bluuebunny/crossref_metadata_2025 huggingface dataset:
DECIDING HOW TO DECIDE: THE CASE OF HEALTH CARE RATIONING
Authors: LANDWEHR CLAUDIA
Published: July 2009

One of the challenges awaiting health care systems around the world is the containment of expenses in the face of exploding costs for new drugs and treatments. In most countries, the allocation of health care has not been politicized so far and the problem is still treated as a purely regulative one. However, there is increasing interest in the procedures used for priority‐setting. The paper argues that while normative standards for their evaluation are desirable, more attention should be paid to institutional factors and their effects. I identify two demands on decision‐making—discursiveness and coordinativeness—from which I derive four ideal‐typical procedures. By way of international comparison, corresponding empirical cases are analysed. I conclude with considerations on whether efficient and publicly accepted decisions over the allocation of health care are possible and, if yes, by means of what type of procedures and in what forum(s) they can be taken.
TRADITIONS OF LOCAL GOVERNMENT
Authors: ORR KEVIN , VINCE RUSS
Published: July 2009

This article explores local government traditions in the UK. This task is an important one for scholars who wish to understand and appreciate the rich cultural complexity of local government organizations. In local government settings, traditions can be used in the study and evaluation of political and managerial practices. They provide lenses through which the routines, structures and processes of management and politics may be viewed. The delineation of multiple traditions heightens the sense that local government is not a unified homogeneous organizational entity, but rather a melange of voices, interests and assumptions about how to organize, prioritize and mobilize action. They can be used to engage practitioners with the idea that different traditions inform political and managerial practices and processes in local councils. The approach embraces the significance of participants' constitutive stories about local government rather than the search for essential truths about the politics and management of the public sector.
THE DOG THAT DIDN'T BARK: HOW PUBLIC MANAGERS HANDLE ENVIRONMENTAL SHOCKS
Authors: MEIER KENNETH J. , O’TOOLE LAURENCE J.
Published: July 2009

Do negative budgetary shocks reduce performance in public organizations? If so, by how much and in terms of which criteria? Are public managers able to make internal management choices to limit or eliminate the effects of such shocks? These questions are investigated in a set of hundreds of organizations over an 8‐year period. For the most part, budgetary shocks of 10 per cent or more have only limited or no negative impacts on performance in the short term. The most salient policy objective and production for more disadvantaged clientele are especially insulated from shocks. Decisions about internal resource allocation and personnel management can be shown to protect core production while sacrificing more peripheral activities and capital investment. Questions that remain to be investigated include whether short‐term protection comes at the expense of some longer‐term losses, and—ironically—whether effective management under such circumstances weakens over time the political case for adequate budgets.
INTRODUCTION: DETERMINANTS OF PERFORMANCE IN PUBLIC ORGANIZATIONS
Authors: WALKER RICHARD M. , BOYNE GEORGE A.
Published: July 2009

The performance of public organizations is one of the key topics in public administration research and practice. This topic was examined at the ‘The Determinants of Performance in Public Organizations II’ conference held at the University of Hong Kong in December 2006. The conference was held in association with the Public Management Research Association. In the present symposium we introduce four of the articles presented at conference. The articles explore: network performance (Kenis and Provan), goal ambiguity (Lee et al.), environmental shocks (Meier and O’Toole), and diversity (Pitts and Jarry). Alongside this we spotlight the importance of this field and introduce three research themes—contingency theory, measurement and data, and analysis.
TOWARDS AN EXOGENOUS THEORY OF PUBLIC NETWORK PERFORMANCE
Authors: KENIS PATRICK , PROVAN KEITH G.
Published: July 2009

This article offers insights into the complexity of assessing the performance of public networks. We have identified three so‐called exogenous factors: form of the network, type of inception—whether the network was initially formed as voluntary or mandated—and developmental stage of the network. We argue that where a network stands on each of these factors will determine the appropriateness of specific criteria for assessing the performance of the network.
NEW ESTIMATION OF CHINA'S EXCHANGE RATE REGIME
Authors: Frankel Jeffrey A.
Published: July 2009

Abstract.  The present paper updates the question: what precisely is the exchange rate regime that China has put into place since 2005, when it announced a move away from the US dollar peg? Is it a basket anchor with the possibility of cumulatable daily appreciations, as was announced at the time? We apply to this question a new approach of estimating countries’ de facto exchange rate regimes, a synthesis of two techniques. One is a technique that has been used in the past to estimate implicit de facto currency weights when the hypothesis is a basket peg with little flexibility. The second is a technique used to estimate the de facto degree of exchange rate flexibility when the hypothesis is an anchor to the US dollar or some other single major currency. Because the RMB and many other currencies today purportedly follow variants of band‐basket‐crawl, it is important to have available a technique that can cover both dimensions, inferring weights and inferring flexibility. The synthesis adds a variable representing ‘exchange market pressure’ to the currency basket equation, whereby the degree of flexibility is estimated at the same time as the currency weights. This approach reveals that by mid‐2007, the RMB basket had switched a substantial part of the US dollar's weight onto the euro. The implication is that the appreciation of the RMB against the US dollar during this period was due to the appreciation of the euro against the dollar, not to any upward trend in the RMB relative to its basket.
HOW ROBUST ARE ESTIMATES OF EQUILIBRIUM REAL EXCHANGE RATES: THE CASE OF CHINA
Authors: Dunaway Steven , Leigh Lamin , Li Xiangming
Published: July 2009

