bluuebunny/crossref_metadata_2025 huggingface dataset:
Control techniques forCulicoidesbiting midges and their application in the U.K. and northwestern Palaearctic
Authors: CARPENTER S. , MELLOR P. S. , TORR S. J.
Published: August 2008

AbstractThe recent emergence of bluetongue virus (Reoviridae:Orbivirus) (BTV) in northern Europe, for the first time in recorded history, has led to an urgent need for methods to control the disease caused by this virus and the midges that spread it. This paper reviews various methods of vector control that have been employed elsewhere and assesses their likely efficacy for controlling vectors of BTV in northern Europe. Methods of controllingCulicoidesspp. (Diptera: Ceratopogonidae) have included: (a) application of insecticides and pathogens to habitats where larvae develop; (b) environmental interventions to remove larval breeding sites; (c) controlling adult midges by treating either resting sites, such as animal housing, or host animals with insecticides; (d) housing livestock in screened buildings, and (e) using repellents or host kairomones to lure and kill adult midges. The major vectors of BTV in northern Europe are species from theCulicoides obsoletus(Meigen) andCulicoides pulicaris(L.) groups, for which there are scant data on breeding habits, resting behaviour and host‐oriented responses. Consequently, there is little information on which to base a rational strategy for controlling midges or for predicting the likely impact of interventions. However, data extrapolated from the results of vector control operations conducted elsewhere, combined with some assessment of how acceptable or not different methods may be within northern Europe, indicate that the treatment of livestock and animal housing with pyrethroids, the use of midge‐proofed stabling for viraemic or high‐value animals and the promotion of good farm practice to at least partially eliminate local breeding sites are the best options currently available. Research to assess and improve the efficacy of these methods is required and, in the longer term, efforts should be made to develop better bait systems for monitoring and, possibly, controlling midges. All these studies will need better methods of analysing the ecology and behaviour of midges in the field than are currently in use. The paucity of control options and basic knowledge serve to warn us that we must be better prepared for the possible emergence of other midge‐borne diseases, particularly African horse sickness.
An assessment of the effect of data partitioning on the performance of modelling algorithms for habitat suitability for ticks
Authors: ESTRADA‐PEÑA A. , THUILLER W.
Published: August 2008

Abstract A comparison of the performance of five modelling methods using presence/absence (generalized additive models, discriminant analysis) or presence‐only (genetic algorithm for rule‐set prediction, ecological niche factor analysis, Gower distance) data for modelling the distribution of the tick species Boophilus decoloratus (Koch, 1844) (Acarina: Ixodidae) at a continental scale (Africa) using climate data was conducted. This work explicitly addressed the usefulness of clustering using the normalized difference vegetation index (NDVI) to split original records and build partial models for each region (cluster) as a method of improving model performance. Models without clustering have a consistently lower performance (as measured by sensitivity and area under the curve [AUC]), although presence/absence models perform better than presence‐only models. Two cluster‐related variables, namely, prevalence (commonness of tick records in the cluster) and marginality (the relative position of the climate niche occupied by the tick in relation to that available in the cluster) greatly affect the performance of each model (P < 0.05). Both sensitivity and AUC are better for NDVI‐derived clusters where the tick is more prevalent or its marginality is low. However, the total size of the cluster or its fragmentation (measured by Shannon’s evenness index) did not affect the performance of models. Models derived separately for each cluster produced the best output but resulted in a patchy distribution of predicted occurrence. The use of such a method together with weighting procedures based on prevalence and marginality as derived from populations at each cluster produced a slightly lower predictive performance but a better estimation of the continental distribution of the tick. Therefore, cluster‐derived models are able to effectively capture restricting conditions for different tick populations at a regional level. It is concluded that data partitioning is a powerful method with which to describe the climate niche of populations of a tick species, as adapted to local conditions. The use of this methodology greatly improves the performance of climate suitability models.
Environmental and demographic factors determining the spatial distribution of Triatoma guasayana in peridomestic and semi‐sylvatic habitats of rural northwestern Argentina
Authors: VAZQUEZ‐PROKOPEC G. M. , CECERE M. C. , KITRON U. , GÜRTLER R. E.
Published: August 2008

