bluuebunny/crossref_metadata_2025 huggingface dataset:
Reversal of Sleep‐Disordered Breathing with Opioid Withdrawal
Authors: Ramar Kannan
Published: June 2009

Obstructive sleep apnea, central sleep apnea, sleep related hypoventilation, Biot's or ataxic breathing, and cluster breathing are some of the commonly described sleep disorders in patients who are on long‐term opioids. Continuous positive airway pressure that is commonly used to treat obstructive sleep apnea may not be effective in treating sleep‐disordered breathing in long‐term opioid users, and an adaptive servoventilator (ASV) may be needed. We present a 30‐year‐old woman with excessive daytime sleepiness and sleep‐disordered breathing for the past 4 years. Medical history was complicated by chronic osteomyelitis, periorbital abscess, and chronic facial pain requiring methadone for pain control for the last 4 years. In this case, ASV, though effective, was not tolerable due to chronic facial pain, and successful withdrawal of methadone at our pain rehabilitation center resolved the sleep‐disordered breathing and improved daytime sleepiness. This is to our knowledge the first case report of resolution of sleep‐disordered breathing and improvement in daytime sleepiness after withdrawal of long‐term opioid use.
Prevalence, Predictors, and Prognosis of Atrial Fibrillation Early After Pulmonary Vein Isolation: Findings from 3 Months of Continuous Automatic ECG Loop Recordings
Authors: JOSHI SANDEEP , CHOI ANDREW D. , KAMATH GANESH S. , RAISZADEH FARBOD , MARRERO DANIEL , BADHEKA APURVA , MITTAL SUNEET , STEINBERG JONATHAN S.
Published: June 2009

Introduction:
Following pulmonary vein isolation (PVI) for atrial fibrillation (AF), early recurrences are frequent, benign and classified as a part of a “blanking period.” This study characterizes early recurrences and determines implications of early AF following PVI.

Methods and Results:
Seventy‐two consecutive patients (59.8 ± 10.7 years, 69% male) were studied following PVI for paroxysmal or persistent AF. Subjects were fitted with an external loop recorder for automatic, continuous detection of AF recurrence for 3 months. AF prevalence was highest 2 weeks after PVI (54%) and declined to an eventual low of 22%. A significant number (488, 34%) of recurrences were asymptomatic; however, all patients with ≥1 AF event had ≥1 symptomatic event. No clear predictor of early recurrence was identified. Forty‐seven (65%) patients had at least 1 AF episode, predominantly (39 of 47 patients, 83%) within 2 weeks of PVI. Of the 33 patients who did not experience AF within the first 2 weeks, 85% (28/33) were complete responders (P = 0.03) at 12 months. Recurrence at any time within 3 months was not associated with procedural success or failure.

Conclusions:
Early AF recurrence peaks within the first few weeks after PVI, but continues at a lower level until the completion of monitoring. A blanking period of 3 months is justified to identify patients with AF recurrences that do not portend procedure failure. Freedom from AF in the first 2 weeks following ablation significantly predicts long‐term AF freedom.
Genetic Modulation of Brugada Syndrome by a Common Polymorphism
Authors: LIZOTTE ERIC , JUNTTILA M. JUHANI , DUBE MARIE PIERRE , HONG KUI , BENITO BEGONA , DE ZUTTER MARC , HENKENS STEFAN , SARKOZY ANDREA , HUIKURI HEIKKI V. , TOWBIN JEFFREY , VATTA MATTEO , BRUGADA PEDRO , BRUGADA JOSEP , BRUGADA RAMON
Published: June 2009

Background:
Brugada syndrome predisposes some subjects to ventricular tachyarrhythmias and sudden cardiac death. Mutations in SCN5A gene have been associated with ∼25% of Brugada syndrome patients. A common variant in SCN5A, H558R has shown to improve sodium channel activity in mutated channels. We studied whether common variant H558R has any clinical implications in the phenotype of Brugada syndrome.

Methods:
Our study population consisted of Brugada syndrome subjects 75 with SCN5A mutation and 92 without SCN5A mutation. Their mean age was 39 ± 15 and 42 ± 17 years, and 65% and 86% were male, respectively. We measured PR‐, QRS‐, QTc‐intervals from leads II and V2 of the 12‐lead ECG. We also evaluated J‐point amplitude from lead V2 and R‘/S ratio from lead aVR (the “aVR sign”). The H558R (A→G) genotype was detected with direct sequencing of the SCN5A gene.

Results:
The AA genotype carriers had longer QRS duration in lead II (P = 0.017) and higher J‐point elevation in lead V2 (P = 0.013), higher “aVR sign” (P = 0.005) and a trend toward more subjects with symptoms (P = 0.067) than G allele carriers. None of the results were significant in Brugada syndrome subjects without SCN5A mutation.

Conclusion:
The common variant H558R seems to be a genetic modulator of Brugada syndrome among carriers of a SCN5A mutation, in whom the presence of the less common allele G improves the ECG characteristics and clinical phenotype.
Transcranial Measurement of Cerebral Microembolic Signals During Endocardial Pulmonary Vein Isolation: Comparison of Three Different Ablation Techniques
Authors: SAUREN LOES D. , VAN BELLE YVES , DE ROY LUC , PISON LAURENT , LA MEIR MARK , VAN DER VEEN FREDERICK H. , CRIJNS HARRY J. , JORDAENS LUC , MESS WERNER H. , MAESSEN JOS G.
Published: June 2009

Introduction:
Isolation of the pulmonary veins (PVI) using high ablation energy is an effective treatment for atrial fibrillation (AF) with a success rate of 50–95%; however, postoperative neurological complications still occur in 0.5–10%. In this study the incidence of cerebral microembolic signals (MES) as a risk factor for neurological complications is examined during 3 percutaneous endocardial ablation procedure strategies: segmental PVI using a conventional radiofrequency (RF) ablation catheter, segmental PVI using an irrigated RF tip catheter, and circumferential PVI with a cryoballoon catheter (CB).

