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.     

Dynamic endocrine testing. The Mayo Clinic model

An endocrine testing center (ETC) is a universal requirement for the practice of endocrinology. Modifications of the Mayo Clinic model for an ETC should be applicable to most endocrine practices. Key components of an ETC include a centralized testing area, registered nurse-physician team, detailed testing protocols, and patient education programs.     

Gonadal steroids have paradoxical effects on brain oxytocin receptors

Specific brain receptors for oxytocin have been described in several mammalian species. The distribution of these receptors differs greatly across species and in the rat, receptor binding in specific brain regions appears to depend upon gonadal steroids. This study used in vitro receptor autoradiography to examine the effects of testosterone on oxytocin receptor binding in the mouse forebrain. Three groups of male mice were compared: castrates treated with blank capsules, castrates treated with testosterone filled capsules, and intact males. Irrespective of steroid treatment, the distribution of oxytocin receptors in mouse forebrain differed markedly from patterns previously described in the rat. In addition to these species differences in receptor distribution, testosterone had effects in the mouse which differed from the induction of receptors previously reported in the rat. In the mouse ventromedial nucleus of the hypothalamus, binding in the untreated castrate males was approximately double that observed in either the intact or the testosterone-treated castrates. In other regions of the mouse brain, such as the intermediate zone of the lateral septum, binding to oxytocin receptors was increased with testosterone treatment. These results suggest that the brain oxytocin receptor varies across species not only in its distribution but also in its regional regulation by gonadal steroids. These apparently paradoxical changes in oxytocin receptor binding may result from either direct or indirect effects of gonadal steroids in mouse brain.     

Measurements and correlation of effect of cosolvents on the solubilities of complex molecules in supercritical carbon dioxide

A new transparent microscale circulation-type high pressure equilibrium cell with on-line sampling was devised. With this apparatus, experimental solubility of molecularly complex species such as steroids (cholesterol, stigmasterol and ergosterol) and fatty acids (palmitic acid and stearic acid) in supercritical carbon dioxide(sc-C0₂) were measured. Also, to find an appropriate substance for enhancing both the polarity and the solubility power of the SC-CO₂ solvent, we arbitrarily selected three polar substances such as acetone, methanol and water and the effect of these cosolvents on the solubility of solutes in SC-CO₂ are examined. The supercritical phase equilibrium data of solute-cosolvent-sc-CO₂ systems were quantitatively correlated using a new equation of state based on the lattice fluid theory incorporated with the concept of multibody interaction. We found that the addition of tracer amount of acetone or methanol to SC-CO₂ enhances the solubility of all solutes about thirty to sixty times when compared with the case of pure sc-CO₂ However, for the case of cosolvent water, no further enhancement of the solubility of solutes was realized. Also, the versatile fittability of the equation of state proposed in this work was demonstrated with the newly measured ternary supercritical equilibrium data.     

A study of CaCO3 fouling with a microscopic imaging technique

The present study introduces a new experimental method to visualize the fouling process of CaCO₃. A mini-channel heat exchanger system with a microscopic imaging technique was developed for real-time visualization of the fouling process. The present study discussed how scale started initially, how scale formed thick layers, and how a small crystal grew into a large one, touching the adjacent one. Detail microscopic images of scale crystals and corresponding fouling resistances were obtained over the entire fouling process. The microscopic observation indicated that the fouling process could be divided into three stages: an induction period, a period of uniform generation of nuclei, and a period of uniform growth of scale. Sudden appearance of numerous small nuclei indicated the end of the induction period, a key event before the rapid increase in the fouling resistance. The present experimental method using microscopic images of the wet fouling process provides a valuable insight on the fouling mechanism.     

Effect of microporosity on tensile properties of as-cast AZ91D magnesium alloy

In the present study, the effect of microporosity on the tensile properties of as-cast AZ91D magnesium alloy was investigated through experimental observation and numerical prediction. The test specimens were fabricated by die-casting and gravity-casting. For gravity-casting, the inoculation and use of various metallic moulds were applied to obtain a wide range of microporosity. The deficiency of the interdendritic feeding of the liquid phase acted as a dominant mechanism on the formation of the micropores in the Mg?Al-alloys, rather than the evolution of hydrogen gas. Although tensile strength and elongation has a nonlinear and very intensive dependence upon microporosity, the yield strength appeared to have a linear relationship with microporosity. However, it was possible to quantitatively estimate the linear contribution of microporosity on the individual tensile property for a range of microporosity, which was below about 1%. The numerical prediction suggests that the effect of microporosity on fractured strength and elongation decreased as the strain hardening exponent increased. Furthermore, the shape and distribution of micropores may play a more dominant role than local plastic deformation on the tensile behavior of AZ91D alloy.     

Nondestructive evaluation of the characteristics of degraded materials using backward radiated ultrasound

The frequency dependency of Rayleigh surface wave is investigated indirectly by measuring the angular dependency of the backward radiation of the incident ultrasonic wave in two kinds of degraded specimens by scuffing or corrosion. Then, the frequency dependency is compared with the residual stress distribution or the corrosion-fatigue characteristics for the scuffed or corroded specimens, respectively. The width of the backward radiation profile increases with the increase of the variation in residual stress distribution for the scuffed specimens. In the corroded specimens, the profile width decreases with the increase of the effective aging layer thickness and is inversely proportional to the exponent, m, in the Paris’ law that can predict the crack size increase due to fatigue. The result observed in this study demonstrates high potential of backward radiated ultrasound as a tool for nondestructive evaluation of subsurface gradient of material degradation generated by scuffing or corrosion.     

Poly(butylene terephthalate)–clay nanocomposites prepared by melt intercalation: morphology and thermomechanical properties

Nanocomposites based on poly(butylene terephthalate) (PBT) and an organoclay (Cloisite 30B) were prepared by melt blending using a twin‐screw extruder. Two kinds of PBTs, ie PBT‐A and PBT‐B, with different inherent viscosities (η_inh), were used for this study (η_inh of PBT‐A and PBT‐B were 0.74 and 1.48, respectively). Dispersion of the clay layers in the PBT nanocomposites was characterized by using X‐ray diffraction (XRD) and transmission electron microscopy (TEM). Tensile and dynamic mechanical properties and non‐isothermal crystallization temperatures of the nanocomposites were also examined. Nanocomposites based on the higher‐viscosity PBT (PBT‐B) showed a higher degree of exfoliation of the clay and a higher reinforcing effect when compared to the composites based on the lower‐viscosity PBT (PBT‐A). The clay nanolayers dispersed in PBT matrices lead to increases in the non‐isothermal crystallization temperatures of the PBTs, with such increases being more significant for the PBT‐B nanocomposites than for the PBT‐A nanoocomposites. Copyright © 2004 Society of Chemical Industry