bluuebunny/crossref_metadata_2025 huggingface dataset:
Serious underreporting of visceral leishmaniasis through passive case reporting in Bihar, India
Authors: Singh S. P. , Reddy D. C. S. , Rai M. , Sundar S.
Published: June 2006

Objectives  Visceral leishmaniasis (VL) is a major public health problem in Bihar, India. Unfortunately, accurate data on the incidence or prevalence of the disease are not available. This longitudinal study was undertaken to determine the incidence of VL in a Community Development Block area of the state of Bihar. Survey results were compared with official reports of the disease to assess the extent of underreporting by the Government health system.

Methods  Three health subcentre areas in Kanti Block, consisting of 14 villages with a total population of 26 444, were selected. Active surveillance was performed every month from January 2001 to December 2003 by house to house survey to detect cases of fever for more than 15 days. Patients clinically suspected of suffering from VL were subjected to parasitological examination for confirmation. Analysis of records of the reporting agencies in the district was undertaken to compare and assess the extent of underreporting.

Results  A total of 202 cases of VL were identified in 3 years giving an average annual incidence rate of 2.49/1000 population (95% CI = 2.15–2.83). As identification data of patients was not available with the official reporting agencies for 2001 and 2002, extent of underreporting could be assessed for 2003 only. In the study population, 65 cases of VL were detected during 2003 providing an annual incidence rate of 2.36/1000 population. Only eight (12.30%) cases were reported officially, resulting in underreporting by a factor of 8.13. In 2003, the official incidence rate of VL for Kanti Block was 0.31/1000 against the actual rate of 2.36/1000. As the constraints for official reporting at the block and the district levels are similar, the underreporting at district level was also assumed to be similar. This finding has significance in the preparation for elimination programme.
Multiple cutaneous granular cell tumors, joint hypermobility and mild facial dysmorphism in a child
Authors: Muscardin Luca M. , Paradisi Mauro , Provini Alessia , Cota Carlo , Marzetti Gianfranco
Published: June 2006

Background  The association of multiple cutaneous granular tumors with systemic defects is extremely rare. To date, 14 cases have been described.

Case report  A 14‐year‐old boy presented multiple nodular lesions on his arms and legs; facial dysmorphism and joint hypermobility were also present. Histopathologic examination of two nodules showed granular cell tumors. We review the literature regarding multiple granular cell cutaneous tumors in children with associated somatic defects and genetic syndromes.

Conclusions  The combination of multiple cutaneous granular tumors with alterations in other organs is not only fortuitous, justifying the proposal of a distinct syndrome, termed “Bakos's syndrome” after the author who first described this association. The relation with neurofibromatosis type 1 is discussed, and an association is suggested with the range of variants of this syndrome.
Elastofibroma dorsi: histologic and echographic considerations
Authors: Cota Carlo , Solivetti Francesco , Kovacs Daniela , Cristiani Renzo , Amantea Ada
Published: June 2006

Background  Elastofibroma dorsi is a relatively rare soft‐tissue tumor of the elderly with typical localization to the subscapular area. To date, few cases have been reported in the dermatology literature. The differential diagnosis includes frequently observed subcutaneous neoplasms such as lipoma, fibrolipoma or more aggressive tumors. The diagnosis is made with histologic examination.

Case report  We present a typical case of elastofibroma dorsi, studied with ultrasound investigation and color–power Doppler, and discuss the correlation with the histologic picture.

Conclusions  Considering the strict correspondence between the characteristic histologic findings of elastofibroma and the specific ultrasound pattern, we believe that ultrasound investigation with color and power Doppler allows, in typical cases, a definitive diagnosis of elastofibroma.
Psoriasiform and palmoplanter pustular lesions induced after Kawasaki disease
Authors: Mizuno Yuki , Suga Yasushi , Muramatsu Shigenori , Hasegawa Toshio , Ogawa Hideoki
Published: June 2006

A 7‐month‐old boy was referred to us because of psoriatic lesions on the bilateral cheeks and on the extensor region of the left upper arm at the same site of his vaccination for tuberculosis 4 months previously (Fig. 1a,b). He also presented with small pustules scattered on the palms and soles (Fig. 1c).

Clinical manifestations of the patient. Psoriasiform plaques appeared on both cheeks (a) and on the extensor surface of the left upper arm (b). Multiple tiny pustules appeared on the left sole (c). The psoriasiform eruption on both cheeks (d) and the left upper arm (e) disappeared 2 months after the onset of Kawasaki disease

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Can specific vessel‐based papulopustular lesions of Behçet's disease be differentiated from nonspecific follicular‐based lesions clinically?
Authors: Boyvat Ayşe , Heper Aylin Okçu , Koçyiğit Pelin , Erekul Selim , Gürgey Erbak
Published: June 2006

Background  Although papulopustular lesions are one of the diagnostic criteria for Behçet's disease, controversy exists as to the nature of these lesions. Specific vessel‐based papulopustular lesions as well as nonspecific follicular lesions may be seen in patients with Behçet's disease. Some authors suggest that papulopustular lesions should be considered a positive criterion only if they exhibit a vessel‐based neutrophilic reaction.

Objective  To determine whether specific vessel‐based papulopustular lesions can be differentiated clinically from nonspecific follicular lesions in patients with Behçet's disease.

Methods  Twenty‐three papulopustular lesions in 20 patients with Behçet's disease were initially examined clinically by two dermatologists blind to each other's diagnosis. Biopsies taken from these lesions were examined by a pathologist unaware of the patient data.

