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.     

Area- and time-specific marginal capacity costs of electricity distribution

Marginal costs of electricity vary by time and location. In the past, researchers attributed the variations to factors related to electricity generation and transmission. These authors, however, have not analyzed possible variations in marginal distribution capacity costs (MDCC). The objectives of this paper are:

1. (i) to show that large MDCC variations are due to the dispersion in distribution capital expenditures by time and space,

2. (ii) to propose a method for quantifying the area- and time-specific MDCC in the presence of lumpy investments, and

3. (iii) to compare our MDCC estimates to those commonly used in the electric utility industry.

Our proposed method and its results were adopted by the California Public Utilities Commission (CPUC) in 1992 for Pacific Gas and Electric Company (PG&E), the largest privately owned electric utility in the U.S.     

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。     

Evaluation of Monkman-Grant parameters for type 316LN and modified 9Cr-Mo stainless steels

The Monkman-Grant (M-G) and its modified parameters were evaluated for type 316LN and modified 9Cr-Mo stainless steels prepared with minor element variations. Several sets of creep data for the two alloy systems were obtained by constant-load creep tests in 550-650°C temperature range. The M-G parameters,m, m’,C, andC’ were proposed and discussed for the two alloy systems. Them value of the M-G relation was 0.90 in type 316LN steel and 0.84 in modified 9Cr-Mo steel. Them’, value of the modified relation was 0.94 in type 316LN steel and 0.89 in 9Cr-Mo steel. Although creep fracture modes and creep properties between type 316LN and modified 9Cr-Mo steels showed a basic difference, the M-G and its modified relations demonstrated linearity quite well. Them’ of modified relation almost overlapped regardless of the creep testing conditions and chemical variations in the two alloy systems, and the parameterm’ was closer to unity than that of the M-G relation.     

Effect of Wall Surface Properties at Different Drying Kinetics on the Deposition Problem in Spray Drying

Current methods in alleviating the wall deposition problem in spray drying emphasize mainly controlling the stickiness of the drying particles and less attention is placed on the properties of the dryer wall. In this experimental study, the effect of wall surface properties on the deposition mechanism has been investigated. Properties considered in classifying different wall materials were surface energy, roughness, and dielectric properties. The model solution contained sucrose, representing low-molecular-weight sugars commonly encountered in spray drying of fruit and vegetable juices. The effect of wall properties on deposition was explored at different drying rates producing particles of different surface rigidity. Larger surface roughness produced higher deposition fluxes for particles with high impact velocity and moisture. Surface energy and surface roughness were found to have no significant effect for dry rigid particles at the middle and bottom elevation of the drying chamber. However, material with lower surface energy (Teflon) exhibited less deposition for rubbery particles at such elevations. Analysis shows that dielectric wall material (Teflon) tends to enhance deposition of dry particles because of attrition at the surface. Higher wall temperature was found to produce slightly more deposition. The results of this work give a general indication of the effect of wall material on the deposition problem and provide the fundamental understanding for further studies along this line. Proper selection of dryer wall material will provide potential alternatives for reducing the deposition problem.     

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.     

The effect of transfusion on cardiac function in patients with chronic anemia

BACKGROUND: The deteriorating cardiac function of patients with chronic anemia may be improved with transfusion. The effect of transfusion on cardiac function was evaluated in patients with chronic anemia. STUDY DESIGN AND METHODS: In a prospective study, ejection fraction (EF) was determined before and after transfusion in 41 patients with chronic anemia. The results were compared and analyzed. RESULTS: The volume of red cells transfused and the levels of pretransfusion hemoglobin, hematocrit, and red cell, white cell, and platelet counts did not affect the posttransfusion EF, whereas the pretransfusion EF of the right or left ventricle inversely affected the posttransfusion change in EF in the respective ventricle (p < 0.001 and r = -0.5022; p = 0.01 and -0.3917, respectively). There was no significant difference in the change in EF in the right and left ventricles. CONCLUSION: Transfusion produced little immediate effect on cardiac function, but did change the EF to an extent that aided cardiac function in chronic anemia patients. The pretransfusion EF itself, but not the degree of anemia or volume of red cells transfused, affected the posttransfusion change in EF.