Methods and Results:
Thirty patients underwent percutaneous endocardial PVI. Ostial isolation was performed in 10 patients with a conventional 4‐mm RF catheter (CRF) and in 10 patients with a 4‐mm irrigated RF catheter (IRF). A circumferential PVI was performed in 10 patients with a CB. Transcranial Doppler (TCD) monitoring was used to detect MES in the middle cerebral arteries.

The total number of cerebral MES differs significantly among the 3 PVI groups; 3,908 cerebral MES were measured with use of the CRF catheter, 1,404 cerebral MES with use of the IRF catheter, and 935 cerebral MES with use of the CB catheter.

Conclusion:
This study demonstrates a significant difference in cerebral MES during PVI with 3 different ablation procedures. The use of an irrigated RF and a cryoballoon produces significantly fewer cerebral MES than the use of conventional RF for a PVI procedure, suggesting a higher risk for neurologic complications using conventional RF energy during a percutaneous PVI procedure.
Novel Use of a Vascular Plug to Anchor an Azygous Vein ICD Lead
Authors: BAR‐COHEN YANIV , TAKAO CHERYL M. , WELLS WINFIELD J. , SAXON LESLIE A. , CESARIO DAVID A. , SILKA MICHAEL J.
Published: June 2009

Vascular Plug for ICD Lead.  We describe the case of a young patient with severe hypertrophic cardiomyopathy and marginal defibrillation thresholds (DFTs) at implant of a standard transvenous implantable cardioverter‐defibrillator (ICD) system. The patient subsequently experienced multiple failed ICD shocks during a prolonged episode of spontaneous ventricular tachycardia/fibrillation. Placement of a second single‐coil shocking lead in the azygous vein resulted in acceptable DFTs, but the new lead migrated superiorly within hours of the procedure. To stabilize the lead position, a vascular plug was placed in the distal azygous vein, and the shocking lead screw was actively fixated to the meshwork of the device. Subsequent testing confirmed both adequate defibrillation and stable lead position. (J Cardiovasc Electrophysiol, Vol. 21, pp. 99–102, January 2010)
Reduction in Atrial Flutter Ablation Time by Targeting Maximum Voltage: Results of a Prospective Randomized Clinical Trial
Authors: GULA LORNE J. , REDFEARN DAMIAN P. , VEENHUYZEN GEORGE D. , KRAHN ANDREW D. , YEE RAYMOND , KLEIN GEORGE J. , SKANES ALLAN C.
Published: June 2009

Background: Radiofrequency ablation (RFA) of the cavotricuspid isthmus (CTI) is an established therapy for typical atrial flutter. Previous studies have demonstrated that the CTI is often composed of discrete muscle bundles, and evidence has suggested that these bundles correlate with high‐voltage local electrograms in the tricuspid isthmus. This randomized, multicenter clinical trial was designed to prospectively compare the hypothesis that a maximum voltage‐guided (MVG) technique targets critical conducting bundles in the isthmus, as reflected by a reduction in ablation requirements compared to the anatomical approach to atrial flutter ablation.

Methods: Bidirectional block was achieved in patients undergoing ablation for typical atrial flutter using 1 of 2 randomly assigned methods. The anatomical approach produced a contiguous line of ablation lesions from the inferior aspect of the tricuspid annulus to the inferior vena cava using a standard method. The MVG technique sequentially targeted the maximum voltage local electrograms in the CTI along a similar line.

Results: Sixty‐nine patients were randomized, with mean age 63 ± 10 and 58 (84%) male. Among patients in the anatomic group (n = 34), mean ablation time was 11.2 ± 7.5 minutes compared to 5.9 ± 3.3 in the MVG group (n = 35) (P = 0.0026). A mean of 14.2 ± 9.7 ablation lesions were created in the anatomic group, and 7.9 ± 4.8 in the MVG group (P = 0.0042).

Conclusions: Ablation for atrial flutter using an MVG technique results in significantly less ablation requirements than the traditional approach, potentially by concentrating ablation lesions on the muscle bundles responsible for transisthmus conduction.
Inferior Vena Cava Syndrome Due to Echinococcus multilocularis
Authors: Rossi Isabelle Anne , Delay Dominique , Qanadli Salah Dine , Jaussi Andres
Published: June 2009

Alveolar echinococcosis is an invasive, tumor‐like zoonosis, accidentally transmitted to humans. We present a case of recurrent inferior vena cava (IVC) syndrome due to alveolar echinococcosis and strongly suspected on transthoracic echocardiographic examination.
Feasibility of Using Tissue Doppler Velocities in Stress Echo during Upright Bicycle Exercise
Authors: Hovland Anders , Bjørnstad Hanne , Prytz Jan , Støylen Asbjørn , Vik‐Mo Harald
Published: June 2009