Results  Leukocytoclastic vasculitis or perivascular infiltration was observed in 10 lesions, perifollicular and perivascular infiltration was noted in nine lesions, and perifollicular inflammation was seen in four biopsy specimens. Most of the lesions interpreted clinically as specific papulopustular lesions of Behçet's disease had predominantly perivascular infiltration or leukocytoclastic vasculitis; however, three papulopustular lesions evaluated by both observers as specific papulopustular lesions had only perifollicular inflammation, and one lesion diagnosed clinically as a nonspecific follicular eruption revealed perivascular neutrophilic reaction. Interobserver variance was noted in three papulopustular lesions.

Conclusions  Clinical examination may not be sufficient to predict the dermatopathologic pattern in all lesions. Papulopustular lesions with no specific clinical and histopathologic features may create problems in the diagnosis of Behçet's disease.
Multiple granular cell tumors in a child with growth retardation. Report of a case and review of the literature
Authors: Tomson Nevianna , Abdullah Anthony , Tan Chin Yau
Published: June 2006

Granular cell tumor is an uncommon benign tumor, most often found in the skin and subcutaneous tissue, although it may occur at any anatomical site. Multiple cutaneous lesions are rare, particularly in childhood. An association between multiple cutaneous granular cell tumors and systemic defects has been suggested. We report a case of a 9‐year‐old boy with multiple cutaneous granular cell tumors and growth retardation, and review the literature.
Coopératives de solidarité, développement et pérennité d’une innovation sociale. une étude comparative de deux expériences québécoises
Authors: Langlois Geneviève , Girard Jean‐Pierre
Published: June 2006

Résumé*:  Le Québec est le seul endroit en Amérique du Nord qui permet la création de coopératives multisociétaires. Ces organisations portent le nom de coopératives de solidarité. Le phénomène est relativement récent, soit depuis 1997 et tranche radicalement avec la longue tradition de coopératives de type unicité du sociétariat. Sur une base comparative, l’article présente deux expériences pour en exposer les contributions possibles au développement et à la pérennité d’une innovation sociale, un cas d’exploitation d’une station de ski et un autre, d’une coopérative offrant l’accès à des professionnels de médecine douce et un service d’animation auprès de personnes âgées. Un cadre d’analyse expose les forces et les faiblesses de l’économie sociale en matière d’innovation sociale, par exemple, la capacité d’hybridation des ressources et l’importance du soutien requis pour appuyer la mise en place de ces organisations. Selon cette étude et avec les réserves que comporte la comparaison de seulement deux cas, il s’avère que trois facteurs sont nécessaires pour assurer la pérennité d’une innovation sociale: une présence et une implication prolongées des instigateurs; la prise en considération de ses caractéristiques inhérentes et des valeurs qu’elle véhicule au fur et à mesure de son évolution; une diffusion d’information et une reconnaissance de l’innovation par la majorité de ceux sur qui elle exerce un impact.
Accounting for the social economy: the socioeconomic impact statement
Authors: Mook Laurie , Quarter Jack
Published: June 2006

Abstract**:  Organizations within the social economy have unique characteristics, yet their accounting procedures do not reflect this uniqueness, and rather are designed for private‐sector organizations that exchange their goods and services in the market. We argue that conventional accounting creates a perception that social economy organizations are users of resources and separate from the private and public sectors, rather than creators of value and an integral part of our society (Quarter, Mook, and Richmond, 2003a). This paper addresses the accounting needs of social economy organizations by presenting a model of social accounting—the Socioeconomic Impact Statement—that may help bring out the impact of such organizations. The paper presents a demonstration project of the potential utility of the Socioeconomic Impact Statement.
Epidemiologic characteristics of rhinitis in Turkish Children: the International Study of Asthma and Allergies in Childhood (ISAAC) phase 2
Authors: Kuyucu Semanur , Saraçlar Yıldız , Tuncer Ayfer , Geyik Pınar Özdemir , Adalıoğlu Gönül , Akpınarlı Akgül , Şekerel Bülent E. , Sümbüloğlu Vildan
Published: June 2006

Rhinitis is a common problem with important comorbidities. In order to search the association between rhinitis, allergic phenotypes and other risk factors in Turkish children, a parental questionnaire about allergic diseases and risk factors, and skin prick test (SPT) with 13 inhalant allergens were performed in a population‐based sample of 2774 children aged 9–11 yr. Bronchoprovocation testing with hypertonic saline (HS)and total IgE analysis were limited to a subsample of 350 children. Rhinitis was defined as a problem with sneezing, rhinorrhea, or nasal congestion when the child did not have a viral respiratory infection. The prevalences of ever rhinitis, current (last 12 months) rhinitis (CR), and ever hay fever were 36.3%, 30.6%, and 8.3%, respectively. SPT positivity rate was 20.4% among children with CR. Current wheezing and flexural dermatitis were significantly associated with CR. CR significantly increased the risk of asthma among both atopic and non‐atopic subjects [odds ratio (OR), 3.98; 95% CI, 1.81–8.76; and OR, 2.79; 95% CI, 1.82–4.26, respectively]. The association between CR and bronchial hyperreactivity (BHR) was not significant. The multiple logistic regression analysis revealed family atopy (OR = 2.25, 95% CI = 1.79–2.83, p < 0.001), current indoor heating with gas stove (OR = 1.78, 95% CI = 1.18–2.64, p = 0.006) and dampness/molds at home during the first year of life (OR = 1.70, 95% CI = 1.25–2.31, p = 0.001) as significant risk factors for CR. Turkish school children showed a high prevalence of rhinitis with a preponderance of non‐atopics. The highly significant association between rhinitis and asthma independent of atopic sensitization emphasize the importance of non‐atopic forms of rhinitis.
Molecular collaborations between serpins and trefoil factor promote endodermal cell growth and gastrointestinal differentiation in budding tunicates
Authors: Kawamura Kazuo , Kariya Yuko , Ono Yoshie , Muramoto Akira , Ohta Kyoko , Fujiwara Shigeki
Published: June 2006

