However, predictors of survival outcome after RRS activation because of unexpected clinical deterioration are not well defined. We investigated whether hospital length of stay (LOS) before RRS activation can predict the clinical outcomes. Methods Using a nationwide multicenter RRS database, we identified patients for whom RRS was activated during hospitalization at 9 tertiary referral hospitals in South Korea between January 1, 2016, and December 31, 2017. All information on patient characteristics, RRS activation, and clinical outcomes were retrospectively collected by reviewing patient medical records at each center. Patients were categorized into two groups according to their hospital LOS before RRS activation: early deterioration (LOS < 5 days) and late deterioration (LOS ≥ 5 days). The primary outcome was 28-day mortality and multivariable logistic regression was used to compare the two groups. In addition, propensity score-matched analysis was used to minimize the effects of confounding factors. Results Among 11,612 patients, 5779 and 5883 patients belonged to the early and late deterioration groups, respectively. Patients in the late deterioration group were more likely to have malignant disease and to be more severely ill at the time of RRS activation. After adjusting for confounding factors, the late deterioration group had higher 28-day mortality (aOR 1.60, 95% CI 1.44–1.77). Other clinical outcomes (in-hospital mortality and hospital LOS after RRS activation) were worse in the late deterioration group as well, and similar results were found in the propensity score-matched analysis (aOR for 28-day mortality 1.66, 95% CI 1.45–1.91). Conclusions Patients who stayed longer in the hospital before RRS activation had worse clinical outcomes. During the RRS team review of patients, hospital LOS before RRS activation should be considered as a predictor of future outcome.

Longer Hospital Length of Stay After Admission Before Rapid Response System Activation is Associated with Worse Clinical Outcome: A Retrospective Multicenter Cohort Study

Background: Rapid response system (RRS) has been increasingly adopted to improve patient safety in hospitals worldwide. However, predictors of survival outcome after RRS activation because of unexpected clinical deterioration are not well defined. We investigated whether hospital length of stay (LOS) before RRS activation can predict the clinical outcomes.Methods: Using a nationwide multicenter RRS database, we identified patients for whom RRS was activated during hospitalization at 9 tertiary referral hospitals in South Korea between January 1, 2016, and December 31, 2017. All information on patient characteristics, RRS activation, and clinical outcomes were retrospectively collected by reviewing patient medical records at each center. Patients were categorized into two groups according to their hospital LOS before RRS activation: early deterioration (LOS <5 days) and late deterioration (LOS ≥5 days). The primary outcome was 28-day mortality and multivariable logistic regression was used to compare the two groups. In addition, propensity score-matched analysis was used to minimize the effects of confounding factors.Results: Among 11,612 patients, 5,779 and 5,883 patients belonged to the early and late deterioration groups, respectively. Patients in the late deterioration group were more likely to have malignant disease and to be more severely ill at the time of RRS activation. After adjusting for confounding factors, the late deterioration group had higher 28-day mortality (aOR 1.60, 95% CI 1.44–1.77). Other clinical outcomes (in-hospital mortality and hospital LOS after RRS activation) were worse in the late deterioration group as well, and similar results were found in the propensity score-matched analysis (aOR for 28-day mortality 1.66, 95% CI 1.45–1.91).Conclusions: Patients who stayed longer in the hospital before RRS activation had worse clinical outcomes. During the RRS team review of patients, hospital LOS before RRS activation should be considered as a predictor of future outcome.

Abstract 3306: Effect Of General Obesity On Neurological Deterioration After Acute Stroke

Objective: The increasing prevalence of obesity in Asia has led to concern that obesity negatively affects outcomes after acute cardiovascular events and stroke. Here, we examined the relationship between body mass index (BMI), as a general indicator of obesity, and neurological deterioration after acute stroke. Patients and Methods: Consecutive acute stroke patients (n=2310: 489 hemorrhagic stroke, 1702 ischemic stroke, 119 TIA; median age 73.0; 1392 male) participated in this study. All patients were admitted within 7 days of stroke onset to a regional brain attack center in Japan between January 2005 and December 2010, and provided written informed consent. Patient attributes (age; sex; current smoking and/or drinking status; past history of stroke, hypertension, diabetes mellitus, and hypercholesterolemia; and body weight and height) were recorded upon admission; BMI was calculated using the height and weight measurements. Patients whose NIHSS score increased by 4 or more from admission to discharge or who died during hospitalization were classified into the neurological deterioration group; all other patients were classified into the non-deterioration group. Logistic regression analysis was performed using the deterioration and non-deterioration groups as dependent variables, and factors related to deterioration were examined using SPSS version 15.0. Results: The deterioration group comprised 221 patients, and had a higher proportion of patients with hypertension and/or diabetes mellitus and age over 75 years, but these patients had significantly lower BMI values than the 2089 patients in the non-deterioration group (22.4 ± 4.2 kg/m 2 vs. 23.2 ± 3.5, p=0.002). No intergroup differences were observed for history of stroke, smoking and/or drinking status, or hypercholesterolemia. Logistic regression analysis of the patient attributes listed above indicated that age and history of hypertension (odds ratio=1.77 and 1.75, 95% CI: 1.24-2.52 and 1.07-2.85, respectively) were positively correlated with neurological deterioration; in contrast, a larger BMI was negatively correlated with neurological deterioration (odds ratio by 1 kg/m 2 increase in BMI=0.948, 95% CI: 0.899-0.999, p=0.04). Conclusion: Lower BMI at admission was positively correlated with neurological deterioration after acute stroke after adjusting for other cerebrovascular risk factors.

Relationships Among the Symptoms of the Elderly as Revealed by Multivariate Analysis: A Preliminary Study

One hundred and sixty-eight elderly subjects in a geriatric hospital and the adjoining nursing home were examined in a study of relationships among the items of Hasegawa's dementia scale. A three-dimensional model using multivariate analysis demonstrated the relationships among items. The results led to the identification of six clinical groups determined by the presence of stroke and the score on the dementia scale. Nonstroke subjects of middle intellectual level had disturbances of memory and orientation. This group fell into two categories during the course of a five-year follow-up study: severe dementia and intellectual deterioration. Retrospective multivariate analysis results suggested that features characteristic of the severe intellectual deterioration group were earlier disturbances of orientation and distant memory. This statistical method used only objective clinical data in order to avoid subjective and, often, baised judgements.