Journal of Japanese Society for Parenteral and Enteral Nutrition

Objective: To clarify lifestyle characteristics of rheumatoid arthritis (RA) patients with sarcopenia.
Subjects and Methods: A total of 208 consecutive RA outpatients were assessed. Skeletal muscle mass was measured by dual energy x-ray absorptiometry (DXA). The criterion of sarcopenia was defined as a low skeletal muscle index (appendicular muscle mass/height² , kg/m²; men, ≤6.87 kg/m²; women, ≤5.46 kg/m²; reference population, Japanese young adults aged 18-40 years). Brief-type self-administered diet history questionnaire (BDHQ) was used for investigation of the intake of energy, nutrients and food.
Results: In RA patients, the sarcopenia group showed significantly higher disease activity and lower activity of daily living (ADL) compared to those in the non-sarcopenia group. In addition, a greater number of patients in the sarcopenia group had exercise restrictions than in the non-sarcopenia group. Calcium intake had a tendency to be lower, and intake of milk and other dairy products was significantly lower, in the sarcopenia group than in the non-sarcopenia group.
Conclusion: Exercise restriction, low ADL, and low intake of milk and other dairy products were determined to be the lifestyle characteristics of RA patients with sarcopenia.

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Many kinds of connectors in infusion line are used in order to prevent catheter-related bloodstream infections. This study examined and compared the potential contamination between seven kinds of needleless connectors and I-system^®; a method to connect and fix by inserting rubber injection port with a needle. In each state, (1) after connecting for 120 hours (long time connection test), or (2) after 70 times connection operation (female connector durability test), the surface of female connector was applied with microorganisms, and (3) after the connection part of male connector was applied with microorganisms, then the new infusion line was connected, the contamination rate in the tube was examined. As a result, it was found that some devices are invaded by the bacteria at high frequency depending on the conditions. In any experiments, I-system^® prevented the invasion of the bacteria. In Japan, needleless connector is referred to closed infusion system and is simply considered effective as a countermeasure to prevent infections. However it should be used after recognizing a possibility of an increase in opportunity of infections depending on the use method.

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OBJECTIVE: A peripherally inserted central catheter (PICC) provides effective central venous access without serious mechanical complications. Several specific problems, however, have been reported, including malpositioning of the catheter tip, thrombophlebitis, and difficult venous access. Although the use of fluoroscopic guidance during insertion is recommended to avoid tip malpositioning, the transfer of patients to the radiology suite and radiation exposure can sometimes be problematic. We, therefore, extensively utilized ultrasound at the bedside during venous puncture and localization of the tip without using fluoroscopy to address these issues.
METHODS: A total of 116 adult inpatients underwent PICC placement in wards. PICCs were inserted through peripheral veins of an upper arm under ultrasound guidance. Then, images of the catheter in the ipsilateral axillary vein and internal jugular vein were detected by ultrasound. If malpositioning to the internal jugular vein was recognized, the tip position was adjusted before procedural completion. After completing catheter placement, all patients underwent chest radiography to assess the catheter tip position.
RESULTS: Venous puncture was successful in 115 patients (99%). Catheter insertion was successful in 111 patients (95.7%). In 4 patients (3.4%), the catheters could not be threaded due to stenosis of the subclavian vein.
CONCLUSION: Using ultrasound during venous puncture and catheter tip localization, PICC can be placed with marked accuracy.

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