Abstract.  Assessments of a country's real exchange rate relative to its ‘equilibrium’ value as suggested by ‘fundamental’ determinants have received increasing attention. Using China as an example, the present paper illustrates models commonly used to derive equilibrium real exchange rate estimates. The large variance in the estimates raises serious questions about the robustness of these results. The basic conclusion is that, at least for China, small changes in model specifications, explanatory variable definitions, and time periods used in estimation can lead to very substantial differences in equilibrium real exchange rate estimates. Therefore, such estimates should be treated with great caution.
MEASURING THE EFFECTS OF OIL PRICES ON CHINA'S ECONOMY: A FACTOR‐AUGMENTED VECTOR AUTOREGRESSIVE APPROACH
Authors: Lescaroux François , Mignon Valérie
Published: July 2009

Abstract. The aim of this paper is to investigate the impacts of oil prices on the Chinese economy. To this end, we rely on the factor‐augmented vector autoregressive methodology, which allows us to evaluate the response of various macroeconomic variables to an oil price shock. Our results suggest that an oil price shock leads to: (i) a contemporaneous increase in consumer and producer price indexes, inducing a rise in interest rates; (ii) a delayed negative impact on GDP, investment and consumption; and (iii) a postponed increase in coal and power prices.
Lone mothers and the puzzles of daily life: do care regimes really matter?
Authors: Kröger Teppo
Published: July 2009

Kröger T. Lone mothers and the puzzles of daily life: do care regimes really matter?

Int J Soc Welfare 2010: 19: 390–401 © 2009 The Author, Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare.

This article studies childcare patterns and day‐to‐day strategies of 111 working lone mothers from Finland, France, Italy, Portugal and the UK, and asks whether their arrangements are prescribed by care regimes. Lone mothers' arrangements are grouped into five based on the availability and use of different formal and informal childcare resources. The article argues that, even though lone mothers have a more favourable starting point in Finland and France compared with Britain, Italy and Portugal where formal childcare coverage is patchier, childcare arrangements are not very dissimilar within different care regimes. Instead, similarities across care regimes are highlighted. Formal provisions have their limitations in all the countries studied and in all cases significant expectations are placed on informal childcare. The availability of informal childcare cannot, however, be taken for granted in any country, and working lone mothers whose informal and formal resources do not adequately meet their childcare needs were located in every care regime, facing care poverty.
Supraspinal Gβγ‐dependent stimulation of PLCβ3originating from G inhibitory protein‐μ opioid receptor‐coupling is necessary for morphine induced acute hyperalgesia
Authors: Bianchi Enrica , Norcini Monica , Smrcka Alan , Ghelardini Carla
Published: July 2009

Although alterations in μ‐opioid receptor (μOR) signaling mediate excitatory effects of opiates in opioid tolerance, the molecular mechanism for the excitatory effect of acute low dose morphine, as it relates to μOR coupling, is presently unknown. A pronounced coupling of μOR to the α subunit of G inhibitory protein emerged in periaqueductal gray (PAG) from mice systemically administered with morphine at a dose producing acute thermal hyperalgesia. This coupling was abolished in presence of the selective μOR antagonistd‐Phe–Cys–Tyr–d‐Trp–Orn–Thr–Pen–Thr–NH2administered at the PAG site, showing that the low dose morphine effect is triggered by μOR activated G inhibitory protein at supraspinal level. When Gβγ downstream signalling was blocked by intra‐PAG co‐administration of 2‐(3,4,5‐trihydroxy‐6‐oxoxanthen‐9‐yl)cyclohexane‐1‐carboxylic acid, a compound that inhibits Gβγ dimer‐dependent signaling, a complete prevention of low dose morphine induced acute thermal hyperalgesia was obtained. Phospholipase C β3, an enzyme necessary to morphine hyperalgesia, was revealed to be associated with Gβγ in PAG. Although opioid administration induces a shift in μOR‐G protein coupling from Gi to Gs after chronic administration, our data support that this condition is not realized in acute treatment providing evidence that a separate molecular mechanism underlies morphine induced acute excitatory effect.
Regulation of synaptic vesicle accumulation and axon terminal remodeling during synapse formation by distinct Ca2+signaling
Authors: Yoshida Tomoyuki , Uchida Satoshi , Mishina Masayoshi
Published: July 2009

The synaptic vesicle accumulation and subsequent morphological remodeling of axon terminals are characteristic features of presynaptic differentiation of zebrafish olfactory sensory neurons. The synaptic vesicle accumulation and axon terminal remodeling are regulated by protein kinase A and calcineurin signaling, respectively. To investigate upstream signals of presynaptic differentiation, we focused on Ca2+signaling as Ca2+/calmodulin is required for the activation of both calcineurin and some adenylyl cyclases. We here showed that application of Ca2+/calmodulin inhibitor or olfactory sensory neuron‐specific expression of calmodulin inhibitory peptide suppressed both synaptic vesicle accumulation and axon terminal remodeling. Thus, the trigger of presynaptic differentiation could be Ca2+release from intracellular stores or Ca2+influx. Application of a phospholipase C inhibitor or olfactory sensory neuron‐specific expression of inositol 1,4,5‐trisphosphate (IP3) 5‐phosphatase suppressed synaptic vesicle accumulation, but not morphological remodeling. In contrast, application of a voltage‐gated Ca2+channel blocker or expression of Kir2.1 inward rectifying potassium channel prevented the morphological remodeling. We also provided evidence that IP3signaling acted upstream of protein kinase A signaling. Our results suggest that IP3‐mediated Ca2+/calmodulin signaling stimulates synaptic vesicle accumulation and subsequent neuronal activity‐dependent Ca2+/calmodulin signaling induces the morphological remodeling of axon terminals.
Improving Disparity Estimates for Rare Racial/Ethnic Groups with Trend Estimation and Kalman Filtering: An Application to the National Health Interview Survey
Authors: Elliott Marc N. , McCaffrey Daniel F. , Finch Brian K. , Klein David J. , Orr Nate , Beckett Megan K. , Lurie Nicole
Published: July 2009

