bluuebunny/crossref_metadata_2025 huggingface dataset:
Studies on woloszynskioid dinoflagellates IV: The genus Biecheleria gen. nov.
Authors: Moestrup Øjvind , Lindberg Karin , Daugbjerg Niels
Published: August 2010

The well known freshwater dinoflagellate Woloszynskia pseudopalustris is transferred to the new genus Biecheleria, based on the very unusual structure of the eyespot (comprising a stack of cisternae), the apical apparatus of a single elongate amphiesma vesicle, the structure of the resting cyst, and molecular data. Biecheleria is phylogenetically related to Symbiodinium and Polarella of the family Suessiaceae. This family, which extends back to the Jurassic, is redefined with the eyespot (Type E sensu Moestrup and Daugbjerg) and apical apparatus as diagnostic features, unknown elsewhere in the dinoflagellates. Biecheleria also comprises the brackish water species Biecheleria baltica sp. nov. (presently identified as Woloszynskia halophila) and the marine species Biecheleria natalensis (syn. Gymnodinium natalense). Gymnodinium halophilum described in 1952 by B. Biecheler but apparently not subsequently refound, is transferred to Biecheleria. The Suessiaceae further includes the marine species Protodinium simplex, described by Lohmann in 1908 but shortly afterwards (1921) transferred to Gymnodinium by Kofoid and Swezy and subsequently known as Gymnodinium simplex. It only distantly related to Gymnodinium. A new family, the Borghiellaceae, is proposed for the sister group to the Suessiaceae, based on eyespot structure (Type B of Moestrup and Daugbjerg), the morphology of the apical apparatus (if present), and molecular data. It presently comprises the genera Baldinia and Borghiella. Cells of Biecheleria pseudopalustris and B. baltica contain a microtubular strand (msp) associated with vesicles containing opaque material. Such structures are known in other dinoflagellates to serve as a peduncle, indicating that the two species may be mixotrophic.
A survey of opioid administration in an emergency department
Authors: PLUMMER JOHN L , GOURLAY GEOFFREY K , BAGGOLEY CHRISTOPHER J
Published: August 2010

This study aimed to document patterns of opioid use in an emergency department, and determine factors which influenced choice of opioid. A survey of opioid administrations was conducted over a two month period in the Emergency Department at Flinders Medical Centre. Opioids were administered in 476 presentations by 456 different patients, representing 5.7% of total presentations during the survey period. Morphine and pethidine were the most frequently used opioids. Morphine was used more commonly for chest pain not associated with injury and for pulmonary oedema. Pethidine was more frequently used for pain due to injury, abdominal pain, biliary colic or cholecystitis. Morphine was given mainly by the intravenous route whereas pethidine was usually given intramuscularly. The most frequent reason for choosing a particular opioid was familiarity. Patients who expressed a preference for a particular opioid usually preferred pethidine, consistent with anecdotal reports.

Patterns of opioid use were affected by real or perceived differences in pharmacological activities within this class of drugs. However, the major influences were tradition and familiarity.
Reduction of anterior shoulder dislocation by external rotation
Authors: Tseng George , Wong Tai‐Wai , Yeung Kai‐Cho , Tan Winston
Published: August 2010

Objective: To examine the efficacy of external rotation as initial treatment for anterior shoulder dislocation.

Design: Prospective uncontrolled study of the efficacy and adverse effects of external rotation when used as the initial technique to reduce anterior shoulder dislocation.

Results: Ninety two cases of anterior shoulder dislocation were treated over an 18 month period. External rotation was used successfully to reduce the dislocation in 72 cases (78%). A further nine cases were reduced by external rotation with the aid of traction (total 88%). Six of eight cases complicated by fracture of a humeral tuberosity were reduced by external rotation. Twenty six reductions were achieved without the use of analgesia. Two cases of nerve palsy were seen, both associated with the use of traction.

Conclusions: External rotation is a simple and safe method of reduction for anterior dislocations of the shoulder. The technique is recommended as the initial reduction technique for anterior shoulder dislocations. The use of traction should be discouraged.
Diagnosing pulmonary embolism
Authors: Cameron Peter
Published: August 2010

Diagnosing pulmonary embolus (PE) remains one of the great challenges of emergency medicine. The diagnosis relies on a balance of probabilities rather than any definitive test. The probability is based on history, examination and investigations. The principal investigations are chest X‐ray, arterial blood gas, electrocardiograph, ventilation perfusion scan, ultrasound and angiography where necessary. Newer techniques such as CT scan and magnetic resonance imaging will become more useful as the technology improves. Transoesophoegeal echocardiography is an important investigative tool for massive PE.

Thrombolysis is increasingly being used in the management of PE and the higher risk of adverse outcome should be balanced against the probability of false positive results and the use of invasive angiography.
Prostate cancer death is unlikely in high‐risk patients following quality permanent interstitial brachytherapy
Authors: Merrick Gregory S. , Butler Wayne M. , Galbreath Robert W. , Lief Jonathan , Bittner Nathan , Wallner Kent E. , Adamovich Edward
Published: August 2010

Study Type – Therapy (case series) Level of Evidence 4

What’s known on the subject? and What does the study add?

The management of high‐risk prostate cancer remains controversial. These patients remain at substantial risk for prostate cancer failure and death despite potentially curative therapy. In recent years, high quality brachytherapy with or without supplemental therapies to consist of moderate dose external beam radiation therapy and androgen deprivation therapy has resulted in marked improvement in biochemical control and a decrease in prostate cancer deaths. With aggressive high quality brachytherapy, the risk of death from diseases of the heart is twice as great as that of prostate cancer.