Abstract Triatoma guasayana (Wygodzinsky & Abalos), a sylvatic vector of Chagas’ disease, occurs in natural and peridomestic habitats of the dry Chaco region of Argentina, Bolivia and Paraguay. Ten‐year retrospective spatial analyses of peridomestic T. guasayana abundance in the rural community of Amamá were expanded to the neighbouring community of Trinidad in northwestern Argentina. The distribution of T. guasayana in domiciles, peridomiciles (storerooms, chicken coops and corrals) and natural habitats (bromeliads, dry cacti and logs) around houses (i.e. ‘semi‐sylvatic’ habitats) was analysed. The distribution of the 316 T. guasayana specimens collected in domestic and peridomestic sites during 1993–2002 was significantly clustered in both communities. Searches confirmed that the spatial distribution of semi‐sylvatic and peridomestic T. guasayana was determined by the joint effects of the local abundance of goats and the density of semi‐sylvatic habitats. The integration of detailed entomological and demographic longitudinal data with geographic information system data, high‐resolution satellite imagery, appropriate spatial and temporal analyses and field observations allowed us to infer the underlying processes determining the distribution of T. guasayana in rural communities. This approach may be applied to other sylvatic and peridomestic vectors of Chagas’ disease in order to identify high‐risk areas for targeted control or environmental management.
Historical divergence vs. contemporary gene flow: evolutionary history of the calcicole Ranunculus alpestris group (Ranunculaceae) in the European Alps and the Carpathians
Authors: PAUN O. , SCHÖNSWETTER P. , WINKLER M. , CONSORTIUM INTRABIODIV , TRIBSCH A.
Published: August 2008

Although many species have similar total distributional ranges, they might be restricted to very different habitats and might have different phylogeographical histories. In the European Alps, our excellent knowledge of the evolutionary history of silicate‐dwelling (silicicole) plants is contrasted by a virtual lack of data from limestone‐dwelling (calcicole) plants. These two categories exhibit fundamentally different distribution patterns within the Alps and are expected to differ strongly with respect to their glacial history. The calcicole Ranunculus alpestris group comprises three diploid species of alpine habitats. Ranunculus alpestris s. str. is distributed over the southern European mountain system, while R. bilobus and R. traunfellneri are southern Alpine narrow endemics. To explore their phylogenetic relationships and phylogeographical history, we investigated the correlation between information given by nuclear and chloroplast DNA data. Analyses of amplified fragment length polymorphism fingerprints and matK sequences gave incongruent results, indicative for reticulate evolution. Our data highlight historical episodes of range fragmentation and expansion, occasional long‐distance dispersal and on‐going gene flow as important processes shaping the genetic structure of the group. Genetic divergence, expressed as a rarity index (‘frequency‐down‐weighted marker values’) seems a better indicator of historical processes than patterns of genetic diversity, which rather mirror contemporary processes as connectivity of populations and population sizes. Three phylogeographical subgroups have been found within the R. alpestris group, neither following taxonomy nor geography. Genetic heterogeneity in the Southern Alps contrasts with Northern Alpine uniformity. The Carpathians have been stepwise‐colonised from the Eastern Alpine lineage, resulting in a marked diversity loss in the Southern Carpathians. The main divergence within the group, separating the ancestor of the two endemic species from R. alpestris s. str., predates the Quaternary. Therefore, range shifts produced by palaeoclimatic oscillations seem to have acted on the genetic structure of R. alpestris group on a more regional level, e.g. triggering an allopatric separation of R. traunfellneri from R. bilobus.
Phylogeography of Pinus tabulaeformis Carr. (Pinaceae), a dominant species of coniferous forest in northern China
Authors: CHEN KANGMING , ABBOTT RICHARD J. , MILNE RICHARD I. , TIAN XIN‐MIN , LIU JIANQUAN
Published: August 2008

