Response of Aedes aegypti and Aedes albopictus (Diptera: Culicidae) Survival, Life History, and Population Growth to Oak Leaf and Acorn Detritus.

Aedes albopictus (Skuse) (Diptera: Culicidae) and Aedes aegypti (L.) (Diptera: Culicidae) are invasive container mosquitoes that are of potential medical importance in the southern United States. Seeds (acorns) and leaves from oak trees can contribute seasonally to the detritus of larval container habitats. Herein, we examined the effect of acorns and leaves from the southern live oak (Quercus virginiana Mill.), which has a concomitant range with these mosquitoes, on the population performance of Ae. aegypti and Ae. albopictus. Three levels of acorns and oak leaves were used (0.99, 1.98, and 7.94 g), along with two mixtures (leaf + acorn: 0.50 + 1.48 and 1.48 + 0.50 g). Tannins, secondary plant metabolites that effect herbivory, were measured across all treatment levels; nitrogen and carbon was also measured for detritus and representative females. Survival, female mass, development time, and λ' (per capita rate of population increase) were used to evaluate population performance of both species. Detritus amount but not type led to differences in tannins; however, these differences did not correspond to differences in performance. Acorns had higher carbon and C:N than leaves. Survival for both species was lower in medium amounts of acorns. Female mass varied with leaf amount, whereas development time differed between amounts of pure leaf and acorn. λ' was lowest in medium and high acorns compared with leaves or mixtures. Thus, acorns do appear to limit mosquito survival and affect population growth, suggesting that inputs of this common detritus type may negatively affect container Aedes production.

A synthetic modular approach for modeling the role of the 3D microenvironment in tumor progression.

Here, we demonstrate the flexibility of peptide-functionalized poly(ethylene glycol) (PEG) hydrogels for modeling tumor progression. The PEG hydrogels were formed using thiol-ene chemistry to incorporate a matrix metalloproteinase-degradable peptide crosslinker (KKCGGPQG↓IWGQGCKK) permissive to proteolytic remodeling and the adhesive CRGDS peptide ligand. Tumor cell function was investigated by culturing WM239A melanoma cells on PEG hydrogel surfaces or encapsulating cells within the hydrogels, and either as monocultures or indirect (non-contact) cocultures with primary human dermal fibroblasts (hDFs). WM239A cluster size and proliferation rate depended on the shear elastic modulus for cells cultured on PEG hydrogels, while growth was inhibited by coculture with hDFs regardless of hydrogel stiffness. Cluster size was also suppressed by hDFs for WM239A cells encapsulated in PEG hydrogels, which is consistent with cells seeded on top of hydrogels. Notably, encapsulated WM239A clusters and single cells adopted invasive phenotypes in the hDF coculture model, which included single cell and collective migration modes that resembled invasion from human melanoma patient-derived xenograft tumors encapsulated in equivalent PEG hydrogels. Our combined results demonstrate that peptide-functionalized PEG hydrogels provide a useful platform for investigating aspects of tumor progression in 2D and 3D microenvironments, including single cell migration, cluster growth and invasion.

Obstetrician-gynecologist as primary care provider.

Obstetrics and gynecology is a unique field that combines preventive and primary care with female pelvic surgery and obstetrics. With the evolution of managed care, it has been a challenge to fit this field into the standard primary care paradigm. This article describes a 3-tiered, patient-oriented definition of primary care that encompasses the essential aspects of all primary care specialties, followed by a critical examination of how primary care specialties, including obstetrics and gynecology, fit into this definition. This approach suggests that to better meet the primary care needs of both patients and society, obstetrician-gynecologists must continue to improve their skills in preventive care, diagnosis and treatment of self-limited conditions, and diagnosis of serious nongynecologic conditions.

The management and treatment of an abnormal Pap smear.

