Overcoming the challenges of mosquito (Diptera: Culicidae) sampling in remote localities: a comparison of CO2 attractants on mosquito communities in three tropical forest habitats.

Emerging infectious diseases are on the rise with future outbreaks predicted to occur in frontier regions of tropical countries. Disease surveillance in these hotspots is challenging because sampling techniques often rely on vector attractants that are either unavailable in remote localities or difficult to transport. We examined whether a novel method for producing CO2 from yeast and sugar produces similar mosquito species captures compared with a standard attractant such as dry ice. Across three different vegetation communities, we found traps baited with dry ice frequently captured more mosquitoes than yeast-baited traps; however, there was little effect on mosquito community composition. Based on our preliminary experiments, we find that this method of producing CO2 is a realistic alternative to dry ice and would be highly suitable for remote field work.

Ratio of serum urea to serum creatinine in wild black bears.

In winter, the ratio of serum urea to serum creatinine is 10 or less in denning female and male bears. In midsummer it is 22 or more, similar to that of other mammals. However, in late summer and early fall, while food is available, the urea-to-creatinine ratio approaches or becomes 10 or less. The low value of this ratio appears to indicate the biochemical state of hibernation, and many bears are in this state weeks before they den.

Toxoplasma gondii pneumonitis in patients infected with the human immunodeficiency virus.

Pulmonary toxoplasmosis is a rarely recognized opportunistic infection in immunocompromised patients. A few case reports have described pulmonary toxoplasmosis in human immunodeficiency virus-infected patients in association with Toxoplasma gondii central nervous system disease. We encountered six cases of pulmonary toxoplasmosis in human immunodeficiency virus-infected patients who presented with a protracted febrile illness, respiratory symptoms, and an abnormal chest roentgenogram in the absence of neurologic findings. No clinical or roentgenographic features distinguished T gondii pneumonitis from more common opportunistic pulmonary infections. As the acquired immunodeficiency syndrome epidemic progresses, the presenting illnesses have evolved. Toxoplasma gondii must be considered a potential cause of pulmonary disease during the evaluation of human immunodeficiency virus-infected patients with respiratory symptoms.

Ultrasonic assessment of skin and wounds with the scanning laser acoustic microscope.

The aim of the present study was to test the hypothesis that ultrasonic propagation properties in skin and wound tissue would correlate with material properties such as collagen content, water content, and tensile strength of those tissues. Both ultrasonic speed and ultrasonic attenuation coefficient were directly correlated with tissue collagen content, [r = 0.80 and r = 0.56, respectively (p less than 0.001)]. In addition, ultrasonic speed and attenuation coefficient were inversely correlated with tissue water content, [r = -0.57 and r = -0.73, respectively (p less than 0.001)]. Tensile strength also correlated very significantly with ultrasonic speed (r = 0.90, p less than 0.001), and significantly with attenuation coefficient (r = 0.58, p less than 0.001). The results demonstrate the feasibility of using ultrasound for noninvasively determining the material properties of biologic tissues including healing cutaneous wounds.

Sterol excretion and cholesterol absorption in diabetics and nondiabetics with and without hyperlipidemia.

Fecal neutral and acidic sterols and cholesterol absorption were measured in 12 normal control subjects, 40 diabetic subjects with and without hyperlipidemia, and 27 subjects with hyperlipidemia but without diabetes mellitus. All subjects were on a low-cholesterol diet (less than 300 mg cholesterol/day). Fecal excretion of neutral and acidic sterols was increased in patients with hypertriglyceridemia and was more marked in diabetic patients with hypertriglyceridemia. Cholesterol absorption was decreased in diabetic patients with hypertriglyceridemia. Otherwise, there were no significant differences in sterol excretion or cholesterol absorption in diabetic and nondiabetic subjects compared with control groups with similar lipid levels. The best predictors of fecal neutral- and acidic-sterol excretion and of estimated cholesterol synthesis were very low [corrected]-density lipoprotein triglycerides and high-density lipoprotein cholesterol. Correction of hyperlipidemia may be beneficial in decreasing cholesterol synthesis and, thereby, in decreasing the risk of atherogenesis.

