Toshiyuki Ishimaru

Attenuation of anorexia induced by heat or surgery during sustained administration of ginsenoside Rg1 into rat third ventricle

Effects of ginsenoside Rg1 (Rg1), a major component of panax ginseng, on modulation of ingestive behavior were investigated. No direct effect was observed on food intake after 10 μl infusion of 1.0, 2.0, 4.0 or 8.0 mM Rg1 into the rat third ventricle for 10 min. Continuous osmotic infusion of 4.0 mM Rg1 at a rate of 0.966 μl/h into the third ventricle prevented feeding suppression caused by surgical procedure to implant an osmotic minipump. Continuous infusion of Rg1 attenuated anorexia, increased water intake, and decreased ambulation, that were produced by elevation of environmental temperature from 21° C to 30° C. Consequently, rats maintained body weight and rectal temperature unchanged. The results indicate that sustained central administration of Rg1 may relieve anorexia caused by implantation surgery or by a heated environment.

Association between risk of bloodstream infection and duration of use of totally implantable access ports and central lines: a 24-month study.

BACKGROUND Prolonged use of totally implantable access ports (APs) and central lines (CLs) has been known to carry a risk of bloodstream infection (BSI), but the safe cutoff day for discontinuing use remains unknown. We performed a receiver operating characteristic (ROC) curve analysis to determine this cutoff. METHODS A retrospective 24-month study covered a total of 22,481 days of device use. For each day of use, the following findings were recorded: patient age and sex; presence or absence of diabetes mellitus, preexisting sepsis, and renal disease; and occurrence of device-associated BSI. BSI was defined in accordance with the Centers for Disease Control and Preventions definition of catheter-related infection. RESULTS BSIs occurred in 81 patients with an AP, for a BSI rate of 2.81 cases per 1,000 days of use. Among the 896 patients with a CL, the BSI rate was 5.60 cases per 1,000 days of use. The ROC analysis found a cutoff time of 33 days for APs (median days of use, 48) and 10 days for CLs (median days of use, 20.5). For the total 22,481 days of use, the odds ratio between APs and CLs with respect to BSI was 0.556 (95% confidence interval [CI], 0.256-1.208; P = .138). Days of use beyond the cutoff had an odds ratio of 2.867 (95% CI, 1.823-4.507; P < .001). Among the risk factors, preexisting sepsis had an odds ratio of 7.843 (95% CI, 4.666-13.184; P < .001). CONCLUSION Use of an AP for more than 33 days and a CL for more than 10 days may carry an increased risk of device-associated BSI. These cutoff periods are longer than those expected at the time of device placement and indicate the importance of postplacement care.

Risk factors for central venous catheter-related bloodstream infection: a 1073-patient study

We intended to evaluate the risk factors for catheter-related bloodstream infection (CR-BSI) with central venous (CV) catheters. For the hub of the CV line, we used three-way stopcocks in the first year of the study and closed needleless connectors (NCs) in the second year. Background factors included the age and sex of patients; the ward; the specialty service; the CV catheter and its days of placement; and the staff compounding the intravenous infusion, i.e., either nurses, who disinfect hands-free, or pharmacists using clean benches. Outcome factors included positive culture from the blood-related samples and the body temperature estimate. Of a total of 29 221 device-days in 1073 patients, positive cultures showed an overall incidence of 2.26 per 1000 device-days. Multivariate analysis showed a higher odds ratio of positive cultures for the ICU (odds ratio [OR], 4.415; 95% confidence interval [CI], 2.054–9.490]) and for CV catheter placement for more than 30 days (OR, 7.529; 95% CI, 4.279–13.247), but no significance for male sex (OR, 1.752; 95% CI, 0.984–3.119) or for pharmacists’ compounding (OR, 2.150; 95% CI, 0.974–4.749). Univariate analysis showed no significance for the following factors: age more than 70 years (OR, 0.968; 95% CI 0.561–1.641), the surgery service (OR, 1.029; 95% CI, 0.582–1.818), double-lumen CV catheters (OR, 0.841; 95% CI, 0.465–1.521), or the NC (1.107; 95% CI, 0.673–1.821). We conclude that the theoretical benefit of the NC, the abolished dead space in the hub, contributed little to the outcomes of blood-related culture. The hands-free disinfection may have resulted in comparable odds ratios for the nurses and the pharmacists compounding the infusions.

Detection of Candida antigen and antibody in serum from patients with invasive candidiasis

Abstract Objective: To compare the sensitivity and specificity of three different assays for diagnosis of invasive candidiasis. Methods: A passive hemagglutination assay (PHA), counter-immunoelectrophoresis assay (CIE), and Cand-tec were used to test sera from 125 patients with hematologic malignancies and 65 other hospitalized patients. The former group included 15 patients with invasive candidiasis, 38 patients with Candida colonization, and 72 patients without candidiasis. Results: Sensitivity/specificity of PHA, CIE, and Cand-tec were 87%/85%, 67%/98%, and 33%/97%, respectively. The measurement of antibody in paired sera, by PHA, was sensitive and specific; however, increased antibody titers usually occurred late in the disease. Conclusions: The combination of PHA and CIE, with a sensitivity of 67% and specificity of 98%, appeared to be the best assays for detection of invasive candidiasis in this cohort. The Cand-tec assay for Candida antigen had poor sensitivity for diagnosis of infection.

Cluster analysis on multiple drugs susceptibility supplements genotyping of methicillin-resistant Staphylococcus aureus☆

OBJECTIVE To evaluate the typing power of cluster analysis of antimicrobial susceptibility. METHODS Results of pulsed-field gel electrophoresis in 71 strains of methicillin-resistant Staphylococcus aureus were compared with cluster analysis of the diameter of growth inhibition in 11 drugs. Subjects were a consecutive series of patients (n = 71) from the wards and outpatient units of a community teaching hospital. RESULTS The cluster analysis took 2 to 3 seconds once the data were entered into a computer. The sensitivity, specificity, and accuracy of the cluster analysis were 76.3%, 58.3%, and 73.2%, respectively, using genotyping as the reference. CONCLUSIONS The cluster analysis offered real-time epidemiologic data at minimal cost and labor, warranting its cost-effective role.