Objective.Single‐year estimates of health disparities in small racial/ethnic groups are often insufficiently precise to guide policy, whereas estimates that are pooled over multiple years may not accurately describe current conditions. While collecting additional data is costly, innovative analytic approaches may improve the accuracy and utility of existing data. We developed an application of the Kalman filter in order to make more efficient use of extant data.

Data Source.We used 1997–2004 National Health Interview Survey data on the prevalence of health outcomes for two racial/ethnic subgroups: American Indians/Alaska Natives and Chinese Americans.

Study Design.We modified the Kalman filter to generate more accurate current‐year prevalence estimates for small racial/ethnic groups by efficiently aggregating past years of cross‐sectional survey data within racial/ethnic groups. We compared these new estimates and their accuracy to simple current‐year prevalence estimates.

Principal Findings.For 18 of 19 outcomes, the modified Kalman filter approach reduced the error of current‐year estimates for each of the two groups by 20–35 percent—equivalent to increasing current‐year sample sizes for these groups by 56–135 percent.

Conclusions.This approach could increase the accuracy of health measures for small groups using extant data, with virtually no additional cost other than those related to analytical processes.
Jurisdiction Size and Local Public Health Spending
Authors: Santerre Rexford E.
Published: July 2009

Objective. To examine if a minimum efficient scale (MES) holds with respect to the population serviced by a local health department (LHD) given the congestability, externality, and scale/scope economy effects potentially associated with public health services.

Data Sources/Study Setting. A nationally representative sample of LHDs in 2005.

Study Design. Multiple regression analysis is used to isolate the relation between population and spending while controlling for other factors known to influence local public health costs.

Data Collection. Data were obtained from the 2005 National Profile of Local Public Health Agencies, a project supported through a cooperative agreement between the National Association of County and City Health Officials and the Centers for Disease Control and Prevention.

Principal Findings. The MES of a local public health department is approximately 100,000 people. After that size, additional population has little impact on public health spending per capita.

Conclusions. Seventy‐seven percent of LHDs in the sample fall below the 100,000 MES. Higher levels of government may want to provide financial inducements so that smaller LHDs consolidate or enter into agreements with larger public health organizations to provide services.
Investors' Reactions to Management Earnings Guidance: The Joint Effect of Investment Position, News Valence, and Guidance Form
Authors: HAN JUN , TAN HUN‐TONG
Published: July 2009

We report the results of an experiment that shows that investors' earnings‐ and investment‐related judgments are jointly influenced by their investment position (long versus short), the news valence of guidance issued by management, and the amount of ambiguity in the guidance. Prior research indicates that guidance form (point versus range) has no effect on investors' earnings estimates made in reaction to management guidance. We extend this research by showing that guidance form matters, conditional on investment position and news valence. Similarly, prior research indicates that investors who hold long (short) positions in a stock are more optimistic (pessimistic) about the company's prospects. We extend this research by showing that the effect of investment position documented in prior studies is conditional on news valence and guidance form. We contribute to prior literature on the effects of investment position and guidance form by delineating boundary conditions for each of these effects.
Understanding Young Children's Three‐Dimensional Creative Potential in Art Making
Authors: Pavlou Victoria
Published: July 2009

This article explores aspects of young children's three‐dimensional development in art making. Understanding young children's three‐dimensional awareness and development is often a neglected area of early childhood educators' education and practice and often children's creative potential is not fully realised. The present article is based on a small scale qualitative study which focused on understanding 5–6 year‐olds' representational intentions in three‐dimensional artworks, understanding of visual/design concepts and expressive use of media (scrap paper and mod roc). The findings of the study suggest that young children are able to create satisfying three‐dimensional representations giving emphasis on forms, uprightness, balance, movement and modeling of multiple sides.
‘I'd rather be seen as a practitioner, come in to teach my subject’: Identity Work in Part‐Time Art and Design Tutors
Authors: Shreeve Alison
Published: July 2009

This article explores issues of identity as part‐time tutors engage in teaching in further and higher education. It is based on a phenomenographic research approach that examines variation in experience. Based on interviews with 16 creative practitioners who also teach, it draws on the narratives of identity resulting from the interview process. The five possible ways that the relationship between practice and teaching can be experienced can also be associated with five different experiences of identity. The research also draws on case studies more aligned with one category of experience than another, enabling aspects of identity work to be related to the worlds of practice and teaching and to individual histories of participation in these worlds. Factors that help to contribute to particular forms of identity are therefore discussed, as well as the impact that tutor identity can have on the students' learning experience.
Performance Art at Secondary Level
Authors: Horn Sheridan
Published: July 2009

