Review of non-invasive vulvovaginal rejuvenation.

Vulvovaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM) may affect up to 90% of menopausal women. Features include vulvovaginal atrophy, vulvovaginal laxity, vulvovaginal dryness and irritation, dyspareunia, anorgasmia and urinary symptoms. The vulva, vagina and bladder are oestrogen-responsive tissues, but oestrogen replacement therapy is not possible in women who have hormone-responsive cancers or normal oestrogen levels. Therefore, there is a role for alternative treatments. To date, three non-surgical energy-based therapies have been proposed: fractional microablative CO2 laser, erbium:YAG laser and temperature-controlled radiofrequency (RF). Our objective was to assess the available evidence for the safety and efficacy of erbium:YAG laser, microablative fractional CO2 laser and RF in the treatment of VVA/GSM. The authors reviewed the current published literature evaluating these therapies. All three therapies appear safe; however, all the studies were uncontrolled and used different protocols and outcome measurements. Therefore, comparison of treatments is difficult. It appears that there is more evidence in favour of the CO2 laser than the erbium:YAG laser. Both lasers have more evidence than RF. In conclusion, microablative CO2 laser, erbium:YAG laser and RF may be offered to patients suffering from VVA/GSM as an alternative or adjunct to conventional therapies. Further well-conducted controlled studies are needed.

Plasma Heating due to Cyclic Diffusion across a Separatrix.

We observe plasma heating due to collisional diffusion across a separatrix when a magnesium ion column in a Penning-Malmberg trap is cyclically pushed back and forth across a partial trapping barrier. The barrier is an externally applied axisymmetric "squeeze" potential, which creates a velocity separatrix between trapped and passing particles. Weak ion-ion collisions then cause separatrix crossings, leading to irreversible heating. The heating rate scales as the square root of the oscillation rate times the collision frequency and thus can be dominant for low-collisionality plasmas. The particle velocity distribution function is measured with coherent laser induced fluorescence and shows passing and trapped particles having an out-of-phase response to the forced plasma oscillations.

Trapped Particle Effects in the Parametric Instability of Near-Acoustic Plasma Waves.

Quantitative experiments on the parametric decay instability of near-acoustic plasma waves provide strong evidence that trapped particles reduce the instability threshold below fluid models. At low temperatures, the broad characteristics of the parametric instability are determined by the frequency detuning of the pump and daughter wave, and the wave-wave coupling strength, surprisingly consistent with cold fluid, three-wave theories. However, at higher temperatures, trapped particle effects dominate, and the pump wave becomes unstable at half the threshold pump wave amplitude with similar exponential growth rates as for a cold plasma.

Evolution of a Vortex in a Strain Flow.

Experiments and vortex-in-cell simulations are used to study an initially axisymmetric, spatially distributed vortex subject to an externally imposed strain flow. The experiments use a magnetized pure electron plasma to model an inviscid two-dimensional fluid. The results are compared to a theory assuming an elliptical region of constant vorticity. For relatively flat vorticity profiles, the dynamics and stability threshold are in close quantitative agreement with the theory. Physics beyond the constant-vorticity model, such as vortex stripping, is investigated by studying the behavior of nonflat vorticity profiles.

First Test of Long-Range Collisional Drag via Plasma Wave Damping.

This paper presents the first experimental confirmation of a new theory predicting enhanced drag due to long-range collisions in a magnetized plasma. The experiments measure damping of Langmuir waves in a multispecies pure ion plasma, which is dominated by interspecies collisional drag in certain regimes. The measured damping rates in these regimes exceed classical predictions of collisional drag damping by as much as an order of magnitude, but agree with the new theory.

Measurement of correlation-enhanced collision rates.

We measure the perpendicular-to-parallel collision rate nu perpendicular parallel in laser-cooled magnetized ion plasmas, spanning the uncorrelated to correlated regimes. In correlated regimes, we measure collision rates consistent with the "Salpeter correlation enhancement" of roughly exp(Gamma), for correlation parameters Gamma less, similar 4. This enhancement also applies to fusion in dense plasmas such as stars.

