Non-acute Group Research Articles

Circulating levels of adiponectin and AdipoR expression in peripheral blood mononuclear cells are associated with lower respiratory tract Infection.

The role of adiponectin (APN) in regulating inflammation is well recognized in metabolic disease, but the dysregulation of APN in lower respiratory tract infection (LRTI) remains controversial. We aimed to measure APN and its signaling receptors, adiponectin receptor (AdipoR), in peripheral blood mononuclear cells (PBMCs) from LRTI patients to explore their potential roles in the LRTI process. A total of 99 LRTI patients from the Second Xiangya Hospital of Central South University were categorized into acute (n=35) and non-acute (n=64), and non-severe (n=62) and severe (n=37) groups. Serum APN was quantified using ELISA, and mRNA levels of PBMC AdipoRs were determined by RT-qPCR. Both levels of APN in circulation and AdipoR1 mRNA were significantly elevated in the LRTI patients (P=2.61E-04; P=2.49E-08), while no statistical difference was observed for AdipoR2. APN levels were increased in the non-acute group compared to the acute group (P=6.06E-04) and AdipoR1 levels were higher in the severe group (P=0.004). Increased APN and AdipoR1 mRNA levels were positively associated with LRTI even after adjustment for sex, age, BMI and blood lipids (OR=1.10; 95% CI 1.04-1.18; P=9.61E-04; OR=2.69; 95% CI 1.29-5.58; P=0.008). Subgroup analyses based on sex, age, and BMI revealed APN elevation in males, ≥65-year-olds, and overweight individuals, with higher AdipoR2 mRNA in females and those under 65; AdipoR1 was uniformly elevated. Additionally, APN was negatively correlated with lymphocyte count in acute and severe subgroup; AdipoR1 was positively correlated with indicators of inflammation in LRTI group. Our study highlights that serum APN and AdipoR1 mRNA in PBMCs are associated with LRTI. Circulating APN and PBMC AdipoR1 have different significances in LRTI acute onset and severity.

Lung isolation—a personalized and clinically adapted approach to control bronchoscopy-associated acute massive airway hemorrhage

BackgroundThe current concept of bronchoscopy-associated massive airway hemorrhage is not accurate enough, and the amount of bleeding as the only evaluation criterion cannot comprehensively evaluate magnitude of the effects and the severity.ObjectiveTo propose the concept of bronchoscopy-associated acute massive airway hemorrhage, analyze its impact on patients and highlight the treatment approach of acute massive airway hemorrhage without ECMO support.DesignsA retrospective cohort study.SettingInclude all patients who received bronchoscopy intervention therapy at Interventional Pulmonology Center of Emergency General Hospital from 2004 to December 2021.Patients223 patients met the inclusion criteria.InterventionPatients were divided into two groups: acute massive airway hemorrhage group (n = 29) and non-acute massive airway hemorrhage group (n = 194).Main outcome measuresPerioperative adverse events between two groups were the main outcome. Secondary outcome was the impact of lung isolation on patient in group Acute.ResultsThe incidence of acute massive airway hemorrhage was 0.11%, and the incidence of non-acute massive airway hemorrhage was 0.76% in this study. There were significant differences in the incidence of intraoperative hypoxemia, lowest SpO2, hemorrhagic shock, cardiopulmonary resuscitation, intraoperative mortality, and transfer to ICU between acute group and non-acute group (P<0.05, respectively). Lung isolation was used in 12 patients with acute massive airway hemorrhage, and only 2 patients died during the operation.ConclusionBronchoscopy-associated acute massive airway hemorrhage had more serious impact on patients due to rapid bleeding, blurred vision of bronchoscopy, inability to stop bleeding quickly, blood filling alveoli, and serious impact on oxygenation of the lung lobes. Polyvinyl chloride single-lumen endotracheal intubation for lung isolation, with its characteristics of low difficulty, wide applicability and available in most hospitals, may reduce the intraoperative mortality of patients with bronchoscopy-associated acute massive airway hemorrhage.Trial registrationChinese Clinical Trial Registry on 13/03/2022. Registration number: ChiCTR2200057470.