OBJECTIVE

To evaluate cause‐specific survival (CSS), biochemical progression‐free survival (bPFS) and overall survival (OS) in high‐risk prostate cancer brachytherapy patients.

PATIENTS AND METHODS

From April 1995 to June 2005, 284 patients with high‐risk prostate cancer (Gleason score ≥8 or prostate‐specific antigen >20 ng/mL or clinical stage ≥ T2c) underwent brachytherapy. Supplemental external beam radiation therapy was given to 257 (90.5%) patients and 179 (63.0%) received androgen deprivation therapy (ADT). Median follow up was 7.8 years. The median post‐implant day 0 D90 was 118.9% of prescription dose. Patients with metastatic prostate cancer or castrate‐resistant disease without obvious metastases who died of any cause were classified as dead from prostate cancer. Multiple parameters were evaluated for impact on survival.

RESULTS

Twelve‐year CSS, bPFS and OS were 94.2%, 89.0% and 69.7%. On multivariate analysis, bPFS was best predicted by percent positive biopsies and ADT. The analysis failed to identify any predictors for CSS, while OS was highly correlated with patient age, percent positive biopsies and diabetes. Fourteen percent of patients died from diseases of the heart, while 8%, 8% and 6% of patients died from non‐prostate cancer, other causes and prostate cancer, respectively. When OS was stratified by patients with 0–3 vs ≥4 comorbidities, the 12‐year OS was 73.0% and 52.7% (P= 0.036).

CONCLUSIONS

High‐quality brachytherapy results in favourable bPFS and CSS for high‐risk patients. Death from diseases of the heart is more than twice as likely as death from prostate cancer. Strategies to improve cardiovascular health may positively impact OS.
The WHO classification of 1973 is more suitable than the WHO classification of 2004 for predicting survival in pT1 urothelial bladder cancer
Authors: Otto Wolfgang , Denzinger Stefan , Fritsche Hans‐Martin , Burger Maximilian , Wieland Wolf F. , Hofstädter Ferdinand , Hartmann Arndt , Bertz Simone
Published: August 2010

Study Type – Prognosis (systematic review)  Level of Evidence 2a

What’s known on the subject? and What does the study add?

Grading so far is the most important prognostic parameter in non muscle‐invasive urothelial bladder cancer.

We first compared prognostic value of grading concerning WHO classifications 1973 and 2004 on stage T1 bladder cancer.

OBJECTIVE

To ascertain which of the currently defined World Health Organization (WHO) grading classifications of pT1 urothelial bladder cancer (BC), published in 1973 and 2004, is more suitable for predicting outcome.

PATIENTS AND METHODS

Transurethral resection of the bladder (TURB) specimens of 310 patients with first diagnosis of initial pT1 BC were reassessed by three urological pathologists according to the WHO classifications of 1973 and 2004. The TURB procedure was followed by either immediate cystectomy or adjuvant bacille Calmette‐Guérin (BCG) instillations. Kaplan–Meier analysis was used to compare survival rates of the different tumour grades (mean follow‐up was 57 months).

RESULTS

According to the 1973 WHO classification, none of the pT1 BC specimens were graded as G1, while 36% were graded as G2 and 64% were graded as G3. Histological reassessment according to the 2004 WHO classification highlighted only 4% low‐grade and 96% high‐grade tumours. The 10‐year cancer‐specific survival rates of high‐grade tumours (85%) were intermediate between G2 (96%) and G3 (78%).

CONCLUSIONS

The results of the present study support the presumption that the 1973 WHO classification is more suitable for predicting outcome for pT1 tumours, by defining at least two prognostic groups. A new classification should revise the definition of low‐ and high‐grade pT1 BC to preserve the prognostic value of tumour grading.
Hypoxia‐inducible factor and mammalian target of rapamycin pathway markers in urothelial carcinoma of the bladder: possible therapeutic implications
Authors: Tickoo Satish K. , Milowsky Matthew I. , Dhar Nitin , Dudas Maria E. , Gallagher David J. , Al‐Ahmadie Hikmat , Gopalan Anuradha , Fine Samson W. , Ishill Nicole , Bajorin Dean F. , Reuter Victor E.
Published: August 2010

What’s known on the subject? and What does the study add?

The hypoxia‐inducible factor (HIF) and mammalian target of rapamycin (mTOR) pathways are important in tumorigenesis and novel agents targeting these respective pathways have shown promising activity in several malignancies. The current study demonstrates the expression of HIF and mTOR related pathway markers in urothelial carcinoma providing a rationale for clinical trials evaluating agents targeting these pathways.

OBJECTIVE

To investigate the rationale for using targeted therapies against hypoxia‐inducible factor (HIF) and mammalian target of rapamycin (mTOR) pathways in urothelial carcinoma of the bladder, by studying the immunohistochemical expression of molecules of these pathways in urothelial carcinoma, as recent pre‐clinical studies and clinical trials have shown the potential utility of such targeted therapies.

PATIENTS AND METHODS

Immunohistochemical stains were performed on a tissue microarray prepared from 92 cases of ≥ pT2 urothelial (transitional cell) carcinoma of bladder, using antibodies against HIF‐1α and VEGF‐R2, and phospho‐S6 and phospho‐4E BP1, molecules of HIF and activated mTOR pathways, respectively. Immunoreactivity was graded from 0 to 3+ (0, 0–5%; 1+, 6–25%; 2+, 26–50%; 3+, > 50% tumour cells positive).

