Inhibition of X52 Corrosion in CO2-Saturated Brine by a Dialkyl-Diamide from Coffee Bagasse Oil.

This work reports the performance of a green corrosion inhibitor with double hydrocarbon chain. The evaluated inhibitor was a dialkyl-diamide from coffee bagasse oil and its electrochemical behavior was evaluated on an API-X52 steel in CO2-saturated brine at 60 °C. The electrochemical behavior was determined by measurements of open circuit potential, polarization resistance, and electrochemical impedance spectroscopy. In addition, the thermodynamic parameters of the corrosion process were obtained in the temperature range from 40 °C to 80 °C. Electrochemical studies showed that the inhibitor is capable of suppressing metal dissolution by up to 99% at 25 ppm. On the other hand, the thermodynamic parameters indicate that when adding the inhibitor, there is a strong increase in both Ea and ΔH° values, and that as time increases, they decrease until reaching similar values to those observed in the absence of the inhibitor. Furthermore, ΔS° values tend to become more negative with immersion time because of the formation of a stable film on the metal surface.

Current Needs Assessment for Using Lung Clearance Index for Asthma in Clinical Practice.

PURPOSE OF REVIEW: Asthma pathophysiology has shown that remodeling of the bronchial airways mainly affects the small rather than large airways. The severity of asthma is conventionally measured by forced expiratory volume 1 (FEV1) but this maneuver is insensitive to changes in distal airways with smaller diameter. The aim of this review is to evaluate the current evidence supporting LCI as a clinical tool for assessing small airways disease in asthma patients, as well as whether it is useful as a treatment response parameter in severe therapy-resistant asthma (STRA) patients. RECENT FINDINGS: There is an increasing need for novel tests that can assess distal airway disease in asthma. Lung Clearance Index (LCI) may be a useful test for assessing more severe airway obstruction and the persistence of small airway disease. LCI measurement has been shown to be more sensitive than spirometry in cystic fibrosis (CF), but its clinical utility in asthma has not been thoroughly investigated. LCI abnormalities may be a sensitive marker for the persistence of small distal airway disease and may be associated with a more severe asthma endotype unresponsive to inhaled glucocorticoids. There is a need to identify other lung function tests for asthma that can identify early airway remodeling while simultaneously measuring the rate of lung function impairment. When compared to other conventional methods, multiple-breath washout (MBW) measures the lung clearance index (LCI), a more sensitive predictor of early airway disease that is feasible to perform in children. The goal of this review is to evaluate the current evidence of LCI as a clinical tool in asthma patients.

Effect of PEG grafting density on surface properties of polyurethane substrata and the viability of osteoblast and fibroblast cells.

The surface of Tecoflex SG-80A Polyurethane (PU) films was modified by grafting polyethylene glycol (PEG) chains at three different molar amounts (0.05, 0.10, and 0.15 mmol). The resulting substrata were characterized by FTIR-ATR, TGA, AFM, SEM and contact angle to assess the surface modifications occurred during the grafting reactions. Osteoblasts and fibroblasts were cultured with PU extracts for 24 h, and their cell viability and morphology were evaluated by CellTiterBlue assay, Crystal Violet staining and Live/Dead assay. FTIR and TGA results indicated that PEG chains were successfully grafted onto PU surfaces, specifically in the hard segment of PU forming allophanate groups as the PEG grafting density increased. SEM and AFM images suggest that PU substrata were partially covered by PEG, increasing the dispersive and basic components of the PU surface energy. It was found that extracts from PEG-grafted polyurethanes increased the osteoblast viability, although fibroblasts viability remained constant regardless PEG grafting density; in spite of this both cells presented a more spread morphology at the lower PEG grafting density. Our results showed that surface energy of PU substrata can be tuned by PEG grafting density; also, the PEG leached tends to increase the pH of culture medium which leads to a higher viability of osteoblasts; nevertheless, PEG grafting density should be optimized to promote a healthy cell morphology as alterations in its morphology were detected at higher concentrations. Graphical abstract.

