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.     

Anti-D in a D-positive renal transplant patient

PURPOSE: We report a case of postoperative reparalysis in the recovery room, following nebulized epinephrine. The patient was pharmacologically reversed with edrophonium after paralysis with rocuronium. CLINICAL FINDINGS: A 12-yr-old girl developed postoperative reparalysis following the intraoperative administration of rocuronium. A total of 0.92 mg.kg-1 rocuronium was administered. After surgery, pharmacological reversal was achieved with 20 mg edrophonium with 0.15 mg atropine sulfate iv 35 min after the last administration of rocuronium. Muscular relaxation was monitored using an ulnar peripheral nerve stimulator (PNS). After reversal, a full train-of-four and sustained tetanus at 50 Hz were present. In the recovery room, following nebulized epinephrine, the patient became apneic. The patient was paralyzed and an ulnar PNS demonstrated only one faint twitch. The paralysis was reversed with 1.5 mg neostigmine with 0.3 mg glycopyrrolate. CONCLUSION: Postoperative reparalysis following rocuronium may be a cause of postoperative respiratory distress. The definitive diagnosis is made using PNS and observing the response to pharmacological reversal. Nebulized epinephrine may have a previously undescribed role in the development of postoperative reparalysis.     

Fixed-order H∞ compensator design

A method is presented for the construction of fixed-order compensators to provide H_∞ norm constraint for linear control systems with exogenous disturbances. The method is based on the celebrated bounded-real lemma that predicates the H_∞ norm constraint via a Riccati inequality. The synthesis of fixed-order controllers whose dimensions are less than the order of a given plant, is demonstrated by a set of sufficient conditions along with a numerical algorithm.     

点阴极电场辅助阳极连接中的紧密接触面积和电流

用等效电路的方法研究了点阴极情况下的电场辅助阳极连接效应，计算了连接电流，连接孕育期和紧密接触面积，本文结果表明，连接初期电流迅速衰减，随后缓慢变小，直至某一稳定值，孕育期随温度上升指数下降，连接温度高时，孕育期将难以观察到；待连接表面之间紧密接触面积随时间延长而非线性扩展，紧密接触区域增大时，其边界向外推进速度渐小，而接触面积增加渐快。     

Sheldon H. White (1928-2005).

Sheldon "Shep" Harold White, one of developmental psychology's most distinguished scholars, died on March 17, 2005, at the age of 76. He is perhaps best remembered for his sharp intellect, generous spirit, good humor, and warm compassion. Shep's principal work lay in three intermeshed areas: children's learning and cognitive development, social programs and policies, and the history of developmental psychology. Shep White is sorely missed by his family and friends, and countless children have unknowingly benefited from his research, scholarship, and contributions to public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the determination of boundaries to manipulator workspaces

The accumulation of two independent, broadly applicable formulations for determining the boundary to manipulator workspaces, presented elsewhere, are compared in this paper. Insights gained from one method are used to explain behavior exhibited in the other. Results are also compared and validated. A numerical formulation based on continuation methods is used to map curves that are on the boundary of a manipulator workspace. Analytical criteria based on row rank deficiency criteria of the manipulator's analytical Jacobian are used to map a family of one-dimensional solution curves on the boundary. The other formulation, based on a similar rank-deficiency criteria, yields analytic boundaries parametrized in terms of surface patches on the boundary. Results concerning the applicability of the numerical method to open- and closed-loop systems are compared with those limited to the open-loop for the analytical method. Conclusions regarding the behavior of the manipulator on geometric entities characterized by singular curves, higher-order bifurcation points, and surfaces inside the workspace are drawn. Applicability of both methods and their limitations are also addressed.     

Mechanism of human immunodeficiency virus type 1 localization in CD4-negative thymocytes: differentiation from a CD4-positive precursor allows productive infection

Human immunodeficiency virus (HIV) infection of the thymus could have profound effects on development of the immune response, particularly in children. We and others have established that in addition to infecting and depleting CD4-bearing thymocytes, functional HIV proviruses are found in thymocytes lacking surface CD4 expression. Using in vitro thymocyte cultures, we show that neither HIV-mediated down regulation of CD4 nor CD4-independent infection contributes to the localization of HIV in cells lacking the primary virus receptor. Rather, infection of a CD4-positive precursor cell (CD4 positive/CD8 positive) with subsequent differentiation into a mature CD4-negative phenotype results in productively infected CD4-negative cells. This novel mechanism may contribute to pathogenesis by distributing viral sequences into functional subsets of T cells typically refractory to HIV infection and could account for the presence of viral DNA in CD8-positive lymphocytes recently observed in patients.     

Top-down logic design with pass-transistor cells and efficientsynthesiser

A pass-transistor based cell library containing only two types of cells is designed and a corresponding logic/circuit synthesiser developed for logic mapping of any combinational circuit. The proposed design has better performance than the recently proposed lean integration with pass transistors (LEAP) cell library. Furthermore, the modified LEAP cell library can be easily migrated to a new process technology due to the smaller number of cells