Enterococcal bacteremia in a medical center

BACKGROUND: The enterococci have become important nosocomial pathogens. They can cause multiple site infections and enterococcal bacteremia becomes more frequently associated with a high mortality rate. Previous studies of enterococcal bacteremia showed a variety of results. To establish the significance and importance of enterococci as nosocomial pathogens in this hospital, to characterize their clinical pictures and to search for the risk factors for mortality, this retrospective study was performed. METHODS: There were 208 cases of enterococcal bacteremia which occurred from 1988 to 1992. Twenty-seven cases had no medical charts, dismissing possibility of evaluation. Finally, 181 cases of enterococcal bacteremia were analysed. RESULTS: One hundred and eighteen episodes were nosocomial infections. Polymicrobial bacteremia occurred in 68.5% of the patients and the most common co-isolate was Pseudomonas aeruginosa. Those patients (78.5%) with underlying diseases and malignancies were the most common underlying problems. The portal of entry could be found in 69.6 percent of patients, with the gastrointestinal tract the most common sources. Antimicrobial susceptibility testing showed high gentamicin resistance rate (89.5%), and ampicillin still had about 80 percent sensitivity rate. The group who received specific antibiotic therapy for enterococcus showed lower mortality (36.4% versus 47.6%). Only one case had infective endocarditis. Forty-nine patients suffered from septic shock, the cause of 30 deaths. Totally 75 patients died during hospitalization. Besides sepsis, another major cause of death was their underlying diseases itself. CONCLUSIONS: Enterococci have no doubt become important nosocomial pathogens and enterococcal bacteremia were associated with high mortality, especially in elderly patients with underlying diseases such as malignancy or diabetes. When clinically dealing with sepsis from the gastrointestinal or biliary tract, especially when previous cephalosporins therapy showed no response, the possibility of enterococcal bacteremia should always be considered.     

Improved Yen-Joye's authenticated multiple-key agreement protocol

An authenticated multiple-key agreement protocol is proposed. The protocol is not only secure against the unknown-key attack but also more efficient than other protocols.     

Flicker noise in gate overlapped polycrystalline silicon thin-filmtransistors

A study of the noise performance of gate overlapped polycrystalline silicon thin-film transistors (TFTs) is presented. Low-frequency noise measurements were carried out on n- and p-type samples fabricated by excimer laser crystallization. It is shown that the carrier number fluctuation model applies not only to n-type but also to p-type devices. The density of oxide traps was extracted from the noise measurements and was of the order of 10¹⁸-10¹⁹ eV^-1 cm^-3     

The effect of topical corticosteroids on refractive outcome and corneal haze after photorefractive keratectomy

BACKGROUND: The effect of topical corticosteroids after excimer laser photorefractive keratectomy (PRK) remains a matter of some controversy. Refractive effects may be different according to the amount of myopia and timing of instillation. METHODS: Two groups of patients were studied: Study A consisted of 215 eyes (128 patients) with PRK (mean baseline myopia, -6.53 +/- 2.22 D) that received no corticosteroids (No Corticosteroid Group) unless significant regression or corneal haze appeared (Delayed Corticosteroid Group), and in Study B, we randomly assigned eyes to the Initial Corticosteroid Group (mean baseline myopia, -6.39 +/- 1.84 D) or the No/delayed Corticosteroid Group (mean baseline myopia -5.78 +/- 2.02 D). Clinical results after PRK for low-to-moderate and high myopia were compared. RESULTS: In the first group, 70.9% (73 eyes) of moderately myopic eyes (mean, -4.56 +/- 1.10 D) belonged to the No Corticosteroid Group that had a mean refraction of -5.39 +/- 1.77 D. Delayed Corticosteroid Group eyes were more myopic (mean, -7.52 +/- 2.10 D), and showed more severe haze than those in the No Corticosteroid Group. In study B, only in high myopes with more than -6.00 D (mean, -7.76 +/- 1.15 D) did refraction and corneal haze outcomes show significant difference between the Initial Corticosteroid Group and the No/delayed Corticosteroid Group. CONCLUSIONS: The effects of topical corticosteroids after PRK were less in moderate myopes compared to high myopes. Delayed instillation of corticosteroids did not reverse the regression or haze whereas initial instillation showed a beneficial effect on high myopes but not on moderate myopes.     

Recording of volume hologram using a beam pattern from taperedoptical fiber

A photorefractive volume hologram was recorded and probed using light diffracted from a tapered optical fiber as a reference beam. A single-mode fiber (SMF) was chemically etched and tapered to give a complicated beam pattern, and it is shown that the tapered optical fiber can be utilized to increase the storage density of the volume hologram. Spatial selectivity of the volume hologram with this method was increased by two times compared to the normal SMF referencing, which is due to the fact that the complicated beam pattern has little correlation with its shifted version     

Revised cutoff values of serum aminotransferase in detecting viral hepatitis among CAPD patients: experience from Taiwan, an endemic area for hepatitis B