LIGHT-CURED CALCIUM SILICATE BASED-CEMENTS AS PULP THERAPEUTIC AGENTS: A META-ANALYSIS OF CLINICAL STUDIES.

OBJECTIVES: To determine the clinical performance of light-cured calcium silicate-based cement for direct or indirect pulp capping. The research question was as follows: in teeth with deep caries lesions, does the use of resin-modified calcium silicate-containing composites improve the radiological success and prevent irreversible pulpitis and pulpal necrosis compared with other pulp-capping agents? MATERIALS AND METHODS: The following databases were screened until September 2021: PubMed, Web of Science, Scielo, Scopus, Embase, and The Cochrane Library. Randomized clinical trials reporting the clinical evaluation of a resin-modified calcium silicate material as an agent for pulp therapy were included. Meta-analysis was performed using the Rev Manager v5.4.1 software. The risk difference and 95% confidence interval of the dichotomous outcome (restoration failure or success) were calculated for comparison. RESULTS: Ten studies were considered for qualitative analysis and meta-analysis. Studies evaluating the performance of light-cured calcium silicate-based cement from 1 month to a maximum follow-up period of 36 months and comparing it with the performance of CaOH, mineral trioxide aggregate, or Biodentine were included. In the global analysis for direct pulp capping at 6-month follow-up, no statistical differences were observed between the experimental group using the light-cured calcium silicate-based cement and control group (P = .28). However, at 12-month follow-up, global analysis favored the control group (P < .001). For indirect pulp capping, at 6- and 24-month follow-ups, no statistically significant differences were observed between the experimental and control groups (P = .88; P = .21). CONCLUSIONS: Light-cured calcium silicate-based cement showed a limited clinical performance as a direct pulp capping agent, especially when evaluated in the long term. However, using it as an indirect pulp capping agent may be a reliable and easy-to-use option for restoring teeth with deep caries. CLINICAL SIGNIFICANCE: This systematic review provides evidence that supports the use of light-cured calcium silicate-based cement as an indirect pulp capping agent.

A new set of equations for the simplified calibration of fluorescence Ca2+ transients in skeletal muscle fibers.

The classical approach for calibrating non-ratiometric fluorescent Ca2+ dyes entails the measurement of the fluorescence maximum (Fmax) and minimum (Fmin), as well as the dissociation constant (Kd) of the Ca2+-Dye reaction (model 1). An alternative equation does not need the Fmin but requires the rate constants kon and koff (model 2). However, both approaches are experimentally time consuming and the rate constants for several dyes are unknown. Here, we propose a set of equations (model 3) that simplify the calibration of fluorescent Ca2+ transients obtained with non-ratiometric dyes. This equation allows the calibration of signals without using the Fmin: [Ca2+] = Kd(F - Frest/Fmax - F) + [Ca2+]IR(Fmax - Frest/Fmax - F), where [Ca2+]IR is the resting [Ca2+]. If the classical calibration approach is followed, the Fmin can be estimated from: Fmin = Frest - ([Ca2+]IR(Fmax - Frest)/Kd). We tested the models' performance using signals obtained from enzymatically dissociated flexor digitorum brevis fibers of C57BL/6 mice loaded with Fluo-4, AM. Model 3 performed the same as model 2, and both gave peak [Ca2+] values 15 ± 0.3% (n = 3) lower than model 1, when we used our experimental Fmin (1.24 ± 0.11 A.U., n = 4). However, when we used the mathematically estimated Fmin (6.78 ± 0.2 A.U) for model 1, the peak [Ca2+] were similar for all three models. This suggests that the dye leakage makes a correct determination of the Fmin unlikely and induces errors in the estimation of [Ca2+]. In conclusion, we propose simpler and time-saving equations that help to reliably calibrate cytosolic Ca2+ transients obtained with non-ratiometric fluorescent dyes. The use of the estimated Fmin avoids the uncertainties associated with its experimental measurement.

Redox-Controlled and Reversible N-N Bond Forming and Splitting with an IronIV Terminal Imido Ligand.