We present evidence supporting novel collaborations between the serine protease inhibitor (serpin) and the trefoil factor during the budding stage of the tunicate Polyandrocarpa misakiensis. Using a maltose‐binding protein/P‐serpin fusion protein, two polypeptides of 40 kDa and 45 kDa were pulled down from Polyandrocarpa homogenates. Based on their partial amino acid sequence data, a single cDNA (928 bp) was cloned. It encodes a polypeptide that has five tandem repeats of a trefoil consensus motif. Thus, we termed the cDNA P‐trefoil. Both P‐trefoil and P‐serpin were expressed exclusively by coelomic cells during budding. P‐Trefoil was expressed mainly by coelomic cells throughout the asexual life cycle of Polyandrocarpa, while P‐Serpin was localized particularly in coelomic cells and in the extracellular matrix in developing buds. The native P‐Trefoil protein showed aminopeptidase activity. It induced cell growth in cultured Polyandrocarpa cells at a concentration of 8 µg/mL. P‐Serpin reinforced this activity of P‐Trefoil. Further, a mixture of P‐Trefoil and P‐Serpin exhibited the in vitro induction of a gut‐specific alkaline phosphatase. These results show for the first time that a serpin can interact with a trefoil factor to play a role in the cellular growth and differentiation of the gastric epithelium.
Pathological study of idiopathic portal hypertension with an emphasis on cause of death based on records of Annuals of Pathological Autopsy Cases in Japan
Authors: Sawada Seiko , Sato Yasunori , Aoyama Hajime , Harada Kenichi , Nakanuma Yasuni
Published: June 2006

Background and Aim:  Idiopathic portal hypertension (IPH) is thought to be benign if bleeding gastroesophageal varices can be controlled or prevented. A recent autopsy of a woman with IPH who died of hemorrhagic intestinal infarction related to mesenteric thrombosis prompted the authors to examine the terminal antemortem features and causes of death of IPH.

Methods:  Autopsy cases registered as IPH from 1986 to 1997 were surveyed in the records of the Annuals of Pathological Autopsy Cases in Japan, with permission from the Japanese Society of Pathology. The records of 65 of these cases were collected and examined pathologically.

Results:  It was found that the most frequent cause of death in these cases was (i) bacterial infection (20 cases). The next three causes of death were directly or indirectly related to hepatic disease or its altered portal hemodynamics as follows: (ii) progressive hepatic failure (16 cases); (iii) massive hemorrhage from ruptured gastroesophageal varices (11 cases); and (iv) hemorrhagic intestinal infarction due to mesenteric venous thrombosis (5 cases). Although portal venous thrombosis was closely associated with (iv), (ii) and (iii) seemed not to be associated with portal venous thrombosis. In addition, intracranial hemorrhage and other heterogeneous factors were identified as the cause of death in five cases and eight cases, respectively.

Conclusion:  These results suggest that progressive hepatic failure and intestinal hemorrhagic infarction should be considered in addition to rupture of gastroesophageal varices when monitoring patients with IPH. Clinicians should be also aware of severe bacterial infection and intracranial hemorrhage as a fatal complication of IPH.
Does co‐infection with multiple viruses adversely influence the course and outcome of sporadic acute viral hepatitis in children?
Authors: Kumar Arvind , Yachha Surender Kumar , Poddar Ujjal , Singh Uttam , Aggarwal Rakesh
Published: June 2006

Background:  This study looked at the frequency of co‐infection with multiple hepatotropic viruses and the effect of such infection on the course and outcome of acute sporadic viral hepatitis (AVH) and fulminant hepatic failure (FHF) in children.

Methods:  Consecutive children up to 15 years of age presenting with AVH or FHF between January 1998 and July 2002 were evaluated prospectively. The following viral markers were assessed in all children: immunoglobulin M (IgM) anti‐hepatitis A virus (HAV), IgM anti‐hepatitis E virus (HEV), hepatitis B surface antigen (HBsAg), IgM anti‐hepatitis B core (HBc), and anti‐hepatitis C virus (HCV).

Results:  A total of 149 children were included in the study, 122 with AVH and 27 with FHF. Co‐infection with multiple viruses was detected in 30 (24.6%) AVH patients (A + E in 24, A + B in three, and E + B, A + C and A + E + B in one each) and seven (26%) FHF patients (A + E in five, and A + B and E + B in one each). The majority of single infections were due to HAV (AVH 70/92, FHF 14/20) followed by HEV (AVH 9/92, and FHF 5/20). HEV infection was associated with infection with another agent in 88% of patients with AVH (odds ratio 53, 95% confidence interval 15–186, P < 0.0001). Frequency of anicteric state, prolonged cholestasis, relapsing hepatitis, ascites, hemolysis and mortality rates were similar in the single and multiple infection groups for both AVH and FHF patients.