BACKGROUND: To determine the best cutoff values of aspartate aminotransferase (AST) and alanine amino-transferase (ALT) in detecting viral hepatitis C infection among patients of continuous ambulatory peritoneal dialysis (CAPD). METHODS: 90 (44 male and 46 female) CAPD patients and 526 adult controls (266 male, 260 female) were enrolled. Serum AST and ALT were measured by an auto-analyser monthly. Serum HBsAg was examined using a RIA method and anti-HCV by an second-generation EIA method. The best cutoff values of AST and ALT for detecting viral hepatitis were obtained from the ROC (receiver-operating characteristic) curve. RESULTS: The prevalence of anti-HCV(+) was significantly higher in CAPD patients (16.7%) than in normal controls (4.9%), while that of HBsAg(+) was similar in both groups. CAPD patients had significantly lower levels of serum aminotransferases compared to normal controls. Mean AST were 23.8 IU/l in normal control and 18.8 IU/l in the CAPD patients (P < 0.001). Mean ALT were 21.9 IU/l in normal controls and 15.3 IU/l in the CAPD patients (P < 0.001). CAPD patients with HCV infection had higher serum AST and ALT levels than those without. However, HBV infection did not cause significant serum aminotransferase elevation in patients. The conventional cutoff values of AST (40 IU/l) and ALT (40 IU/l) for detecting viral hepatitis yielded only a sensitivity of 27.3 and 18.2% respectively; on the contrary, our revised cutoff values of AST (24 IU/l) and ALT (17 IU/l) had better sensitivities (AST, 72.7%; ALT, 63.6%). For serial aminotransferase values, the sensitivity of AST and ALT for detecting HCV were 36.4 and 27.3% by conventional criteria, and were both 81.8%, by our newly revised criteria. CONCLUSIONS: Serum aminotransferase cutoff values should be modified for screening viral hepatitis in a CAPD population. Our new cutoff criteria had important clinical implications in providing benefits of earlier detection and possible prevention from chronic hepatic deteriorations.     

Coronary bypass in vascular patients: a relatively high-risk procedure

A premise of cardiac risk stratification is that the added risk of coronary artery bypass grafting (CABG) is offset by the improved safety of subsequent vascular reconstruction (VR). We questioned if elective CABG is patients with severe peripheral vascular disease (PVD) is a relatively high-risk procedure. A cohort study of 680 elective CABG patients from January 1993 to December 1994 was performed using three mutually exclusive outcomes of complication-free survival, morbidity, and mortality. Patient characteristic, operative, and outcome data were prospectively collected. Retrospective review determined that 58 patients had either a standard indication for or a history of VR. Overall CABG mortality was 2.5%, with statistically similar but relatively higher rates for PVD as compared to non-PVD patients. In contrast, major morbidity occurred at rates 3.6-fold higher in PVD patients (39.7%) than in disease-free patients (16.7%) after adjustment for the effects of patient and operative variables (odds ratio [OR] 3.67, 95% confidence interval [CI] 1.93-6.99). CABG morbidity in the PVD patient was most likely in those patients with aortoiliac (OR 9.51, CI 3.20-28.27) and aortic aneurysmal (OR 5.24, CI 1.28-21.41) disease types. CABG in PVD patients is associated with significant major morbidity. Such morbidity may preclude or alter the timing of subsequent VR.     

Statistical synchronization among participants in real-time multimedia conferencing

In this paper, an algorithm to determine the set of packets generated continuously and periodically from different participants that are arriving at a node either for mixing at the master of a conference, or for simply playing back at a regular participant of a conference, is proposed. The essence of the algorithm is to estimate the expected packet arrival time (or reference time) for each participant. With the reference time at hand, the maximum jitter and the optimum waiting time for a mixer to wait packets from all participants can be determined. An enhancement to improve synchronization which deals with the estimation of the time offsets between the individual periods of the sources and the period of the receiver is also presented. The error of the proposed algorithm is enumerated by the Chernoff bound and demonstrated by simulation and is shown to be acceptable in practical application. The algorithm can also be employed when traffic sources operate with different periods.     

隧道挖掘中采用补偿灌浆的实例

在英国伦敦多克兰斯轻便铁路刘易舍姆延长线（DLR－LWE）双隧道掘进工程中，在敏感建筑物下进行了补偿灌浆，以防止隧道开挖引起的过度沉降。但是，过度灌浆也会对隧道下部施加超越。介绍了由隧道掘进承包商所编辑的关于地面和建筑物沉降以及由补偿灌浆引起的隧道衬砌变形的详细现场监测数据。     

Principle and applications of retroreflective vision sensing for discrete part-presentation

For flexible manufacturing of short production runs where a large variety of product sizes, component types, and surface reflectance characteristics are encountered, it is desirable to build flexible computer-controlled systems for feeding parts into machine tools or assembly processes that combine maximum flexibility and reliability with minimum cost and cycle-time. This is not a general bin-picking problem; the parts are assumed to be propositioned approximately in totes/pallets/kits with regularly spaced locations. This article presents a machine vision technique based on the principle of retroreflective vision sensing for part-presentation. Since retroreflective material has a distinctive surface reflectance that is not commonly found in natural or man-made objects, the use of retroreflective surfaces enables reliable high object-to-background contrast images to be obtained for a wide variety of objects. Unlike conventional machine vision techniques, which rely on the variance of the surface reflectance of the objects to generate detailed images, retroreflective vision sensing aims at generating a reliable two-dimensional digital object silhouettes so that the location and orientation of the part can be reliably determined. Two application examples, machine loading and assembly, are illustrated.