Background and Aim: There are several studies on myocardial tissue Doppler velocities during dobutamine stress, but few studies on the same parameters during bicycle exercise. We wanted to examine how sample sites affected velocities, beat‐to‐beat variability and segments eligible for analysis. Methods: Twenty patients with normal coronary arteries were included in the study. Echocardiograms were obtained at rest and at peak exercise on the exercise bike and were analyzed off line by two independent raters. Results and Conclusions: Tissue velocities decreased from base to apex. Mean difference between the raters was−0.02 cm/sec at rest and 0.45 cm/sec during exercise. Peak‐to‐peak variability was lowest in the mitral ring during rest (10–14%) and increased at peak exercise (15–21%). The proportion of segments eligible for analysis was 84% in the septum and 67% in the anterior wall during exercise. Thus, in patients with normal coronary arteries, tissue Doppler velocities decrease from base toward the apex during bicycle exercise. Interrater agreement is reduced during exercise and beat‐to‐beat variability is lowest in the mitral ring.
The New World of Crises and Crisis Management: Implications for Policymaking and Research
Authors: Boin Arjen
Published: June 2009

In recent years, we have witnessed a series of spectacular crises and disasters: 9/11, Madrid and London, the Asian tsunami, the Mumbai attacks, the implosion of the financial system—the world of crises and disasters seems to be changing. This special issue explores how these crises and disasters are changing and what governments can do to prepare. This opening article defines critical concepts, sketches a theoretical perspective, offers key research findings, and introduces the contributions to the special issue.
The Public Management of Risk: The Case for Deliberating among Worldviews
Authors: Lodge Martin
Published: June 2009

This article argues that the public management of risk faces inherent “wicked issue” problems which are further accentuated in the context of the contemporary regulatory state. It is suggested that in order to overcome these limitations and inevitable trade‐offs, there needs to be a more conscientious effort in setting out distinct components of any public management of risk, which should be considered and discussed through the lens of distinct worldviews contrasting interpretations and solutions, as well as potential “black‐spots.” It is only by acknowledging limitations of any one strategy and by considering plural solutions that there is less likelihood of disappointment when dealing with crises and disasters.
European Cooperation on Future Crises: Toward a Public Good?
Authors: Rhinard Mark
Published: June 2009

As crises grow more transnational in origin and effect, managing them effectively will require international cooperation. This article explores the dilemmas inherent to producing common crisis management capacities across national governments. Drawing on the literature related to “international public goods,” the article builds an approach for understanding these dilemmas through the lens of collective action and the perverse incentives associated therein. The article applies this approach to cooperation in Europe on an issue that typifies the transnational crisis—the spread of communicable disease—and highlights obstacles to European Union ambitions to build a robust system for disease surveillance and control. Having isolated the obstacles, the article then identifies solutions to facilitate cooperation toward more effectively producing the good in question.
Preventing Transboundary Crises: The Management and Regulation of Setbacks
Authors: Roe Emery
Published: June 2009

Setbacks—unanticipated, unwanted, and often sudden checks on moving forward—are common in crisis prevention. Managing setbacks, however, is rarely discussed. Even less discussed is the central role that setback management can play in preventing transboundary crises across interdependent critical infrastructures for electricity, water, transportation, and financial services. With a focus on the ongoing financial crisis and on strategies for resilience and anticipation, the article draws out implications for crisis prevention as the first, rather than last, line of defense in managing future crises.
Melting Down and Scaling Up: Stabilizing Climate Change by Promoting Private Sector Technology Development
Authors: Perusse Brian , Riggins Matthew , Rodgers Jeff , Zimring Maury
Published: June 2009

This paper will examine the role the private sector plays in researching, developing, and deploying technology that has the potential to deter or decrease the impacts of global warming. It will explore the degree to which the private sector can have an impact on global warming by focusing on four specific technologies: aircraft engines, wind turbines, solar energy, and clean coal technologies. We will compare the environmental impact of these technologies with the business case for pursuing each, specifically related to profitability and market maturity. We conclude that the business case alone is not sufficiently compelling to stimulate meaningful industry investment in these areas. Consequently, specific government involvement is needed for CO2 reduction. This analysis will shed light on the role that government must play in order to more effectively engage potential private sector players in the global warming challenge.
Medication changes based on echocardiography in dialysis patients
Authors: CHONG Chun K. , MUZOORA Michael , ECKERT George J. , KAMALESH Masoor , MOE Sharon M.
Published: June 2009

Kidney/Disease Outcome Quality Initiative (K/DOQI) guidelines recommend baseline echocardiography at the initiation of dialysis and every 3 years thereafter in patients for early detection of cardiac disease to optimize medical therapy. Because dialysis patients are at increased cardiovascular risk and thus most are already on cardioprotective medications, we hypothesize that serial screening echocardiography will not alter cardioprotective medications in dialysis patients. Retrospective analysis of medication administration of 231 dialysis patients was conducted. Patients were divided into 2 groups, those with and those without echocardiograms. Medication changes post echocardiography were compared with subjects without echocardiograms at comparable time points. The primary end point was the number of medication class changes that occurred in 2 months post echocardiography. Medication classes examined were β blockers (BB), angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), nitrates, calcium channel blockers (CCB), and statins. In the Echo group, there were 29 (19%) subjects with at least 1 medication class change post echocardiography, compared with 121 (81%) subjects without change. The number of patients on specific medication classes before and after echocardiography were BB (90 [60%] vs. 97 [65%], P=0.05), ACEI/ARB (74 [49%] vs. 82 [55%], P=0.01), nitrates (34 [23%] vs. 33 [22%], P=0.56), CCB (77 [51%] vs. 79 [53%], P=0.56), and statins (69 [46%] vs. 70 [47%], P=0.71). When compared with the No Echo group, there was no significant change in number of any medication classes. The occurrence of medication changes post echocardiography in dialysis patients is low and is not different than changes in routine care of dialysis patients without echocardiograms. Thus, serial screening echocardiography may not have added benefit to optimizing medical management of cardiovascular disease in dialysis patients. Further studies are warranted to demonstrate evidence for the use of serial screening echocardiography in this high‐risk population.
Effect of recombinant human erythropoietin on insulin resistance in hemodialysis patients
Authors: KHEDR Essam , EL‐SHARKAWY Magdy , ABDULWAHAB Saed , ELDIN Essam Nor , ALI Medhat , YOUSSIF Abla , AHMED Bassam
Published: June 2009