RESULTS

In all, 58, 34, 35 and 17% of the tumours showed grade 2–3+ expression of phospho‐4E BP1, phospho‐S6, HIF‐1α and VEGF‐R2, respectively. Moderate correlation for immunoreactivity was observed between molecules within the same pathway [(phospho‐4E BP1 with phospho‐S6 (rho = 0.411), and HIF‐1α with VEGF‐R2 (rho = 0.265)], but not between molecules across pathways.

CONCLUSIONS

Urothelial carcinomas of the bladder express molecules of the HIF and mTOR pathways, providing a rationale for clinical trials evaluating agents targeting these pathways. Correlation between molecules within the same pathway, and not across pathways, suggests that investigating the usefulness of a specific targeted agent might benefit from pre‐treatment evaluation of pathway marker expression.
High sodium and low potassium intake in patients with Type 2 diabetes
Authors: Ekinci E. I. , Cheong K. Y. , Dobson M. , Premaratne E. , Finch S. , MacIsaac R. J. , Jerums G.
Published: August 2010

Diabet. Med. 27, 1401–1408 (2010)

Aims  To document dietary sodium and potassium intake and adherence to the Australian National Heart Foundation (NHF) guidelines in patients with Type 2 diabetes mellitus attending an Australian tertiary referral and university teaching hospital.

Methods  In a longitudinal study, 24h urinary sodium (uNa), potassium (uK), creatinine (uCr), urea (uUrea) and glucose (uGlu) excretions, urine volume (uVol) and body mass index were recorded in 122 regular attenders over an 8 year period (2001–2008; mean of 1.9 samples/patient/year). In a cross‐sectional study, the same measurements were recorded in patients providing urine samples in the month of June from 2001 to 2009 (782 patients, averaging 87/year).

Results  In the longitudinal study, uNa (mmol/24 h) was 170 ± 53 (mean ± SD) in males and 142 ± 51 in females, whereas uK (mmol/24 h) was 75 ± 22 in males and 62 ± 18 in females. Once adjusted for insensible losses, only 3% of males and 14% of females met the NHF dietary sodium intake guidelines, and 14% of males and 3% of female patients met the NHF dietary potassium guidelines. Body mass index, uUrea, uVol and uGlu were independent predictors of uNa (adjusted r2 = 0.57, P < 0.0001). The mean intra‐individual coefficient of variation of the corrected uNa was 21 ± 1%. The cross‐sectional study confirmed these findings, and no temporal trends were observed. There was no correlation with glycated haemoglobin to suggest natriuresis with hyperglycaemia.

Conclusions  Most patients with Type 2 diabetes mellitus do not meet NHF sodium or potassium intake guidelines. A diet high in sodium and low in potassium may contribute to the development of hypertension and to resistance to blood‐pressure‐lowering therapies.
Familial young‐onset forms of diabetes related to HNF4A and rare HNF1A molecular aetiologies
Authors: Carette C. , Dubois‐Laforgue D. , Saint‐Martin C. , Clauin S. , Beaufils S. , Larger E. , Sola A. , Mosnier‐Pudar H. , Timsit J. , Bellanné‐Chantelot C.
Published: August 2010

Diabet. Med. 27, 1454–1458 (2010)

Objective  We have dissected the rare molecular anomalies that may affect hepatocyte nuclear factor‐1α (HNF1A) and hepatocyte nuclear factor‐4α (HNF4A) in patients with familial young‐onset diabetes for whom HNF1A mutations have been excluded by sequence analysis.

Methods  Eighty‐four unrelated HNF1A‐negative patients with diabetes diagnosed before the age of 40 years, a family history of diabetes and the absence of features suggestive of Type 2 diabetes were included. We analysed by sequencing the HNF4A promoter and coding regions, the HNF1A promoter region and specific regions of HNF1A(B) and HNF1A(C) isoforms and searched for large deletions of HNF1A and HNF4A by multiplex ligation‐dependent probe amplification (MLPA).

Results  We identified five novel HNF4A mutations (5/84, 6%), including four missense and one in‐frame deletion, and one mutation of the HNF1A promoter (1/84). Sequence analysis of isoform‐specific coding regions of HNF1A did not reveal any mutation. We next identified two whole gene deletions of HNF1A and HNF4A, respectively (2/84, 2.4%).

Conclusions  Altogether, the search for rare molecular events in HNF1A and HNF4A led us to elucidate 8/84 (9.5%) of our HNF1A‐negative cases. This study shows that genetic aetiologies remain to be elucidated in familial young‐onset diabetes. It also highlights the difficulty of the differential diagnosis with Type 2 diabetes because of the wide clinical expression of monogenic young‐onset diabetes and the absence of specific biomarkers.
Analysing the ‘Black Box’ of HRM: Uncovering HR Goals, Mediators, and Outcomes in a Standardized Service Environment
Authors: Boxall Peter , Ang Siah Hwee , Bartram Timothy
Published: August 2010

abstract

This multi‐level study analyses the ‘black box’ of HRM in an Australian cinema chain, a standardized service environment. Management's espoused goals for the casual workers who run the cinema service include attempts to build customer‐oriented behaviour, both directly and via empowerment, and also efforts to ensure compliance with company policies and to enhance employee commitment. Our analysis of an employee survey and supervisory performance ratings shows that it is behavioural compliance that is positively associated with rated performance rather than customer‐oriented behaviour. While customer service is an important value, it is willing engagement with a highly scripted, efficiency‐oriented work process that makes it happen, not a more empowering form of work design. On the other hand, the management process also fosters a level of employee commitment, which has some value in a tight labour market. The study demonstrates the way in which actual models of HRM can contain a complex and ‘contradictory’ set of messages, consistent with critical accounts of the labour process and suggesting that notions of ‘internal fit’ need to recognize such tensions. It underlines the importance of identifying the multiple goals in management's espoused theories of HRM and then assessing their links via managerial behaviour and employee responses to performance outcomes.
Can Internet surveys help us understanding allergic disorders? – results from a large survey in urticaria in Greece
Authors: Kalogeromitros D , Psaltopoulou T , Makris M , Koti I , Chliva C , Stefanadi E , Hatziagelaki E , Maurer M
Published: August 2010