How coniferous trees in northern China changed their distribution ranges in response to Quaternary climatic oscillations remains largely unknown. Here we report a study of the phylogeography of Pinus tabulaeformis, an endemic and dominant species of coniferous forest in northern China. We examined sequence variation of maternally inherited, seed‐dispersed mitochondrial DNA (mtDNA) (nad5 intron 1 and nad4/3–4) and paternally inherited, pollen‐ and seed‐dispersed chloroplast DNA (cpDNA) (rpl16 and trnS‐trnG) within and among 30 natural populations across the entire range of the species. Six mitotypes and five chlorotypes were recovered among 291 trees surveyed. Population divergence was high for mtDNA variation (GST = 0.738, NST = 0.771) indicating low levels of seed‐based gene flow and significant phylogeographical structure (NST > GST, P < 0.05). The spatial distribution of mitotypes suggests that five distinct population groups exist in the species: one in the west comprising seven populations, a second with a north–central distribution comprising 15 populations, a third with a southern and easterly distribution comprising five populations, a fourth comprising one central and one western population, and a fifth comprising a single population located in the north‐central part of the species’ range. Each group apart from the fourth group is characterized by a distinct mitotype, with other mitotypes, if present, occurring at low frequency. It is suggested, therefore, that most members of each group apart from Group 4 are derived from ancestors that occupied different isolated refugia in a previous period of range fragmentation of the species, possibly at the time of the Last Glacial Maximum. Possible locations for these refugia are suggested. A comparison of mitotype diversity between northern and southern subgroups within the north‐central group of populations (Group 2) showed much greater uniformity in the northern part of the range both within and between populations. This could indicate a northward migration of the species from a southern refugium in this region during the postglacial period, although alternative explanations cannot be ruled out. Two chlorotypes were distributed across the geographical range of the species, resulting in lower levels of among‐population chlorotype variation. The geographical pattern of variation for all five chlorotypes provided some indication of the species surviving past glaciations in more than one refugium, although differentiation was much less marked, presumably due to the greater dispersal of cpDNA via pollen.
mRNA processing by RNases J1 and J2 affects Bacillus subtilis gene expression on a global scale
Authors: Mäder Ulrike , Zig Léna , Kretschmer Julia , Homuth Georg , Putzer Harald
Published: August 2008

Ribonucleases J1 and J2 of Bacillus subtilis are evolutionarily conserved enzymes combining an endoribonucleolytic and a 5′−3′ exoribonucleolytic activity in a single polypeptide. Their endoribonucleolytic cleavage specificity resembles that of RNase E, a key player in the processing and degradation of RNA in Escherichia coli. The biological significance of the paralogous RNases J1 and J2 in Bacillus subtilis is still unknown. Based on the premise that cleavage of an mRNA might alter its stability and hence its abundance, we have analysed the transcriptomes and proteomes of single and double mutant strains. The absence or decrease of both RNases J1 and J2 together profoundly alters the expression level of hundreds of genes. By contrast, the effect on global gene expression is minimal in single mutant strains, suggesting that the two nucleases have largely overlapping substrate specificities. Half‐life measurements of individual mRNAs show that RNases J1/J2 can alter gene expression by modulating transcript stability. The absence/decrease of RNases J1 and J2 results in similar numbers of transcripts whose abundance is either increased or decreased, suggesting a complex role of these ribonucleases in both degradative and regulatory processing events that have an important impact on gene expression.
Mutation in the LPS outer core biosynthesis gene, galU, affects LPS interaction with the RTX toxins ApxI and ApxII and cytolytic activity of Actinobacillus pleuropneumoniae serotype 1
Authors: Ramjeet Mahendrasingh , Cox Andrew D. , Hancock Mark A. , Mourez Michael , Labrie Josée , Gottschalk Marcelo , Jacques Mario
Published: August 2008

