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Since the beginning of the COVID-19 pandemic, SARS-CoV-2 has caused a global burden for health care systems due to high morbidity and mortality rates, leading to caseloads that episodically surpass hospital resources. Due to different disease manifestations, the triage of patients at high risk for a poor outcome continues to be a major challenge for clinicians. The AIFELL score was developed as a simple decision instrument for emergency rooms to distinguish COVID-19 patients in severe disease stages from less severe COVID-19 and non-COVID-19 cases. In the present study, we aimed to evaluate the AIFELL score as a prediction tool for clinical deterioration and disease severity in hospitalized COVID-19 patients. During the second wave of the COVID-19 pandemic in Switzerland, we analyzed consecutively hospitalized patients at the Triemli Hospital Zurich from the end of November 2020 until mid-February 2021. Statistical analyses were performed for group comparisons and to evaluate significance. AIFELL scores of patients developing severe COVID-19 stages IIb and III during hospitalization were significantly higher upon admission compared to those patients not surpassing stages I and IIa. Group comparisons indicated significantly different AIFELL scores between each stage. In conclusion, the AIFELL score at admission was useful to predict the disease severity and progression in hospitalized COVID-19 patients.

© 2015 Elsevier Ltd. All rights reserved. Excessive proliferation of human pulmonary artery smooth muscle cells (HPASMC) is one of the major factors that trigger vascular remodeling in hypoxia induced pulmonary hypertension. Several studies have implicated that hypoxia inhibits the tumor suppressor p21 (CDKN1A). However the precise mechanism is unknown. The mouse model of hypoxia induced PH and in vitro experiments were used to assess the impact of microRNAs (miRNAs) on the expression of CDKN1A. In these experiments the miRNA family miR 130 was identified to regulate the expression of CDKN1A. Transfection of HPASMC with miR 130 decreased the expression of CDKN1A and in turn significantly increased smooth muscle proliferation. Conversely inhibition of miR 130 by anti miRs and seed blockers increased the expression of CDKN1A. Reporter gene analysis proved a direct miR 130 CDKN1A target interaction. Exposure of HPASMC to hypoxia was found to induce the expression of miR 130 with concomitant decrease of CDKN1A. These findings were confirmed in the mouse model of hypoxia induced pulmonary hypertension showing that the use of seed blockers against miR 130 restored the expression of CDKN1A. These data suggest that miRNA family miR 130 plays an important role in the repression of CDKN1A by hypoxia. miR 130 enhances hypoxia induced smooth muscle proliferation and might be involved in the development of right ventricular hypertrophy and vascular remodeling in pulmonary hypertension.

© Blotzheim et al. Objective: We investigated the prevalence of bronchial asthma in patients with Tako Tsubo Syndrome (TTS). Design: This retrospective case series study was conducted in a primary care hospital in Zurich Switzerland. Data of all patients with newly diagnosed TTS (2002 2012) were assessed electronically by the use of ICD 10. Asthma prevalence was compared to published epidemiologic data. Setting: Bronchial asthma is characterized by airway inflammation and during attack release of endogenous catecholamines. Sympathomimetic drugs are the mainstay of treatment for asthma patients. Likewise catecholamine mediated diffuse microvascular myocardial dysfunction seems to be of critical importance for the development of TTS. Results: 20 cases of TTS were identified. 90 were female showed a median age of 70±13y [25y 90y] an apical and/or midventricular ballooning pattern with preserved basal function and a median initial LVEF of 34±9 [25 55]. 65 of patients underwent coronary angiography to rule out significant coronary artery disease. Hypertension was present in 45 of patients 35 were smokers none was suffering from diabetes. Prevalence of asthma in patients with TTS was significantly higher compared to the normal population (25 vs. 7 p=0.012). In 30 of the TTS patients an iatrogenic cause for development of TTS was identified. Conclusion: Prevalence of asthma was significantly higher in patients with TTS compared to epidemiologic data from an age matched population. Phenotypes of patients developing obstructive ventilatory disease and TTS might share common pathogenic mechanisms beyond the use of bronchodilatators. In addition we identified other iatrogenic etiologies in patients with TTS.