Background  Urticaria is often underdiagnosed and/or undertreated. We have conducted an Internet‐based study to record epidemiological and clinical features as well as therapeutic interventions for urticaria in a large sample of patients in Greece.

Methods  A standard anonymous questionnaire was posted for a 3‐month period on ‘http://www.in.gr’, a Greek popular Internet portal. Each individual participated only once. Participants were screened for the presence or history of urticaria by two key questions and were then asked to provide information on symptomatology and management.

Results  A total of 12 396 subjects voluntarily responded to the survey, of which 8440 (5136 females) who reported to have or had urticaria, were finally analysed. A total of 4780 (56.6%) had experienced weals only, 507 (6.0%) angio‐oedema only and 3018 (35.8%) both. Weals and angio‐oedema were found to be more common in women; 2761(57.8%) and 277(54.6%), respectively. Age of onset significantly correlated with disease duration; a 1% higher possibility of longer duration of urticaria exists (more than 6 weeks compared with less than 6 weeks) for each additional year of age of onset after controlling for gender. Patients with chronic urticaria had increased mean age compared with those reporting the acute form (35.04 vs. 33.88 years, P < 0.001). Dermatologists were the most frequently visited specialists and the most common treatments were antihistamines and topical preparations. The self‐reported eliciting factors of urticaria were as follows: physical stimuli (approximately 25%), psychological distress (17.2%), direct contact to metals or chemicals (14.5%), foods and drugs (10%), whereas a third of the participants could not identify any trigger.

Conclusions  Internet surveys can be a useful tool for screening the general population for common allergic disorders, such as urticaria.
Information and its value to health workers in rural Uganda: a qualitative perspective*
Authors: Musoke Maria G. N.
Published: August 2010

A study was conducted in 1998/99 to investigate the accessibility and use of information by health workers in rural Uganda. Data were collected qualitatively using semi‐structured interviews. As a qualitative study, it focused in‐depth on a relatively small sample of health workers selected purposefully. Different categories of health workers were interviewed.

Data were analysed using a grounded theory approach. In this paper, two main categories that emerged from the data will be discussed, namely: value of information and constraints. Information was valuable in clinical work, information dissemination, decision making, administration and detection. Constraints to effective information use included the quality and relevance of the information as well as the difficulties of sometimes putting theory into practice. Finally, the concepts that emerged from the analysis of the use of information pointed directly to the information needs of the health workers studied, which shows that information was valuable in meeting those needs. Some implications of the study and areas for further research are highlighted.
Potential impacts of wave‐powered marine renewable energy installations on marine birds
Authors: GRECIAN W. JAMES , INGER RICHARD , ATTRILL MARTIN J. , BEARHOP STUART , GODLEY BRENDAN J. , WITT MATTHEW J. , VOTIER STEPHEN C.
Published: August 2010

One potential approach to combat the impacts of climate change is the expansion of renewable energy installations, leading to an increase in the number of wave‐powered marine renewable energy installations (MREIs). The consequences of increased use of these devices for birds are unknown. Here we describe the wave‐powered energy‐generating devices currently either operational or in development and review the potential threats and benefits of these to marine birds, their habitats and prey. Direct negative effects include risk of collision, disturbance, displacement and redirection during construction, operation and decommissioning. Above‐water collision is a particular concern with wind‐powered devices, but, because of their low profiles, the collision risk associated with wave‐powered devices is likely to be much lower. Conversely, wave devices also pose the novel threat of underwater collision. Wave‐energy‐generating devices may indirectly impact marine birds by altering oceanographic processes and food availability, with implications for trophic cascades. Through appropriate mitigation, wave‐powered MREIs offer the potential to enhance habitats. Direct positive effects may include provision of roosting sites, and indirect positive effects may include prey aggregation due to suitable substrates for sessile organisms or because they act as de facto protected areas. The cumulative effect of these could be the improvement and protection of foraging opportunities for marine birds. Recent studies have been critical of the methods used in the assessment of wind‐powered MREI impacts, which lack sufficient sample sizes, controls or pre‐development comparisons. Here we suggest solutions for the design of future studies into the effects of MREIs. Wave‐powered MREIs are certain to become part of the marine environment, but with appropriate planning, mitigation and monitoring they have the potential to offer benefits to marine birds in the future.
Refinement of a viral transmission risk model for blood donations in seroconversion window phase screened by nucleic acid testing in different pool sizes and repeat test algorithms
Authors: Weusten Jos , Vermeulen Marion , van Drimmelen Harry , Lelie Nico
Published: August 2010

BACKGROUND: In minipool nucleic acid test (MP‐NAT) screening protocols, the donations implicated in reactive test pools are released for transfusion when they are nonreactive in a repeat test on the individual samples, but in individual‐donation (ID)‐NAT screening algorithms the release of nonrepeatable reactive (NRR) donations is under discussion.