This article considers the far‐reaching potential and the particular characteristics of performance art within the secondary art curriculum. It discusses the means by which an art department has incorporated it into their teaching curriculum at a state secondary school with reference to installations and the work of different performance artists in residence; details of their performances, methods and artistic intentions are discussed. After consideration of the varied responses from staff and students within Trinity Catholic School, the values and significance of direct experience are discussed. In its transience and its reflecting of the performative acts common to ordinary life, performance art offers a challenge to young people's thinking and creativity.
Critical Perspectives on Colonisation of the Art Curriculum in Korea
Authors: Park Jeong‐Ae
Published: July 2009

This article examines some characteristics of art education in Korea. It takes the form of a historical overview using a postcolonial lens. The findings were that the predominant Western aesthetic concepts and theories as central culture embodied in Korean art education as local culture are: (i) ideas of art as self‐expression developed in Europe and the USA between the 1920s and 1950s; (ii) the concept of art in daily living in the USA in the 1930s; (iii) design elements and principles by Arthur Wesley Dow in the USA in the 1920s; (iv) Bauhaus design theory in Europe in the 1920s; and (v) the appreciation of nature beauty by John Ruskin in the late nineteenth century in England. These educational ideas have been influential on policy‐making in Korean art education, and therefore new concepts are integrated with these elements for curriculum changes. In this way, the characteristic of the colonised Korean art curriculum is so hybrid that it is difficult to understand the concepts and the practical implications of the various policies for art teaching. Consequently, it has not served the issues of cultural diversity and pluralism that are so problematic in twenty‐first century Korean society.
F. M. Courtis Collection: A Window on Teacher Education at Bendigo, Australia
Authors: Collet Penelope
Published: July 2009

For the best part of the last millennium collections have been used in universities in Europeto support teaching and research. European authors have referred to university collections as ‘windows on the university’. This article uses the European context to historically situate art collections in Australian teacher education institutions. The F.M. Courtis Collection at La Trobe University exemplifies how such teaching collections continue to contribute to teaching and learning today.
The Creation of the ‘Hong Kong Visual Arts Education Web’ and the Use of the Inquiry‐Based Teaching Approach
Authors: Sang Anita Ng Heung
Published: July 2009

This article describes a collaborative action research conducted by a lecturer and several primary school art teachers, who between 2001 and 2006 created the Visual Arts Education Web (‘iii web’) in Hong Kong. The creation of the ‘iii web’ was accomplished through research that employed questionnaires, focus group discussions and individual interviews. Teachers' perceptions of using websites in teaching were examined, art education websites from Hong Kong, Taiwan, Mainland China and the USA were compared, in order to create a website that could meet the needs of Hong Kong primary school art teachers. Inquiry‐based learning is one of the important teaching approaches that were introduced during the Hong Kong Education Reform in 2003. An example of using the ‘iii web’ to teach public art is described to illustrate how the teacher and students used inquiry‐based learning in art education.
High Blood Pressure Control: Put the Champagne Away
Authors: Lenfant Claude
Published: July 2009

Knowing is not enough; we must apply. Willing is not enough; we must do.
A New Transcutaneous Energy Transmission System With Hybrid Energy Coils for Driving an Implantable Biventricular Assist Device
Authors: Okamoto Eiji , Yamamoto Yoshiro , Akasaka Yuhta , Motomura Tadashi , Mitamura Yoshinori , Nosé Yukihiko
Published: July 2009

Abstract:  We have developed a new transcutaneous energy transmission (TET) system for a totally implantable biventricular assist device (BVAD) system in the New Energy and Industrial Development Organization (NEDO) artificial heart project. The TET system mainly consists of an energy transmitter, a hybrid energy coil unit, an energy receiver, an internal battery system, and an optical telemetry system. The hybrid energy coil unit consists of an air‐core energy transmission coil and an energy‐receiving coil having a ferrite core. Internal units of the TET system are encapsulated in a titanium alloy casing, which has a size of 111 mm in width, 73 mm in length, and 25 mm in height. In in vitro experiments, the TET system can transmit a maximum electric energy of 60 Watts, and it has a maximum transmission efficiency of 87.3%. A maximum surface temperature of 46.1°C was measured at the ferrite core of the energy‐receiving coil during an energy transmission of 20 Watts in air. The long‐term performance test shows that the TET system has been able to operate stably for over 4 years with a decrease of energy‐transmission efficiency from 85% to 80%. In conclusion, the TET system with the hybrid energy coil can overcome the drawback of previously reported TET systems, and it promises to be the highest performance TET system in the world.
A Lateral Approach for Screw Repair in Lag Fashion of Spiral Third Metacarpal and Metatarsal Medial Condylar Fractures in Horses
Authors: SMITH LEWIS C. R. , GREET TIMOTHY R. C. , BATHE ANDREW P.
Published: July 2009

Objective—To describe a lateral approach for screw fixation in lag fashion of simple spiral medial condylar fractures of the third metacarpus/metatarsus (MC3/MT3).

Study Design—Case series.

Animals—Thoroughbred racehorses (n=9).