Lipopolysaccharides (LPS) and Apx toxins are major virulence factors of Actinobacillus pleuropneumoniae, a pathogen of the respiratory tract of pigs. Here, we evaluated the effect of LPS core truncation in haemolytic and cytotoxic activities of this microorganism. We previously generated a highly attenuated galU mutant of A. pleuropneumoniae serotype 1 that has an LPS molecule lacking the GalNAc‐Gal II‐Gal I outer core residues. Our results demonstrate that this mutant exhibits wild‐type haemolytic activity but is significantly less cytotoxic to porcine alveolar macrophages. However, no differences were found in gene expression and secretion of the haemolytic and cytotoxic toxins ApxI and ApxII, both secreted by A. pleuropneumoniae serotype 1. This suggests that the outer core truncation mediated by the galU mutation affects the toxins in their cytotoxic activities. Using both ELISA and surface plasmon resonance binding assays, we demonstrate a novel interaction between LPS and the ApxI and ApxII toxins via the core oligosaccharide. Our results indicate that the GalNAc‐Gal II‐Gal I trisaccharide of the outer core is fundamental to mediating LPS/Apx interactions. The present study suggests that a lack of binding between LPS and ApxI/II affects the cytotoxicity and virulence of A. pleuropneumoniae.
Polymorphisms within PfMDR1 alter the substrate specificity for anti‐malarial drugs inPlasmodium falciparum
Authors: Sanchez Cecilia P. , Rotmann Alexander , Stein Wilfred D. , Lanzer Michael
Published: August 2008

Resistance to several anti‐malarial drugs has been associated with polymorphisms within the P‐glycoprotein homologue (Pgh‐1, PfMDR1) of the human malaria parasitePlasmodium falciparum. Pgh‐1, coded for by the genepfmdr1, is predominately located at the membrane of the parasite's digestive vacuole. How polymorphisms within this transporter mediate alter anti‐malarial drug responsiveness has remained obscure. Here we have functionally expressedpfmdr1inXenopus laevisoocytes. Our data demonstrate that Pgh‐1 transports vinblastine, an established substrate of mammalian MDR1, and the anti‐malarial drugs halofantrine, quinine and chloroquine. Importantly, polymorphisms within Pgh‐1 alter the substrate specificity for the anti‐malarial drugs. Wild‐type Pgh‐1 transports quinine and chloroquine, but not halofantrine, whereas polymorphic Pgh‐1 variants, associated with altered drug responsivenesses, transport halofantrine but not quinine and chloroquine. Our data further suggest that quinine acts as an inhibitor of Pgh‐1. Our data are discussed in terms of the model that Pgh‐1‐mediates, in a variant‐specific manner, import of certain drugs into theP. falciparumdigestive vacuole, and that this contributes to accumulation of, and susceptibility to, the drug in question.
Causes of failure of a barcode‐based pretransfusion check at the bedside: experience in a university hospital
Authors: Ohsaka A. , Kobayashi M. , Abe K.
Published: August 2008

summary The objective of this study was to assess the cause of failure of bedside barcode identification before blood administration. The bedside check is the most critical step for prevention of mistransfusion. A barcode patient‐blood unit identification system was implemented in all inpatient wards, operating rooms and an outpatient haematology unit in July 2002. The transfusion service monitored compliance with bedside barcode identification and checked it at 24 h or 1 h after issuing of blood. If electronic checking was not completed at that time, the transfusion service clarified the cause of failure and indicated the immediate use of the issued blood when it was not yet transfused. From April 2004 to December 2007, a total of 43 068 blood components were transfused without a single mistransfusion and 958 transfusions (2·2%) were performed without electronic checking. The overall compliance rate with bedside barcode identification was 97·8%, and it was 99·5% in the past 6 months. The cause of failure of bedside barcode identification was human error in 811 cases (84·7%), handheld device error in 74 (7·7%), system error in 50 (5·2%) and wristband error in 23 (2·4%). The number of errors leading to failure of bedside barcode identification was decreased for human errors, especially manipulation errors, after initiation of notification at 1 h after issuing of blood. The transfusion service may have an important role in increasing transfusion safety by monitoring compliance with bedside verification and bedside use of issued blood.
Platelet storage in Fresenius/NPBI polyolefin and BTHC‐PVC bags: a direct comparison
Authors: Hornsey V. S. , McColl K. , Drummond O. , MacGregor I. R. , Prowse C. V.
Published: August 2008