Table 2 summarizes the management of the abnormal Pap smear. Management of dysplasia in this institution is aggressive--as destructive therapy of mild dysplasia is advised, opposed to watching the patient and treating only if the disease persists. The rationale for this is the 33% to 45% failure rate for follow-up appointments in the primarily inner-city population served. The key to follow-up is to repeat cervical cytology in all patients treated, even those treated with hysterectomy, every three months until two consecutive normal smears are obtained. At that time, surveillance and intervals may be modified, but screening should continue at least annually. The mortality rate of carcinoma of the cervix has dropped precipitously during the last 40 years, in part, from simple screening of the cervix with the Papanicolaou smear. The effort to treat premalignant changes has been rewarded. The use of the colposcope and destructive forms of therapy have allowed successful treatment of patients with less morbidity and mortality than the immediate reliance on cervical conization. Remember, conization is still indicated and prudent in selected patients. Following these guidelines may contribute to the downward trend.

Anatomic changes in the pelvis after uncomplicated vaginal delivery: a CT study on 14 women.

We analyzed CT scans of the pelvis made within 24 hr of an uncomplicated term vaginal delivery in 14 women to document the anatomic changes that occur in the immediate postpartum period. Scans were interpreted by three radiologists, and the results were compared with those from pelvic CT scans made from normal, age-matched, nonpregnant women. In addition to soft-tissue windows, bone windows also were obtained to assess the pubic symphysis and sacroiliac joints in both the postpartum women and the control subjects. The mean uterine length, transverse width, and anteroposterior diameter in the postpartum women (14 +/- 1.4, 12 +/- 1.5, and 9 +/- 1.6 cm, respectively) were significantly larger than in the nonpregnant women (7 +/- 1.4, 5 +/- 0.8, and 4 +/- 0.9 cm) (p less than .0001). CT scans showed intrauterine blood in nine of the postpartum women (64%), and three (21%) had intrauterine gas. There was widening of the sacroiliac joint in one (7%) of the postpartum women compared with none of the control subjects. Widening of the pubic symphysis was present in six (42%) of the postpartum women and in none of the control subjects. Six (42%) of the postpartum women had gas in the sacroiliac joints, 33% of which occurred bilaterally; gas in the pubic symphysis was seen in four (28%) of the postpartum scans. In one patient, an asymptomatic muscle hematoma was discovered. We conclude that normal changes in the pelvis after uncomplicated term vaginal delivery include enlargement of the uterus, intrauterine blood, widening of the symphysis and sacroiliac joints, and gas in the sacroiliac joints.

The role of endocervical curettage in satisfactory colposcopy.

The role of endocervical curettage was studied in women with cervical dysplasia who underwent satisfactory colposcopic evaluation. Among 1130 women seen in the colposcopy clinic of a large city hospital during a 2-year period, 96 with satisfactory colposcopy and positive endocervical curettage constituted the study group. In these patients, the extent of dysplasia in the endocervical canal in cone biopsy specimens was measured using an ocular micrometer. When true-positive endocervical curettage was defined as dysplasia extending 5 mm or more inside the transformation zone, the false-positive rate for endocervical curettage was 81.8%. No patient with mild or moderate dysplasia on endocervical curettage had dysplasia that was more than moderate in degree or that extended more than 4.5 mm inside the transformation zone on histopathologic examination of the cone biopsy specimen. Because of the high rate of false-positive endocervical curettage, patients with mild and moderate dysplasia and selected women with severe dysplasia in endocervical curettings could be treated by local cervical ablation, with follow-up by endocervical curettage.

Aggressive angiomyxoma first diagnosed as levator hernia.

When a 32-year-old woman was first seen, physical findings suggested she had a large levator hernia, but at the time of surgical resection an aggressive angiomyxoma was found.

Complications at cesarean section.

Despite the dramatic improvements in the mortality and morbidity rates of cesarean section, abdominal delivery is inherently more hazardous than vaginal delivery. Much of the mortality and morbidity that we recognize today is the result of the condition that mandated the cesarean section rather than of the procedure itself. The surgeon who recognizes complications early and acts skillfully to limit or repair damage will protect the patient from resulting morbidity. We must not be lulled by the routine nature of cesarean section; complications await the complacent.

Symptomatic and asymptomatic cervical infections with human papillomavirus during pregnancy.