Decreased Synovial Fluid Ghrelin Level Is Associated With Acute Cartilage Injury in Patients With Anterior Cruciate Ligament Tear.

Ghrelin, an amino acid hormone secreted primarily from the stomach, can regulate bone metabolism, regulate inflammation via suppressing proinflammatory cytokines, and suppress expression of matrix metalloproteinases (MMPs). To measure synovial fluid levels of ghrelin in young patients with anterior cruciate ligament (ACL) tear to assess the role of ghrelin as a potential biomarker for cartilage injury. Controlled laboratory study. This study included 120 patients who underwent ACL reconstructionbetween January 1, 2016, and May 31, 2021. We categorized 60 patients with acute cartilage injury (International Cartilage Regeneration & Joint Preservation Society grade 2 or 3) as the acute group and 60 patients with no acute cartilage injury as the nonacute group, with the healthy contralateral knee of each patient acting as the control group (n = 120). Synovial fluid samples were collected from the knees in the operating room before ACL reconstruction. We assessed the inflammatory biomarkers interleukin (IL)-6, MMP-1, MMP-9, and MMP-13, as well as serum ghrelin level and Mankin score, and results were compared between the 3 study groups with the Mann-Whitney U test. Lower serum ghrelin levels in the synovial fluid were found in the acute group compared with the nonacute group and healthy controls (232.4 vs 434.4 vs 421.5 pg/mL, respectively; P < .001). Ghrelin level in the synovial fluid was significantly and positively correlated with IL-6 (r = 0.4223; P < .0001), MMP-13 (r = 0.3402; P < .0001), and Mankin score (r = 0.1453; P = .0244). In patients with ACL injury, ghrelin synovial fluid was significantly differently expressed in patients with cartilage injury and no cartilage injury. Ghrelin synovial fluid has the potential to be a biomarker to predict acute cartilage injury in patients with ACL injury.

Surgical timing of endoluminal repair of Stanford type B aortic coarctation and relationship to prognosis: a single-center retrospective cohort study.

Stanford type B aortic dissection (TBAD) is a rare cardiovascular emergency with rapid onset and great harm. Currently, no relevant studies have analyzed the difference in clinical benefits of endovascular repair in patients with TBAD in acute and non-acute stages. To investigate the clinical characteristics and prognosis of endovascular repair in patients with TBAD at different surgical timing. The medical records of 110 patients with TBAD from June 2014 to June 2022 were retrospectively selected as the study subjects. The patients were divided into an acute group (onset time ≤14 days) and a non-acute group (onset time >14 days) according to the time to surgery, and the two groups were compared in terms of surgery and hospitalization, aortic remodeling, and follow-up results. Univariate and multivariate logistic regression were used to analyze the factors affecting the prognosis of TBAD treated with endoluminal repair. The proportion of pleural effusion, heart rate, the rate of complete thrombosis of the false lumen and the difference in the maximum diameter of the false lumen in the acute group were higher than those in the non-acute group (P=0.015, <0.001, 0.029, <0.001). The length of hospital stay and the maximum postoperative diameter of the false lumen was lower than in the non-acute group (P=0.001, 0.004). There was no statistically significant difference between the two groups in the technical success rate, overlapping stent length, overlapping stent diameter, immediate postoperative contrast type I endoleak, incidence of renal failure, ischemic disease, endoleaks, aortic dilatation, retrograde type A aortic coarctation, and death (P=0.386, 0.551, 0.093, 0.176, 0.223, 0.739, 0.085, 0.098, 0.395, 0.386); coronary artery disease [odds ratio (OR) =6.630, P=0.012], pleural effusion (OR =5.026, P=0.009), non-acute surgery (OR =2.899, P=0.037), and involvement of the abdominal aorta (OR =11.362, P=0.001) were all independent risk factors affecting the prognosis of TBAD treated with endoluminal repair. Acute phase endoluminal repair of TBAD may contribute to aortic remodeling, and the prognosis of TBAD patients can be assessed clinically in combination with coronary artery disease, pleural effusion, and involvement of the abdominal aorta for early intervention to reduce the associated mortality.

Assessment of acute and non-acute suicide crisis symptoms: Validation of the Korean version of the acute suicidal affective disturbance inventory.