summary New platelet storage systems, such as changes in the plastic of the storage bags, require validation. In this study, pooled buffy coat platelets stored in Fresenius/NPBI polyolefin bags were compared with those stored in Fresenius/NPBI butyryl‐trihexyl citrate (BTHC) plasticized polyvinyl chloride (PVC). The CompoSelect thrombocyte polishing filter system (1000 mL polyolefin bag) and the CompoStop F730 system (1300 mL BTHC‐PVC bag) were used to prepare paired, plasma‐suspended, buffy coat platelet concentrates. Samples were taken up to day 7 for in vitro analysis. In a separate experiment, 12 units were prepared using the CompoStop F730 system and samples taken after leucofiltration for FXIIa assay. By day 7, platelet concentrates stored in BTHC‐PVC demonstrated significantly higher pH levels (7·32 ± 0·05 vs. 7·26 ± 0·05) and a greater degree of cell lysis as shown by increased lactate dehydrogenase levels (497 ± 107 vs. 392 ± 81 U L−1). The supernatants contained higher concentrations of soluble P‐selectin and the chemokine ‘regulated on activation, normal T‐cell expressed and presumably secreted’, which are released from the α‐granules during activation. The ATP concentrations were significantly lower in BTHC‐PVC. Platelet counts, mean platelet volume and hypotonic shock response were similar for both bags. FXIIa antigen concentrations were 0·6 ± 0·2 ng mL−1 indicating that activation of the contact factor pathway had not occurred. Although the CompoStop F730 leucoreduction filter did not activate the contact system, platelets stored in 100% plasma in BTHC‐PVC bags demonstrated different in vitro characteristics from those stored in polyolefin. Further work is required to demonstrate whether these differences will affect in vivo recovery and survival.
Fresh blood for everyone? Balancing availability and quality of stored RBCs
Authors: Dzik W.
Published: August 2008

summary Effective, prolonged ex vivo storage of red blood cells is an essential requirement for inventory management of each nation’s blood supply. Current blood storage techniques are the development of a century of research. Blood undergoes metabolic and structural deterioration during prolonged ex vivo storage. Current regulatory requirements for the limit of blood storage do not consider oxygen delivery or clinical outcomes. Recently, concern that stored blood may produce adverse outcomes in recipients has sparked renewed interest in studies that can evaluate the clinical impact of fresh vs. stored blood. In 2008, a retrospective study of outcomes among transfused patients undergoing cardiac surgery suggested that blood stored for more than 14 days prior to transfusion led to higher perioperative mortality compared with blood stored for less than 14 days. Here, we critically examine the details of the above‐mentioned study. Numerous substantial flaws in data analysis and presentation may have led to an erroneous conclusion about the effect of blood storage age and perioperative mortality. Given the fundamental importance of a safe and adequate blood supply to national healthcare, the question of the proper storage age for blood should be studied using a prospective study design.
Working hours and produced cellular components as variables to evaluate blood bank efficiency
Authors: Veihola M. , Kekomäki R. , Linna M. , Sintonen H. , Aroviita P.
Published: August 2008

summary Along with the increasing expenses of the blood system, enhancing efficiency is a necessary task at blood establishments. Labour is the primary expense and is the most likely area for efficiency improvements. The aim of this study was to evaluate and compare the relative efficiency of component production departments from the perspective of labour and cost. The data set was from 13 European blood centres and blood banks for 3 years and was analysed using data envelopment analysis (DEA). Working hours, estimated total costs, produced red blood cells and produced platelets were used in DEA modelling. Comparative analyses included an empirical cost model, in which the costs of working hours were adjusted with purchasing power parities to equalize the costs between countries. Estimated total costs were used to determine the savings potential of production, the unit cost and the economic value of discarded components (waste cost). Results showed a wide variation in labour efficiency (25–100%), in unit cost (fraction of labour costs in component production department) and in cost efficiency (13–100%). Savings potential both in labour and in costs was more than 50% in six departments in all study years. Median waste cost was 9·4% of estimated total costs in the four largest departments and 6·6% in the other departments. Thus, size of department was not a measure of its efficiency. Simple empirical analyses are applicable in efficiency comparisons and can encourage blood establishments to improve their resource management.
Treatment with pimecrolimus cream 1% clears irritant dermatitis of the periocular region, face and neck
Authors: Mensing C. O. , Mensing C. H. , Mensing H.
Published: August 2008

Background  Irritant dermatitis of the face and neck is particularly prevalent in women ≥ 30 years old, who typically present with periocular cutaneous symptoms. Current therapies are limited, indicating a need for rapid, effective alternatives. Pimecrolimus cream 1%, a nonsteroid, cell‐selective inhibitor of inflammatory‐cytokine release, is effective in the treatment of inflammatory skin diseases, such as chronic irritant dermatitis of the hands, and thus offers a potential therapeutic option for this indication. This study reports on the safety and efficacy of pimecrolimus treatment in patients with irritant periocular dermatitis, extending to the face and neck in some patients.