Individuals with precapillary pulmonary hypertension (PH) experience severely impaired quality of life. A disease specific outcome measure for PH the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) was developed and validated in the UK and subsequently adapted for use in additional countries. The aim of this study was to translate and assess the reliability and validity of the CAMPHOR for German speaking populations. Methods Three main adaptation stages involved translation (employing bilingual and lay panels) cognitive debriefing interviews with patients and validation (assessment of the adaptation’s psychometric properties. The psychometric evaluation included 107 patients with precapillary PH (60 females; age mean (standard deviation) 60 (15) years) from 3 centres in Austria Germany and Switzerland. Results No major problems were found with the translation process with most items easily rendered into acceptable German. Participants in the cognitive debriefing interviews found the questionnaires relevant comprehensive and easy to complete. Psychometric analyses showed that the adaptation was successful. The three CAMPHOR scales (symptoms activity limitations and quality of life) had excellent test retest reliability correlations (Symptoms = 0.91; Activity limitations = 0.91; QoL = 0.90) and internal consistency (Symptoms = 0.94; Activity limitations = 0.93; QoL = 0.94). Predicted correlations with the Nottingham Health Profile provided evidence of the construct validity of the CAMPHOR scales. The CAMPHOR adaptation also showed known groups validity in its ability to distinguish between participants based on perceived general health perceived disease severity oxygen use and NYHA classification. Conclusions The CAMPHOR has been shown to be valid and reliable in the German population and is recommend for use in clinical practice.

Levels of microRNAs (miRNAs) are increasingly assessed in biological fluids, for example, in samples obtained by bronchoalveolar lavage (BAL). "Post-collection kinetics" of miRNA expression levels, however, have not been investigated to date. In these experiments, we analyzed the dynamic expression profile of 5 different miRNAs (miR-17, miR-19b, miR-20b, miR-125a, and miR-223-3p) in BAL within the first 24 h following collection by routine bronchoscopy. miRNAs were quantified 0, 1, 4, 8, and 24 h after collection in samples that were kept at 4 °C or at room temperature. The expression of all five miRNAs was found to remain stable between the first 8 h after collection. 24 h after collection miRNAs faced substantial alterations in their expression profile. These data emphasize that BAL samples intended for further miRNA analysis can be handled at room temperature within the first 8 h after bronchoscopy.

Diagnosis of acute lung allograft rejection is currently based on transbronchial lung biopsies. Additional methods to detect acute allograft dysfunction derived from plasma and bronchoalveolar lavage samples might facilitate diagnosis and ultimately improve allograft survival. This review article gives an overview of the cell profiles of bronchoalveolar lavage and plasma samples during acute lung allograft rejection. The value of these cells and changes within the pattern of differential cytology to support the diagnosis of acute lung allograft rejection is discussed. Current findings on the topic are highlighted and trends for future research are identified.

Objective. Rheumatoid arthritis (RA) is a chronic inflammatory disorder of unknown origin. Histone deacetylase (HDA) activity is considered to play a major role in the transcriptional regulation of proinflammatory genes. We undertook this study to investigate the balance of histone acetylase and HDA activity in synovial tissue from RA patients compared with that from patients with osteoarthritis (OA) and normal controls. Methods. Activity of histone acetylases and HDAs was measured in nuclear extracts of total synovial tissue samples, which were obtained from RA and OA patients undergoing surgical joint replacement, and compared with the activity in synovial tissues from patients without arthritis. Tissue expression of HDAs 1 and 2 was quantified by Western blotting. In addition, immunohistochemistry was performed for HDA-2. Results. Mean SEM HDA activity in synovial tissue samples derived from patients with RA was measured as 1.5 0.3 moles/g, whereas the activity levels in OA (3.2 0.7 moles/g) and normal (7.1 4.2 moles/g) synovial tissue samples were significantly higher. Histone acetylase activity reached similar levels in RA and OA tissues and in normal tissues. The ratio of HDA activity to histone acetylase activity in RA synovial tissue was significantly reduced (12 2%) compared with that in OA synovial tissue (26 3%). The activity ratio in normal control samples was arbitrarily set at 100 40%. In addition, the tissue expression of HDA-1 and HDA-2 proteins was clearly lower in RA samples than in OA samples. Conclusion. The balance of histone acetylase/ HDA activities is strongly shifted toward histone hyperacetylation in patients with RA. These results offer novel molecular insights into the pathogenesis of the disease that might be relevant to the development of future therapeutic approaches.