Suicide risk assessment is predominantly based on assessing current/recent suicidal ideation and past suicidal behavior. However, suicidal ideation and lifetime suicide attempt are poor predictors of imminent suicide risk or crisis. The acute suicidal affective disturbance inventory-lifetime (ASADI-L) was developed to assess symptoms of acute suicidal affective disturbance, which includes a drastic increase in suicidal intent, perceptions of social and/or self-alienation, hopelessness, and overarousal. However, the ASADI-L has not yet been validated in a Korean population. Also, the ASADI-L has only been validated for people who experience a drastic increase in suicidal intention over the course of hours or days (i.e., the acute suicidal intention group) and not validated for those who experience suicidal intention for a longer period (i.e., the non-acute suicidal intention group). Thus, the aims of this study were to (1) validate the ASADI-L in a sample of Korean community adults; and (2) compare clinical characteristics of the acute and non-acute suicidal intention groups. Among 1,675 community adults, data from 682 participants who reported a lifetime drastic increase in suicidal intent were analyzed. Results indicated that the ASADI-L has relevant reliability, validity, and a unidimensional factor structure. The acute suicidal intention group had higher ASAD symptoms as well as clinical symptoms than the non-acute group, but the two groups did not differ in history of suicide attempt. Overall, these findings suggest that the ASADI-L is a valid measure of acute and non-acute suicidal affective disturbance among Korean adults. Further investigation of the differences in acute and non-acute suicide risk is warranted.

Left Ventricular Pseudoaneurysms Discovered Early After Acute Myocardial Infarction: The Surgical Timing Dilemma.

Left ventricular pseudoaneurysm is a rare disease; it is defined as a ventricular rupture contained by epicardium, pericardial adhesions, or both. It most frequently occurs as a complication of acute myocardial infarction. Surgical treatment is recommended for pseudoaneurysms that are large or symptomatic and for those discovered less than 3 months after myocardial infarction. We report our experience with 2 patients who had left ventricular pseudoaneurysms discovered less than a week after inferior myocardial infarction. Both patients were middle-aged men with right coronary occlusion in whom the diagnoses were established by echocardiography during the first week after infarction. Because both patients were clinically stable, we opted to defer surgery until scarring could facilitate correction; this decision was based on a review of the literature showing that in-hospital mortality is higher with early surgery. The patients were monitored closely in the intensive care unit and were prescribed β-blockers and vasodilators. Both patients underwent left ventricular patch reconstruction with exclusion of the pseudoaneurysm and posterior septum; both received moderate inotropic support and prophylactic intra-aortic balloon pump assistance. Their postoperative courses were uneventful. In 5 prior reports describing 45 patients (13 with acute pseudoaneurysm [≤2 wk after infarction] and 32 with nonacute pseudoaneurysm), in-hospital mortality was 61.5% for patients in the acute group and 15.6% for the nonacute group (P = .0066). We recommend that clinicians consider deferring surgery for patients with stable acute left ventricular pseudoaneurysm to reduce the risks associated with early repair.

Factors associating with disability of non-specific low back pain in different subgroups: A hierarchical linear regression analysis

This study aimed to explore factors associating with disability, which means physical impairment affecting a person’s mobility, capacity, stamina, or agility, of non-specific low back pain (NSLBP) of the acute and non-acute groups. Two hundred thirty-five patients with NSLBP of less than 8 weeks’ duration as acute groups (n = 124) and more than 8 weeks’ duration as non-acute group (n = 111) were recruited. It was collected data on pain intensity, disability and psychosocial factors, including pain catastrophising, fear of movement and pain self-efficacy. Disability was measured Roland Morris Disability Questionnaire. A hierarchical multiple regression analysis was performed to analyse factors associating with disability of the acute and non-acute groups. The Result was that explanatory power increased with each additional variable of the order of demographic characteristics, pain intensity and psychosocial factors for both groups. Pain intensity, pain catastrophising and pain self-efficacy had significant explanatory power, with pain self-efficacy having the most significant association on the acute group. Only pain self-efficacy having the most significant association on disability of the non-acute group. In conclusion, the factors associating with disability differed depending on the duration of the disease, and pain self-efficacy might be one of the factors associating with disability of patients with NSLBP.