Wave-particle interactions in electron acoustic waves in pure ion plasmas.

Electron acoustic waves (EAW) with a phase velocity less than twice the plasma thermal velocity are observed on pure ion plasma columns. At low excitation amplitudes, the EAW frequencies agree with theory, but at moderate excitation the EAW is more frequency variable than typical Langmuir waves, and at large excitations resonance is observed over a broad range. Laser induced fluorescence measurements of the wave-coherent ion velocity distribution show phase reversals and wave-particle trapping plateaus at +/-vph, as expected, and corroborate the unusual role of kinetic pressure in the EAW.

Rapid heating of a strongly coupled plasma near the solid-liquid phase transition.

Between 10(4) and 10(6) 9Be+ ions were trapped in a Penning trap and laser cooled to approximately 1 mK, where they formed a crystalline plasma. We measured the ion temperature as a function of time after turning off the laser cooling and observed a rapid temperature increase as the plasma underwent the solid-liquid phase transition at T approximately 10 mK (Gamma approximately 170). We present evidence that this rapid heating is due to a sudden release of energy from weakly cooled degrees of freedom involving the cyclotron motion of trapped impurity ions. This equilibration of cyclotron motion with motion parallel to the magnetic field is more than 10 orders of magnitude faster than that predicted by currently available theory, which is valid only in the absence of correlations (Gamma<<1).

Compressional and shear wakes in a two-dimensional dusty plasma crystal.

Wakes composed of compressional and shear waves were studied experimentally in a two-dimensional screened-Coulomb crystal. Highly charged microspheres suspended in a plasma settled in a horizontal monolayer and arranged in a triangular lattice with a repulsive interparticle potential. Wakes were excited by a moving spot of Ar+ laser light. Depending on the laser spot speed, compressional waves formed a Mach cone and multiple lateral or transverse wakes, similar to ship wakes on the water surface, due to a combination of acoustic and dispersive properties. Shear waves, however, formed only a Mach cone, due to their nearly acoustic, i.e., dispersionless character. The experimental results show agreement with a recently developed theory and with molecular dynamics simulations, which assume a binary Yukawa interparticle potential. A generally useful method is presented for calculating the real part of the dispersion relation of the compressional waves based on the analysis of the spatial structure of a phonon wake. Fitting the resulting dispersion relation provides an independent measure of the interparticle potential, parametrized by the screening parameter kappa and particle charge Q.

Thermally excited modes in a pure electron plasma.

Thermally excited plasma modes are observed in near-thermal-equilibrium pure electron plasmas over a temperature range of 0.05

Laser-generated waves and wakes in rotating ion crystals.

Locally excited plasma waves are generated in a Coulomb crystal by "pushing" with radiation pressure on a rotating cloud of laser-cooled 9Be+ ions. The waves form a stationary wake that is directly imaged through the dependence of the ion fluorescence on Doppler shifts, and theoretical calculations in a slab geometry are shown to accurately reproduce these images. The technique demonstrates a new method of exciting and studying waves in cold ion clouds.

Sequence analysis of dru regions from methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococcal isolates.

Methicillin-resistance in staphylococci results from expression of mecA, which occurs in a larger region of DNA (the mec region) lacking counterpart in susceptible cells. The mec region harbors in addition a highly polymorphic element, the dru (direct repeat unit) segment, which in an early S. aureus strain, BB270, was found to contain 10 imperfect 40 base-pair repeats. We have explored the utility of direct sequencing of dru segments for discriminating among strains of methicillin-resistant S. aureus (MRSA) and coagulase-negative staphylococci (MRCNS). We sequenced dru segments of 24 clinical isolates of MRSA, and 15 of MRCNS, and reexamined strain BB270. Six S. aureus and 2 S. epidermidis isolates were found to have deletions which removed all drus. The other strains were found to have multiple contiguous dru repeats of precisely 40 bp. Analysis of these strains plus dru segment sequence from 4 recent reports yielded 18 unique dru segment sequences (designated "dru types") differing in numbers of repeats and/or sequences of particular repeats. Dru typing was more discriminating than sequencing of non-mec region genes, including a repeat-containing segment (spa Xr) of the S. aureus protein A gene. Yet dru type was sufficiently stable to register epidemiological clusters. Dru sequencing is a useful tool for tracking methicillin-resistant lineages of S. aureus and CNS.

