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Background Comparison of clinical findings, chest radiographs (CXR), lung ultrasound (LUS) findings, and C‐reactive protein (CRP) concentrations at admission and serial follow‐up in dogs with aspiration pneumonia (AP) is lacking. Hypothesis Lung ultrasound lesions in dogs with AP are similar to those described in humans with community‐acquired pneumonia (comAP); the severity of CXR and LUS lesions are similar; normalization of CRP concentration precedes resolution of imaging abnormalities and more closely reflects the clinical improvement of dogs. Animals Seventeen dogs with AP. Methods Prospective observational study. Clinical examination, CXR, LUS, and CRP measurements performed at admission (n = 17), 2 weeks (n = 13), and 1 month after diagnosis (n = 6). All dogs received antimicrobial therapy. Lung ultrasound and CXR canine aspiration scoring systems used to compare abnormalities. Results B‐lines and shred signs with or without bronchograms were identified on LUS in 14 of 17 and 16 of 17, at admission. Chest radiographs and LUS scores differed significantly using both canine AP scoring systems at each time point (18 regions per dog, P < .001). Clinical and CRP normalization occurred in all dogs during follow up. Shred signs disappeared on LUS in all but 1 of 6 dogs at 1 month follow‐up, while B‐lines and CXR abnormalities persisted in 4 of 6 and all dogs, respectively. Conclusion and Clinical Importance Lung ultrasound findings resemble those of humans with comAP and differ from CXR findings. Shred signs and high CRP concentrations better reflect clinical findings during serial evaluation of dogs.

A number of video-fluoroscopic swallowing study (VFSS) abnormalities have been reported in patients with Parkinson's disease (PD). However, the most crucial finding of subsequent aspiration pneumonia has not been validated fully. We conducted a retrospective and case-control study to determine the clinically significant VFSS findings in this population, and to propose a practical scale for predicting aspiration pneumonia in patients with PD. We enrolled 184 PD patients who underwent VFSS because of suspected dysphagia. The patients who developed aspiration pneumonia within six months of the VFSS were assigned as cases and the patients without aspiration pneumonia at six months were designated as controls. Logistic regression analysis was performed to determine the prognostic VFSS features based on the data of swallowing 3 mL of jelly, which were used to make a PD VFSS scale (PDVFS). The validity of the new PDVFS was evaluated by ROC analysis. Additionally, we used the survival time analysis to compare time to death between groups, stratified by the PDVFS score. Twenty-five patients developed aspiration pneumonia. Among the previously-proposed VFSS features, mastication, lingual motility prior to transfer, aspiration, and total swallow time were identified as significant prognostic factors. We combined these factors to form the PDVFS. The PDVFS score ranges from 0 to 12, with 12 being the worst. ROC analysis revealed 92% sensitivity and 82% specificity at a cutoff point of 3. The higher PDVFS group showed shorter time-to-death than the lower PDVFS group (log rank P = 0.001). Our newly developed VFSS severity scale (based on jelly swallowing) for patients with PD was easy to rate and could predict subsequent aspiration pneumonia and poor prognosis in patients with PD.

Impaired swallowing can lead to malnutrition, dehydration, choking, reduced quality of life and death.5–7 Because so many people are at risk of developing AP, a significant emphasis of this Statement is on prevention. [...]microaspiration due to abnormal swallowing results from a wide range of pathologies, and so heterogeneous patient groups are included in published studies on AP. Every hospital and care home should have at least one oral health ‘champion’ promoting good oral healthcare. Oral examination should be performed in all hospitalised patients at risk of AP or with suspected AP, and at least weekly in care home residents, checking for infection (eg, candidiasis), quality of dentition, food residue and cleanliness of mucosal surfaces.