Primary hypercholesterolemia: effect of treatment on serum lipids, lipoprotein fractions, cholesterol absorption, sterol balance, and platelet aggregation.

The nonabsorbable bile acid sequestrant resin, colestipol, was administered to 16 patients with primary hypercholesterolemia, and its effect on serum lipids, lipoprotein fractions, and circulating platelet aggregate ratio and platelet aggregation in response to adenosine diphosphate (ADP) was compared with that of sitosterol. Cholesterol absorption and sterol balance studies were done in four of the subjects during the following treatment periods: diet alone, colestipol, and sitosterol. Total serum cholesterol was significantly reduced by colestipol but only slightly decreased by sitosterol. Combination treatment with colestipol and sitosterol was associated with a smaller decrease in serum cholesterol than was demonstrated with colestipol alone. Serum triglycerides tended to increase during colestipol therapy (this increase was not clinically significant) but showed a minimal nonsignificant decrease with sitosterol treatment. Colestipol decreased cholesterol absorption, whereas sitosterol slightly increased it. Fecal sterol excretion was increased with colestipol treatment but was minimally affected by administration of sitosterol. Low-density lipoprotein and high-density lipoprotein cholesterol significantly decreased with colestipol treatment. The circulating platelet aggregate ratio was significantly lower in the group of patients with hypercholesterolemia who received colestipol initially than in control subjects, but platelet aggregation in response to ADP was not significantly different between these two groups. No significant change in platelet aggregation was noted during colestipol or sitosterol treatment despite a significant decrease in total serum cholesterol with colestipol therapy, a suggestion that the platelet and lipid abnormalities are not interrelated.

Anticoagulant treatment of thromboembolism with intravenous heparin therapy in the early postoperative period following total joint arthroplasty.

BACKGROUND: Treatment of thromboembolism with intravenous heparin therapy in the early postoperative period after total joint arthroplasty has been associated with a high rate of complications. The purpose of the present study was to compare the rate of bleeding complications in a group of patients who required intravenous heparin therapy for the treatment of thromboembolism after total hip or knee arthroplasty with the rate in a control group of patients who received only prophylactic anticoagulation. METHODS: The postoperative courses of forty-four consecutive patients who were managed with intravenous administration of heparin and oral administration of warfarin for the treatment of a thromboembolic event following unilateral total hip or knee arthroplasty were compared with those of a control group of 376 consecutive patients who had these same procedures but did not have a thromboembolic complication. The patients in the control group were managed with prophylactic anticoagulation with use of enoxaparin. Sixty-eight percent (thirty) of the forty-four patients in the heparin group received the initial dose of heparin on or before the fourth postoperative day, and 82 percent (thirty-six) received an initial bolus of 5000 units of heparin at the initiation of therapy. RESULTS: The rate of bleeding complications was 9 percent (four of forty-four) in the heparin group, compared with 6 percent (twenty-three of 376) in the control group (p = 0.44). The mean transfusion requirement in the heparin group (1.8 units of packed red blood cells) was significantly greater than that in the control group (0.8 unit) (p < 0.0001). Three of the four patients who had a bleeding complication while receiving heparin and warfarin had coagulation parameters that were substantially higher than recommended levels. The mean duration of hospitalization in the heparin group (fifteen days) was significantly longer than that in the control group (seven days) (p < 0.0001). CONCLUSIONS: The results of the present study suggest that the use of intravenous heparin therapy for the treatment of thromboembolism in the early postoperative period after total joint arthroplasty is associated with a rate of bleeding complications that is similar to that associated with the use of prophylactic anticoagulation with use of enoxaparin alone. One should expect an increased transfusion requirement and a longer duration of hospitalization for patients who require intravenous heparin therapy for the treatment of a thromboembolic event.

