Failure to cure Mycobacterium gordonae peritonitis associated with continuous ambulatory peritoneal dialysis

Nontuberculous mycobacteria are increasingly recognized as important pathogens in peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). Mycobacterium gordonae rarely causes human infection and is the least likely mycobacterium to produce clinical infection in CAPD patients. We describe a patient with persistent M. gordonae peritonitis acquired while undergoing CAPD. During 18 months of treatment, clinical improvement occurred but a microbiological cure could not be achieved. Principles of therapy for mycobacterial peritonitis developing during CAPD are reviewed, and potential explanations for our patient's failure to respond to therapy are discussed.     

Four-channel polarization-insensitive optically transparent wavelength converter

Multichannel wavelength converters may be important components in the cross-connects in future wavelength-division multiplexed (WDM) transport networks. We demonstrate a multichannel, polarization-insensitive, optically transparent wavelength converter, based on four-wave mixing in two semiconductor optical amplifiers in a polarization-diversity arrangement. Bit-error-rate (BER) measurements with four input 2.5-Gb/s WDM channels, spaced by 2 nm, show penalties for wavelength conversion less than 2.6 dB at 10/sup -9/ BER. Changes in the state of polarization of the input signals cause the output power to change by less than 1.2 dB, and the corresponding power penalties change by less than 0.9 dB.     

Infections in patients with cystic fibrosis following lung transplantation

BACKGROUND: There is controversy over whether colonization with drug-resistant organisms is a contraindication to lung transplantation. METHODS: We undertook a retrospective review of the results of lung transplantation for patients with cystic fibrosis (CF) at Duke University Medical Center. RESULTS: As of May 1996, 21 patients with CF underwent bilateral lung transplantation. The first patient died within 24 h of transplantation from sepsis due to Stenotrophomonas maltophilia. Of the remaining 20 patients, 17 (85%) are alive and in stable condition. The three deaths were related primarily to bronchiolitis obliterans at 4 and 18 months in two patients and to cytomegalovirus pneumonitis at 5 months in the other patient. The 17 surviving patients have been followed up for a mean of 13 months (range, 0.5 to 34 months). Most of them were colonized and infected with multidrug-resistant organisms before transplantation. Following transplantation, 11 patients had complications from infections. One patient had bacteremia due to a panresistant Burkholderia cepacia and was treated successfully. Two patients had bacteremia and wound infection due to Burkholderia gladioli, previously thought to be pathogenic only in plants. Both patients were treated successfully. Of the six patients with Aspergillus fumigatus isolated from cultures before transplantation, only one had invasive disease following transplantation and responded to treatment. CONCLUSION: The organisms present before transplantation were not the primary cause of mortality in our patient population. Our findings suggest that lung transplantation should be considered in CF patients infected with multidrug-resistant organisms.     

Phase I study of mitoxantrone plus etoposide with multidrug blockade by SDZ PSC-833 in relapsed or refractory acute myelogenous leukemia

PURPOSE: Expression of the multidrug resistance gene (MDR1) p170 protein is frequent in leukemic blasts from patients with relapsed acute myelogenous leukemia (AML). A phase I study using the nonimmunosuppressive MDR1 blocker SDZ PSC-833 (PSC) in combination with mitoxantrone (MITO) and etoposide (VP) was performed. PATIENTS AND METHODS: Starting doses (LVL0) of MITO (3.25 mg/m2/d on days 1 and 3 to 6) and VP (210 mg/m2/d on days 1 and 3 to 5) were 40% of the maximal-tolerated dose (MTD) from a prior study. A 1.5-mg/kg loading dose of PSC was followed by a 120-hour continuous infusion of 10 mg/kg/d on days 2 to 6. Blood samples for PSC, MITO, and VP pharmacokinetics (PK) were taken on days 1 and 3, and samples for MDR1 expression were taken on day 0. RESULTS: Severe mucositis developed in all patients at LVL0; therefore, MITO and VP doses were reduced to 2.5 and 170 mg/m2 (LVL-1) for the next seven patients, and this dose proved to be MTD. All LVL0 and three LVL-1 patients had transient elevations in the serum bilirubin level to > or = 4 mg/dL. Serum creatinine level increased to greater than 2 mg/dL in one case. There were no other grade 3 or 4 nonhematologic toxicities observed. The peripheral blood was cleared of leukemia in three LVL0 and four LVL-1 patients. The marrow was cleared of leukemic cells in one LVL0 and five LVL-1 patients, and a significant reduction in marrow leukemic infiltrate was observed in eight of 10. No patient achieved complete remission (CR), and all died of progressive disease (n = 8) or infection (n = 2). MDR1 expression was detected by fluorescent-activated cell sorter (FACS) analysis in five of seven cases. An elevated MDR1 mRNA level was detected by quantitative polymerase chain reaction (Q-PCR) in six of eight cases studied. Clearing of leukemia cells from the marrow occurred in four of six MDR1-positive and one of three MDR1-negative patients. Despite the fact that LVL0 doses had to be reduced due to toxicity, coadministration of PSC did not produce a consistent effect on MITO PK; however, it did repeatedly lead to increased levels of VP in the serum. CONCLUSION: We conclude that PSC-MITO-VP is a tolerable regimen with antileukemic activity. Addition of PSC necessitated a 66% reduction in MITO and VP doses from a prior study without PSC.     

