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.     

Intravaginal Controlled Administration of Flurogestone Acetate: (III) Development of Rate-Control Vaginal Devices

A Rate-Control vaginal device was developed which overcomes the low bioavailability and unpredictable Q - t^1/2 type release and absorption rate profiles of flurogestone acetate delivered by the currently marketed Syncro-Mate pessary.

The in vitro release and vaginal absorption profiles from the Rate-Control vaginal device were run simultaneously, a linear Q - t relationship was obtained with a significant improvement in bioavailability. A mathematical model was developed to correlate the in vitro drug release and the vaginal absorption profiles of flurogestone acetate from the vaginal devices.

The design, development and the simultaneous release and absorption profiles of flurogestone acetate from this new vaginal device were outlined and discussed.     

Task Planning For A Mobile Robot In An Indoor Environment Using Object-oriented Domain Information

For a mobile robot to be practical, it needs to navigate in dynamically changing environments and manipulate objects in the environment with operating ease. The main challenges to satisfying these requirements in mobile robot research include the collection of robot environment information, storage and organization of this information, and fast task planning based on available information. Conventional approaches to these problems are far from satisfactory due to their requirement of high computation time. In this paper, we specifically address the problems of storage and organization of the environment information and fast task planning in the area of robotic research. We propose an special object-oriented data model (OODM) for information storage and management in order to solve the first problem. This model explicitly represents domain knowledge and abstracts a global perspective about the robot's dynamically changing environment. To solve the second problem, we introduce a fast task planning algorithm that fully uses domain knowledge related to robot applications and to the given environment. Our OODM based task planning method presents a general frame work and representation, into which domain specific information, domain decomposition methods and specific path planners can be tailored for different task planning problems. This method unifies and integrates the salient features from various areas such as database, artificial intelligence, and robot path planning, thus increasing the planning speed significantly     

Homogeneity of fruits and vegetables comminuted in a vertical cutter mixer

The homogeneity of comminuted composites of 20 lb samples of apples, cabbage, and green beans containing field-incurred residues of p, p'-methoxychlor was studied to determine whether a 5 min comminution in a 40 qt vertical cutter mixer produces a homogeneous composite and whether the size of test portions used accurately represents the composite. Duplicate test portions of 100, 50, 25, 10, 5, and 2 g taken from each of 6 separate sections of the mixer were analyzed by standard pesticide residue methodology for p, p'-methoxychlor. Results of this study confirmed that comminution of fresh produce in a 40 qt vertical cutter mixer, according to instructions described in the U.S. Food and Drug Administration's Pesticide Analytical Manual, Volume I, Section 203B, produces a homogeneous composite. No significant differences were found in the data for the 3 crops taken from the 6 sections of the mixer. Test portion weights of 100, 50, and 25 g produced equivalent results for all 3 crops. Statistically significant differences were observed for cabbage at 2, 5, and 10 g and for green beans at 2 g.     

Development of Anticandidal Delivery Systems: (I) Anticandidal Activities of Antifungal Agents and Synergistic Combination with Other Drugs

Susceptibility testing with antifungal agents, e. g., minimum inhibitory concentration (MIC) determination, is performed to obtain reliable data that permit selection of the most suitable agents for treatment of an infective condition. To determine the drugs that provide maximum effectiveness against oral candidiasis, the MICs of various antifungal agents were determined. Also, synergism between two chosen antifungal agents was evaluated, and the effect of benzocaine, an anesthetic, and hydrocortisone, an antiinflammatory agent, on their MICs was examined. It was observed that among all the drugs tested, clotrimazole was the most promising candidate for use as an oral local antifungal. The combination of clotrimazole and chlorhexidine resulted in a decrease in the MIC. While the addition of hydrocortisone to this combination resulted in a slight increase in the MIC, the inclusion of benzocaine resulted in a substantial decrease in the MIC of the antifungal agent combination.     