STUDY DESIGN AND METHODS: A previously developed window phase (WP) transmission risk model for NAT‐screened blood transfusions has been refined to take the effect of repeat tests of initially reactive (IR) MP‐ or ID‐NAT results into account. The model has then been applied to simulate the effect of different screening algorithms with ULTRIO and the new‐generation ULTRIO Plus assay (Novartis Diagnostics) on transmission risk for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).

RESULTS: We calculated WP risk‐day equivalents for MP16‐, MP8‐, and ID‐NAT with and without duplicate retesting of IR results of 3.1, 2.7, 1.5, and 1.3 days for HCV; 6.3, 5.5, 3.3, and 2.9 days for HIV; and 24.4, 22.2, 15.6, and 14.1 days for HBV, respectively. These latter infectious HBV WPs reduced to 20.4, 18.2, 11.6, and 10.3 days, respectively, with the more sensitive ULTRIO Plus assay.

CONCLUSION: ULTRIO Plus ID‐NAT screening reduces the virus transmission risk in the WP by 54% to 58% compared to ULTRIO MP16‐NAT, while the incremental risk caused by releasing donations with duplicate ID‐NAT NRR results is 5% to 6%. To achieve maximum safety and specificity a similar repeat test algorithm can be applied to ID‐NAT as used for serologic assays.
Evidence for Rosettes as an Unrecognized Stage in the Life Cycle of Leishmania Parasites
Authors: IOVANNISCI DAVID M. , PAUL PLESTED C. , MOE GREGORY R.
Published: August 2010

ABSTRACT. Leishmania parasites, which afflict 12 million people in 88 countries, exist as promastigotes transmitted by insect vectors and as amastigotes residing in mammalian macrophages. Promastigote cells arranged in rosettes have also been described but universally disregarded as a distinct stage in the life cycle. We present evidence that only rosettes of Leishmania major promastigotes express cell surface poly‐α2,8 N‐acetyl neuraminic acid (PSA) and PSA containing de‐N‐acetyl neuraminic acid (NeuPSA). Expression of rosette‐specific PSA antigens was mosaic, with individual promastigotes expressing PSA, NeuPSA or both. A 50 kDa protein was detected by Western blot analysis of a detergent‐insoluble cell fraction with both PSA and NeuPSA‐reactive antibodies. Frequencies of rosette formation as well as cell surface PSA/NeuPSA expression were temperature dependent. Rosettes also engaged in an unusual swarming behavior, congregating into extended clusters. Distinct structures resembling cellular fusion bodies were formed in and released from rosettes. The results indicate that rosettes are an unrecognized stage in the life cycle of Leishmania. We hypothesize that rosettes initiate mating in Leishmania during which PSA/NeuPSA expression plays an important role. Recognizing rosettes as a distinct form of the Leishmania life cycle opens new possibilities for treatment or prevention of disease and, possibly, in vitro genetic recombination without passage of cells through insect vectors.
Sudden and Unexpected Death in Three Cases of Ehlers‐Danlos Syndrome Type IV*
Authors: Shields Lisa B.E. , Rolf Cristin M. , Davis Gregory J. , Hunsaker III John C.
Published: August 2010

Abstract:  Ehlers–Danlos syndrome (EDS) type IV is a connective tissue disorder characterized by the inability to produce sufficient amounts of collagen or a defect in the structure of collagen. The most serious complications include a rupture of a viscus or vascular rupture with or without mural dissection. Death may result from internal hemorrhage. This report describes three cases of sudden and unexpected death caused by EDS type IV. Two cases involved hemothorax as a result of dissection of the subclavian artery and aorta, respectively. The third case represented spontaneous pulmonary rupture and hemorrhage. A detailed family history should be sought, and additional specimens collected to confirm the diagnosis, including skin fibroblasts for collagen testing and blood for DNA testing. The forensic pathologist should consider the possibility of EDS type IV upon discovery of spontaneous visceral or arterial rupture and should alert the family members of this hereditary and potentially fatal condition.
A modified technique of guinea pig testing to identify delayed hypersensitivity allergens
Authors: Sato Yoshihisa , Katsumura Yoshio , Ichikawa Hidkyuki , Kobayashi Toshiaki , Kozuka Takehiio , Morikawa Fujio , Ohta Saburo
Published: August 2010

A modified guinea pig testing technique was developed For the detection of weak allergens and allergenicity of materials unsuitable for testing by intradermal injection. This test involved the use of Freund's complete adjuvant to stimulate the immune system of the animal, and external application instead of intradermal injection of the test compound in the induction stage. The allergenicity of Sudan III, Brilliant Lake Red R and Sudan I was tested by this procedure.

In the dose‐effect study of Sudan I, the dose dependency of a positive reaction of the induction and challenge concentrations was recognised.

The test was compared with three other guinea pig sensitization tests. The results obtained with this test correlated well with those obtained with the guinea pig maximization test.
A comparison of three guinea‐pig sensitization procedures for the detection of 19 reported human contact sensitizers
Authors: Goodwin B. F. J. , Crevel R. W. R. , Johnson A. W.
Published: August 2010

A maximization test (after Magnusson & Kligman 1970), a single injection adjuvant test (SIAT) and a modified Draize test procedure for assessing contact sensitization potential in guinea‐pigs have been compared for their ability to detect 19 known human contact sensitizers. The results show that the modified Draize procedure is a good screening test particularly for strong sensitizers. The maximization procedure is a very stringent test of sensitization potential, able to detect some marginal sensitizers. The sensitivity of the SIAT procedure is sufficiently similar to that of the maximization test to act as an alternative for routine testing, particularly in view of its practical advantages over the maximization procedure.
Virus warts in meat handlers
Authors: Wall L. M. , Oakes D. , Rycroft R. J. G.
Published: August 2010

An epidemiological study has been made of virus warts on the hands of all workers in a large meat processing factory. The meat handled is pork and beef. A total of 1141 employees were examined, 687 of whom were constantly handling meat.

