Vulvovaginal Trichosporonosis

Objective: Isolation of Trichosporon species from vaginal secretions is a rare event, and no data are available on its pathogenic role. A case series is presented to determine the pathogenic role of Trichosporon species in vulvovaginal infections. Methods: We performed a retrospective chart review of patients seen in the W.S.U. Vaginitis Clinic in order to identify patients from whom Trichosporon species were isolated. Results: Between 1986 and 2001, a total of 13 patients had a total of 18 positive vaginal cultures for Trichosporon species. All 18 vaginal isolates were T. inkin. In general, positive vaginal cultures were accompanied by low yeast colony counts. Four out of 18 positive T. inkin cultures were obtained from visits by asymptomatic patients. Of the remaining 14 positive T. inkin cultures from patients with symptoms, nine out of 14 cultures had other diagnoses (Candida albicans, six cases; bacterial vaginosis, two cases; Trichomonas, one case). Five positive T. inkin cultures were obtained from visits at which patients had symptoms and no associated diagnosis. In only one of the five episodes could we establish a clear pathogenic role for Trichosporon. In this case the patient was treated with boric acid and had resolution of symptoms and a negative culture at follow-up. In-vitro susceptibility tests revealed that T. inkin was resistant to flucytosine and susceptible to all topical and oral azoles. Conclusions: T. inkin is occasionally found in vulvovaginal cultures and is usually a non-pathogen. Transient colonization tended to occur in women, usually of African—American origin, with major perturbations in vaginal flora (bacterial vaginosis and trichomoniasis) and increased pH. Pathogenic consequences of Trichosporon colonization appear to be rare

New Product Innovation with Multiple Features and Technology Constraints

We model a firm\u27s decisions about product innovation, focusing on the extent to which features should be improved or changed in the succession of models that comprise a life cycle. We show that the structure of the internal and external environment in which a firm operates suggests when to innovate to the technology frontier. The criterion is maximization of the expected present value of products during the life cycle. Computational studies complement the theoretical results and lead to insights about when to bundle innovations across features. The formalization was influenced by extensive interviews with managers in a high-technology firm that dominates its industry

Identification And Characterization Of A Second Encephalitogenic Determinant Of Myelin Proteolipid Protein (Residues 178-191) For SJL Mice

We previously described a synthetic peptide of myelin proteolipid protein (PLP), peptide 139-151, which induces experimental allergic encephalomyelitis in SJL/J (H-2s) mice. We have now identified an additional determinant, PLP residues 178-191, that is also a potent encephalitogen in this strain. When PLP peptide 178-191 was compared with peptide 139-151 on an equimolar basis, the day of onset of disease induced by PLP 178-191 was earlier, but the incidence, severity, and histologic features were indistinguishable. Lymph node cells from animals immunized with the whole PLP molecule responded to both PLP 178-191 and 139-151, suggesting immunologic codominance of the two epitopes. PLP 178-191 elicited stronger proliferative responses and this may relate to the earlier onset of disease induced with this peptide. Two CD4+, peptide-specific, I-A(s)-restricted T cell lines, selected by stimulation of lymph node cells with either PLP 178-191 or 139-151, were each encephalitogenic in naive syngeneic mice. The presence of multiple encephalitogenic codominant PLP epitopes within a single mouse strain emphasizes the complexity of the immune response to PLP and its potential as a target Ag in autoimmune demyelinating diseases

Induction of Paralysis and Visual System Injury in Mice by T Cells Specific for Neuromyelitis Optica Autoantigen Aquaporin-4.

While it is recognized that aquaporin-4 (AQP4)-specific T cells and antibodies participate in the pathogenesis of neuromyelitis optica (NMO), a human central nervous system (CNS) autoimmune demyelinating disease, creation of an AQP4-targeted model with both clinical and histologic manifestations of CNS autoimmunity has proven challenging. Immunization of wild-type (WT) mice with AQP4 peptides elicited T cell proliferation, although those T cells could not transfer disease to naïve recipient mice. Recently, two novel AQP4 T cell epitopes, peptide (p) 135-153 and p201-220, were identified when studying immune responses to AQP4 in AQP4-deficient (AQP4-/-) mice, suggesting T cell reactivity to these epitopes is normally controlled by thymic negative selection. AQP4-/- Th17 polarized T cells primed to either p135-153 or p201-220 induced paralysis in recipient WT mice, that was associated with predominantly leptomeningeal inflammation of the spinal cord and optic nerves. Inflammation surrounding optic nerves and involvement of the inner retinal layers (IRL) were manifested by changes in serial optical coherence tomography (OCT). Here, we illustrate the approaches used to create this new in vivo model of AQP4-targeted CNS autoimmunity (ATCA), which can now be employed to study mechanisms that permit development of pathogenic AQP4-specific T cells and how they may cooperate with B cells in NMO pathogenesis

Impact of the Tropopause Temperature on the Intensity of Tropical Cyclones: An Idealized Study Using a Mesoscale Model