Insulin resistance is a characteristic feature of uremia. Insulin resistance and concomitant hyperinsulinemia are present irrespective of the type of renal disease. Treatment with recombinant human erythropoietin (rHuEPO) was said to be associated with improvement in insulin sensitivity in uremic patients. The aim of this study was to compare insulin resistance in adult uremic hemodialysis (HD) patients including diabetic patients treated with or without rHuEPO. A total of 59 HD patients were studied, patients were divided into 2 groups of subjects: 30 HD patients on regular rHuEPO treatment (group A), and 29 HD patients not receiving rHuEPO (group B) diabetic patients were not excluded. Full medical history and clinical examination, hematological parameters, lipid profile, serum albumin, parathyroid horomone, Kt/V, fasting glucose, and insulin levels were measured in all subjects. Homeostasis Model Assessment of Insulin Resistance (HOMA‐IR) was used to compare insulin resistance. The results of this study showed that the mean insulin level of HD patients treated with rHuEPO (group A) (17.5 ± 10.6 μU/mL) was significantly lower than patients without rHuEPO (group B) (28.8 ± 7.7 μU/mL), (P<0.001). Homeostasis Model Assessment of Insulin Resistance levels in group A were significantly lower than in group B (3.8 ± 2.97, 7.98 ± 4.9, respectively, P<0.001). Insulin resistance reflected by HOMA‐IR levels among diabetic patients in group A was significantly lower than among diabetic patients in group B (3.9 ± 3.2, 9.4 ± 7.2, respectively, P<0.001). Also, HOMA‐IR levels among nondiabetic patients in group A were significantly lower than among nondiabetic patients in group B (3.7 ± 2.85, 6.9 ± 1.43, respectively, P<0.01). We found a statistically significant negative correlation between duration of erythropoietin treatment, fasting blood glucose, insulin levels, and insulin resistance (r=−0.62, −0.71, and −0.57, P<0.001). Patients treated with rHuEPO showed less insulin resistance compared with patients not treated with rHuEPO in diabetic and nondiabetic patients and, duration of erythropoietin treatment is negatively correlated with insulin levels and insulin resistance in HD patients.
Cocaine and Ethanol: Combined Effects on Coronary Artery Blood Flow and Myocardial Function in Dogs
Authors: Wilson Lance D. , Malik Mamta , Willson Howard
Published: June 2009

Objectives: In combination, cocaine and ethanol are more cardiotoxic than is either substance alone. These substances together constitute a drug abuse combination that commonly results in fatality. Previously the authors have demonstrated that cardiotoxicity of cocaine and ethanol is in part due to synergistic myocardial‐depressant effects. However, it remains unclear whether this myocardial depression is associated with concomitant adverse effects on coronary blood flow in relation to these substances. The aim of this study was to investigate combined effects of cocaine and ethanol on myocardial blood flow, in relation to indices of myocardial function.

Methods: Anesthetized dogs were instrumented for hemodynamic monitoring with Doppler flow probes placed on the circumflex and left anterior descending (LAD) coronary arteries. Dogs were randomized to three groups (eachn = 6): ethanol (E, 1.5 g/kg followed by placebo), cocaine (C, placebo followed by cocaine, 7.5 mg/kg IV), or cocaine plus ethanol (C + E). All measurements were made at control, after placebo or ethanol, and then at fixed time intervals after cocaine or placebo bolus over 3 hours.

Results: In both the C + E and the C groups, circumflex blood flow (CBF) decreased by 71% (95% confidence interval [CI] = 56% to 85%) and 57% (95% CI = 43% to 72%, both p < 0.04 vs. baseline) immediately after cocaine bolus. This was associated with transient depression of cardiac output, myocardial contractile function, and rate‐pressure product (RPP), all indices of myocardial oxygen demand. A subsequent rebound increase of coronary sinus blood flow (CSBF) of 56% (95% CI = 26% to 137%, p < 0.03) compared to baseline occurred only in the C group and was associated with increases of myocardial contractile function and RPP. In the C + E group, 2 hours after drug administration, there was a decrease in CSBF of 49% (95% CI = 32% to 67%; p < 0.01) compared to baseline, which was associated with concomitant numerical decreases of the indices of myocardial oxygen demand and accumulation of cocaethylene.

Conclusions: Acute decreases in myocardial flow secondary to cocaine, and cocaine and ethanol in combination, were similar and temporally associated with cocaine’s direct myocardial‐depressant effects. Rebound increases in myocardial function and blood flow due to cocaine were attenuated by ethanol. Delayed myocardial depression and decreases in myocardial blood flow were observed only with coadministration of cocaine and ethanol.
Prospective Validation of the Pediatric Appendicitis Score in a Canadian Pediatric Emergency Department
Authors: Bhatt Maala , Joseph Lawrence , Ducharme Francine M. , Dougherty Geoffrey , McGillivray David
Published: June 2009

Objectives:  Clinical scoring systems attempt to improve the diagnostic accuracy of pediatric appendicitis. The Pediatric Appendicitis Score (PAS) was the first score created specifically for children and showed excellent performance in the derivation study when administered by pediatric surgeons. The objective was to validate the score in a nonreferred population by emergency physicians (EPs).