Methods  Twenty‐seven patients with periocular irritant dermatitis (extending onto the face and neck in eight) were treated twice daily with pimecrolimus cream 1% for 7 d, followed by once‐daily application for a further 7 d. Erythema, swelling, and pruritus were assessed at baseline, weeks 1–4 using a 4‐point clinical score (0, absent; 1, mild; 2, moderate; and 3, severe).

Results  All patients showed marked improvement within 2–3 d of treatment with disease clearance in 23 of 27 patients within 14 d. In the remaining four patients, mild relapse occurred at weeks 3–4, but improvement was observed following a further 10‐d treatment. Side‐effects were mild and transient.

Conclusion  Pimecrolimus cream 1% provides a new potential option for treatment of irritant dermatitis of the periocular region, head and neck. Further double‐blind, controlled studies are required to confirm the efficacy and safety of pimecrolimus cream 1% for this indication.
Pyoderma gangrenosum following isotretinoin therapy for acne nodulocystic
Authors: Paula Tinoco Maria , Tamler Carla , Maciel Gustavo , Soares Deborah , Carlos Avelleira João , Azulay David
Published: August 2008

A 19‐year‐old man with nodulocystic acne on baseline was treated with isotretinoin therapy. After 1 month on the medication, he developed pyoderma gangrenosum on his pubis area, arms and legs, and pathergy on a puncture site. Possible underlying diseases were excluded. The patient was started on steroids (prednisone 1 mg/kg/d) and isotretinoin therapy was withdrawn. Later the prednisone was tappered and dapsone 100 mg/daily was initiated. After 10 months of follow‐up all lesions had healed and no underlying diseases developed.
Clinicopathologic challenge
Authors: Wong Judy , Huerter Christopher
Published: August 2008

What is your diagnosis?
Clinical features of cutaneous and disseminated cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis in Paraty, Rio de Janeiro
Authors: Vieira‐Gonçalves Ricardo , Pirmez Claude , Jorge Maria Eugenia , Souza Wilson Jacinto Silva , Oliveira Márcia Pereira , Rutowitsch Marcio S. , Da‐Cruz Alda Maria
Published: August 2008

Background  American tegumentary leishmaniasis (ATL) caused by Leishmania (Viannia) braziliensis is endemic in Rio de Janeiro State (RJ), where the disease shows epidemiologic and clinical characteristics distinct from those of ATL in other Brazilian regions. Paraty is the second most important endemic area in RJ; however, reports on leishmaniasis in this region refer to the occurrence of the disease without describing its characteristics.

Methods  The clinical features of 71 cases of ATL reported between 1991 and 1997 in Paraty are presented. Thirty patients were re‐evaluated 10 years later.

Results  Males and females were affected in similar proportions, and the disease was more prevalent in patients aged between 10 and 49 years (63.4%). Cutaneous leishmaniasis was the most prevalent clinical form observed. Unique lesions were present in 69% of cases, 91.6% of which displayed an ulcerated aspect. Although mucosal leishmaniasis was not observed, severe clinical manifestations, such as disseminated cutaneous lesions caused by L. braziliensis, were diagnosed in two patients. These patients presented skin lesions with different clinical aspects spread throughout the body, as well as low cellular immune responses. Montenegro skin test (92% positivity) and serology (8% IgM and 56% IgG anti‐Leishmania positive results) were the most utilized tests for supporting the diagnosis of leishmaniasis. Parasites, detected in 27 of the 33 cases analyzed, were characterized as L. braziliensis.

Conclusion  ATL in Paraty shares the clinical and laboratory characteristics reported for ATL in other regions of RJ, probably because of the similar epidemiologic context related to the Atlantic rainforest region.
Skin manifestations of rheumatoid arthritis: a study of 215 Turkish patients
Authors: Ergun Tulin , Inanc Nevsun , Tuney Davut , Kotiloglu Esin Karaa , Seckin Dilek , Tetik Cihangir , Direskeneli Haner
Published: August 2008

Objective  To investigate the frequency and clinicopathological features of skin involvement in rheumatoid arthritis (RA), to find out whether early and aggressive disease‐modifying treatment is changing the spectrum towards a milder disease pattern.