Conclusions:  Co‐infection with multiple viruses is observed in one‐quarter of patients with sporadic AVH in childhood. Such infection does not produce a more severe disease. HEV positivity is a strong marker for multiple infections.
PREOPERATIVE LOCO‐REGIONAL IMAGING IN RECTAL CANCER
Authors: Skandarajah Anita R. , Tjandra Joe J.
Published: June 2006

Preoperative staging of rectal cancer can influence the choice of surgery and the use of neoadjuvant therapy. This review evaluates the use of endorectal ultrasound (ERUS) and magnetic resonance imaging (MRI) in the local staging of rectal cancer. Staging for distant metastases is beyond the scope of this review. A MEDLINE search for published work in English between 1984–2004 was carried out by entering the key words of ERUS, MRI and preoperative imaging and rectal cancer. Initially, 867 articles were retrieved. Abstracts were reviewed and papers selected according to the inclusion criteria of a minimum of 50 patients and papers published in English. Papers focusing on preoperative chemoradiotherapy and distal metastases were excluded. Thirty‐one papers were included in the systematic review. The examination techniques and images obtained are discussed and the respective accuracy is reviewed. ERUS and MRI have complementary roles in the assessment of tumour depth. Ultrasound has an overall accuracy of 82% (T1, 2, 40–100%; T3, 4, 25–100%) and is particularly useful for early localized rectal cancers. MRI has an accuracy of 76% (T1, 2, 29–80%; T3, 4, 0–100%) and is useful in more advanced disease by providing clearer definition of the mesorectum and mesorectal fascia. Both methods have similar accuracy in the assessment of nodal metastases. Ultrasound is more operator dependent and accuracies improve with experience, but it is more portable and accessible than MRI. Improvements in technology and increased operator experience have led to more accurate preoperative staging. ERUS and MRI are complementary and are most accurate for early localized cancers and more advanced cancers, respectively.
T4 GASTRIC CARCINOMA: THE BENEFIT OF NON‐CURATIVE RESECTION
Authors: Kim Dong Y. , Joo Jae K. , Seo Kyeung W. , Park Young K. , Ryu Seong Y. , Kim Hyeong R. , Kim Young J. , Kim Shin K.
Published: June 2006

Background:  The prognosis of patients with gastric carcinoma with invasion of the adjacent organs (T4 gastric carcinoma) is very poor. We evaluated the survival benefit of resection in this group of patients.

Method:  We retrospectively reviewed the hospital records of 288 patients with T4 gastric carcinoma to compare the clinicopathological results in patients with curative resection (n = 95) with patients with non‐curative resection (n = 193) during the period 1986–2000.

Results:  With a 33% curative resectability in patients with T4 gastric carcinoma, patients with tumour resection (curative and non‐curative) had a significantly improved survival rate. The overall survival rate was higher for patients who underwent resection (11.6%) than for patients who were not resected (2.5%), regardless of curability (P < 0.001). Using Cox’s proportional hazard regression model, lymph node invasion and curability were independent statistically significant prognostic parameters. The prognosis of patients with invasion to the peritoneum and adrenal glands was significantly poorer than that of patients in whom there was no such invasion. But, the number of organs invaded had no effect on patient survival.

Conclusions:  Patients with T4 gastric carcinoma might be benefited from curative resection. The results also emphasize the improved survivorship of T4 gastric carcinoma patients with resection compared with those who did not undergo resection. Although curative resection cannot be undertaken in patients with T4 gastric carcinoma, we recommend performing resection in patients with locally advanced gastric carcinoma, regardless of curability.
CORRELATION BETWEEN BANKART AND HILL‐SACHS LESIONS IN ANTERIOR SHOULDER DISLOCATION
Authors: Widjaja Audi B. , Tran Anh , Bailey Michael , Proper Stewart
Published: June 2006

Background:  Bankart lesions and Hill‐Sachs lesions are commonly associated with anterior shoulder dislocations. The presence of Bankart lesion indicates the need for surgical repair. Magnetic resonance imaging (MRI) has been shown to be sensitive in detecting these two lesions. The aim of this study is to investigate the correlation between Bankart lesions and Hill‐Sachs lesions on MRI for patients with traumatic anterior shoulder dislocations.

Methods:  Between 2003 and 2005, 61 patients from Alfred and Sandringham Hospitals had an MRI as part of the investigation for traumatic anterior shoulder dislocations. The MRI scans were reviewed and subsequently confirmed by a radiologist to show the presence or absence of Bankart and Hill‐Sachs lesions. The data were then analysed by a statistician.

Results:  Although patients with one of these lesions were more than two‐and‐a‐half times as likely to have the other, small study numbers precluded this result from achieving statistical significance. (odds ratio, 2.67 (0.83–8.61), P = 0.10). Younger age was a strong predictor of a recurrence of shoulder dislocation (odds ratio, 0.93 (0.89–0.98), P = 0.005). The presence of Bankart or Hill‐Sachs lesions on MRI for the primary shoulder dislocation group was similar to the recurrent group (73% vs. 72% for Bankart lesion and 67% vs. 70% for Hill‐Sachs lesion).

