Hub Colonization as the Initial Step in an Outbreak of Catheter-Related Sepsis Due to Coagulase Negative Staphylococci during Parenteral Nutrition

A prospective study was carried out to determine the pathogenesis of coagulase negative staphylococci catheter-related sepsis during parenteral nutrition. Forty-three catheters were cultured by semiquantitative and quantitative methods. The skin around the puncture site was cultured at the time of catheter removal and three segments of the catheter were cultured apart: the hub, the proximal subcutaneous segment, and the tip. Skin cultures were negative (89%) or yielded different coagulase negative staphylococci from those recovered in catheter and/or blood. Seventeen catheters were the source of sepsis. In 15 cases an infected hub was associated with an infected tip. In two cases the hub was negative (one sepsis due to mixture contamination and the other due to hematogenous seeding of the catheter tip). Sixteen cases of sepsis were due to coagulase negative staphylococci. Staphylococcus epidermidis has been the species most commonly isolated, followed by Staphylococcus haemolyticus, Staphylococcus saprophyticus, and Staphylococcus hominis. In our patients most catheter sepsis have their origin in an infected hub and are not due to migration of skin bacteria along catheter subcutaneous tunnel. (Journal of Parenternal and Enteral Nutrition 8:668–672, 1984)     

Measurement challenges in shared decision making: putting the ‘patient’ in patient‐reported measures

Measuring clinicians' shared decision‐making (SDM) performance is a key requirement given the intensity of policy interest in many developed countries – yet it remains one of the most difficult methodological challenges, which is a concern for many stakeholders. In this Viewpoint Article, we investigate the development of existing patient‐reported measures (PRMs) of SDM identified in a recent review. We find that patients were involved in the development of only four of the 13 measures. This lack of patient involvement in PRM development is associated with two major threats to content validity, common to all 13 PRMs of SDM: (i) an assumption of patient awareness of ‘decision points’ and (ii) an assumption that there is only one decision point in each healthcare consultation. We provide detailed examples of these threats and their impact on accurate assessment of SDM processes and outcomes, which may hamper efforts to introduce incentives for SDM implementation. We propose cognitive interviewing as a recommended method of involving patients in the design of PRMs in the field of SDM and provide a practical example of this approach.     

The relationship of stress and coping methods to adolescent marijuana use

As the use of marijuana among adolescents remains high, more effective interventions are needed. We conducted this cross‐sectional survey at an outpatient, university‐based, adolescent clinic to determine the prevalence of marijuana use in an inner‐city adolescent population and to examine the relationship of stress and coping methods to marijuana user status (never user, experimenter, and frequent user). The subjects were 918 adolescents aged 12–21 years. Lifetime use in this population was 59% (n = 611) with 18.4% (n = 191) reporting frequent weekly use. Almost all (97%) marijuana users acknowledged marijuana use by friends. Stepwise logistic regression analysis showed that negative life events, greater use of the negative coping method of anger and less frequent use of the positive coping method of parental support were significantly and independently related to marijuana user status. In the presence of high peer use, exploring parent‐child relationships and use of anger coping and intervening accordingly may decrease marijuana use.     

Oleamide activates peroxisome proliferator-activated receptor gamma (PPARγ) in vitro

Background

Lipid metabolism is altered in subjects with liver steatosis. FAS is a key enzyme in de novo lipogenesis and both FAS gene expression and enzymatic activity are primarily regulated by metabolic signals in the liver. Lipoprotein lipase (LPL), the rate-limiting enzyme for the hydrolysis of core triglycerides, plays a pivotal role in lipid metabolism. This study aims to investigate if circulating levels of FAS and LPL could be clinically associated with liver steatosis.

Methods

In this work, we present data obtained from a subsample of 94 subjects with liver steatosis enrolled by NUTRIEPA study, a nutritional trial in subjects with liver steatosis. Serum levels of FAS protein and LPL activity were evaluated by ELISA test and by a fluorescent method, respectively. The diagnosis and the degree of liver steatosis were based on laboratory and ecographic measurements. Statistical methods included Kruskal-Wallis analysis of variance and Wilcoxon signed-rank test, where appropriate. The ?? ² test has been performed to analyse categorical variables.

Results

The subjects with severe steatosis had significantly higher serum levels of FAS protein and LPL activity compared to subjects with mild and moderate liver steatosis. Moreover, a positive trend in serum levels of FAS expression from lower to higher degree of steatosis was also detected.

Conclusions

We describe a relationship between human liver steatosis and elevated levels of circulating lipogenic enzymes. Increased serum levels of FAS expression and LPL activity could be considered a marker of severe liver steatosis.     

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.     

Mongolian Spots in Sjögren-Larsson Syndrome

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