Oxidation of the low-spin FeIV imido complex [{(tBupyrr)2py}Fe═NAd] (1) ((tBupyrr)2py2- = 2,6-bis(3,5-di-tert-butyl-pyrrolyl)pyridine, Ad = 1-adamantyl) with AgOAc or AgNO3 promotes reductive N-N bond coupling of the former imido nitrogen with a pyrrole nitrogen to form the respective ferric hydrazido-like pincer complexes [{(tBupyrrNAd)(tBupyrr)py}Fe(κ2-X)] (X = OAc-, 2OAc; NO3-, 2NO3). Reduction of 2OAc with KC8 cleaves the N-N bond to reform the FeIV imido ligand in 1, whereas acid-mediated demetalation of 2OAc or 2NO3 yields the free hydrazine ligand [(tBupyrrNHAd)(tBupyrrH)py] (3), the latter of which can be used as a direct entry to the iron imido complex when treated with [Fe{N(SiMe3)2}2]. In addition to characterizing these Fe systems, we show how this nitrene transfer strategy can be expanded to Co for the one-step synthesis of Co{(tBu-NHAdpyrr)(tBupyrr)py}] (4) ((tBu-NHAdpyrr)(tBupyrr)py2- = 2-(3-tBu-5-(1-adamantylmethyl-2-methylpropane-2-yl)-pyrrol-2-yl)-6-(3,5-tBu2-pyrrol-2-yl)-pyridine).

Bariatric surgery-induced weight loss reduces B cell activating cytokines and IgG immunoglobulins related to autoimmunity.

BACKGROUND: Obesity is associated with a chronic inflammatory state and autoimmune diseases, but little is known about the role of B cells in this context and the changes in B cell activation factors during obesity and after weight loss. To test whether bariatric-surgery-induced weight loss ameliorates the systemic inflammatory state associated with B cell activation molecules. METHODS: We conducted a prospective observational study in patients treated with bariatric surgery. Anthropometric and body composition measurements were performed preoperatively and at 6 months of follow-up post surgery. The patients were tested for a biochemical profile, plasmatic immunoglobulin G (IgG), cytokines (including specific B cell activating cytokines), and adipokines serum levels RESULTS: The patients' weight loss was accounted for mostly by fat mass (52.9%). We observed a significant reduction in total plasmatic IgG levels (p = 0.001), which could be associated with decreased B cell activity. Accordingly, there was a significant decrease in the B cell activating factors such as APRIL, BAFF, and soluble CD40L and a general improvement in the inflammatory markers hs-CRP, IL-1ß, IL-12, IL-18, and IFN-γ. CONCLUSIONS: These findings point toward reduced B cell activity after weight loss due to bariatric surgery. Moreover, they could be the initial link among the systemic inflammatory factors, and B cell activation in this inflammatory context that leads to IgG production and, potentially, to autoimmunity in patients with severe obesity.

Reduced Th1 response is associated with lower glycolytic activity in activated peripheral blood mononuclear cells after metabolic and bariatric surgery.

BACKGROUND: Obesity promotes cellular immunometabolism changes that trigger the activation of macrophages and lymphocytes, leading to systemic inflammation. Activated leukocytes undergo metabolic reprogramming, increasing glycolytic activity. OBJECTIVE: To examine whether the reduction in the inflammatory state associated with bariatric surgery is associated with decreased glycolytic activity in leukocytes. Setting Single-center, prospective observational study. METHODS: This study involved 18 patients with obesity undergoing bariatric surgery. All measurements were performed preoperatively and six months postoperatively. Peripheral blood mononuclear cells and plasma were obtained to determine the glycolytic rate and mitochondrial membrane potential as surrogates of the metabolic switching and high-sensitivity C-reactive protein, adipokines, and CD69 expression as inflammatory and activation markers. RESULTS: Glycolytic activity engaged by CD3/CD28 activation was reduced six months after bariatric surgery, associated with decreased levels of T helper (Th) 1 and Th17 signature cytokines. An overall reduction in inflammatory markers was observed, which correlated with a higher adiponectin/leptin ratio. CONCLUSIONS: Metabolic and bariatric surgery-induced weight loss leads to reprogramming in T cells' metabolic machinery, resulting in reduced stimulation of glycolysis after activation, which may explain the decrease in systemic inflammation mediated by cytokines such as interferon-γ and interleukin-17A.