Conclusion:  There is a strong correlation between both lesions. This apparent trend can be useful in predicting the presence of a Bankart lesion when a Hill‐Sachs lesion is identified on a plain radiograph. This study suggests the consideration of surgical repair after identification of a Hill‐Sachs lesion on plain radiographs, especially for younger patients where the rate of re‐dislocation is high.
OCCUPATION AND CARPAL TUNNEL SYNDROME
Authors: Stapleton Murray J.
Published: June 2006

Carpal tunnel syndrome is the most common of all the so‐called entrapment syndromes. It therefore features as a most important medical condition for which the underlying cause is unknown. In the USA, this condition is commonly regarded as work related, and as a condition, it results in a cost of medical expenditure alone of $US13 263 per employee so affected. The incidence in the United States of America is 99 out of 100 000 people. Four hundred and fifty thousand carpal tunnel releases are carried out annually in the USA, at a total cost of $2 BIL.1 The condition gives rise to opinions that vary as to whether it is work related. In my practice now as a full‐time medicolegal consultant, so many opinions are written that blandly put forward the statement that ‘Carpal Tunnel Syndrome is work related’ or ‘Carpal Tunnel Syndrome is related to repetitive movement or hard physical labour’. These opinions, in my view, are not supported by current knowledge of carpal tunnel syndrome and it is for that reason that this study has been instituted.
Analysis of growth hormone receptor polymorphism in Japanese semisuper centenarians
Authors: Du Yuchen , Hirose Nobuyoshi , Ping Jing , Ishida Yoshiyuki , Kojima Toshio , Arai Yasumichi , Inagaki Hiroki , Gondo Yasuyuki , Sakaki Yoshiyuki , Haneda Masataka , Ito Sachiko , Isobe Ken‐ichi
Published: June 2006

Background:  Recent studies have demonstrated a significant association between mutations in genes involved in the GHR/IGF1 signaling pathway and extension of the lifespan of model organisms. Exon 3 insertion or deletion is one common polymorphism in the growth hormone receptor (GHR) of humans. The exon 3 deletion allele is reported to have stronger signaling in the GH/GHR pathway, which may correlate to short lifespan.

Methods:  We investigated the common polymorphic variation in 119 Japanese semisuper centenarians (SSC; older than 105) compared with 104 healthy younger controls via the polymorphism‐based polymerase chain reaction method.

Results:  The frequency of exon 3 deletion variation of GHR in SSC was found to be higher than controls, although this was not significant statistically. Also, the single nucleotide polymorphism genotype frequency and allele frequency exhibited no differences between SSC and controls.

Conclusions:  These results show that SSC in Japan do not tend to have the allele of GHR, which has a lower signaling capacity.
Comprehensive Geriatric Assessment for outpatients is important for the detection of functional disabilities and depressive symptoms associated with sensory impairment as well as for the screening of cognitive impairment
Authors: Sumi Eriko , Takechi Hajime , Wada Taizo , Ishine Masayuki , Wakatsuki Yoshio , Murayama Toshinori , Yokode Masayuki , Tanaka Makoto , Kita Toru , Matsubayashi Kozo , Arai Hidenori
Published: June 2006

Background:  The Comprehensive Geriatric Assessment (CGA) for inpatients is very useful to improve the outcomes of elderly patients. However, most of the elderly patients are provided their care by general practitioners in primary care settings without comprehensive assessment. Concise and practical assessment is necessary for the detection of geriatric problems and sufficient care in the outpatient clinic.

Methods:  The CGA was introduced in the outpatient clinic for elderly people in Kyoto University Hospital and 309 patients participated in the study, where cognitive impairment, depressive symptoms, activities of daily living, and self‐reported hearing and visual impairment were assessed.

Results:  In the patients studied, the most prevalent chief complaint was memory loss (19%). Among the patients complaining of memory loss, two‐thirds of the patients were diagnosed as cognitively impaired by the Mini‐Mental State Examination. Multiple logistic regression analysis showed that hearing and visual impairment was significantly associated with functional disabilities and that hearing impairment was significantly associated with depressive symptoms.

Conclusions:  Thus, the CGA for outpatients is useful for the detection of functional disabilities and depressive symptoms by asking about their sensory impairment as well as for the detection of cognitive impairment in elderly patients. Therefore, concise and practical assessment should be introduced in the primary care settings to improve the quality of life of elderly people.
Risk factors of disseminated intravascular coagulation in septic systemic inflammatory response syndrome in nursing home residents
Authors: Kikuchi Motoo , Inagaki Toshiaki , Miyagawa Koichi , Ueda Ryuzo , Shinagawa Nagao , Hanaki Hidekazu
Published: June 2006

Aims:  Disseminated intravascular coagulation syndrome (DIC) is a serious complication in elderly patients with systemic inflammatory response syndrome (SIRS). We investigated whether the clinically relevant parameters of atherosclerosis, nutrition and cellular immunity are determining factors for DIC in septic SIRS patients or not.

Patients and methods:  Forty‐four subjects aged 65 years or over were enrolled, all of whom had bacterial sepsis and a high concentration of C‐reactive protein (≥ 15.0 mg/dL). Subjects were given gabexate mesilate (GM) following diagnosis of DIC. They were divided into the following groups: N‐DIC, subjects with SIRS but not DIC (n = 22); DIC‐A, subjects with SIRS and DIC who survived through treatment with GM (n = 6); and DIC‐D, subjects who had SIRS and DIC and died despite treatment with GM (n = 16).

