Risk factors and clinical significance of bacteremia caused by Pseudomonas aeruginosa resistant only to carbapenems

Background/purposeCarbapenem-resistant Pseudomonas aeruginosa infections have been a challenge and issue in hospital settings. However, the clinical impact of P. aeruginosa blood isolates resistant only to carbapenems has never been discussed previously.MethodsTo assess the risk factors and clinical significance of bacteremia caused by carbapenem resistance only P. aeruginosa (CROPA), a 6-year retrospective case–control study was conducted. The CROPA strains were defined as isolates susceptible to ciprofloxacin, antipseudomonal penicillins and cephalosporins, and aminoglycosides but resistant to one antipseudomonal carbapenem (imipenem or meropenem) or both. The controls were selected among patients with bacteremia due to P. aeruginosa susceptible to all above classes of antipseudomonal antibiotics, which was defined as all-susceptible P. aeruginosa.ResultsTwenty-five patients had at least one blood culture positive for CROPA, and 50 controls had all-susceptible P. aeruginosa bacteremia. CROPA bacteremia had a high 30-day mortality rate (72.0%), as compared to 26.0% for the controls (p < 0.001). Through multivariate analysis, carbapenem exposure was the only risk factor for developing CROPA bacteremia (p = 0.002). A comparison between the surviving and deceased patients with CROPA bacteremia showed that nine (50%) of those who died, but none of the survivors, received carbapenems as the initial empirical therapy (p = 0.027).ConclusionCarbapenem exposure was associated with emergence of CROPA infections. Repeated carbapenem use in such patients might increase rates of inappropriate initial empirical treatment and mortality. Prudent carbapenem use is important to reduce the emergence of CROPA

Alterations in IL-6, IL-8, GM-CSF. TNF-α, and IFN-γ Release by Peripheral Mononuclear Cells in Patients with Active Vitiligo

The purpose of this study was to clarify the relationship between the cellular and humoral immune components in the pathogenesis of vitiligo vulgaris. By using cytokines as indicators of peripheral mononuclear cell (MNC) function, we compared the effects of phytohemagglutinin (PHA) and purified IgG on MNCs derived from patients suffering from active vitiligo with those from normal controls. The results revealed (i) a significant increase in spontaneous production of 11-6 and IL-8 in patients; (ii) PHA, purified IgG from patients (IgG-anti-MC), or IgG from normal controls (N-IgG) induced a significant increase in IL-6 but diminished GM-CSF, TNF-α, and IFN-γ release in patients; and (iii) IgG-anti-MC brought about a significantly higher stimulatory effect on IL-1β and IFN-γ production than N-IgG in normal controls. Immunologically, IL-6 can enhance melanocyte ICAM-1 expression, which may increase leukocyte-melanocyte attachment and cause melanocyte damage in vitiligo. A decrease in GM-CSF (an intrinsic growth factor for melanocyte) production may retard recovery from vitiligo by checking the proliferation of surviving melanocytes. A significant decrease in TNF-α and IFN-γ production may partially explain the reduced inflammatory reaction in vitiliginous lesions. That IgG-anti-MC stimulates an increase in IL-1β and IFN-γ production in controls suggests that IgG-anti-MC may play a role in melanocyte destruction mediated by monocytes

The intrinsic parameter fluctuation on high-j/metal gate bulk FinFET devices

a b s t r a c t In this work, based on the experimentally calibrated 3D device simulation, we for the first time estimate the impact of intrinsic parameter fluctuation on the electrical characteristic of 16-nm-gate TiN/HfO 2 bulk FinFETs. The sources of intrinsic parameter fluctuation include the random discrete dopants, interface traps and work function differences, simultaneously. The full 3D simulated threshold voltage fluctuation, induced by the aforementioned random sources simultaneously, is 26.2 mV for the N-type bulk FinFET (and is 55.5 mV for the planar N-MOSFET). For the N-type bulk FinFET, the statistical sum of these fluctuations is 9.5% (and is 12.3% for the planar device) overestimation, compared with the full 3D simulation. One of the main reasons is the independence assumption on these random variables is destroyed owing to interactions to different extents among RDs, ITs and WKs. The coupled surface potentials cannot be simply estimated by using their statistical sum of individual random source. Under the same threshold voltage, compared with the result of the planar MOSFETs, more than 50% reduction on the threshold voltage fluctuation of the explored bulk FinFETs is observed owing to the benefit of 3D structural nature

A User-Centered Mapping Design for Geomorphological Hazard Thematic Map

Numerous studies have concentrated on developing user-centered designs for hazard zone maps but rarely for hazard-oriented geomorphological maps, named as Geomorphological Hazard Thematic Maps (GHTMs) in this study, which provide more detailed information about natural hazards. This study developed a user-centered mapping design for GHTMs for nonexperts in geomorphology. We invited civil engineers and high school educators to evaluate a sample GHTM\u27s design in group and focus group panel interviews. The civil engineers preferred maps with more geomorphological features, whereas the educators preferred simple designs. Both groups indicated that the inclusion of essential facilities and road networks is essential. The map was also adjusted by adding hillshade layer and by changing the symbology for mass wasting, fault scarps, and fluvial features to increase clarity and simplicity. This case study is the first step toward developing user-centered mapping designs for hazard communication that will deepen their understanding of natural hazards

Discovery of New Eunicellins from an Indonesian Octocoral Cladiella sp.

Two new 11-hydroxyeunicellin diterpenoids, cladieunicellin F (1) and (–)-solenopodin C (2), were isolated from an Indonesian octocoral Cladiella sp. The structures of eunicellins 1 and 2 were established by spectroscopic methods, and eunicellin 2 was found to be an enantiomer of the known eunicellin solenopodin C (3). Eunicellin 2 displayed inhibitory effects on the generation of superoxide anion and the release of elastase by human neutrophils. The previously reported structures of two eunicellin-based compounds, cladielloides A and B, are corrected in this study