Direct testing of bronchoalveolar lavages from ventilator-associated pneumonia patients

In line with a rapid de-escalation of empirical antimicrobial therapy, this study assessed the validity of an E-test-based direct specimen testing method on bronchoalveolar lavage (BAL) samples from ventilator-associated pneumonia (VAP) patients. E-test strips were directly applied onto Mueller-Hinton agar plates seeded with BAL samples and read after 24 h of incubation. In parallel, the BAL samples were analyzed by the routine diagnostic laboratory. The microbroth dilution approach was used as a control method. In a cohort of 20 patients, 135 microorganism-antibiotic combinations were studied. Total agreement between the 2 methods was achieved for 88.9% combinations, with 1.5% very major errors (isolates susceptible by E-test and reported resistant by the diagnostic laboratory) and 9.6% major errors (isolates resistant by E-test and reported susceptible by the diagnostic laboratory). These results indicate that applying E-test directly on BAL samples is a promising method for obtaining susceptibility data after 24 h in critical patients with VAP.     

Progesterone secretion by granulosa cells from rats with four- or five-day estrous cycles: the development of responses to follicle-stimulating hormone, luteinizing hormone, and testosterone

Changes in granulosa cell sensitivity and responsiveness to gonadotropins during the rat estrous cycle were studied by measuring progesterone (P) secretion in vitro in response to treatment with increasing doses of LH or FSH (0, 0.1, 1, 10, 100 ng/ml). The effect of testosterone [(T); 0.5 microM] on response to gonadotropins was also examined. Granulosa cells were isolated from the largest ovarian follicles of rats with 4- and 5-day estrous cycles at 0800 h, 1400 h, and 2000 h on proestrus and on the preceding day of diestrus at 1200 h and 2000 h. In rats with 5-day cycles, granulosa cells were also obtained at 1200 h on the first day of diestrus. Fifty percent maximal P production and 50% effective dose (ED50-dose of gonadotropin which elicited 50% maximal P production) were calculated from dose-response curves for LH and FSH and were used as measures of responsivity and sensitivity to gonadotropins, respectively. Basal P secretion and 50% maximal P secretion increased progressively as cells were isolated at later stages of follicular growth in both 4- and 5-day cycles. In cells from 5-day rats, however, basal and gonadotropin-stimulated P secretion were higher on the second day of diestrus than in cells from 4-day rats. By proestrus responsiveness was equal. Granulosa cell sensitivity to FSH was constant during 4- and 5-day cycles, as indicated by a lack of change in the ED50. Granulosa cell sensitivity to LH was lower than sensitivity to FSH on diestrus of both 4- and 5-day cycles. However, by the morning of proestrus sensitivity to LH increased and was similar to that for FSH. T increased basal P production only slightly, but synergized with both LH and FSH to stimulate 2-fold increases in 50% maximal P production by granulosa cells isolated at all times except 2000 h on proestrus, after the endogenous LH surge. T had no effect on the sensitivity (ED50) of granulosa cells to LH or FSH. In summary, granulosa cell responsiveness to LH and FSH increased in parallel during the final stages of follicular growth, but increased sensitivity was noted only for LH. The development of granulosa cell capacity to secrete P appears to be more advanced in 5-day rats than in 4-day rats relative to the next estrus. Because T synergized with LH and FSH to increase P secretion without altering sensitivity to gonadotropins, it probably acts at a site distal to gonadotropin receptors.     

Strategy of antibiotic rotation: long-term effect on incidence and susceptibilities of Gram-negative bacilli responsible for ventilator-associated pneumonia