Results:  Subjects with a low hemoglobin or serum albumin concentration, and atrial fibrillation at admission had a significantly high incidence of DIC, which was not high in subjects with myocardial ischemia, past history of overt cerebral infarctions or periventricular lucency. There was no difference in hemoglobin concentration between DIC‐A and DIC‐D. Differences in increases in CD11b‐ and CD14‐positive mononuclear cells between DIC and N‐DIC subjects were not significant. Post‐mortem examinations showed that the ratio of the width of the thoracic aorta to that of the abdominal aorta was significantly higher for DIC‐D than DIC‐A.

Conclusion:  Nutritional disorders and irregularity in aortic blood flow are significant risks of DIC. Treatment with GM alone is not sufficient to achieve survival in patients with DIC and SIRS.
New formulae for predicting tracheal tube length
Authors: LAU NICKY , PLAYFOR STEPHEN D. , RASHID ASRAR , DHANARASS MUTHU
Published: June 2006

Background : The aim of this study was to determine the accuracy of standard techniques for estimating oral and nasal tracheal tube length in children and to devise more accurate predictive formulae that can be used at the bedside.

Methods : Data were collected from 255 children who required tracheal intubation whilst on the Pediatric Intensive Care Unit over a period of 1 year. Age, weight, the final length of the tracheal tube and the internal diameter were documented. Patients with a tracheostomy were excluded from the study.

Results : Using linear regression the following formulae best predicted final tracheal tube length. For children over 1 year of age:
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For children below 1 year of age:
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Conclusions : Current Advanced Paediatric Life Support guidelines underestimate the appropriate tracheal tube lengths for orotracheal intubation in children over 1 year of age. Similarly, the novel weight‐based formulae for tracheal tube lengths in children below the age of 1 year proved more accurate than standard reference charts. We therefore recommend that these new formulae are prospectively evaluated.
A simple persistence condition for structured populations
Authors: Hastings Alan , Botsford Louis W.
Published: June 2006

The fundamental question in both basic and applied population biology of whether a species will increase in numbers is often investigated by finding the population growth rate as the largest eigenvalue of a deterministic matrix model. For a population classified only by age, and not stage or size, a simpler biologically interpretable condition can be used, namely whether R0, the mean number of offspring per newborn, is greater than one. However, for the many populations not easily described using only age classes, stage‐structured models must be used for which there is currently no quantity like R0. We determine analogous quantities that must be greater than one for persistence of a general structured population model that have a similar useful biological interpretation. Our approach can be used immediately to determine the magnitude of changes and interactions that would either allow population persistence or would ensure control of an undesirable species.
Effect of cognitive style and professional development on the initiation of radical and non‐radical management accounting innovations
Authors: Emsley David , Nevicky Barbara , Harrison Graeme
Published: June 2006

This study examines the effects of adaptive/innovative cognitive style, and professional development on the initiation of radical and non‐radical innovations by individual management accountants. Data are gathered through questionnaire and follow‐up interviews with practising management accountants. The results show that management accountants with a more innovative (adaptive) cognitive style tend to initiate more (fewer) radical relative to non‐radical innovations, and that this effect is amplified by professional development. The study has implications for research in management accounting innovation and for practice, including the importance of maintaining a balance of radical and non‐radical innovations in organizations, and of professional development.
Should there exist secondary markets for executive stock options?
Authors: Kallunki Juha‐Pekka , Nikkinen Jussi , Sahlström Petri , Wichmann Kristina
Published: June 2006

This paper investigates the potential disadvantages of the secondary markets for executive stock options (ESOs). The benefits of such markets are evident, but they might also have negative effects for shareholders. Executives might, for example, use inside information to time their ESO selling. We investigate two personal motives of managers that can be assumed to affect their optimal selling decision, that is, managers' personal portfolio management issues and the use of inside information. We explore these motives by analyzing unique data from Finland, where there are secondary markets for ESOs. The results of the study support the traditional portfolio diversification hypothesis according to which managers tend to sell their ESOs when holding an ESO is equivalent to holding the underlying stock; that is, in such a case a manager's wealth is closely tied to the stock price of the firm. With respect to the use of inside information the results indicate that ESO selling activity is not related to future stock price behaviour, suggesting that managers do not use inside information to determine the selling time of their ESOs. These results imply that the existence of secondary markets for ESOs does not weaken the usefulness of ESOs as the management compensation, although the benefits of such markets are evident.
A KDEL‐tagged monoclonal antibody is efficiently retained in the endoplasmic reticulum in leaves, but is both partially secreted and sorted to protein storage vacuoles in seeds
Authors: Petruccelli Silvana , Otegui Marisa S. , Lareu Fabricio , Tran Dinh Olivia , Fitchette Anne‐Catherine , Circosta Ariana , Rumbo Martin , Bardor Muriel , Carcamo Rosa , Gomord Véronique , Beachy Roger N.
Published: June 2006