Accelerated Wound Healing by a Topical Wound Healing Lipogel in Patients Undergoing Catheter De-placement - Evidence from a Randomized, Controlled Clinical Study

Objective: The purpose of this clinical study was to assess a novel wound model and to compare the wound healing properties of a topical wound healing hydroactive lipogel (MediGel®) promoting moist wound environment versus standard treatment by a standard plaster und dry environmental conditions in patients undergoing catheter de-placement as a model for non-acute wounds affecting all skin layers in real life conditions (moist environment does improve granulation & epithelialization supported by Lipogel – the MEDIGEL trial). Methods: Patients (n=69) admitted to the dialysis ward of a tertiary care institution with acute or chronic renal insufficiency and in need for dialysis were enrolled into a prospective, observer-blind, randomized, controlled, inter-individual experimental comparison study. Patients enrolled were undergoing placement of Sheldon multi-lumen catheter (11 French diameter) in the external jugular vein at the neck by Seldinger technique to enable access for hemodialysis. One group of patients which had catheter displaced after one session of hemodialysis was regarded as acute wound group. A different group of patients had catheter withdrawn after 14 (+/- 2 days) and was classified as non-acute wound group. Topical treatments were randomly allocated, i.e. traditional care with standard plaster (control group) or investigational product (promoting moist environment) beneath a standard plaster (investigational product). Wound healing was assessed (digital photography, visual scoring) and analyzed via comparison of area under curve at day 0, 3 and 7 after displacement of catheter. Results: Evaluation showed significantly faster wound healing results for the investigational product in comparison to standard (all time points) and with significant AUC difference in both patient groups, acute and non-acute. Visible re-epithelialization was recorded from day 3 to day 7 in acute wounds, delayed in non-acute wounds. Standard plaster-treated wounds remained open and had markedly larger wound area. Formation of fibrous scar tissue was minimal but less prominent in patients treated with the hydroactive lipogel in the non-acute group due to faster epithelialization promoted by moist environment. Conclusion: Clinically relevant accelerated epithelialization and faster wound healing were observed for the investigational product compared to traditional treatment indicating superiority of moist wound environmental conditions both in acute and non-acute wounds after displacement of catheter placed into the jugular vein for 5 hours or 2 weeks in patients undergoing hemodialysis. The model is an innovative approach to study acute and non-acute wounds affecting all three skin layers and should be further investigated.

Methicillin-Resistant Staphylococcus Aureus Carrier Rate in Orthopaedic Trauma Patients: A Prospective Cohort Study.

To identify the methicillin-resistant Staphylococcus aureus (MRSA) carrier rate among surgical patients on an orthopaedic trauma service and to determine whether screening is an effective tool for reducing postoperative MRSA infection in this population. Prospective. Level 1 trauma center. Two hundred forty-eight patients with operatively managed orthopaedic trauma conditions during the study period. Two hundred three patients (82%) had acute orthopaedic trauma injuries. Forty-five patients (18%) underwent surgery for a nonacute orthopaedic trauma condition, including 36 elective procedures and 9 procedures to address infection. MRSA screening protocol, preoperative antibiotics per protocol. MRSA carrier rate, overall infection rate, MRSA infection rate. Our screening captured 71% (175/248) of operatively treated orthopaedic trauma patients during the study period. The overall MRSA carrier rate was 3.4% (6/175). When separated by group, the acute orthopaedic trauma cohort had an MRSA carrier rate of 1.4% (2/143), and neither MRSA-positive patient developed a surgical site infection. Only one MRSA infection occurred in the acute orthopaedic trauma cohort. The nonacute group had a significantly higher MRSA carrier rate of 12.5% (4/32, P = 0.01), and the elective group had the highest MRSA carrier rate of 15.4% (4/26, P < 0.01). The odds ratio of MRSA colonization was 10.1 in the nonacute group (95% confidence interval, 1.87-75.2) and 12.8 for true elective group (95% confidence interval, 2.36-96.5) when compared with the acute orthopaedic trauma cohort. There was a low MRSA colonization rate (1.4%) among patients presenting to our institution for acute fracture care. Patients undergoing elective surgery for fracture-related conditions such as nonunion, malunion, revision surgery, or implant removal have a significantly higher MRSA carrier rate (15.4%) and therefore may benefit from MRSA screening. Our results do not support routine vancomycin administration for orthopaedic trauma patients whose MRSA status is not known at the time of surgery. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Caloric test and video-head-impulse: a study of vertigo/dizziness patients in a community hospital