The prevalence of human papillomavirus (HPV) infection of the cervix was determined in an unselected population of pregnant women presenting to an inner-city Obstetrics Clinic in the first trimester. Cervical scrape specimens were screened for the presence of HPV types 6, 11, 16, 18, and 31 DNA by using three different blot hybridization methods. Specimens from 26 (11.1%) of 234 patients contained HPV DNA sequences. HPV-16 and -31 were detected in six specimens each, whereas HPV-6, -11, and -18 were each identified in three specimens. Five additional specimens contained HPV DNA sequences of undetermined type. Only two of the 26 positive specimens were obtained from patients with genital warts; an additional 12 specimens were from patients with cytological abnormalities. We conclude that cervical HPV infections in some pregnant populations are common and that many such infections are not clinically apparent.

A one-step method for detecting and typing human papillomavirus DNA in cervical scrape specimens from women with cervical dysplasia.

We studied 66 women with a previous dysplastic cervical cytological smear who were referred for colposcopy and biopsy for the presence of human papillomavirus (HPV) types 6, 11, 16, 18, and 31 DNA in cervical specimens. The specimens were analyzed by a novel hybridization method termed reverse blotting, in which cellular DNA is radiolabeled and used to probe a battery of cloned HPV DNAs immobilized on nitrocellulose. Reconstruction experiments demonstrated that this method could detect about one HPV genome equivalent per cell. HPV DNA sequences were detected in 52 (96%) of 54 patients who showed either condylomatous changes or dysplasia by cervical biopsy. HPV-16 was most commonly detected overall and was detected in 61% of moderate or severe dysplastic samples. HPV DNA was also detected in seven of 12 cervical scrapes from women with a history of dysplasia but with either normal or inflammatory changes noted on cervical biopsy. Our results indicate that the reverse-blot method can detect DNA homologous to various HPV types in a single experiment using DNA from the small numbers of cells obtained by cervical scraping.

Diagnosis of chlamydial infection in women attending antenatal and gynecologic clinics.

Two antigen detection systems (MicroTrak [MT], Syva Co., Palo Alto, Calif.; and Chlamydiazyme [CZ], Abbott Laboratories, North Chicago, Ill.) were compared with semiquantitative culture for diagnosis of chlamydial infection in 1,059 patients. Cultures were done on microtiter plates and blind passaged once. Culture-negative but CZ- or MT-positive specimens were recultured. True positives were positive by either initial or repeat cultures. Of 827 nonpregnant and 231 pregnant patients, 9.1 and 12.1%, respectively, had positive cultures. Overall sensitivity of the initial culture was 48.5% without passage and 86.4% with passage. The sensitivity of CZ was 67%. The sensitivity of MT in our laboratory was 50%; however, further review of these specimens by Syva employees gave a combined sensitivity of 71.6%. MT and CZ were more sensitive for pregnant patients (MT, 84.6%; CZ, 85.7%) than for nonpregnant patients (MT, 65.5%; CZ, 60.0%). All the tests had specificities above 95%. Of the specimens that were positive after initial culture without subculture, MT-negative specimens had a mean of 3.7 inclusions in culture, and MT-positive specimens had a mean of 24.8 (P = 0.002); CZ-negative specimens had a mean of 4.3 inclusions, and CZ-positive specimens had a mean of 20.0 (P = 0.026). In addition, cultures of specimens from pregnant patients had more inclusions than did those from gynecology patients, but this was not statistically significant (P = 0.096). No method is ideal; however, MT and CZ were less sensitive than was this culture system for detecting chlamydial infection in patients in gynecology clinics and were of comparable sensitivity for pregnant patients.

Effect of hydrogen sulfide on bacterial inactivation in the rat lung.

This study evaluated the effect of a low concentration of hydrogen sulfide on the rat antibacterial defense system. Rats exposed to 45 ppm hydrogen sulfide (threshold limit value for hydrogen sulfide = 10 ppm) for 4 or 6 hr exhibited a significant (P less .01) reduction in the inactivation of viable staphylococci deposited in the lungs during a bacterial aerosol challenge. Pre-exposure of rats to 46 ppm hydrogen sulfide for 2 hr, however, did not alter intrapulmonary staphylococcal inactivation. We hypothesize that impairment of the alveolar macrophage is the basis of these findings.