Transgenic plants are attractive biological systems for the large‐scale production of pharmaceutical proteins. In particular, seeds offer special advantages, such as ease of handling and long‐term stable storage. Nevertheless, most of the studies of the expression of antibodies in plants have been performed in leaves. We report the expression of a secreted (sec‐Ab) or KDEL‐tagged (Ab‐KDEL) mutant of the 14D9 monoclonal antibody in transgenic tobacco leaves and seeds. Although the KDEL sequence has little effect on the accumulation of the antibody in leaves, it leads to a higher antibody yield in seeds. sec‐AbLeafpurified from leaf contains complexN‐glycans, including Lewisaepitopes, as typically found in extracellular glycoproteins. In contrast, Ab‐KDELLeafbears only high‐mannose‐type oligosaccharides (mostly Man 7 and 8) consistent with an efficient endoplasmic reticulum (ER) retention/cis‐Golgi retrieval of the antibody. sec‐Ab and Ab‐KDEL γ chains purified from seeds are cleaved by proteases and contain complexN‐glycans indicating maturation in the late Golgi compartments. Consistent with glycosylation of the protein, Ab‐KDELSeedwas partially secreted and sorted to protein storage vacuoles (PSVs) in seeds and not found in the ER. This dual targeting may be due to KDEL‐mediated targeting to the PSV and to a partial saturation of the vacuolar sorting machinery. Taken together, our results reveal important differences in the ER retention and vacuolar sorting machinery between leaves and seeds. In addition, we demonstrate that a plant‐made antibody with triantennary high‐mannose‐typeN‐glycans has similar Fab functionality to its counterpart with biantennary complexN‐glycans, but the former antibody interacts with protein A in a stronger manner and is more immunogenic than the latter. Such differences could be related to a variable immunoglobulin G (IgG)‐Fc folding that would depend on the size of theN‐glycan.
Trade Liberalization and the Profitability of Mergers: a Global Analysis*
Authors: Benchekroun Hassan , Chaudhuri Amrita Ray
Published: June 2006

We analyze the effects of bilateral tariff reductions on the profitability of cost‐reducing horizontal mergers. Given Cournot competition in a two‐country world, for any positive tariff below a certain threshold, marginal trade liberalization is shown to encourage only those domestic mergers with sufficiently large cost‐savings and to discourage the rest. For tariffs close to, but smaller than, the prohibitive tariff, however, marginal trade liberalization necessarily encourages all domestic mergers. Moreover, we show that for a given level of cost‐savings, the impact of marginal trade liberalization may not reliably predict that of nonmarginal liberalization.

Although at high tariffs, domestic mergers are shown to be unambiguously more profitable than cross‐border mergers, near free trade, mergers which yield the most cost‐savings become the most profitable. Thus, when comparing domestic and cross‐border mergers, trade liberalization encourages the type which yields the most cost‐savings.
Likelihood for Generally Coarsened Observations from Multistate or Counting Process Models
Authors: COMMENGES DANIEL , GÉGOUT‐PETIT ANNE
Published: June 2006

Abstract. We consider first the mixed discrete‐continuous scheme of observation in multistate models; this is a classical pattern in epidemiology because very often clinical status is assessed at discrete visit times while times of death or other events are observed exactly. A heuristic likelihood can be written for such models, at least for Markov models; however, a formal proof is not easy and has not been given yet. We present a general class of possibly non‐Markov multistate models which can be represented naturally as multivariate counting processes. We give a rigorous derivation of the likelihood based on applying Jacod's formula for the full likelihood and taking conditional expectation for the observed likelihood. A local description of the likelihood allows us to extend the result to a more general coarsening observation scheme proposed by Commenges & Gégout‐Petit. The approach is illustrated by considering models for dementia, institutionalization and death.
Guillain–Barré syndrome in Pakistan: similarity of demyelinating and axonal variants
Authors: Shafqat S. , Khealani B. A. , Awan F. , Abedin S. E.
Published: June 2006

Guillain–Barré syndrome (GBS) comprises multiple subtypes whose nosological and pathophysiologic interrelationships are unclear. In an attempt to better understand the relationship between the disease's major subtypes, we reviewed the characteristics of GBS cases consecutively admitted to a tertiary care hospital in Karachi, Pakistan, over a 13‐year period. Of 175 cases, 80 (46%) were demyelinating and 55 (31%) axonal, whilst 40 (23%) had ambiguous electrophysiological findings precluding classification. The three groups differed in severity of weakness at presentation (axonal ∼ ambiguous > demyelinating; P = 0.002 for arm strength and P = 0.025 for leg strength); mean age (demyelinating > axonal > ambiguous; P = 0.05); and mean cerebrospinal fluid protein concentration (demyelinating > ambiguous > axonal; P = 0.05). However, they were similar in several other respects, including gender ratio, proportion of pediatric cases, history of antecedent infection, length of hospital stay, need and duration of mechanical ventilation, and functional outcome at discharge. Stool culture data was available for 146 (83%) cases in the study; none was positive for Campylobacter jejuni. GBS in Pakistan comprises a high proportion of axonal cases. Similarity of outcomes in axonal and demyelinating variants and lack of C. jejuni stool culture positivity are atypical features.
A case of cerebral Whipple's disease initially presenting with isolated focal myoclonus
Authors: Henning S. , Tings T. , Schmidt H. , Tergau F. , Wolf S. , Scholz K. , Knauth M. , Buchner H. , Gold R. , Paulus W.
Published: June 2006

Neurological manifestations in Whipple's disease are highly variable and tend to occur at later stages of the disease. However, isolated, focal neurological symptoms are reported to be rare. Here we describe the successful treatment of a case of cerebral Whipple's disease initially presenting solely with isolated myoclonic jerks of the left hand and forearm evolving to a segmental myoclonus at a later stage. Additionally, we present – to our knowledge – a novel treatment by administration of immunomodulatory therapy (IVIg) in addition to established antibiotics.
Stiff skin syndrome
Authors: Geng S , Lei X , Toyohara JP , Zhan P , Wang J , Tan S
Published: June 2006