Methods:  A convenience sample of children, 4–18 years old presenting to a pediatric emergency department (ED) with abdominal pain of less than 3 days’ duration and in whom the treating physician suspected appendicitis, was prospectively evaluated. Children who were nonverbal, had a previous appendectomy, or had chronic abdominal pathology were excluded. Score components (right lower quadrant and hop tenderness, anorexia, pyrexia, emesis, pain migration, leukocytosis, and neutrophilia) were collected on standardized forms by EPs who were blinded to the scoring system. Interobserver assessments were completed when possible. Appendicitis was defined as appendectomy with positive histology. Outcomes were ascertained by review of the pathology reports from the surgery specimens for children undergoing surgery and by telephone follow‐up for children who were discharged home. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. The overall performance of the score was assessed by a receiver operator characteristic (ROC) curve.

Results:  Of the enrolled children who met inclusion criteria (n = 246), 83 (34%) had pathology‐proven appendicitis. Using the single cut‐point suggested in the derivation study (PAS 5) resulted in an unacceptably high number of false positives (37.6%). The score’s performance improved when two cut‐points were used. When children with a PAS of ≤4 were discharged home without further investigations, the sensitivity was 97.6% with a NPV of 97.7%. When a PAS of ≥8 determined the need for appendectomy, the score’s specificity was 95.1% with a PPV of 85.2%. Using this strategy, the negative appendectomy rate would have been 8.8%, the missed appendicitis rate would have been 2.4%, and 41% of imaging investigations would have been avoided.

Conclusions:  The PAS is a useful tool in the evaluation of children with possible appendicitis. Scores of ≤4 help rule out appendicitis, while scores of ≥8 help predict appendicitis. Patients with a PAS of 5–7 may need further radiologic evaluation.
Reconstructing the Sequence of Events Surrounding Body Disposition Based on Color Staining of Bone*
Authors: Huculak Meaghan A. , Rogers Tracy L.
Published: June 2009

Abstract:  Literature regarding bone color is limited to determining location of primary and secondary dispositions. This research is the first to use bone color to interpret the sequence of events surrounding body disposition. Two scenarios were compared—bones buried and then exposed on the ground surface and bones exposed then buried. Forty juvenile pig humeri with minimal tissue were used in each scenario with an additional 20 controls to determine if decomposing tissue affects bone color. Munsell Color Charts were used to record bone color of surface and 2.5 cm cross‐sections. Results reveal five main surface colors attributed to soil, sun, hemolysis, decomposition, and fungi. Fungi on buried bones suggests prior surface exposure. Cross‐sections of strictly buried bones are identical to buried then exposed bone, stressing the importance of bone surface analysis. Cross‐sectioning may help verify remains have been exposed then buried. Decomposition of excess tissue creates minimal color staining.
Application of DNA Forensic Techniques for Identifying Poached Guanacos (Lama guanicoe) in Chilean Patagonia*
Authors: Marín Juan C. , Saucedo Cristian E. , Corti Paulo , González Benito A.
Published: June 2009

Abstract:  Guanaco (Lama guanicoe) is a protected and widely distributed ungulate in South America. A poacher, after killing guanacos in Valle Chacabuco, Chilean Patagonia, transported and stored the meat. Samples were retrieved by local police but the suspect argued that the meat was from a horse. Mitochondrial cytochrome b gene (774 pb), 15 loci microsatellites, and SRY gene were used to identify the species, number of animals and their population origin, and the sex of the animals, respectively. Analysis revealed that the samples came from a female (absence of SRY gene) Patagonian guanaco (assignment probability between 0.0075 and 0.0282), and clearly distinguishing it from sympatric ungulates (E‐value = 0). Based on the evidence obtained in the field in addition to forensic data, the suspect was convicted of poaching and illegally carrying fire arms. This is the first report of molecular tools being used in forensic investigations of Chilean wildlife indicating its promising future application in guanaco management and conservation.
Farmers' health and agricultural productivity
Authors: Loureiro Maria L.
Published: June 2009

Agriculture is one of the most hazardous productive sectors around the world. Most previous studies have focused on health issues of farmers in developing countries, while little attention has been paid to farmers' health problems in developed countries. The present study assesses the effect of farmers' health conditions on agricultural productivity in Norway. Employing stochastic frontier regression techniques, we conclude that differences in farmers’ health help to explain the variance in agricultural production efficiency.
Measuring technical efficiency in the stochastic varying coefficient frontier model
Authors: Karagiannis Giannis , Tzouvelekas Vangelis
Published: June 2009

Due to the assumption that the best practice methods refer to each input separately instead of the whole set of inputs used by a firm, the benchmark technology as defined in the stochastic varying coefficient frontier model may be infeasible and theoretically improper whenever the maximum response coefficients are not coming from the same production unit. To overcome this problem, we propose alternative measures of output‐oriented and single‐factor technical efficiencies inspired from the maximum likelihood formulation of the nonneutral frontier model. The empirical results indicate that there are significant differences between the two in terms of the estimated efficiency scores but not significant differences we detected in terms of the efficiency ranking.
Risk‐matching behavior in microcredit group formation: evidence from northern Ethiopia
Authors: Berhane Guush , Gardebroek Cornelis , Moll Henk A. J.
Published: June 2009