OBJECTIVE: To evaluate the long-term effect of a program of rotating antibiotics on the incidence of ventilator-associated pneumonia and the susceptibilities of Gram-negative bacilli responsible for ventilator-associated pneumonia. DESIGN: Prospective program for the surveillance of antibiotic susceptibilities of microorganisms responsible for ventilator-associated pneumonia. SETTING: Academic, university-based, medical intensive care unit (16 beds). SUBJECTS: 2,856 mechanically ventilated patients. INTERVENTIONS: A new program of antibiotic use was introduced at the end of 1996 that involved the rotation of antibiotics in empirical and therapeutic use of the treatment of ventilator-associated pneumonia. The rotation concerned the beta-lactam and aminoglycoside classes, with a rotation interval of 1 month. The use of antibiotics was monitored monthly. No preference was given to any particular antibiotic. In a previous study, the period before the introduction of this protocol (1995-1996) was compared with the period 2 yrs after (1997-1998): The results indicated a decreased incidence of ventilator-associated pneumonia, a lower incidence of potentially resistant Gram-negative bacilli, and increased sensitivities of Gram-negative bacilli, especially Pseudomonas aeruginosa and Burkholderia cepacia. After 1998, we decided to continue a routine for this rotation. The long-term effect of this program was studied by comparing the incidence of Gram-negative bacilli responsible for ventilator-associated pneumonia and their susceptibilities obtained in a third period: 1999-2001. The long-term effect (5 yrs) of such a strategy-2-yr protocol period (1997-1998) and 3-yr routine period (1999-2001)-could be evaluated. MEASUREMENTS AND MAIN RESULTS: During the 7-yr study period, 2,856 patients were mechanically ventilated for >48 hrs. The incidence of ventilator-associated pneumonia remained significantly lower in period 3 (1999-2001): 23% (period 1, 1995-1996) vs. 15.7% (period 2, 1997-1998) vs. 16.3% (period 3, 1999-2001; p =.002). Late-onset ventilator-associated pneumonia occurred in 86.6% and 94% of cases, respectively, in periods 1 and 3 (p =.02). The decrease of the incidence of early-onset ventilator-associated pneumonia was statistically significant during the 7-yr study period: 13% vs. 9% vs. 5.9% (p =.02). Combined with a higher incidence of late-onset ventilator-associated pneumonia, the incidence of potentially resistant Gram-negative bacilli increased in period 3: 42.2% vs. 34.5% vs. 41.7% (nonsignificant), except for B. cepacia: 11.7% vs. 7.4% vs. 3.7% (p =.005). Nevertheless, the potential antibiotic-resistant Gram-negative bacilli were more sensitive to most of the beta-lactams, especially piperacillin-tazobactam and cefepime. CONCLUSIONS: Rotation of antibiotics could help to avoid ventilator-associated pneumonia. It could greatly improve the susceptibilities of the potentially antibiotic-resistant Gram-negative bacilli responsible for late-onset ventilator-associated pneumonia. This program could be applied in routine with good results 5 yrs after its introduction. Further studies, especially multiple-center trials, are necessary to confirm this result and better define the rotation type and intervals.     

Personality and psychopathology in children with and without loss of control over eating

Background

In children with loss of control (LOC) over eating, recent research has revealed evidence for distinct personality features, such as more impulsivity. The aim of this study was to assess parent- and child-report personality profiles in children with and without LOC over eating and to relate these profiles to general and eating-disorder psychopathology.

Method

A total of 120 children (60 with LOC over eating; 68 girls) aged 8 to 13 years were recruited from the community. Clinical interview, self-report, and parent-report questionnaires were administered to assess personality as well as both general and eating-disorder psychopathology.

Results

The group with LOC over eating showed lower self-directedness and cooperativeness compared to the group without LOC. The children with LOC were significantly more impulsive. Personality dimensions were significantly correlated with greater general but not eating-disorder psychopathology and frequency of LOC over eating.

Conclusion

A distinct pattern of personality traits in children with LOC over eating was found that is partly in line with research on binge-eating disorder, bulimia nervosa, and obesity in adulthood. The findings suggest that longitudinal studies should examine whether certain patterns of personality in children with LOC over eating account for differences in psychopathology later in life.     

Du Pan syndrome phenotype caused by heterozygous pathogenic mutations in CDMP1 gene

Du Pan syndrome is a rare acromesomelic dysplasia with characteristic clinical and radiographic findings. It is inherited as an autosomal recessive trait. Almost all the patients reported have been from Muslim countries. We report on a female and her child with Du Pan syndrome from a Caucasian, Polish family. Three new heterozygous mutations clustered on one allele of the CDMP1 gene were identified in the affected individuals resulting in the first familial case with dominant Du Pan syndrome. A possible synergistic effect of the cis-acting mutations located in the active domain of the mature CDMP1 protein is likely to be responsible for the clinical expression of the disorder.     

Functional roles of oral reflexes in chewing and biting: phase-, task- and site-dependent reflex sensitivity

Because loading during chewing is not totally predictable and jaw-closing muscles are strong and act over short distances, feedback from oral receptors is important in the control of mastication. Information on such feedback can be obtained by studying reflexes in jaw muscle EMGs. This review will deal with the contribution of reflex mechanisms to modifying motor neuron activity during chewing, and the dependency of reflex sensitivity on motor task, phase of movement, and site of stimulation.