Methods—Nondisplaced medial MC3/MT3 condylar fractures (3 thoracic, 6 pelvic limbs), with mean length 126 mm (range, 91–151 mm) were repaired by internal fixation, under general anesthesia, using multiple 4.5 mm cortical screws inserted in lag fashion from the lateral aspect of the limb, using radiographic or fluoroscopic guidance. Horses were recovered from anesthesia in half‐limb casts; 7 unassisted and 2 using a rope‐recovery system. Horses had 2 months box rest, 1 month in‐hand walking, and follow‐up radiographic examination at 3 months.

Results—Horses recovered uneventfully from anesthesia. Five horses raced; 1 returned to training, was persistently lame, and was retired to stud; 2 were retired directly to stud; and 1 horse was lost to follow‐up.

Conclusions—MC3/MT3 medial condylar fractures were successfully repaired by screws inserted n lag fashion form the lateral aspect.

Clinical Relevance—Use of a lateral approach to medial condylar MC3/MT3 fractures allows screw insertion perpendicular to the fracture plane without interference with palmar/plantar soft tissue structures or from the splint bones. Although repair was performed under general anesthesia, the technique should be adaptable to application in standing horses.
Immunohistochemical Localization of RANK, RANKL and OPG in Healthy and Arthritic Canine Elbow Joints
Authors: SPAHNI ANDREA I. , SCHAWALDER PETER , ROTHEN BARBARA , BOSSHARDT DIETER D. , LANG NIKLAUS , STOFFEL MICHAEL H.
Published: July 2009

Objective— To determine if the receptor activator of nuclear factor‐κB–receptor activator of nuclear factor‐κB ligand–osteoprotegerin (RANK–RANKL–OPG) system is active in bone remodeling in dogs and, if so, whether differences in expression of these mediators occur in healthy and arthritic joints.

Study Design— Experimental study.

Sample Population— Fragmented processus coronoidei (n=20) were surgically removed from dogs with elbow arthritis and 5 corresponding healthy samples from dogs euthanatized for reasons other than elbow joint disease.

Methods— Bright‐field immunohistochemistry and high‐resolution fluorescence microscopy were used to investigate the distribution of RANK, RANKL, and OPG in healthy and arthritic joints.

Results— All 3 molecules were identified by immunostaining of canine bone tissue. In elbow dysplasia, the number of RANK‐positive osteoclasts was increased. In their vicinity, cells expressing RANKL, a mediator of osteoclast activation, were abundant whereas the number of osteoblasts having the potential to limit osteoclastogenesis and bone resorption via OPG was few.

Conclusions— The RANK–RANKL–OPG system is active in bone remodeling in dogs. In elbow dysplasia, a surplus of molecules promoting osteoclastogenesis was evident and is indicative of an imbalance between the mediators regulating bone resorption and bone formation. Both OPG and neutralizing antibodies against RANKL have the potential to counterbalance bone resorption.

Clinical Relevance— Therapeutic use of neutralizing antibodies against RANKL to inhibit osteoclast activation warrants further investigation.
The Utility of Live Three‐Dimensional Echocardiography in the Surgical Treatment of Bilateral Coronary Fistulas
Authors: Ou Ching‐huei , Chou Yi‐Pen , Hsiung Ming C. , Wei Jeng , Chang Chung‐Yi , Yin Wei‐Hsian , Tsai Shen kou
Published: July 2009

In patients with coronary and pulmonary arterial fistulas, the drainage sites may be difficult to identify if there are multiple connections by standard 2D echocardiography techniques. However, real time 3D TEE was used intraoperatively in our case to facilitate site identification, the number of fistulous connections, and documentation of the fistula ligation.
Two‐Dimensional Echocardiographic Findings of Pulmonary Valve Cyst Secondary to Pulmonary Valvuloplasty
Authors: Dod Harvinder , Bhardwaj Ravindra , Singh Preeti , Massinople David , Sajja Venu , Williams H. James , Livengood Ryan H. , Jain Abnash , Failinger Conard , Nanda Navin C.
Published: July 2009

Real time two‐dimensional transthoracic and transesophageal echocardiography demonstrated a mobile echolucent mass attached to the pulmonary valve in a 25‐year‐old adult, 20 years following balloon pulmonary valvuloplasty. The mass was surgically excised and pathology showed it to be a cyst.
Continuing Medical Education Program in Echocardiography
Authors: Fan Pohoey , Barberato Silvio H. , Misocami Marcio , Pecoits‐Filho Roberto
Published: July 2009

Article Title: Association between Left Atrium Enlargement and Intradialytic Hypotension: Role of Diastolic Dysfunction in the Hemodynamic Complications during Hemodialysis
Retiform hemangioendothelioma: presentation of a case expressing D2‐40
Authors: Emberger Michael , Laimer Martin , Steiner Hansjörg , Zelger Bernhard
Published: July 2009

Retiform hemangioendothelioma (RH) is a low‐grade angiosarcoma with low metastatic risk, usually occurring as a single lesion on the trunk or extremity in middle‐aged adults. Histopathology shows a distinctive pattern with arborizing blood vessels arranged in a retiform pattern (similar to rete testis tissue) and focal papillae with fibrosclerotic (hyaline) cores. The blood vessels are lined by comparatively monomorphic endothelial cells, frequently presenting a hobnail pattern. We report a case of RH presenting as an indolent brownish plaque on the back of a 17‐year‐old male. Surgical resection and sentinel lymph node biopsy showed no evidence of metastasis. In contrast to the recent literature, this case of RH showed positivity for D2‐40, a marker of lymphatic endothelium. We also report ultrastructural findings for this case of RH.
Pigmented extramammary Paget's disease of the axilla mimicking melanoma: case report and review of the literature
Authors: Hilliard Nicholaus J. , Huang Conway , Andea Aleodor
Published: July 2009