Theoretical models on group lending assume the formation of groups of homogenous risk types. Recent theoretical and empirical findings challenge this view arguing that when markets for insurance are missing, risk homogeneity may not hold any more and risk heterogeneity can be the optimal outcome. Using data from an MFI in Tigray (Ethiopia), this article examines the homogeneity hypothesis and reflects on implications for repayment. No evidence is found that supports risk homogeneity, even accounting for matching frictions. However, we also do not find an explicit link between the presence of risk heterogeneity and side‐payments due to missing insurance as suggested in the literature. Instead, other trust‐based social networks seem to underlie heterogeneity. Such social networks are often synchronized with credit groups and influence the probability of repayment under heterogeneity. The implication is that successful repayment rates in group lending need not arise only under risk homogeneity but can also arise under risk heterogeneity. Heterogeneity may also serve to bridge missing insurance markets in poor rural environments. MFIs therefore need to consider such local conditions when designing their lending schemes.
Announcement effects and the theory of storage: an empirical study of lumber futures
Authors: Karali Berna , Thurman Walter N.
Published: June 2009

We investigate how lumber futures returns are affected by monthly housing starts announcements and analyze the dependence of the response on lumber inventories and time to delivery. To do so we develop a generalized least squares (GLS) method to jointly analyze simultaneously traded contracts. We find that increases in the unanticipated component of housing starts announcements increase returns on lumber futures contracts. Further, and as predicted by the theory of storage but previously unrecorded, the effects of housing starts shocks decline with lumber inventories. There is also a time‐to‐delivery effect: near‐delivery contracts respond more sharply to housing starts news than do farther‐out contracts.
Assessing agricultural trade policies options with the European Union: a Brazilian perspective
Authors: Piketty Marie Gabrielle , Weissleder Lucie , De Souza Filho Hildo Meirelles , Batalha Mário Otávio , Adenäuer Marcel , Becker Arno
Published: June 2009

Brazil has shown interest in agricultural trade negotiations at bilateral, regional, and multilateral levels. This study addresses several important negotiations, using the agricultural sector model CAPRI (Common Agricultural Policy Regional Impact Analysis), to analyze liberalization scenarios between the European Union and the Mercosur countries focusing particularly on their impacts in Brazil. Four possible agreements between Europe and Mercosur are simulated, including a broader multilateral agreement proposed in the G20. The results suggest that a bilateral scenario involving larger tariff rate quota increase, as called for by Mercosur, generates larger gains than accepting the European Union proposal of 2004 or further multilateral trade liberalization based on the G20 proposal. However, much larger increases in tariff rate quotas for all products are not necessarily justified in all cases. Moreover, Brazil's production and export potential is limited by factors other than trade restrictions.
Ex ante analysis of the benefits of transgenic drought tolerance research on cereal crops in low‐income countries
Authors: Kostandini Genti , Mills Bradford F. , Omamo Steven Were , Wood Stanley
Published: June 2009

This article develops a framework to examine the ex ante benefits of transgenic research on drought in eight low‐income countries, including the benefits to producers and consumers from farm income stabilization and the potential magnitude of private sector profits from intellectual property rights (IPRs). The framework employs country‐specific agroecological–drought risk zones and considers both yield increases and yield variance reductions when estimating producer and consumer benefits from research. Benefits from yield variance reductions are shown to be an important component of aggregate drought research benefits, representing 40% of total benefits across the eight countries. Further, estimated annual benefits of US$178 million to the private sector suggest that significant incentives exist for participation in transgenic drought tolerance research.
Respiratory patterns in panic disorder reviewed: a focus on biological challenge tests
Authors: Niccolai V. , Van Duinen M. A. , Griez E. J.
Published: June 2009

Objective: To provide a systematic review of studies investigating respiration in PD and comments on relative inconsistencies.

Method: A Medline search of controlled studies focusing on pCO2, respiratory rate, tidal volume, and minute volume in PD patients was conducted for baseline/resting condition, challenge, and recovery phase. Respiratory variability and comparisons between panickers and non‐panickers were also examined.

Results: Lower pCO2levels in PD subjects are a consistent finding during the baseline/resting condition, the challenge, and recovery phases. Tidal volume and minute volume are increased in PD subjects relative to controls during the baseline/resting condition. However, the most robust finding is a higher than normal respiratory variability, which appears to be a promising factor for the identification of respiratory etiopathological pathways in PD.

Conclusion: Respiratory variability might be a candidate for a biological marker of PD: an abnormal breathing pattern as found in panic disorder (PD) patients compared with controls might indicate instability of the respiratory homeostasis.
Effects of hybridization on the immunity of collaredFicedula albicollisand pied flycatchersF. hypoleuca, and their infection by haemosporidians
Authors: Wiley Chris , Qvarnström Anna , Gustafsson Lars
Published: June 2009