Correlation of tissue constituents with the acoustic properties of skin and wound.

The purpose of this study was to compare measurements of ultrasound properties of skin and wound tissue with measurements of material properties such as total collagen concentration, acetic acid soluble collagen concentration, water concentration, and morphologic properties. Using a scanning laser acoustic microscope (SLAM), both ultrasonic speed and attenuation coefficient values were obtained for control skin (2-3 cm from the wound), for skin immediately adjacent to wounds (within 0.3 mm), as well as for wound tissue itself. The attenuation coefficient and speed measurements were lowest for wound tissue followed by adjacent skin and then control skin. As the wounds healed there appeared to be an increase in both speed and attenuation coefficient although the wound age at which these increases started and the length of time for which they continued varied from one dog to the next. The precision of duplicate sample measurement of wave speed was +/- 1.7% for control skin, whereas that for attenuation coefficient it was +/- 16%. Both ultrasonic speed and attenuation coefficient were directly correlated with tissue collagen concentration and inversely correlated with tissue water concentration (p less than 0.001). Attenuation coefficient correlated best (r = 0.73) with acetic acid soluble collagen concentration which reflects the changes in collagen taking place during the repair process. These attenuation measurements made at 100 MHz using the SLAM were compared for control skin and wound samples with measurements made at 10-40 MHz using backscatter acoustic techniques (BAT). The tissue samples analyzed by each ultrasound technique were from adjacent locations on the animals.

Thromboembolism after hip and knee arthroplasty: diagnosis and treatment.

Postoperative thromboembolism is a potentially lethal complication. Its diagnosis may be difficult, as the classic clinical signs and symptoms are often absent, making a high index of suspicion imperative for diagnosis. Anticoagulant therapy is effective in reducing morbidity and mortality due to thromboembolism, but is associated with a substantial rate of bleeding complications in the immediate postoperative period. Inferior vena cava filters constitute an alternative to anticoagulant therapy, but are also associated with a substantial complication rate. The appropriate use of diagnostic tests combined with clinical suspicion can guide the orthopaedic surgeon in deciding which patients require treatment for thromboembolism.

The relationship of the factor V Leiden mutation or the deletion-deletion polymorphism of the angiotensin converting enzyme to postoperative thromboembolic events following total joint arthroplasty.

BACKGROUND: Although all patients undergoing total joint arthroplasty are subjected to similar risk factors that predispose to thromboembolism, only a subset of patients develop this complication. The objective of this study was to determine whether a specific genetic profile is associated with a higher risk of developing a postoperative thromboembolic complication. Specifically, we examined if the Factor V Leiden (FVL) mutation or the deletion polymorphism of the angiotensin-converting enzyme (ACE) gene increased a patient's risk for postoperative thromboembolic events. The FVL mutation has been associated with an increased risk of idiopathic thromboembolism and the deletion polymorphism of the ACE gene has been associated with increased vascular tone, attenuated fibrinolysis and increased platelet aggregation. METHODS: The presence of these genetic profiles was determined for 38 patients who had a postoperative symptomatic pulmonary embolus or proximal deep venous thrombosis and 241 control patients without thrombosis using molecular biological techniques. RESULTS: The Factor V Leiden mutation was present in none of the 38 experimental patients and in 3% or 8 of the 241 controls (p = 0.26). Similarly there was no difference detected in the distribution of polymorphisms for the ACE gene with the deletion-deletion genotype present in 36% or 13 of the 38 experimental patients and in 31% or 74 of the 241 controls (p = 0.32). CONCLUSIONS: Our results suggest that neither of these potentially hypercoaguable states are associated with an increased risk of symptomatic thromboembolic events following total hip or knee arthroplasty in patients receiving pharmacological thromboprophylaxis.

Measurement uncertainty assessment of the scanning laser acoustic microscope and application to canine skin and wound.

