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.     

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。     

Phase transition of LCP fluids confined in nanochannels through MD simulation

Manipulation of molecular orientation alignment in MCTLCPs (main-chain thermotropic liquid crystalline polymers) by pure shear at nano scale has been investigated for the first time using molecular dynamics (MD) simulation. Results indicate that high planar shear induces long-range uniform orientation ordering (liquid crystalline phase) of initially randomly orientated molecules of MCTLCP fluid confined in a nanochannel, which is confirmed by analyzing the orientation order parameter and the snapshots of MCTLCP liquid in a nanochannel under different shear rates. Insights into the origin of the phase transition phenomena are given at molecular level through investigating the thermodynamic density distribution of MCTLCP molecules in the nanochannel, suggesting that the energy shift due to a radical jump of system density affects both the magnitude and the orientation of the molecular ordering. Simulation results also show that there is a critical shear rate for transforming isotropic phase into liquid crystalline phase. The critical shear rate is dependent on the temperature of the MCTLCP system. Findings in this paper may present useful information for processing TLCP molecules at nano scale and the understanding of nanoflow.     

Traveling-wave piezoelectric linear motor Part I: the stator design.

A new type of piezoelectric linear motor incorporating a traveling wave has been developed. The linear motor is comprised of a stator and a carriage. The stator design, which consists of a meander-line structure and gear teeth mounted on the meander-line structure, is the focus of this article. The meander-line structure is constructed with bimorph actuators arranged in a line. These actuators are driven by two phased sets of alternating current (ac) in order to generate a traveling wave. The traveling wave is transferred to the gear teeth, by which the carriage is driven. Modeling of the stator is derived by use of a strain energy method. The performance of various materials is evaluated by analytical and experimental methods. The analytical and the experimental results are quite approximate. Modal analysis is investigated using ANSYS. Appropriate modes associated with ultrasonic levels of resonant frequency are selected to obtain desired motion and to enhance the output performance. Surface speed for various applied input voltage are studied and indicate a nearly linear relationship. The stator in combination with the carriage makes up the linear motor.     

FluNet: A hybrid internet simulator for fast queue regimes

Motivated by the scale and complexity of simulating large-scale networks, recent research has focused on hybrid fluid/packet simulators, where fluid models are combined with packet models in order to reduce simulation complexity as well as to track dynamics of end-sources accurately. However, these simulators still need to track the queuing dynamics of network routers, leading to considerable simulation complexity in a large-scale network model. In this paper, we propose a new hybrid simulator – FluNet – where queueing dynamics are not tracked, but instead, an equivalent rate-based model is used. The FluNet simulator is predicated on a fast-queueing regime at bottleneck routers, where the queue length fluctuates on a faster time-scale than end systems. This allows us to simulate large-scale systems, where the simulation “time step-size” is governed only by the time-scale of the end-systems, and not by that of the intermediate routers; whereas a queue-tracking based fluid simulator would require decreasingly smaller step-sizes as the system scale size increases. We validate our model using a ns-2 based implementation. Our results indicate a good match between packet systems and the associated FluNet system.     

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.