Because they are ubiquitous and typically reduce the fitness of hosts, parasites may play important roles in hybrid zone dynamics. Despite much work on herbivores and hybrid plants, the effect of parasites on the fitness of animal hybrids is poorly known. In an attempt to partly fill this gap, we examined the prevalence of avian haemosporidiansHaemoproteusin a hybrid zone between collared Ficedula albicollis and pied flycatchersF. hypoleuca. 40 species‐informative genetic markers allowed us to identify F1 hybrids, thus avoiding problems inherent in many studies that group hybrid genotypes. Furthermore, naturally occurring extra‐pair paternity allowed us to test the immune responses of pure and hybrid nestlings to a novel antigen (phytohaemagglutinin) in a shared environment. In contrast to previous suggestions that animal hybrids may more often display resistance against parasites than plant hybrids, F1 hybrids exhibited prevalence of parasitism and immune responses that were intermediate between the two parental species. We also detected differences between the two parental species in their prevalence of infection, with the competitively dominant species (collared flycatcher) being less often infected byHaemoproteus. Overall, our results contribute to other recent data supporting the idea that the resistance of animals to parasites is variously and unpredictably affected by hybridization, and that there is a concordance in the general patterns observed in plants and animals. Haemosporidians in avian hybrids provide a useful system for investigating the interactions between hosts and parasites that characterize host contact zones.
Imiquimod‐induced vitiligo after treatment of nodular basal cell carcinoma
Authors: Gowda Smitha , Tillman Donald K. , Fitzpatrick James E. , Gaspari Anthony A. , Goldenberg Gary
Published: June 2009

An 84‐year‐old male presented with recurrent nodular infiltrative basal cell carcinoma on the left shoulder. The patient was treated with curettage followed by the application of topical imiquimod 5% cream five times a week. The patient discontinued imiquimod after a total of 18 applications because of local inflammation. Depigmentation was noted in the treated area 11 months after the initiation of treatment with imiquimod. The depigmented area did not resolve 14 months after treatment initiation. Histologic examination of the depigmented area established the absence of melanin using Fontana‐Masson stain and the absence of melanocytes using S‐100 and Melan A stains. The adjacent unaffected skin showed a normal number of melanocytes and melanin pigment. To our knowledge, this is the first biopsy‐proven case of vitiligo in an imiquimod‐treated area.
Apocrine mixed tumor of the skin with a prominent pilomatricomal component
Authors: Baran Johanna L. , Hoang Mai P.
Published: June 2009

Pilomatrical differentiation within an apocrine mixed tumor (AMT) when present is only focal and has not been reported to be extensive. We herein report an AMT with prominent pilomatrical differentiation. A 47‐year‐old male presented with a 0.7 cm lesion on the right eyebrow. Histologic sections revealed, underneath a neurofibroma, a well‐circumscribed tumor composed of nodules of branching epithelial elements and occasional keratinous cysts within a myxoid and lipomatous stroma. The ductal structures appeared to be composed of two layers of basophilic cuboidal cells and exhibited decapitation secretion. In approximately 50% of the tumor, eosinophilic ghost/shadow cells associated with a foreign body giant cell reaction formed a nodule resembling a pilomatricoma. Focally, columns of matrical cells were seen giving rise to shadow cells. Cytokeratin (CK) 5/6 and CK14 labeled the epithelial component. CK7, CK19 and Ber‐EP4 labeled the ductal structures. Carcinoembryonic antigen and epithelial membrane antigen highlighted the luminal surface. S100 stained the stromal cells within the myxoid matrix, adipocytes and spindle cells within the overlying neurofibroma. CK10 highlighted the corneocytes within the keratinous cysts. CK17 labeled the epithelial lining of the keratinous cyst. The presence of follicular and apocrine differentiation within our tumor reinforces the common embryologic derivation of these elements.
Subcutaneous dirofilariasis caused by Dirofilaria repens in Greece: a case report
Authors: Tzanetou Konstantina , Gasteratos Stephanos , Pantazopoulou Akrivi , Gogou Charalambos , Konidaris Dimitrios , Fragia Konstantina
Published: June 2009

Dirofilaria repens (formerly Dirofilaria conjunctiva) is a natural parasite of the subcutaneous tissues of dogs, cats and wild carnivores in Europe, Africa and Asia. Microfilariae are transmitted to humans by various species of mosquito. An autochthonous case of subcutaneous dirofilariasis is reported in a Greek patient from the island of Corfu. The clinical manifestation of the infection was a palpable, painless, subcutaneous nodule in the region of the groin, which 2 days before the patient consulted the doctor developed symptoms and signs of inflammation (pain, edema and redness). The entire lesion was surgically removed, and the nematode worm D. repens was identified on histological sections of biopsy material. The aim of this report was (a) to describe the microscopic morphological features of D. repens that enable identification of the parasite on histological examination and (b) to emphasize the importance of consideration of subcutaneous dirofilariasis in the differential diagnosis of subcutaneous nodules with inflammatory eosinophilic infiltration in countries where the infection is endemic.
MPO‐ANCA‐ and IgA‐positive systemic vasculitis: a possibly overlapping syndrome of microscopic polyangiitis and Henoch‐Schoenlein purpura
Authors: Nagasaka Takeshi , Miyamoto Jyuria , Ishibashi Masafumi , Chen Kon Ron
Published: June 2009

Microscopic polyangiitis (MPA) can be distinguished from Henoch‐Schoenlein purpura (HSP) based on the presence of renal‐pulmonary complications, myeloperoxidase‐antineutrophil cytoplasmic antibody (MPO‐ANCA) seropositivity and pauci‐immune glomerulonephritis; these characteristics of MPA are generally not found in HSP. Here, we present a unique case with MPA and HSP overlapping syndrome. A 74‐year‐old man presented with a skin rash accompanied by intracranial bleeding, acute renal failure and pulmonary hemorrhage resulting in a fatal outcome. An autopsy revealed the marked formation of crescentic glomerulonephritis, diffuse pulmonary alveolar hemorrhage and focal cerebral bleeding. Histological features showing both dermal small‐vessel vasculitis and cutaneous polyarteritis nodosa‐like arteritis suggested MPA rather than HSP, in which the dermal small vessels are exclusively affected. Meanwhile, capillary immunoglobulin (Ig)A deposits in the skin and glomeruli suggested HSP.