Titanium-Mediated Catalytic Hydrogenation of Monocyclic and Polycyclic Arenes.

Two electron-reduction of the TiIV guanidinate complex (ImDipp N)(Xyket guan)TiCl2 gives (η6 -ImDipp N)(xyket guan)Ti (1intra ) and (ImDipp N)(Xyket guan)Ti(η6 -C6 H6 ) (1inter ) (Xyket guan=[(tBuC=N)C(NXylyl)2 ]- , Xylyl=2,5-dimethylphenyl) in the absence or presence of benzene, respectively. These complexes have been found to hydrogenate monocyclic and polycyclic arenes under relatively mild conditions (150 psi, 80 °C)-the first example of catalytic, homogeneous arene hydrogenation with TON >1 by a Group IV system.

Werner-Type Complexes of Uranium(III) and (IV).

Transmetalation of the ß-diketiminate salt [M][MenacnacPh] (M+ = Na or K; MenacnacPh- = {PhNC(CH3)}2CH-) with UI3(THF)4 resulted in the formation of the homoleptic, octahedral complex [U(MenacnacPh)3] (1). Green colored 1 was fully characterized by a solid-state X-ray diffraction analysis and a combination of UV/vis/NIR, NMR, and EPR spectroscopic studies as well as solid-state SQUID magnetization studies and density functional theory calculations. Electrochemical studies of 1 revealed this species to possess two anodic waves for the U(III/IV) and U(IV/V) redox couples, with the former being chemically accessible. Using mild oxidants, such as [CoCp2][PF6] or [FeCp2][Al{OC(CF3)3}4], yields the discrete salts [1][A] (A = PF6-, Al{OC(CF3)3}4-), whereas the anion exchange of [1][PF6] with NaBPh4 yields [1][BPh4].

Efficacy assessment of an intramammary treatment with a new recrystallized enrofloxacin vs ceftiofur and parenteral enrofloxacin in dairy cows with nonsevere clinical mastitis.

A recrystallized form of enrofloxacin as dehydrate-HCl (enro-C) was assessed for bacteriological and clinical cure efficacies in Holstein-Friesian cows affected of nonsevere clinical mastitis. Treatments were enro-Csusp (n = 81), treated with a pharmaceutical suspension of enro-C/quarter; group enro-Cpd (n = 80) treated as above, but using enro-C powder suspended in water; group CF (n = 65), treated with ceftiofur HCl/quarter; and group enroR (n = 66), treated with standard enrofloxacin solution (5 mg/kg, intramuscular). Cows had a mean milk production of 31 L/day and were 2-3 lactational periods old. Treatments were administered every 24 hr for 3 days. Groups treated with enro-C exhibited statistically significant (p > .05) better clinical cure as compared to groups treated with CF or enroR (95.06%, 96.25%, 67.79%, and 57.55%, for enro-Csusp , enro-Cpd , CF, and enroR , respectively). In contrast, probability of bacteriological cure was not statistically different among treatments. Yet, the outstanding clinical and bacteriological cure rates obtained for enro-C for nonsevere cases of mastitis is superior to previously reported data for parenteral enrofloxacin and other antibacterial-intramammary treatments. Impact of using enro-C on the rate and pattern of bacterial resistance, somatic cell counts and milk electric conductivity, must be studied. Also, the use of enro-C for complicated cases of mastitis should be studied and milk withdrawal times must be accurately established.

What kind of information and communication technologies do patients with COPD prefer to use? A cross-sectional study in Latin America.