Accuracy and precision were experimentally evaluated for the scanning laser acoustic microscope (SLAM) by measurements on homogeneous liquids of known ultrasonic properties. Using aqueous solutions of bovine serum albumin, the attenuation coefficient accuracy and precision are +/-12% and +/-15%, respectively. Using Dow Corning 710, a silicone oil, the speed accuracy and precision are +/-2.9% and +/-0.4%, respectively. Precision was assessed using duplicate samples of canine skin and wound tissue. The estimated precisions in the measurement of the attenuation coefficient and speed were +/-16% and +/-1.7%, respectively.

The use of retrievable inferior vena cava filters in orthopaedic patients.

This study was undertaken to evaluate the safety and efficacy of retrievable inferior vena cava filters in high-risk orthopaedic patients. A total of 58 patients had a retrievable inferior vena cava filter placed as an adjunct to chemical and mechanical prophylaxis, most commonly for a history of previous deep-vein thrombosis or pulmonary embolism, polytrauma, or expected prolonged immobilisation. In total 56 patients (96.6%) had an uncomplicated post-operative course. Two patients (3.4%) died in the peri-operative period for unrelated reasons. Of the 56 surviving patients, 50 (89%) were available for follow-up. A total of 32 filters (64%) were removed without complication at a mean of 37.8 days (4 to 238) after placement. There were four filters (8%) which were retained because of thrombosis at the filter site, and four (8%) were retained because of incorporation of the filter into the wall of the inferior vena cava. In ten cases (20%) the retrievable filter was left in place to continue as primary prophylaxis. No patient had post-removal thromboembolic complications. A retrievable inferior vena cava filter, as an adjunct to chemical and mechanical prophylaxis, was a safe and effective means of reducing the acute risk of pulmonary embolism in this high-risk group of patients. Although most filters were removed without complications, thereby avoiding the long-term complications that have plagued permanent indwelling filters, a relatively high percentage of filters had to be left in situ.

The distribution of genetic founder contributions within and among selection and control lines of an experiment with laying hens.

Pedigree analysis was used to monitor genetic dynamics in retrospect in two identically selected lines (S1, S2) and a control (CL) of laying hens, originating from a common base. The pedigree of the last generation animals had nine generations of ancestors the members of the first known generation of ancestors were taken as founders. In each generation and in all lines one son was randomly chosen from each of 20 sires. Selection of females was randomly one daughter from each of 80 dams in CL and the best 80 according to a complex criterion in S1 and S2. The experiment included seven generations of selection. After three generations 51.6, 51.5 and 95.5% of the female founders of the base generation remained in S1, S2 and CL, respectively. The corresponding figures for the founder males were 67.7, 65.1 and 96.2%. These fractions did not change much in the following generations. On average 88.5, 87.1 and 78.8% of the remaining founders of the last generation were present in the pedigree of a last generation animal in S1, S2 and CL, respectively. The average genetic contribution of a founder male to the genome of the last generation was 1.22, 1.25 and 1.04% in S1, S2 and CL, respectively. The corresponding female contributions were 0.64, 0.60 and 0.49%, respectively. The most important founders of S1 and S2, which contributed 90% of the genome of their own line, contributed 80% of the genome of the other line and 73% of the one of CL in both cases. The most important founders of CL contributed 82% to the genomes of S1 and S2. The numbers of founder genome equivalents, were 9.8, 10.3 and 12.2 for S1, S2 and CL in the last generation and indicate a considerable loss of founder alleles in all lines. Effective population sizes calculated from average rate of inbreeding obtained from pedigrees were 91.1, 98.3 and 122.5 for S1, S2 and CL, respectively. Using the squared founder contributions for this purpose resulted in effective sizes of 0.966, 0.941 and 0.959 of the former values for S1, S2 and CL, respectively. Mating only animals with four different grand sires reduced inbreeding compared with random mating over the duration of the experiment. The effectiveness of this scheme was, however, strongly reduced in the last generation.