Pigmented Paget's disease is a rare variant that is often confused clinically and histologically with melanoma in situ. Herein, we describe a case of pigmented extramammary Paget's disease involving the axilla of a 79‐year‐old white male thought initially to represent malignant melanoma clinically and histologically. Review of the literature reveals that pigmented variant of Paget's disease, either mammary or extramammary, could be initially misdiagnosed as melanoma unless this entity is considered in the differential diagnosis, and additional confirmatory studies are performed.
Acantholytic dyskeratotic epidermal nevus with eccrine differentiation: a case report and review of literature
Authors: Shaffer Holly C. , Schosser Robert , Phillips Charles
Published: July 2009

Terminology regarding classification of benign lesions with prominent eccrine differentiation can be confusing as these lesions can have overlapping clinical and histologic characteristics. In this report, we examine a case and review of the literature to suggest that these entities may be better classified as a spectrum of benign lesions with overlapping features rather than distinct entities. We describe a case of an acantholytic dyskeratotic epidermal nevus with eccrine differentiation on the back of a 2‐year‐old patient. We then discuss the classic clinical and histologic presentations of eccrine nevi and epidermal nevi with eccrine differentiation as they relate to each other and to our case.
No indications for HPV involvement in the hypertrophic skin lesions of a Darier disease case without ATP2A2 gene mutations
Authors: Borgogna Cinzia , Zavattaro Elisa , Dell'Oste Valentina , Mondini Michele , Valente Guido , Colombo Enrico , Weissenborn Soenke , Leigheb Giorgio , Landolfo Santo , Gariglio Marisa
Published: July 2009

Darier disease (DD) is a relatively common genodermatosis characterized by impaired differentiation and abnormal cell‐to‐cell adhesion. Haploinsufficiency of the ATP2A2 gene product, sarco/endoplasmic reticulum Ca2+ ATPase isoform 2 (SERCA2), is the underlying cause of most cases. Although DD may have a papillomatous appearance, few and controversial results have been reported about the role of human papillomavirus (HPV) in this disease. The aim of this study was to determine a possible correlation between development of hypertrophic lesions in DD and infection by HPV. We report the case of an 84‐year‐old woman with a hypertrophic DD variant that has been successfully treated with oral retinoids. HPV analysis for a broad spectrum of cutaneous and mucocutaneous genotypes was performed on surgical specimens obtained from the cutaneous lesions and snap‐frozen plucked eyebrows. Genetic analysis of the ATP2A2 gene did not detect any mutations. Epidermal expression of SERCA2b was shown by immunohistochemistry. We describe a patient with DD lacking mutations of the ATP2A2 gene, but with reduced SERCA2b expression in the epidermal keratinocytes. The results obtained by polymerase chain reaction (PCR) genotyping, quantitative real‐time PCR, and in situ hybridization indicate that HPV replication was very low and suggest no direct role of the virus in the development of the disease.
Matrix metalloproteinase‐26 is present more frequently in squamous cell carcinomas of immunosuppressed compared with immunocompetent patients
Authors: Kuivanen Tiina , Jeskanen Leila , Kyllönen Lauri , Isaka Keiichi , Saarialho‐Kere Ulpu
Published: July 2009

Background: Skin cancers are the most frequent malignancies in organ transplant recipients (OTRs). Squamous cell carcinomas (SCCs) occur 65–250 times more frequently in OTRs and tend to be aggressive in behavior. Because matrix metalloproteinases (MMPs) have a central role in tumorigenesis and invasion, we investigated the epithelial and stromal MMP and tissue inhibitor of MMP (TIMP) expression profile in SCCs of immunosuppressed (IS) compared with immunocompetent (IC) patients to determine if differences could explain the more aggressive behavior of SCCs in OTRs.

Methods: Matched pairs from 20 SCCs of IS and IC patients were studied using immunohistochemistry for MMP‐1, MMP‐7, MMP‐8, MMP‐9, MMP‐13 and MMP‐26 and TIMP‐1 and TIMP‐3.

Results: Among all MMPs studied, only staining for MMP‐26 was significantly more intense in cancer cells of the post‐transplant group compared with the IC group (p = 0.01), whereas MMP‐9 expression was more abundant in stromal macrophages surrounding SCCs of IC patients (p = 0.02). MMP‐26 expression in cancer cells (p = 0.04) and that of MMP‐9 in neutrophils (p = 0.005) were more abundant in SCCs of patients using cyclosporine.

Conclusions: We conclude that MMP‐26 and MMP‐9 may contribute to the more aggressive behavior of SCCs in OTRs.
Fibrofolliculoma/trichodiscoma and fibrous papule (perifollicular fibroma/angiofibroma): a revaluation of the histopathological and immunohistochemical features
Authors: Misago Noriyuki , Kimura Tetsunori , Narisawa Yutaka
Published: July 2009

Background: The multiple facial lesions of fibrofolliculoma (FF)/trichodiscoma (TD) and those of fibrous papule (FP; perifollicular fibroma/angiofibroma, AF) are characteristic of Birt‐Hogg‐Dubé (BHD) syndrome and tuberous sclerosis, respectively. However, there was a recently reported case of BHD syndrome with multiple facial FP lesions and a case of tuberous sclerosis, in which one FF lesion was included among the multiple facial FPs.