We investigated whether thoracic skeletal muscle mass index at the diagnosis of aspiration pneumonia (AP) is a predictor for AP recurrence and explored predicting factors for AP recurrence in patients with stroke. This study retrospectively reviewed data of patients with AP who were diagnosed with stroke and who had full medical follow-up data from January 2014 to July 2020 in the Catholic University of Korea Bucheon St. Mary's Hospital. AP was defined based on clinical signs and/or symptoms suggestive of pneumonia and radiologic findings of pneumonic infiltrations in the dependent portions of the lung. We measured thoracic muscle volume using the cross-sectional area (CSA) of the erector spinae muscle (ESMCSA, cm2) at the 12th vertebral region. Computed tomography scans at the time of AP diagnosis during the acute stroke period were used for analysis and respective CSAs were divided by height squared (m2) to yield the muscle index at T12 (T12MI, cm2/m2) to normalize for stature. Multivariate logistic regression models were used to investigate relationships between clinical parameters and AP recurrence. During the study period, a total of 268 stroke patients with dysphagia who developed AP were analyzed. The mean T12MI of patients with and without recurrence of AP was 622.3±184.1 cm2/m2 and 708.1±229.9 cm2/m2, respectively (P = 0.001). Multivariate logistic regression revealed that lower T12MI (P = 0.038) and older age (P = 0.007) were independent predictors of AP recurrence in patients with stroke and dysphagia. Low thoracic muscle index at the diagnosis of initial AP after stroke can predict subsequence AP recurrence.

Dear Editor, I read with interest the recent publication entitled “Comparison of lung ultrasound, chest radiographs, C-reactive protein, and clinical findings in dogs treated for aspiration pneumonia.” 1 This study was presented in 2019 at the European Veterinary Emergency and Critical Care Symposium (EVECCS) titled “Comparison of thoracic point of care ultrasound and radiographic findings as well as clinical evolution and C Reactive Protein concentrations in dogs treated for aspiration pneumonia” and published as an abstract. 2,3 Both the abstract and this publication appear to present the same data based on an identical study cohort at identical time points (T0-admission, n = 17; T1-2 weeks, n = 13, and T2, 30-days, n = 6); 16 of 17 dogs having shred signs at T0; and median C-reactive protein (CRP) values of 129 mg/L (24-267) at T0, 7.7 (3-32) at T1, and 5.2 (3-8) at T2 when comparing Table 1 of the EVECCS published abstract and this article in the Journal of Veterinary Internal Medicine. 1,3 It appears that the authors changed their lung ultrasound protocol from an imprecisely defined 9-view sliding methodology called “point of care thorax” as described in their abstract 2,3 to a 9-view lung ultrasound protocol. 1 In other words, the authors changed from a nondiscrete sliding protocol over the upper, middle and lower thirds of the thorax as approximately—view 1-8th intercostal space (ICS), view 2-5th ICS, view 3-3rd ICS, view 4-3rd ICS, view 5-5th ICS, view 6-6th ICS, view 7-6th ICS, view 8-5th ICS, and view 9-4th ICS to a discrete intercostal lung examination of the 4th ICS, 6th ICS and 8th ICSs in the upper third, middle third, and lower third of the thorax. CONFLICT OF INTEREST DECLARATION Dr Lisciandro is the co-owner of FASTVet.com, a private corporation that provides veterinary ultrasound training to practicing veterinarians.

Correspondence to Dr Hiroki Matsuura, Emergency Medicine, Okayama City Hospital, Okayama 700-0962, Okayama, Japan; superonewex0506@yahoo.co.jp Clinical introduction An 88-year-old man with intermittent fever, cough, vomiting and progressive dysphagia was transferred to our ED. Diffuse idiopathic skeletal hyperostosis Acute calcific retropharyngeal tendinitis Crowned dens syndrome Posterior longitudinal ligament ossification Answer: 1 Lateral radiograph of cervical spine revealed focal ossifications of the anterior longitudinal ligaments at C3/4 with posterior pharyngeal wall and the oesophagus pressed by the osteophytes (figure 2). Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