Methods  Two hundred and fifteen consecutive RA patients were enrolled. Main outcome measures were the frequency of cutaneous features and their relation to disease severity and treatment modality, ultrasound (USG) examination of nodules, histopathological examination of nodules and papules.

Results  Mean age and disease duration were 55.3 years and 138.1 months, respectively. Sixty‐six percent of the patients had erosive disease, 70% were rheumatoid factor (RF) positive and 44% had Classes III and IV functional index. Among 43 patients having nodules, 20 were diagnosed as rheumatoid nodules (RNs) and the others as synovitis, bursitis, and so on, on clinical basis and by ultrasound. In 7 of 20 RNs, diagnosis was confirmed by histopathological examination. When clinical, histopathological, and USG data were analyzed collectively, sensitivity, and specifity of USG were found as 100 and 75%, respectively. Sixteen patients had relevant papular lesions. Fourteen of these were diagnosed as palisading neutrophilic granulomatous dermatitis (PNGD) and two as rheumatoid neutrophilic dermatitis (RND) on histopathological examination. Accelerated nodulosis was seen in one, and vasculitis in two of the patients.

Conclusions  We observed a milder disease pattern compared to Anglo‐Saxon countries with lower RN and vasculitis frequency. This cannot be explained by early and aggressive treatment as disease onset to treatment interval was long in our patient group. PNGD resembles RN in terms of frequency and association with severe disease.
Non‐melanoma skin cancer and its risk factors in an Austrian population of heart transplant recipients receiving induction therapy
Authors: Geusau Alexandra , Dunkler Daniela , Messeritsch Eva , Sandor Nicolaus , Heidler Gudrun , Rödler Suzanne , Ankersmit Jan , Zuckermann Andreas , Tschachler Erwin
Published: August 2008

Background  Solid organ transplant recipients have a high risk of developing nonmelanoma skin cancers (NMSC). We describe the characteristics and incidence of skin tumors in an Austrian population of heart transplant recipients (HTR).

Methods  Three hundred and twenty‐two HTR out of 970 who had received their organ between December 1984 and July 2003 were analyzed for NMSC. Factors associated with tumor development including the different immunosuppressive (IS) modalities were evaluated. Besides triple combination immunosuppressive therapy, all allograft recipients had received induction therapy either with antithymocyte globulin, OKT3 or monoclonal anti‐IL‐2 receptor antibodies.

Results  Median post‐transplant follow‐up for all patients was 74.18 months (minimum: 2.6, maximum: 224.8). The median time from transplantation until the excision of the first NMSC was 79.57 months (minimum: 2.69, maximum: 192.8). A total of 263 NMSC were excised in 73 patients. The cumulative incidence of developing a skin tumor increased from 7.3% after 5 years to 26.9% after 10 years and to 56.5% after 15 years. Older age at transplantation (P < 0.0001) and the presence of pre‐cancerous skin conditions (P < 0.0001) were associated with an increased occurrence of NMSC. No significant difference in NMSC incidence was found when the different IS therapies were compared.

Conclusions  The cumulative incidence of NMSC in our cohort of HTR is comparable to published data on HTR adjusted according to the geographic location. Transplant patients with clinical evidence of pre‐cancerous skin conditions have a higher degree of susceptibility for the development of NMSC and require particular dermatologic care.
Cutaneous pustular manifestations associated with disseminated septic embolism due to a Panton‐Valentine leukocidin‐producing strain of community‐acquired methicillin‐resistant Staphylococcus aureus
Authors: Wu Chang‐Teng , Lin Jainn‐Jin , Hsia Shao‐Hsuan
Published: August 2008

We report a 12‐year‐old child presented with cutaneous pustular lesions. The lesions are associated with disseminated septic embolism due to Community‐acquired methicillin‐resistant Staphylococcus aureus (CA‐MRSA). The mortality of CA‐MRSA sepsis associated with cutaneous findings is high. In areas where CA‐MRSA is endemic, empiric treatment of suspected cutaneous manifestations should include antibiotics predictably active against this pathogen.
Teledermatology on the Faroe Islands
Authors: Jemec Gregor B. E. , Heidenheim Michael , Dam Tomas N. , Vang Edith
Published: August 2008