Methods: The histopathological and immunohistochemical features of FF/TD and FP lesions were revaluated to study the relationship between the two. This investigation evaluated 20 FF/TD lesions including two cases of BHD syndrome and 35 FP lesions including three cases of tuberous sclerosis.

Results: There are common histopathological features in the two lesions, such as the follicular and perifollicular elements, an angiofibromatous element and stellate fibrocytes. The similar immunohistochemical features between the two lesions included the expression patterns of CD34, factor XIIIa, nestin and c‐kit in the stromal cells as well as abnormal CK15 expression in the hair follicles.

Conclusions: Both FF/TD and FP are hamartomas composed of perifollicular or interfollicular connective tissue and a hair follicular epithelial component, which may be caused by an abnormal functioning of the hair follicle bulge cells.
Elastic fiber pattern in scleroderma/morphea
Authors: Walters Ruth , Pulitzer Melissa , Kamino Hideko
Published: July 2009

Background: Scleroderma/morphea is characterized by expansion of the dermis with thickened collagen bundles and loss of CD34+ dermal dendrocytes. Variable elastic fiber changes have been described, but to our knowledge, no systematic study of the elastic fiber pattern correlated with CD34 expression has been reported.

Methods: To better define the typical elastic fiber morphology, we examined seven cases of normal skin and 28 cases of scleroderma/morphea ranging from inflammatory to sclerosing stages. All but four biopsies were submitted with a clinical impression of either scleroderma or morphea. CD34 immunohistochemistry was performed on 26 biopsies with available tissue.

Results: Elastic van Gieson stain showed preservation of elastic fibers in all cases. In addition, straightening with parallel orientation and compression between thickened collagen bundles was frequently present and was graded as limited in 46% and diffuse in 54% of cases. The extent of elastic fiber alteration correlated with the degree of sclerosis. A variable loss of CD34+ dermal dendritic cells was seen in all cases.

Conclusion: This study confirms the preservation and frequent presence of parallel, straightened and compressed elastic fibers in scleroderma/morphea and suggests that the elastic fiber pattern, in addition to CD34 immunohistochemistry, may serve as a useful diagnostic adjunct.
PIP4KIIA and β‐globin: transcripts differentially expressed in reticulocytes and associated with high levels of Hb H in two siblings with Hb H disease
Authors: Wenning Marcia R. S. C. , Mello Maricilda P. , Andrade Tiago G. , Lanaro Carolina , Albuquerque Dulcineia M. , Saad Sara T. O. , Costa Fernando F. , Sonati Maria F.
Published: July 2009

We are reporting here the results of differential gene expression experiments comparing two siblings, a 21‐yr‐old male and a 19‐yr‐old female, with the same alpha‐thalassemia genotype (−α3.7/−−SEA) and quite different levels of Hb H in the peripheral blood (18.7 and 5%, respectively). By using mRNA differential‐display reverse‐transcription‐PCR and suppression subtractive hybridization, two main transcripts were selected in both procedures and validated by qRT‐PCR, one corresponding to the phosphatidylinositol phosphate 4‐kinase type II‐alpha (PIP4KIIA) gene and the other to the β‐globin gene, both over expressed in the patient with the higher percentage of Hb H. Type II PIP kinases produce phosphatidylinositol 4,5 biphosphate, a critical and pleiotropic regulatory molecule involved in diverse cellular activities, including gene expression. Our results suggest that PIP4KIIA may be one of the factors related to the regulation of the β‐globin gene expression and the different levels of Hb H in α‐thalassemic patients.
Transportin Mediates Nuclear Entry of DNA in Vertebrate Systems
Authors: Lachish‐Zalait Aurelie , Lau Corine K. , Fichtman Boris , Zimmerman Ella , Harel Amnon , Gaylord Michelle R. , Forbes Douglass J. , Elbaum Michael
Published: July 2009

Delivery of DNA to the cell nucleus is an essential step in many types of viral infection, transfection, gene transfer by the plant pathogen Agrobacteriumtumefaciens and in strategies for gene therapy. Thus, the mechanism by which DNA crosses the nuclear pore complex (NPC) is of great interest. Using nuclei reconstituted in vitro in Xenopus egg extracts, we previously studied DNA passage through the nuclear pores using a single‐molecule approach based on optical tweezers. Fluorescently labeled DNA molecules were also seen to accumulate within nuclei. Here we find that this import of DNA relies on a soluble protein receptor of the importin family. To identify this receptor, we used different pathway‐specific cargoes in competition studies as well as pathway‐specific dominant negative inhibitors derived from the nucleoporin Nup153. We found that inhibition of the receptor transportin suppresses DNA import. In contrast, inhibition of importin β has little effect on the nuclear accumulation of DNA. The dependence on transportin was fully confirmed in assays using permeabilized HeLa cells and a mammalian cell extract. We conclude that the nuclear import of DNA observed in these different vertebrate systems is largely mediated by the receptor transportin. We further report that histones, a known cargo of transportin, can act as an adaptor for the binding of transportin to DNA.
The Emerging Role of the RAB25 Small GTPase in Cancer
Authors: Agarwal Roshan , Jurisica Igor , Mills Gordon B. , Cheng Kwai Wa
Published: July 2009