3 In the authors' experience, this border tends to vary with species, breed, respiratory effort and underlying lung lesions. 3 It is also the authors' experience that it can be difficult to determine the caudal extent of the lung margin on a lateral radiograph, particularly given this border changes during the respiratory cycle. [...]it is interesting to note that as VetBLUE increases the sites assessed from a single intercostal space to multiple intercostal spaces, it more closely aligns with earlier studies published by Dr Armenise 6 and the protocol used in the current study. An abstract in dogs suggests LUS protocols that examine larger lung surface area can detect pathology otherwise missed with protocols that scan less lung surface area, although this is a small study and prospective veterinary studies are needed to know how many sites need to be scanned to maximize sensitivity and specificity at finding underlying pleural and lung pathology. 8 The duration of time to perform lung ultrasound will likely need to be balanced against the speed with which a diagnosis needs to be made.

Although lung involvement in aspiration pneumonia typically has a gravity-dependent distribution on chest images, which patient’s conditions contribute to its radiological pattern has not been fully elucidated. This study was designed to determine the factors associated with the gravity-dependent distribution of community-acquired pneumonia (CAP) on chest computed tomography (CT). This retrospective study included elderly patients aged ≥ 65 years with CAP who underwent chest CT within 1 week before or after admission. The factors associated with lower lobe- and posterior-predominant distributions of ground glass opacity or airspace consolidation were determined. Of the 369 patients with CAP, 348 (94%) underwent chest CT. Multivariate analyses showed that impaired consciousness, a low Barthel index of activities of daily living, and high hemoglobin levels were associated with lower lobe-predominant distribution, while male sex and impaired consciousness were associated with posterior-predominant distribution. Cerebrovascular diseases were unrelated to these distributions. While male sex, impaired consciousness, high hemoglobin levels, low albumin levels, and the number of involved lobes were associated with in-hospital mortality, gravity-dependent distributions were not. Impaired consciousness might be the most significant predictor of aspiration pneumonia; however, the gravity-dependent distribution of this disease is unlikely to affect disease prognosis.

Background Recent studies reported that an increase in intramuscular adipose tissue of the quadriceps in older patients negatively affects the recovery of activities of daily living (ADL) more than the loss of muscle mass. However, whether intramuscular adipose tissue of the quadriceps in older patients with aspiration pneumonia is related to ADL recovery remains unclear. This study aimed to determine the relationship between intramuscular adipose tissue of the quadriceps and ADL recovery in older patients with aspiration pneumonia. Methods Thirty-nine older inpatients who were diagnosed with aspiration pneumonia participated in this prospective study. The main outcome of this study was ADL at discharge. ADL were assessed using the Barthel Index (BI). The intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness observed on ultrasound images. A multiple linear regression analysis was performed to confirm whether the quadriceps echo intensity was related to the BI score at discharge, even after adjusting for confounding factors. Results The medians [interquartile range] of the BI score at admission and discharge were 15.0 [0.0–35.0] and 20.0 [5.0–55.0], respectively. The BI score at discharge was significantly higher than that at admission ( p  = 0.002). The quadriceps echo intensity (β =  − 0.374; p  = 0.036) and BI score at admission (β = 0.601; p  < 0.001) were independently and significantly related to the BI score at discharge (R 2  = 0.718; f 2  = 2.546; statistical power = 1.000). In contrast, the quadriceps thickness (β =  − 0.216; p  = 0.318) was not independently and significantly related to the BI score at discharge. Conclusions Increased intramuscular adipose tissue of the quadriceps at admission is more strongly and negatively related to ADL recovery at discharge than the loss of muscle mass among older patients with aspiration pneumonia. Interventions targeting the intramuscular adipose tissue of the quadriceps may improve ADL among these patients. Highlights 1. We determined the relationship between intramuscular adipose tissue at admission and ADL recovery at discharge in patients with aspiration pneumonia. 2. Quadriceps echo intensity at admission was negatively related to the Barthel Index score at discharge. 3. Quadriceps thickness at admission was not related to the Barthel Index score at discharge. 4. Increase in intramuscular adipose tissue of the quadriceps at admission is negatively related to the recovery of ADL at discharge in patients with aspiration pneumonia.