A sequence variant of Staphylococcus hominis with a high prevalence of oxacillin and fluoroquinolone resistance.

A newly identified subspecies of Staphylococcus hominis, S. hominis subsp. novobiosepticus, was found to be the cause of several invasive infections at a hospital in New Jersey. This subspecies differs from classical S. hominis, now S. hominis subsp. hominis, by the phenotypic characteristics of novobiocin resistance and the inability to ferment trehalose. DNA sequences of segments of 16S rRNA, DNA gyrase (gyrA), and DNA topoisomerase IV (grlA) genes were determined for the type strains of the 2 subspecies, and for 34 S. hominis clinical isolates. The 16S rRNA sequences of the type strains differed at 3 positions over 410 bp; the grlA sequences differed at 6 positions over 119 bp. These sequence differences define S. hominis subsp. novobiosepticus and S. hominis subsp. hominis "sequevars." Of 34 S. hominis clinical isolates, 31 were S. hominis subsp. novobiosepticus sequevars, 28 of which were resistant to both oxacillin and ciprofloxacin. The clinical microbiology laboratory, using a MicroScan system, identified 7 of the 31S. hominis subsp. novobiosepticus sequevars as S. hominis subsp. hominis on the basis of phenotypic characteristics. Three S. hominis subsp. hominis sequevars were all identified phenotypically as S. hominis subsp. hominis and were oxacillin- and ciprofloxacin-susceptible. Although the precise relationship between the S. hominis sequevars and their phenotypic subspecies remains to be determined, our results indicate that antibiotic-resistant clinical isolates of S. hominis belong almost exclusively to the S. hominis subsp. novobiosepticus sequevar.

Topoisomerase sequences of coagulase-negative staphylococcal isolates resistant to ciprofloxacin or trovafloxacin.

Coagulase-negative staphylococcal isolates (n = 188) were screened for susceptibility to oxacillin, ciprofloxacin, and trovafloxacin, a new fluoroquinolone. At an oxacillin concentration of >/=4 microg/ml, 43% were methicillin resistant; of these, 70% were ciprofloxacin resistant (MIC, >/=4 microg/ml). Of the methicillin-resistant, ciprofloxacin-resistant isolates, 46% were susceptible to /=8 microg/ml) and increased trovafloxacin MICs (0.25 to 2 microg/ml) could be conferred by the combined presence of single mutations in each gyrA and grlA gene. Trovafloxacin MICs of >/=8 microg/ml also occurred, but these required an additional mutation in grlA.

Topoisomerase mutations in trovafloxacin-resistant Staphylococcus aureus.

A total of 201 Staphylococcus aureus isolates were surveyed for susceptibility to ciprofloxacin and trovafloxacin. Of 66 methicillin-resistant isolates, 89% were ciprofloxacin resistant and 6% were also trovafloxacin resistant. Trovafloxacin-resistant strains had unusual patterns of quinoline resistance mutations in DNA topoisomerase genes, including two mutations in the A subunit (encoded by grlA) of topoisomerase IV.

Organizational impact in the dermatologic literature.

We revisit our citation data derived from 58,201 articles published between 1981 and 1994 in the 17 top-ranked peer-reviewed international dermatology journals to identify the institutions that house the people who have made the greatest impact on the dermatologic literature during this period. Using these citation data, we estimate an institution's impact in 2 ways. First, institutions are ranked by the gross number of citations to articles from 1981 to 1994 accurred during this same period. To recognize institutions whose articles, on average, have received higher numbers of citations, we also rank institutions by the average number of citations received by each article published by a particular institution (blended impact factor).