The plant outline and the work of the 144 workers in the butchery section are described in detail. The prevalence of warts in meat handlers was 33.6–70.4% in different sections. The prevalence in non‐meat handlers varied from 18.2% to 44.4%. Half of the employees with warts were unaware of them, particularly in regard to plane warts.
High dissociation constants (pKa) of basic permeants are associated with in vivo skin irritation in man
Authors: Mangia A. , Andersen P. H. , Berner B. , Maibach H. I.
Published: August 2010

Previously, we have investigated the relationship between dissociation constant (pKa) and skin irritation potential. In the present experiment, 12 basic compounds, with varying pKa values ranging from 1.4 10 11.2, were applied on the hacks of 12 healthy adult panellists. Cutaneous reactions were measured objectively using reflectance speetrcscopy and transepidermal water loss (TEWL), and evaluated subjectively with a modified Draize scale. A positive correlation between increasing pKa and skin irritation capacity, measured either visually or by reflectance spectroscopy, was found, but only mecamylamine (pKa= 11.2) induced a significant increase in transepidermal water loss. Compounds with low pKa also induced a paradoxical vasoconstriction measured by reflectance spectroscopy. Only high pKa appeared predictive of in vivo skin irritation, and these chemicals apparently induce skin irritation with only minimal disruption of the skin barrier. A simple 1‐variable model is predictive of skin irritation for this series of organic permeants with increasing PKa.
Contact allergy to impurities in surfactants: amount, chemical structure and carrier effect in reactions to 3‐dimethylaminopropylamine
Authors: Angelini Gianni , Rigano Luigi , Foti Caterina , Vena Gino A. , Grandolfo Mauro
Published: August 2010

Since finding that all Subject with contact allergy to cocamidopropylbetaine give positive reactions to 3‐dimethylaminopropylamine (DMPA), we wished to verify whether sensitization to other industrially‐used tensioactives might also be due to contact of DMPA as an impurity. We also investigated the possible “carrier action” that tensioactives might exert on minimal quantities of DMPA. Finally, we analyzed the relationship between the structure of DMPA and other chemically‐correlated molecules and their sensitizing potential, with particular reference to the structure of alkylam‐idopropylbetaines. For this purpose, in 34 patients with contact allergy to DMPA, we tested: (i) DMPA in concentrations below the threshold limit in water and in different tensioactives: (ii) substances that employ DMPA as a reagent in their synthesis: (iii) substances similar to DMPA as regards chemically reactive groups. The study showed that: (i) DMPA remains as a quantitatively detectable impurity in all tensioactives employing it in their synthesis: (ii) some common anionic (SLES) and non‐ionic (polysorbate 20) tensioactives enhance the risk of sensitization from very low doses of DMPA, presumably due to a “carrier effect:” (iii) the sensitizing chemical structures in DMPA and related molecules are the primary amine and the tertiary (dimethyl‐substituted) amine groups, when separated by either 2 or 3 carbon atoms:(iv) no sensitizing action can be attributed to the functional groups present in alkylamidopropylbetaine molecules.
Contact stomatitis due to palladium and platinum in dental alloys
Authors: Koch Patrick , Baum Hans‐Peter
Published: August 2010

We report a patient with contact stomatitis due to combined sensitization to palladium and platinum. Patch testing showed strong and persistent allergic patch test reactions to palladium chloride (1% pet.) ammonium tetrachloroplatinate (0.25% pet), and a palladium metal plate. A platinum metal plate showed a weaker reaction. Histological examination of a biopsy from the test site of palladium chloride (1% pet.) at D3 showed both eczematous and lichenoid changes.
Idiopathic post‐traumatic dermatitis at the site of recent joint replacement
Authors: Bewsher S. M. , Kurzydlo A. M. , Gillespie R. J.
Published: August 2010

Idiopathic dermatitis over the site of previous trauma is a recognized but infrequently reported phenomenon that provides a diagnostic dilemma. Careful investigation is needed in order to exclude other rare and/or treatable causes.
Allergic contact dermatitis caused by sesame oil in a topical Chinese medicine, shi‐un‐ko
Authors: Oiso Naoki , Yamadori Yoshika , Higashimori Noriko , Kawara Shigeru , Kawada Akira
Published: August 2010

Topical Chinese medicines are used for skin disorders as traditional medicine in Japan. We describe a case of allergic contact dermatitis from a topical Chinese medicine, shi‐un‐ko.
Nickel allergy – prevalence in a population of Swedish youths from patch test and questionnaire data
Authors: Fors Ronny , Persson Maurits , Bergström Erik , Stenlund Hans , Stymne Birgitta , Stenberg Berndt
Published: August 2010

Background:  The prevalence of body piercing and orthodontic treatment has increased during recent decades. Such changes in lifestyle may influence the occurrence of nickel allergy.

Objectives:  The aim of this study was to describe the prevalence of nickel allergy in a Swedish youth population.

Methods:  In a cross‐sectional survey, 6095 adolescents answered a questionnaire on their lifestyle and medical history, and 4439 consented to patch testing for contact allergy. Patch test results were adjusted for dropouts by a missing value analysis.