RAB25, a member of the rat sarcoma (RAS) family of small GTPase, has been implicated in the pathophysiology of ovarian, breast and other cancers. Its role in endosomal transport and recycling of cell‐surface receptors and signaling proteins presents a novel paradigm for the disruption of cellular pathways and promotion of tumor development and aggressiveness. Variations in structure and post‐translational modifications control the localization of RAS superfamily proteins to specific subcellular compartments and recruitment of downstream effectors, allowing these small GTPases to function as sophisticated modulators of a complex and diverse range of cellular processes. Here, we review the link between RAB25 and tumor development and current knowledge regarding its possible roles in cancer.
A mouse model linking viral hepatitis and salivary gland dysfunction
Authors: Kasman LM , London LL , London SD , Pilgrim MJ
Published: July 2009

Objective:  Viral hepatitis is known to cause xerostomia in humans, but this has not been reported in an animal model. We report a severe, acute, highly reproducible saliva deficiency occurring in BALB/c mice as a result of experimental viral hepatitis.

Materials and Methods:  BALB/c mice, splenectomized or carrying genetic mutations to detect immunological contributions to the saliva deficiency syndrome, were infected intraperitoneally with a non‐lethal dose of murine cytomegalovirus. Pilocarpine‐stimulated saliva volumes were determined between 0 and 15 days after infection. Salivary gland, liver, spleen, and sera were analyzed for the presence of virus, cytokines, inflammatory infiltrates, and tissue damage.

Results:  Saliva deficiency was detectable 2 days after cytomegalovirus infection, peaked at 88% below normal by day 7, and resolved partially in all mice by 15 days postinfection as sialoadenitis increased. Neither salivary gland viral titers, sialoadenitis, splenectomy, nor systemic inflammatory markers correlated with hyposalivation severity. Elevated liver enzymes did correlate with hyposalivation, and mice genetically resistant to murine cytomegalovirus‐induced hepatitis were significantly protected.

Conclusions:  Murine cytomegalovirus‐induced salivary gland dysfunction is biphasic, with an acute hepatitis‐associated phase and a later sialoadenitis‐associated phase. Acute murine cytomegalovirus infection of BALB/c mice may provide a model for investigation of hepatitis‐associated xerostomia.
Brain‐type natriuretic peptide at birth reflects foetal maturation and antenatal stress
Authors: Kanbe Taro , Maeno Yasuki , Fujino Hiroshi , Kanda Hiroshi , Hirose Akiko , Okada Junichiro , Morikawa Toshihiko , Iwata Sachiko , Iwata Osuke , Matsuishi Toyojiro
Published: July 2009

Aim:  Antenatal stress, maturation and other foetal conditions affect the postnatal cardiovascular function. Atrial‐ (ANP) and brain‐type natriuretic peptide (BNP) play important roles in regulating extracellular fluid volume and blood pressure, which may surrogate the foetal cardiovascular condition. The aim of this study was to investigate the dependence of serum ANP and BNP at birth on antenatal variables in high‐risk infants.

Methods:  Plasma ANP and BNP levels in the umbilical cord blood were compared with antenatal clinical information in 280 infants.

Results:  High levels of ANP and BNP were associated with multiple pregnancy, antenatal magnesium sulphate and foetal distress. Caesarean section (CS) was paradoxically associated with low ANP and high BNP; low ANP was related with CS before labour whereas high BNP was related with CS after the commencement of labour. High BNP levels further correlated with younger gestational age and intrauteral growth restriction. With regard to short‐term postnatal variables, high BNP levels were associated with low Apgar scores and respiratory failure whereas high ANP only correlated with the latter.

Conclusion:  High natriuretic peptide levels were associated with prematurity at birth, uteral contraction and antenatal stress: cord blood ANP and BNP may be a useful surrogate marker for hidden antenatal stress.
Remifentanil for INSURE in preterm infants: a pilot study for evaluation of efficacy and safety aspects
Authors: Welzing L , Kribs A , Huenseler C , Eifinger F , Mehler K , Roth B
Published: July 2009

Aim:  To evaluate intubating conditions, extubation times and outcome in preterm infants receiving remifentanil as induction agent for the INSURE procedure.

Methods:  In twenty‐one preterm infants of 29 to 32 weeks gestation and signs of respiratory distress, we utilized remifentanil as induction agent for the INSURE procedure. Following intubation and surfactant application, the infants were mechanically ventilated until respiratory drive was judged to be satisfactory for continuing CPAP therapy. Intubating conditions were classified by our own scoring system by rating limb movements, coughing and breathing. Heart rate, blood pressure and oxygen saturation were recorded during the entire INSURE procedure.

Results:  Remifentanil provided excellent or good intubating conditions in all patients. We observed no serious side effects after remifentanil infusion, in particular, no thorax rigidity, clinically significant bradycardia or arterial hypotension. Average extubation time after surfactant administration was 16.9 min (1–45 min); none of the infants had to be reintubated. Following extubation, the infants required only 3.3 days (1–8 days) of CPAP therapy. None exhibited serious complications of prematurity like periventricular leucomalacia, intraventricular haemorrhage >I°, necrotizing enterocolitis or retinopathy.

Conclusion:  In this pilot study, INSURE with remifentanil was associated with good intubating conditions and early extubation resulting in an excellent neonatal outcome.