The aim of the present study was to assess the frequency of uses and preferences of information and communication technologies (ICTs) among Latin American chronic obstructive pulmonary disease (COPD) patients. We conducted an anonymous cross-sectional survey study on Latin American COPD patients. The adapted version of the Michigan questionnaire was employed in eligible outpatients in different cities of Latin America. We categorized age and educational levels into three groups. The time passed since COPD diagnosis was categorized as ≤5 years and >5 years. χ2 and crude and adjusted logistic regressions were performed. A total of 256 patients were enrolled with a mean age of 68.7 years old. The most recurrently used ICTs were short message service (SMS; 47.1%) and WhatsApp (30.7%) for receiving COPD information. Moreover, SMS (85.8%) and Facebook (36.1%) were rated as useful for asking physicians information about COPD. Regression analysis showed that the best predictor for patients using ICTs, for any purpose, was higher education (undergraduate or graduate school). Understanding the preferences of ICTs among COPD patients could help improve patient's outcomes through developing applications in response to specific requirements of each patient.

Impact of cognitive impairment, depression, disease activity, and disease damage on quality of life in women with systemic lupus erythematosus.

OBJECTIVES: To define the relative role of cognitive impairment, depression, disease activity, and disease damage in the decreased health-related quality of life (HRQoL) frequently observed in systemic lupus erythematosus (SLE) patients. METHOD: We studied 101 Chilean female SLE patients and applied the 12-item Medical Outcomes Study (MOS) Short Form Health Survey version 2 (SF-12v2) to assess HRQoL and the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess cognitive function. Analysis of covariance (ANCOVA) models included demographic and disease-related factors and cognitive function tests of sustained attention, memory, and executive function. RESULTS: All measures of HRQoL were lower in the 101 female SLE patients compared to the women from the Chilean general population. HRQoL was associated with the following factors: (i) depression symptoms, which were detrimental to all components of the physical and mental HRQoL scores; (ii) executive dysfunction (spatial planning), which was associated with lower scores on role limitations due to physical health problems and emotional problems, and general health perceptions; (iii) higher activity and organ damage were deleterious to role physical, bodily pain, and physical summary scores; and (iv) higher damage also impacted physical function. Impairments in sustained attention and memory did not decrease the HRQoL. CONCLUSIONS: Our results highlight the relevance of executive dysfunction to poor physical and mental health components of HRQoL in SLE together with depression, while disease activity and disease damage are associated with lower HRQoL physical components. The need for cognitive function evaluation and rehabilitation in SLE is indicated.

The Mexican consensus on probiotics in gastroenterology. / Consenso mexicano sobre probióticos en gastroenterología.

INTRODUCTION: Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. AIM: To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. MATERIALS AND METHODS: Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement>70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. RESULTS AND CONCLUSIONS: Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis and pouchitis, and the treatment of covert and overt hepatic encephalopathy.

Exogenous lipid pneumonia related to long-term use of Vicks VapoRub® by an adult patient: a case report.

BACKGROUND: Use of petroleum-based over the counter remedies such as Vicks VapoRub to alleviate symptoms of rhinitis is common and can be effective, but carries under-appreciated risks of adverse side effects. In this case report we highlight Exogenous Lipoid Pneumonia (ELP), an uncommon condition that results from accumulation of exogenous lipids in the alveoli, as an adverse side effect of long-term Vicks VapoRub use. CASE PRESENTATION: We present the case of an 85-year-old female patient with ELP apparently due to continuous application of Vicks VapoRub® to her nostrils to alleviate chronic rhinitis. She was diagnosed incidentally via chest radiograph and computed tomography (CT) scan done as follow up to finding elevated C-reactive Protein during a routine exam. The CT scan revealed a pulmonary consolidation in the lower lobe of the right lung with fat density combined with low density areas associated with focal ground-glass opacities. The patient was advised to discontinue use of petroleum-based products, and was prescribed intranasal corticosteroids for her rhinitis. Follow up 2 years later showed that the lipid consolidation had diminished in size by approximately 10 %. CONCLUSION: Physicians must be aware that ELP can develop as a result of long-term application of petroleum-based oils and ointments to the nose and discourage such use of these products. Patients who have used petroleum-based products in this way should be screened for ELP. CT scan is the best imaging modality for establishing the diagnosis. The treatment of this condition is not well defined, but, as shown in this case, the size of the lipid mass can decrease after use of petroleum based substances is discontinued.