Results:  The prevalence of self‐reported dermatitis from contact with metal items was 14.8%. Patch testing showed nickel sensitization in 9.9% of the subjects, and in significantly more girls than boys, 13.3% versus 2.5%, respectively. Taking the dropout into account, the estimated true prevalence of nickel sensitivity evaluated by test reading at D4 is 11.8% in girls and 1.6% in boys.

Conclusions:  The prevalence of nickel sensitization was higher for girls and slightly lower for boys compared with previous Swedish data. Self‐reported information on metal dermatitis as an estimate of nickel allergy has low validity. When possible, missing value analysis should be performed to account for dropouts.
Autoxidation of linalyl acetate, the main component of lavender oil, creates potent contact allergens
Authors: Sköld Maria , Hagvall Lina , Karlberg Ann‐Therese
Published: August 2010

Background:  Fragrances are among the most common causes of allergic contact dermatitis. We have in previous studies shown that linalool, present in lavender oil, autoxidizes on air exposure, forming allergenic oxidation products. Oxidized linalool was found to be a frequent cause of contact allergy in a patch test study on consecutive dermatitis patients. Linalyl acetate, the main component of lavender oil is commonly used as a fragrance chemical in scented products. Because of structural similarities, linalyl acetate should also be susceptible to oxidation on air exposure, forming similar oxidation products as linalool.

Objective:  The aim of the present study was to investigate the autoxidation of linalyl acetate and the influence of oxidation on its sensitizing potency.

Methods:  Analyses were performed using gas chromatography, nuclear magnetic resonance spectrometry and mass spectrometry. Sensitizing potencies of compounds were determined using the local lymph node assay (LLNA) in mice.

Results:  Analyses showed that the content of linalyl acetate decreased over time on air exposure and other compounds were formed. Hydroperoxides, an epoxide and an alcohol were identified as oxidation products from linalyl acetate. In the LLNA, linalyl acetate of high purity showed a weak sensitizing potency (EC3 25%). Autoxidation increased the sensitizing potency of linalyl acetate, and a 10 weeks oxidized sample gave an EC3 value of 3.6%. As for linalool, the hydroperoxides were shown to be the oxidation products with the highest sensitizing potency.

Conclusion:  It is concluded that autoxidation of the weakly allergenic linalyl acetate leads to formation of allergenic oxidation products.
Complementary and alternative remedies: an additional source of potential systemic nickel exposure
Authors: De Medeiros Luciana M , Fransway Anthony F , Taylor James S , Wyman Marcia , Janes Jodith , Fowler Joseph F , Rietschel Robert L
Published: August 2010

Background:  Systemic contact dermatitis from nickel has been reported from a number of sources including medical devices and following experimental oral exposure.

Objective:  To identify other potential sources of systemic nickel exposure.

Methods:  The internet and published medical literature were searched for complementary and alternative remedies which contain nickel.

Results:  We identified and evaluated sources of nickel exposure in 4 homeopathic preparations, which are advertised to treat common skin diseases, as well as in a number of other homeopathic remedies, several herbal products and multivitamin mineral complexes.

Conclusion:  Complementary and alternative remedies are an additional source of systemic nickel exposure and at highest doses the potential risk for systemic contact dermatitis in nickel allergic patients should be considered.
Evaluation of the effect of the specific CCR1 antagonist CP‐481715 on the clinical and cellular responses observed following epicutaneous nickel challenge in human subjects
Authors: Borregaard Jeanett , Skov Lone , Wang Lisy , Ting Naitee , Wang Cunshan , Beck Lisa A. , Sonne Jesper , Clucas Alan
Published: August 2010

Background:  The CC‐chemokine receptor‐1 (CCR1) is thought to be involved in recruitment of inflammatory cells in allergic contact dermatitis (ACD). CP‐481715 is a specific antagonist of CCR1.

Objectives:  To determine the inhibitory effects of CP‐418 715 in ACD by evaluating the clinical signs and cellular infiltration in skin biopsies following epicutaneous nickel challenge in allergic subjects.

Subjects/Methods:  In this phase 1/2 study, 40 subjects were randomized to 5 days of treatment in four parallel groups (placebo three times daily (TID), placebo once daily (QD), 1000 mg CP‐418 715 TID, and 3000 mg CP‐418 715 QD). Twenty‐four hours after the first drug administration, nickel sulfate patches were applied on subjects’ backs and removed 48 hours later.

Results:  Pretreatment with 1000 mg CP‐481715 TID resulted in significant reductions in visual scores of the nickel reactions (P = 0.01). Instrumentally measured erythema tended to decrease in the CP‐481715 mg TID group (P = 0.06). No differences were noted between the 3000 mg CP‐481715 mg QD group and pooled placebo. No significant differences were found for immunohistological cell counts. CP‐418 715 was generally safe and well tolerated.

Conclusions:  Blocking of CCR1 only partly inhibited clinical manifestations of ACD. Several chemokine receptors are likely relevant for the cellular influx observed in ACD lesions.
Perceptions of sensitive skin: changes in perceived severity and associations with environmental causes
Authors: Farage Miranda A.
Published: August 2010

Background:  The number of individuals who perceive themselves to have sensitive skin appear to be on the increase. A single definition of this condition remains elusive.

Objectives:  We used an epidemiological approach to evaluate the reasons why responders feel they have sensitive skin, how their skin has changed over time, and if there are sex, ethnic, and age group differences.