The head-impulse test (HIT) is an important test for examining unilateral vestibular hypofunction. The new video-head-impulse test (vHIT) is more sensitive and specific than the clinical bedside-head-impulse test (bHIT). Alternatively, one can test for vestibular hypofunction with the caloric irrigation test. Various studies showed that both tests may not always identify vestibular hypofunction; instead, the results of the tests might be contradictory. To evaluate the diagnostic value of these tests, we routinely measured patients exhibiting vertigo or dizziness at our community hospital with bithermal caloric irrigation, the bHIT and the vHIT. Only those patients (n = 172) with a pathological caloric irrigation test of more than 25 % unilateral weakness in the Jongkee's formula were included. Out of these patients, 41 % had a pathologic vHIT. Among the subgroup with acute symptoms (symptom onset within 5 days), 63 % had a pathological video-head-impulse, whereas only 33 % of the non-acute group (symptom onset more than 5 days) tested pathological. A pathological HIT depended on the disease stage, the amount of unilateral weakness in caloric examination and on the test itself.

The timing of perinatal hypoxia/ischemia events in term neonates: a retrospective autopsy study. HSPs, ORP-150 and COX2 are reliable markers to classify acute, perinatal events

BackgroundThe understanding of the cellular responses implicated in perinatal brain damages and the characterization of the various mechanisms involved might open new horizons for understanding the time of onset of a brain hypoxic-ischemic lesion and for effective therapeutic strategies.MethodsWe performed an immunohistochemical investigation on brain and brainstem sections of 47 peripartum deaths. The gradation and localization of the expression of antibodies such as TNFα, IL-1β, IL-6, HSPs, β APP, anti-TrypH, GAP43, GFAP, COX2, ORP-150, could be correlated with an hypoxic-ischemic damage to document a significant correlation between response and the time of onset acute (≤8 hs) or non-acute (≥8 hs ≤48 hs).Results and DiscussionsIn non-acute cases HSP70 reaction was prominent in the neuron cytoplasm, while in acute cases a mild reaction was evident in sporadic fields. HSP90 exhibited a similar pattern of positivity as HSP70. In acute group, ORP150 expressed an intense reaction showing a granular pattern in the cytoplasm of the neurons in the cortex of the infarcted areas. In non-acute group the positive reaction was more intense in astrocytes and less extended in neurons. COX2 reaction exhibited the strongest positive reaction in the neuronal cell bodies of acute cases, while a immunolabeling was prominent in the glial cytoplasm in the non-acute cases.ConclusionsChaperones HSP70 and 90, ORP-150 reaction, and COX2 protein, have provided very interesting results. These results would suggest to the clinicians to extend the differential diagnosis of a too large perinatal hypoxic-ischemic insult category to delineate a more accurate chronological judgement.

Salivary antimicrobial proteins in patients with Crohn's disease

The aim was to study the level of salivary proteins with antimicrobial properties in persons with Crohn's disease. Twenty-five patients were recruited, 13 with ongoing symptoms (acute group) and 12 free of clinical signs of the disease at the time of the investigation (nonacute group). A control group matched to the nonacute group was also included in the study. Unstimulated and stimulated whole saliva samples were collected, and the secretion rates estimated. Unstimulated saliva was analyzed for concentrations of total protein, peroxidase, thiocyanate, slgA, lactoferrin, lysozyme, and for specific bacteria aggregation ability. Numbers of mutans streptococci and lactobacilli in saliva were determined, and dental caries status was examined. No differences were found among the groups regarding salivary flow rate, total protein, or any of the antimicrobial proteins. However, three patients with Crohn's disease had no detectable slgA in saliva compared with none in the control group. The lactobacillus count and the number of decayed tooth surfaces were higher in the nonacute group than in the control group.