Stiff skin syndrome is a rare disorder characterized by pronounced skin induration, mild hypertrichosis and limited joint mobility, predominantly on the buttocks and thighs. Many heterogeneous cases have been reported under the name of stiff skin syndrome. We present a case of stiff skin syndrome from China, the diagnosis based on the patient's typical clinical and histopathological features.
Efficacy and tolerability of a new synergized pyrethrins thermofobic foam in comparison with benzyl benzoate in the treatment of scabies in convicts: the ISAC study (Studio Della scabbia in ambiente carcerario)
Authors: Biele M , Campori G , Colombo R , De Giorgio G , Frascione P , Sali R , Starnini G , Milani M ,   The ISaC Investigator Group
Published: June 2006

Background  Scabies is a very common skin infection in convicts. The SIMSPE Society (Società Italiana di Medicina e Sanità Penitenziaria) has organized and conducted a multicentre, randomized, comparative, parallel group, investigator‐blinded trial to evaluate the efficacy and tolerability of synergized pyrethrins foam (PF) in comparison with benzyl benzoate (BB) lotion.

Methods  A total of 240 convicted patients, enrolled in eight National Jail Institutions, with a clinical diagnosis of scabies, were treated with PF (n = 120) for three consecutive days or BB (n = 120) for five consecutive days. Primary study endpoints were the clinical cure rate and the local tolerability. Secondary endpoints were clinical evolution of scabietic lesions and itching intensity. Study outcomes were assessed using appropriate semiquantitative scores at baseline and after 2 and 4 weeks. A second treatment cycle was applied if after 2 weeks the patient was not judged clinically cured.

Results  At week 2, a total of 75% (95% CI: 66–82%) and 71% (95% CI: 62–78%) of patients showed a complete clinical cure rate in the PF and BB groups, respectively. At week 4, the percentage of totally cured patients increased up to 95% (95% CI: 89–97%) and 91% (95% CI: 83–94%) in the PF and BB groups, respectively (P = NS between groups). At week 4, 5% in the PF group and 9% in the BB group complained of itching. Burning and irritation after treatment applications were more common in the BB group in comparison with the PF group. The tolerability score was better in the PF group in comparison with to BB group (2.9 vs. 2.2; P = 0.0001). A total of 95% of patients in the PV group had a good tolerability score (i.e. = 3) in comparison with 41% in the BB group.

Conclusion  Our results show that a 3‐day treatment with pyrethrins thermofobic foam is at least as effective as a 5‐day treatment with benzyl benzoate lotion in convicted subjects with scabies. The foam formulation is better tolerated than the benzyl benzoate lotion.
Homogeneous blue pigmentation in dermatofibroma simulating a blue naevus
Authors: Ozdemir F , Kilinc I , Akalin T
Published: June 2006

A case with a pigmented skin lesion that was diagnosed as a blue naevus on clinical and dermoscopic grounds and histopathologically confirmed as a dermatofibroma is presented. By means of this case, we define dermatofibroma as a new exception for ‘homogeneous blue pigmentation’ on dermoscopy.
Narrowband UVB phototherapy for early‐stage mycosis fungoides: evaluation of clinical and histopathological changes
Authors: Gökdemir G , Barutcuoǧlu B , Sakız D , Köşlü A
Published: June 2006

Background  Early‐stage (IA, IB, IIA) mycosis fungoides (MF) has long been treated with various agents including topical potent steroids, nitrogen mustard, carmustine, oral psoralen plus UVA (PUVA), broadband UVB, electron‐beam radiotherapy, interferon‐α and retinoids. However, each of these modalities is associated with various side‐effects. Narrowband UVB (NB‐UVB) therapy has the same effect but is safer to use than the other methods.

Objective  Our purpose in this prospective study was to determine the effects of NB‐UVB in early‐stage MF both clinically and histopathologically.

Materials and methods  Twenty‐three patients (20 men, three women, aged 27–78 years) with clinically and histologically confirmed MF were enrolled. Patients received NB‐UVB therapy three times a week. Clinical and histological responses, cumulative doses, total number of treatments, side‐effects and duration of remission period were noted.

Results  Six patients had stage IA MF, 15 patients stage IB and two patients stage IIA. Eighteen patients had patch stage and five patients had plaque stage histopathologically. All of the patients in the patch group had a complete response (CR). In the plaque group, three patients (60%) had a CR and two (40%) had partial (PR) or no clinical response (NR). The clinical response between patch and plaque groups was statistically significant. Regarding the histopathological findings, 17 (94.4%) had complete clearing and only one (5.6%) patient had a partial improvement in the patch group. In the plaque group, one (20%) patient had complete clearing and four (80%) patients had partial or no improvement. The difference between the two groups was statistically significant. In the patch group, the mean cumulative dose was 90.15 J/cm2 and the mean number of treatments was 35.33. In the plaque group, the mean cumulative dose was 90.67 J/cm2 and the mean total number of treatments was 39.40. The differences were not statistically significant, either between the mean cumulative dose or the mean number of treatments. The mean duration of follow‐up was 10.87 months (range 1–25 months). Only one of the patients had a relapse.

Conclusions  NB‐UVB therapy for patients with early‐stage MF is an effective and safe treatment with the effect lasting for months. We suggest that clinical clearance correlates with histological improvement except for patients in the plaque stage.