Renal R2 chemoreceptor activity is attenuated after back heating in the rat

The aim of the present study was to determine the afferent connections of the nucleus accumbens in snakes, in particular its catecholaminergic input. For that purpose, in vitro and in vivo applications of retrograde tracers in the nucleus accumbens of Elaphe guttata were combined with tyrosine hydroxylase (TH) immunohistochemistry. Both techniques revealed telencephalic inputs to the nucleus accumbens originating from the diagonal band of Broca, ventral pallidum, amygdaloid complex, and dorsal cortex. Major diencephalic inputs arise from the dorsomedial thalamic nucleus and the hypothalamus. In the brainstem, a few retrogradely labeled cells were observed in the raphe nucleus and the locus coeruleus. Considerably more cells were found in the midbrain tegmentum. Within the confines of the locus coeruleus and, in particular, the midbrain tegmentum, retrogradely labeled cells stained also for TH suggesting that those areas constitute the major catecholaminergic input to the nucleus accumbens of snakes. The experimental approach used in the present study, in particular the in vitro technique, seems to be very suited for studying the development of basal ganglia organization of reptiles in the near future.     

The anabolic effects of parathyroid hormone on cortical bone mass, dimensions and strength--assessed in a sexually mature, ovariectomized rat model

We examined the effect of the pineal neurohormone melatonin (MLT) on protection from viral encephalitis. The antiviral activity of MLT was evaluated in normal mice inoculated with Semliki Forest virus (SFV) and in stressed mice injected with the attenuated non-invasive West Nile virus (WN-25). Administration of MLT (s.c.) daily from 3 days before through 10 days after virus inoculation reduced viremia and significantly postponed the onset of disease and death by 7 to 10 days. Moreover, MLT injection reduced mortality of SFV (10 PFU) inoculated mice from 100% to 44%. In mice inoculated with high dose of SFV (100 PFU), MLT postponed death and reduced mortality by 20%. In all of the surviving mice anti-SFV antibodies were detected 22 days after virus inoculation. Infection of mice stressed by either isolation or dexamethasone injection with WN-25 induced mortality of 75% and 50% respectively, which was reduced by MLT administration to 31% and 25%, respectively. The efficiency of MLT in protecting from lethal viral infections warrants further investigations on its mechanisms of action.     

Onset of gas self-induction and power consumption after gas induction in an agitated tank

The behavior of inducted gas from liquid surface and the; power requirements in an agitated tank using a mechanical agitator are studied in order to increase the amount of gas self-induction and the gas retention time for gas absorption. A 45° six-blade downward impeller turbine was utilized in this study. Air and water, air and 40 wt% 60 wt%, and 80 wt% of glycerin water, and air and 106 cP silicon oil were employed as gas and liquid phases. Variables which were studied included geometrical factors (immersed depth of impeller, baffle with and diameter of impeller) and the physical properties of the liquid (viscosity, density, and surface tension). The correlations for the onset speed of impeller and power consumption after gas induction in the agitated tank are established from our experimental results. The amount of gas self-induction from the liquid surface in the agitated tank increases with increasing impeller diameter and speed and decreases with increasing baffle width, depth of impeller and viscosity of liquid.     

Low density lipoprotein catabolism is enhanced by the cleaved form of alpha-1-antitrypsin

The frequent occurrence of hypocholesterolaemia following inflammatory processes is well known but unexplained. Elevated plasma levels of serine proteinase inhibitors (serpins) and their complexes with target enzymes have been demonstrated in inflammatory, malignant and infectious diseases which are also often accompanied by low plasma cholesterol levels. Under inflammatory conditions, uncomplexed, but cleaved inactive serpins arising from slow deacylation of the serpin-proteinase complex may be present in the circulation. To determine the influence of native and cleaved forms of serpins, such as alpha-1-antitrypsin (AAT), on lipoprotein metabolism, we investigated the effect of these forms on low density lipoprotein (LDL) catabolism in human HepG2 cell line. We have found that the cleaved form of AAT in concentrations from 125 to 2000 nmol l-1 stimulates LDL binding to the HepG2 cells, by up to 49% with a subsequent increase in LDL uptake and degradation of up to 79 and 65% respectively. Native AAT was also found to increase LDL binding and internalization by 20-25%, independently of the amount of AAT added, an effect most probably due to the cleaved form of AAT produced by local proteolysis of native AAT incubated in the cell culture. Moreover we have shown that the cleaved form of AAT interacts with LDL in vitro, and that such an interaction abolishes AAT ability to stimulate LDL binding and internalization. This study for the first time describes the ability of the cleaved form of AAT to stimulate LDL binding and internalization in HepG2 cell culture, and provides evidence that hypocholesterolaemia occurring during inflammatory processes may be mediated by cleaved forms of serpins.