Influence of Wheat Straw Pelletizing and Inclusion Rate in Dry Rolled or Steam-flaked Corn-based Finishing Diets on Characteristics of Digestion for Feedlot Cattle.

Eight Holstein steers (216±48 kg body weight) fitted with ruminal and duodenal cannulas were used to evaluate effects of wheat straw processing (ground vs pelleted) at two straw inclusion rates (7% and 14%; dry matter basis) in dry rolled or steam-flaked corn-based finishing diets on characteristics of digestion. The experimental design was a split plot consisting of two simultaneous 4×4 Latin squares. Increasing straw level reduced ruminal (p<0.01) and total tract (p = 0.03) organic matter (OM) digestion. As expected, increasing wheat straw level from 7% to 14% decreased (p<0.05) ruminal and total tract digestion of OM. Digestion of neutral detergent fiber (NDF) and starch, per se, were not affected (p>0.10) by wheat straw level. Likewise, straw level did not influence ruminal acetate and propionate molar proportions or estimated methane production (p>0.10). Pelleting straw did not affect (p≥0.48) ruminal digestion of OM, NDF, and starch, or microbial efficiency. Ruminal feed N digestion was greater (7.4%; p = 0.02) for ground than for pelleted wheat straw diets. Although ruminal starch digestion was not affected by straw processing, post-ruminal (p<0.01), and total-tract starch (p = 0.05) digestion were greater for ground than for pelleted wheat straw diets, resulting in a tendency for increased post-ruminal (p = 0.06) and total tract (p = 0.07) OM digestion. Pelleting wheat straw decreased (p<0.01) ruminal pH, although ruminal volatile fatty acids (VFA) concentration and estimated methane were not affected (p≥0.27). Ruminal digestion of OM and starch, and post-ruminal and total tract digestion of OM, starch and N were greater (p<0.01) for steam-flaked than for dry rolled corn-based diets. Ruminal NDF digestion was greater (p = 0.02) for dry rolled than for steam-flaked corn, although total tract NDF digestion was unaffected (p = 0.94). Ruminal microbial efficiency and ruminal degradation of feed N were not affected (p>0.14) by corn processing. However, microbial N flow to the small intestine and ruminal N efficiency (non-ammonia N flow to the small intestine/N intake) were greater (p<0.01) for steam-flaked than for dry rolled corn-based diets. Ruminal pH and total VFA concentration were not affected (p≥ 0.16) by corn processing method. Compared with dry rolled corn, steam-flaked corn-based diets resulted in decreased acetate:propionate molar ratio (p = 0.02). It is concluded that at 7% or 14% straw inclusion rate, changes in physical characteristics of wheat straw brought about by pelleting negatively impact OM digestion of both steam-flaked and dry-rolled corn-based finishing diets. This effect is due to decreased post-ruminal starch digestion. Replacement of ground straw with pelleted straw also may decrease ruminal pH.

Risk factors for candidemia in non-neutropenic critical patients in Colombia.

OBJECTIVES: Due to the increase in isolation of Candida spp. in critically ill patients, and the high mortality and economic costs which this infection entails, a study was made of the risk factors associated to candidemia in critically ill patients from 7 intensive care units in Colombia. MATERIALS AND METHODS: A multicenter matched case-control study was conducted in 7 intensive care units of 3 university hospitals. Data on overall length of hospital stay (including both general wards and the intensive care unit) were recorded. RESULTS: A total of 243 subjects (81 cases and 162 controls) between January 2008 and December 2012 were included. In order of frequency, C. albicans, C. tropicalis and C. parapsilosis were isolated. The main identified risk factors were: overall length of hospital stay>25 days (OR 5.33, 95% CI 2.6-10.9), use of meropenem (OR 3.75, 95% CI 1.86-7.5), abdominal surgery (OR 2.9, 95% CI 1.39-6.06) and hemodialysis (OR 3.35, 95% CI 1.5-7.7). No differences in mortality between patients with candidemia and controls were found (39.5 vs. 36.5%, respectively, P=.66) were found. CONCLUSIONS: In Colombia, a long hospital stay, abdominal surgery, the use of meropenem and hemodialysis were identified as risk factors for candidemia.