Progeny testing of heterozygote carriers of the Robertsonian translocation 1/29 in Bovidae.

In our recent population study, 220 daughters of a heterozygote carrier of the Robertsonian translocation 1/29 were analysed by screening of metaphase spreads and typing of microsatellite markers. The segregation between markers near the centromere of chromosomes 1 and 29 and the fusion were analysed. The microsatellite markers were selected from the USDA, MARC cattle genome map. Analyses were done on AGLA17, BM6438, TGLA49, BMS 1928, BM8139, INRA117, BMS574, BMS711 and BMS4015 of chromosome 1, and on BM4602, BMC2228 and BMS1857 of chromosome 29. The two markers BMC2228 and BMS4018 in the linkage group originating from the fusion were able to either recognise or exclude 167 daughters out of 220 as carriers of the Robertsonian translocation 1/29. Fifty-three daughters showed double heterozygote markers like their father, and were therefore not informative. The use of conventional cytogenetics in combination with molecular studies has allowed a more precise evaluation of the Robertsonian translocations than either approach alone might have done.

Ciprofloxacin-induced acute interstitial pneumonitis.

The current authors present the case of a 68-yr-old female patient who developed severe respiratory failure after medication with ciprofloxacin for acute urinary tract infection. A chronic subdural haematoma was surgical evacuated. Postoperatively, an acute urinary tract infection was treated with ciprofloxacin. Six days later, C-reactive protein was rising and the patient was suffering from intermittent high fever, dyspnoea and severe hypoxaemia. The high-resolution-computed tomography (HRCT) showed an interstitial lung disease in the anterior upper lobe on the left side as well as in the lingula. Assuming a bacterial infection amoxyl/clavulanic acid was started which did not improve the clinical symptoms. Bronchoalveolar lavage revealed a marked lymphocytosis (87%). Analysis for typical bacterial infections, Tuberculosis, Mycoplasma, Chlamydia and Legionella spp. were all negative. Another HRCT scan was made because of worsening of symptoms and this showed rapidly progressive infiltrates in most lobes. An open lingular biopsy showed an interstitial lymphoplasmocytotic infiltrate with some eosinophilic granulocytes and a few scattered giant cell granulomas, consistent with hypersensitivity pneumonitis. The patient's symptoms rapidly improved with systemic corticosteroid therapy and another HRCT scan revealed complete remission of pulmonary infiltrates. Ciprofloxacin can induce interstitial pneumonitis with acute respiratory failure. This is an important fact considering that ciprofloxacin is a widely used antibiotic agent in treatment of urinary tract infection.

Use of mucin antibodies and cDNA probes to quantify hypersecretion in vivo in human airways.

Mucus hypersecretion is a prominent feature of the airway's response to injury. The ability to quantitatively detect mucin and mucin mRNA in vivo in human airways would facilitate the determination of safe exposure levels to various air pollutants and the identification of drugs capable of attenuating mucus hypersecretion. To this end, we have developed two assays: an enzyme-linked immunosorbent assay (ELISA) quantifying mucin-like molecules and a polymerase chain reaction (PCR)-based assay quantifying mucin mRNA. These tests are performed on bronchial lavage fluid and epithelial cells brushed from the surfaces of human airways at bronchoscopy. The PCR data are normalized to eliminate potentially confounding effects of nonepithelial cells in the samples. In a study of six smokers and six nonsmokers, the ELISA detected significantly more mucin-like material in the airways of the smokers than of the nonsmokers. The median mucin concentration for the smokers was 52.2 micrograms/ml (range, 16.3 to 4,860.0), whereas that for the nonsmokers was 12.7 micrograms/ml (range, 4.5 to 22.9). The difference between smokers and nonsmokers was statistically significant (P < or = 0.01). The PCR-based test showed a trend for RNA samples from smokers to be enriched (vis-à-vis nonsmokers) in mucin mRNA.