This study investigates the impact of the tropopause temperature on the intensity of idealized tropical cyclones (TCs) superimposed on background states of radiative–convective equilibrium (RCE) in a three-dimensional (3D) mesoscale model. Simulations are performed with constant sea surface temperature and an isothermal stratosphere with constant tropopause temperature. The potential intensity (PI) computed from the thermodynamic profiles of the RCE state (before the TCs are superimposed on it) increases by 0.4–1 m s⁻¹ for each 1 K of tropopause temperature reduction. The 3D TC experiments yield intense tropical cyclones whose intensities exceed the PI value substantially. It is further shown that the discrepancy may be largely explained by the supergradient wind in the 3D simulations. The intensities of these 3D TCs increase by ~0.4 m s⁻¹ per 1 K of cooling in the tropopause temperature in RCE, on the low end of the PI dependence on the tropopause temperature. Sensitivity experiments with a larger horizontal grid spacing of 8 km produce less intense TCs, as expected, but similar dependence (~−0.5 m s⁻¹ K⁻¹) on tropopause temperature. Equilibrium TC solutions are further obtained in 200-day experiments with different values of constant stratospheric temperature. Similar relationships between TC intensity and tropopause temperature are also found in these equilibrium TC solutions

Tropical Intraseasonal Variability in Version 3 of the GFDL Atmosphere Model

Tropical intraseasonal variability is examined in version 3 of the Geophysical Fluid Dynamics Laboratory Atmosphere Model (AM3). In contrast to its predecessor AM2, AM3 uses a new treatment of deep and shallow cumulus convection and mesoscale clouds. The AM3 cumulus parameterization is a mass-flux-based scheme but also, unlike that in AM2, incorporates subgrid-scale vertical velocities; these play a key role in cumulus microphysical processes. The AM3 convection scheme allows multiphase water substance produced in deep cumuli to be transported directly into mesoscale clouds, which strongly influence large-scale moisture and radiation fields. The authors examine four AM3 simulations using a control model and three versions with different modifications to the deep convection scheme. In the control AM3, using a convective closure based on CAPE relaxation, both MJO and Kelvin waves are weak relative to those in observations. By modifying the convective closure and trigger assumptions to inhibit deep cumuli, AM3 produces reasonable intraseasonal variability but a degraded mean state. MJO-like disturbances in the modified AM3 propagate eastward at roughly the observed speed in the Indian Ocean but up to 2 times the observed speed in the west Pacific Ocean. Distinct differences in intraseasonal convective organization and propagation exist among the modified AM3 versions. Differences in vertical diabatic heating profiles associated with the MJO are also found. The two AM3 versions with the strongest intraseasonal signals have a more prominent “bottom heavy” heating profile leading the disturbance center and “top heavy” heating profile following the disturbance. The more realistic heating structures are associated with an improved depiction of moisture convergence and intraseasonal convective organization in AM3

Prevalence and risk factors for vaginal Candida colonization in women with type 1 and type 2 diabetes

BACKGROUND: Diabetes mellitus increases the rate of vaginal colonization and infection with Candida species METHODS: We surveyed women with diabetes receiving care at either an urban or suburban diabetes clinic to examine the relationship between vaginal Candida colonization, diabetes type and duration, and HbA(1c) level. 101 participants completed the self-administered questionnaire and self-collected a vaginal swab for Candida culture. Candida colonization was similar by age and race. RESULTS: Type 1 diabetics were three times as likely as type 2 diabetics to be colonized with any Candida species (OR = 3.4; 95% CI: 1.03, 11.41; p = 0.04); even after adjusting for abnormal HbA(1c), which had an independent effect (OR = 1.4; 95% CI: 1.04, 1.76; p = 0.02). Recent antibiotic use (OR = 4.5; 95% CI: 1.18, 16.79; p = 0.03), lifetime history of chlamydia (OR = 5.8; 95% CI: 1.09, 30.54; p = 0.04), and performing oral sex during the past 2 weeks (OR = 4.9; 95% CI:0.84, 28.27; p = 0.08) were also associated with Candida carriage after adjusting for diabetic type and abnormal HbA(1c). C. albicans was isolated from the majority of colonized type 1 participants (56%), while C. glabrata was the most common isolate among colonized type 2 participants (54%). CONCLUSIONS: Improving glucose control and possibly modifying sexual behavior may reduce risk of Candida colonization, and potentially symptomatic infection, among women with diabetes

A Global Climatology of Extratropical Transition. Part I: Characteristics across Basins

The authors present a global climatology of tropical cyclones (TCs) that undergo extratropical transition (ET). ET is objectively defined based on a TC’s trajectory through the cyclone phase space (CPS), which is calculated using storm tracks from 1979–2017 best track data and geopotential height fields from reanalysis datasets. Two reanalyses are used and compared for this purpose, the Japanese 55-yr Reanalysis and the ECMWF interim reanalysis. The results are used to study the seasonal and geographical distributions of storms undergoing ET and interbasin differences in the statistics of ET occurrence. About 50% of all TCs in the North Atlantic and the western North Pacific undergo ET. In the Southern Hemisphere, ET fractions range from about 20% in the south Indian Ocean and the Australian region to 45% in the South Pacific. In the majority of ETs, TCs become thermally asymmetric before forming a cold core. However, a substantial fraction of TCs take the reverse pathway, developing a cold core before becoming thermally asymmetric. This pathway is most common in the eastern North Pacific and the North Atlantic. Different ET pathways can be linked to different geographical trajectories and environmental settings. In ETs over warmer sea surface temperatures, TCs tend to lose their thermal symmetry while still maintaining a warm core. Landfalls by TCs undergoing ET occur 3–4 times per year in the North Atlantic and 7–10 times per year in the western North Pacific, while coastal regions in the Australian region are affected once every 1–2 years