Methods:  A total of 1039 individuals filled out standard questionnaires. Respondents were not selected based on any criteria related to sensitive skin but consisted of individuals participating in other studies.

Results:  About 53% stated that their skin had been sensitive for more than 5 years, and 31% claimed that their skin has become more sensitive. When asked to describe why they have sensitive skin, severe weather was the reason most commonly selected. Visual (redness/swelling) and sensory (burning/stinging) reactions to products was also selected as the reason. Caucasians more often claimed that products produced visual effects, whereas African‐Americans more often claimed that products produced sensory effects. The environmental factor most strongly associated with sensitive skin was stress.

Conclusions:  Overall, the data support the generally accepted definition of sensitive skin as a reduced tolerance to cosmetics and toiletries; however, many individuals feel they have sensitive skin for other reasons unrelated to cosmetics and toiletries.
Hand eczema among University Hospital nursing staff: identification of high‐risk sector and impact on quality of life
Authors: Lan Cheng‐Che E. , Feng Wen‐Wei , Lu Yi‐Wei , Wu Ching‐Shuang , Hung Shih‐Ting , Hsu Hui‐Yu , Yu Hsin‐Su , Ko Ying‐Chin , Lee Chien‐Hung , Yang Yi‐Hsin , Chen Gwo‐Shing
Published: August 2010

Background:  Hand eczema is a commonly encountered occupational disease and has a negative impact on life quality.

Objective:  This study aimed to identify the specific conditions that may pose a higher risk for occurrence of hand eczema and evaluate the impact of hand eczema on life quality.

Method:  Nursing staff from a university hospital were invited to participate in a cross‐sectional study. Validated questionnaires for hand eczema and life quality were used to evaluate the point prevalence and determine the impacts of hand eczema, respectively.

Results:  The overall response rate was 93%, equivalent to 1132 completed questionnaires. Two hundred and forty‐eight (22%) reported occurrence of hand eczema. Occurrence of hand eczema was significantly associated with nursing for >10 years and working in a special care unit, with prevalences of 27% and 26%, respectively. In addition, hand eczema was associated with suboptimal life quality; pruritus or burning sensations were associated with a lower quality of life among those with hand eczema.

Conclusion:  Hand eczema is a work‐related problem for nursing staff; proper preventive programmes should be implemented for those nursing staff working in high‐risk areas to avoid further lowering of their quality of life.
Keratin protein identification in dimethylbenzanthracene‐induced hamster cheek‐pouch squamous cell carcinomas
Authors: Shuler C. F. , Mostofi R. , Lin L.‐M. , Schwartz S. A.
Published: August 2010

Shuler CF, Mostofi R, Lin L‐M, Schwartz SA. Keratin protein identification in dimethylbenzanthracene‐induced hamster cheek‐pouch squamous cell carcinomas. J Oral Pathol

Individual keratin proteins were identified in 10 DMBA induced squamous cell carcinomas (SCC) of the hamster cheek pouch. SDS‐polyacrylamide gel electrophoresis of water‐insoluble cytoskeletal extracts from the tumor tissue demonstrated alterations in the protein distribution normal for the site. Immunoblot analysis with a broad spectrum polyclonal antikeratin antiserum identified the keratins in the preparations and confirmed changes in their distribution in the tumor preparations. The major keratin species for all the tumor tissues ranged in molecular weight from 45 to 57kd. The normal tissues had keratins with molecular weights from 45 to 73kd. The absence of high molecular weight keratins was a prominent feature in all the cancers. The histologic appearance of the tumors was varied but the distribution of the keratins was not correlated with the various histologies. The results demonstrate that changes in keratin gene expression occur in DMBA‐induced cheek‐pouch carcinomas but the precise alterations in the keratin proteins from those seen normally are not predictable.
Immunocytochemical methods: a technical overview
Authors: Matthews J. B.
Published: August 2010

The most commonly used immunocytochemical techniques and their applications are described. Problems relating to retention of tissue immunoreactivity and specificity of antibodies are discussed with special reference to the effects of tissue processing, presence of cross‐reacting antibodies and lineage non‐specificity of monoclonal antibodies.
Nucleic acid probes in the study of latent viral disease
Authors: Maitland N. J. , Cox M. F. , Lynas C. , Prime S. , Crane I. , Scully C.
Published: August 2010

Abstract— Despite the apparent complexities of vocabulary and techniques involved in nucleic acid hybridization, these methods should become important new weapons in the pathologist's armoury. The particular strengths lie in the analysis of genes whose protein products defy detection either because they are absent (due, for example, to cellular controls as found in viral latency), to a point mutation, or to gene deletion (as is often the case with cellular oncogenes). However, the mere application of this technology will not solve all diagnostic problems. One must be aware, particularly in applying in situ hybridization to a new system, of the artefactural binding of the probes, and suitable control and duplicate experiments should be performed. In addition, it is vital to verify the identity of the probes and the specificity of the reaction by filter hybridization. The latter procedure may seem unwieldy, but is, in fact, no more complex than the recommended procedures for immunohistochemistry, as discussed by Matthews (this symposium). Sadly, for both hybridization and immunological detection, operator inexperience has often prevented such checks of specificity and as a result many spurious results populate the scientific literature, for example a recent controversy over the detection of Human T cell Lymphotrophic Virus Type 1 in multiple sclerosis patients (31). With careful application, however, these techniques will permit the detection of viral molecules under conditions where traditional electron microscopy/histology have failed, and may reveal possible viral aetioligies for a range of hitherto non‐viral diseases.