As MPA and HSP overlapping syndrome characterized by the synergistic effect of MPO‐ANCA and the IgA immune complex may result in a fatal outcome, aggressive immunosuppressive therapy should be initiated as early as possible.
Sweet’s syndrome in familial Mediterranean fever: possible continuum of the neutrophilic reaction as a new cutaneous feature of FMF
Authors: Oskay Tugba , Anadolu Rana
Published: June 2009

Sweet’s syndrome (SS) or acute febrile neutrophilic dermatosis is an uncommon disorder that often occurs in association with other systemic diseases. In its systemic manifestation, SS resembles familial Mediterranean fever (FMF) in many aspects. Although the exact pathogenesis of SS and FMF is not yet clear, their clinical similarities and simultaneous occurrence suggest a possible common underlying mechanism and may represent a continuum of a reactive neutrophilic condition.
Nodal marginal zone lymphoma: current knowledge and future directions of an heterogeneous disease
Authors: Arcaini Luca , Lucioni Marco , Boveri Emanuela , Paulli Marco
Published: June 2009

Nodal marginal zone lymphoma (NMZL) is a defined, separate clinicopathological entity. NMZL is a B‐cell neoplasm originated in the lymph node, whose histology resembles the nodal infiltration by mucosa‐associated lymphoid tissue‐ or splenic‐type marginal zone lymphoma, in the absence of clinical evidence of extranodal or spleen disease. The lack of characteristic phenotypic or molecular diagnostic findings is still hampering the reproducibility of this diagnosis. Herein, we review the main morphological and immunophenotypical markers, discussing the differential with other overlapping entities. We also summarize the clinical features and outcome of this rare lymphoma and we discuss the possible association with hepatitis C virus infection.
Paraplegia in a Bornean orangutan (Pongo pygmaeus pygmaeus) due to multiple myeloma
Authors: Mauel Susanne , Fritsch Guido , Ochs Andreas , Koch Martin , Kershaw Olivia , Gruber Achim D.
Published: June 2009

Background A 38‐year‐old male Bornean orangutan (Pongo pygmaeus pygmaeus) developed progressive hind leg paresis. A computed tomography scan of the vertebral column revealed soft tissue type densities within vertebral bones.

Methods and results At necropsy infiltrating tumor masses were found in the vertebral bodies, protruding into the spinal canal and compressing the spinal cord. Microscopically neoplastic plasma cells infiltrated the vertebral bodies and adjacent soft tissues. Immunohistochemically, tumor cells tested positive for B cell markers (CD38, CD79α), kappa, and lambda light chains, while vimentin, GFAP, S100, and CD138 were not expressed. The tumor was classified as multiple myeloma on the basis of radiographic, pathological, and immunohistochemical findings.

Conclusions This first systematic case description on multiple myeloma in a non‐human primate revealed many similarities with the disease in humans and the immunohistochemical tools proved suitable for their use in the orangutan.
A Helical Membrane‐Binding Domain Targets the Toxoplasma ROP2 Family to the Parasitophorous Vacuole
Authors: Reese Michael L. , Boothroyd John C.
Published: June 2009

During invasion, the obligate intracellular pathogen, Toxoplasma gondii, secretes into its host cell a variety of effector molecules, several of which have been implicated in strain‐specific variation in disease. The largest family of these effectors, defined by the canonical member ROP2, quickly associates with the nascent parasitophorous vacuole membrane (PVM) after secretion. Here we demonstrate that the NH2‐terminal domain of the ROP2 family contains a series of amphipathic helices that are necessary and sufficient for membrane association. While each of the amphipathic helices is individually competent to bind cellular membranes, together they act to bind the PVM preferentially, possibly through sensing its strong negative curvature. This previously uncharacterized helical domain is an evolutionarily robust and energetically efficient design for membrane association.
Association among interleukin‐6 gene polymorphism, diabetes and periodontitis in a Chinese population
Authors: Xiao LM , Yan YX , Xie CJ , Fan WH , Xuan DY , Wang CX , Chen L , Sun SY , Xie BY , Zhang JC
Published: June 2009

Objectives:  Diabetics significantly increase risk for periodontitis. Interleukin‐6 (IL‐6) gene polymorphism may play certain roles in the progression of periodontitis with diabetes. The purpose of this study was to assess the association among IL‐6 gene polymorphisms, type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP) in a Chinese population.

Material and methods:  DNA was obtained from 159 patients with CP, 88 patients with T2DM, 110 patients with CP&T2DM and 135 control subjects. The ‐174/‐572/‐597 polymorphisms of IL‐6 gene were investigated by restriction fragment length polymorphism of polymerase chain reaction products. The results were further confirmed by sequencing. Significance was set at P < 0.008 after Bonferroni correction.

Results:  Among four groups, CP&T2DM group showed the lowest IL‐6‐572 CC genotype and C‐allele frequencies (54.5% and 74.1%). In this regard, there were significant differences between CP&T2DM group and the control group [P = 0.006, odds ratio (OR) = 0.475, 95% CI: 0.279–0.808 and P = 0.002, OR = 0.502, 95% CI: 0.319–0.788 respectively]. Logistic regression with adjustment for age, gender, body mass index, smoking and stress showed no significant difference in terms of IL‐6‐572 genotypes (P = 0.058, OR= 0.523, 95% CI: 0.268–1.022).

Conclusions:  The IL‐6‐572 genotype and allele distributions are unique to subjects with CP&T2DM in a Chinese population.