Delay discounting of real and hypothetical rewards.

The degree to which real and hypothetical rewards were discounted across delays ranging from 6 hr to 1 year was explored in a within-subjects design. An adjusting-amounts procedure was used to estimate the subjective value of real and hypothetical rewards at each delay. A hyperbolic discounting function provided a significantly better fit to individual participants' preferences than did an exponential function. No significant effect of reward type on degree of hyperbolic discounting or area under the discounting curves was detected. These findings offer some support for the validity of using hypothetical rewards to estimate discounting rates in substance-abusing and other populations, but caution is suggested because this support is gleaned from a failure to detect an effect of reward type. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spray forming technology for military applications

Over the past five years, the Annapolis Detachment, Carderock Division, Naval Surface Warfare Center (formerly David Taylor Research Center) has established a state- of- the- art spray forming facility for the study and exploitation of this near net shape manufacturing process. Spray forming is a single step gas atomization/deposition process which yields ferrous and nonferrous, near final shape, near fully dense preforms that has proven to be a viable and cost effective alternative to conventional metalworking technology for the production of material preforms with properties surpassing those of their cast and wrought counterparts. Current programs at Carderock Divison Naval Surface Warfare Center are aimed at optimization of the process, certification of the spray formed products and industrialization of the technology.     

Age-related slowing and the time course of semantic priming in visual word identification.

Investigated, in 4 experiments, the time course of semantic priming effects during 2 forms of visual word identification, lexical decision and pronunciation. On each trial, a target letter string was preceded by a single-word priming context. The effects of varying the stimulus onset asynchrony between the prime and the target indicated that the time course of semantic priming was equivalent for young and older adults. There were no consistent differences between lexical decision and pronunciation in the time course of semantic priming. The age differences associated with response selection were greater than would be predicted by generalized age-related slowing. The semantic priming effects were also inconsistent with a generalized slowing model, but the reliability of these effects was substantially lower than the reliability of the other task-related variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intraocular concentrations of chemotherapeutic agents after systemic or local administration

OBJECTIVES: To investigate the concentrations of carboplatin and etoposide achieved in the aqueous and vitreous humors after intravenous infusion in nonhuman primates, and to investigate whether local administration of carboplatin might result in higher concentrations in the vitreous humor. METHODS: Macaca fascicularis primates were treated with 1 of 3 regimens: (1) intravenous carboplatin (18.7 mg/kg), etoposide (5 mg/kg), and vincristine sulfate (0.05 mg/kg), (2) peribulbar carboplatin (10 mg/mL), or (3) episcleral balloon carboplatin (10 mg/mL). Concentrations of chemotherapeutic agents were measured in the plasma and in the aqueous and vitreous humors. RESULTS: No measurable amount of etoposide was detected in the aqueous or vitreous humor after intravenous administration. Mean measured peak vitreous concentration of carboplatin after intravenous administration was 0.31 microg/mL, which was 1% of the peak plasma value. Mean measured peak vitreous concentrations of carboplatin after peribulbar or episcleral balloon administration were 2.38 microg/mL and 2.95 microg/mL, respectively, which represent 7.68- and 9.52-fold increases over the concentration achieved after intravenous administration. No serious toxic effect was observed in any animal. CONCLUSIONS: Peribulbar and episcleral balloon administration of carboplatin seemed to be safe and resulted in higher vitreous concentrations than intravenous administration in this model. These results suggest that these alternate routes of delivery should be explored in children with vitreous seeding of retinoblastoma.     

Fiber optic sensing technology for detecting gas hydrate formation and decomposition

A fiber optic-based distributed sensing system (DSS) has been integrated with a large volume (72 l) pressure vessel providing high spatial resolution, time-resolved, 3D measurement of hybrid temperature-strain (TS) values within experimental sediment-gas hydrate systems. Areas of gas hydrate formation (exothermic) and decomposition (endothermic) can be characterized through this proxy by time series analysis of discrete data points collected along the length of optical fibers placed within a sediment system. Data are visualized as an animation of TS values along the length of each fiber over time. Experiments conducted in the Seafloor Process Simulator at Oak Ridge National Laboratory clearly indicate hydrate formation and dissociation events at expected pressure-temperature conditions given the thermodynamics of the CH(4)-H(2)O system. The high spatial resolution achieved with fiber optic technology makes the DSS a useful tool for visualizing time-resolved formation and dissociation of gas hydrates in large-scale sediment experiments.     

Cartoons beyond clipart: A computer tool for storyboarding and storywriting

This paper describes the motivation, proposal, and early prototype testing of a computer tool for story visualisation. An analysis of current software for making various types of visual story is made; this identifies a gap between software which emphasises preset banks of artwork, and software which emphasises low-level construction and/or drawing. A proposal is made to fill this gap, and a prototype implementation of the proposal is described in the context of a school-based study with England and Wales’s Year 5, covering ages 9–10 years. Results from this prototype study both validate the novel proposal made and demonstrate that children are capable of manipulating characters and notional camera angles in a more complex way than most current software permits.