The use of teledermatology as an adjunct to conventional clinical dermatology on the Faroe Islands is described. The service is based on a nurse‐led dermatological clinic, and teledermatology is combined with specialist visits for more complex diagnosis or procedures.
Tissue estimation of protein gene product 9.5 (PGP 9.5) expression and apoptosis in vitiligo
Authors: Aroni Kyriaki , Grapsa Antonia , Lazaris Andreas C. , Kavantzas Nikolaos , Kordosis Theodoros , Patsouris Efstratios S.
Published: August 2008

Background  Vitiligo is probably the end result of different interacting processes.

Objective  To determine the possible roles of neural and apoptotic mechanisms in the pathogenesis of vitiligo.

Methods  Fifty‐six biopsies from 28 patients with generalized vitiligo (28 from depigmented lesional areas and 28 from clinically nondepigmented skin at the periphery of the same areas) were examined; the panaxonal marker neuropeptide protein gene product 9.5 (PGP 9.5) and apoptosis were investigated using immunohistochemistry.

Results  Statistically significant differences were detected in the numbers of PGP 9.5‐positive nerve fibers/axons in the papillary dermis between the center and periphery of the lesions (i.e. increased at the center in comparison with the periphery). A statistically significant inverse association was found between PGP 9.5 immunostaining in the dermis at the lesion center and the duration of the disease. When apoptosis and PGP 9.5 expression were compared, there was an identical distribution of PGP 9.5‐positive nerve fibers/axons and apoptotic cells in the epidermis (i.e. basal in the lesion center; diffuse at the lesion periphery).

Conclusions  There is a possible connection between the neural and apoptotic pathogenetic theories of vitiligo.
Drug‐induced Sweet's syndrome secondary to hepatitis C antiviral therapy
Authors: Gheorghe Liana , Cotruta Bogdan , Trifu Viorel , Cotruta Cristina , Becheanu Gabriel , Gheorghe Cristian
Published: August 2008

Pegylated interferon‐alpha in combination with ribavirin currently represents the therapeutic standard for the hepatitis C virus infection. Interferon based therapy may be responsible for many cutaneous side effects. We report a case of drug‐induced Sweet's syndrome secondary to hepatitis C antiviral therapy. To our knowledge, this is the first reported case of Sweet's syndrome in association with pegylated interferon‐alpha therapy.
Corynebacterium‐associated skin infections
Authors: Blaise Géraldine , Nikkels Arjen F. , Hermanns‐Lê Trihn , Nikkels‐Tassoudji Nazli , Piérard Gérald E.
Published: August 2008

Background  Corynebacterium spp. are diphtheroid bacteria responsible for pitted keratolysis, a common plantar infection confined to the thick stratum corneum.

Aim  To study a series of demographic features of patients suffering from pitted keratolysis, and to present a review of the Corynebacterium‐associated infections, including pitted keratolysis, erythrasma, and trichobacteriosis.

Materials and methods  A 2‐year, two‐center, prospective survey assessed the demographics of pitted keratolysis, including age, gender, site of infection, symptoms, patients’ complaints, the use of protective and/or occlusive shoes, seasonality of diagnosis, drug intake, associated skin signs (including dyshidrosis, erythrasma, and trichobacteriosis), recurrences, and previous diagnoses and treatments.

Results  The mean age of the 53 patients with pitted keratolysis was 24.9 years (range, 10–57 years). The male to female ratio was 7.8 : 1. The soles of both feet were commonly involved (92.4%). Pressure‐bearing areas were the usual sites of infection, ranging from restricted involvement of the toes (12/53, 22.6%) to spreading to the entire plantar surface (15/53, 28.3%). A total of 36 (68%) of the 53 patients complained of hyperhidrosis. An unpleasant smell and pain were noted by 35 (66%) and 25 (47%) of the 53 patients, respectively. Occlusive and protective shoes were worn in 51 (96.2%) and 31 (58.4%) of the 53 cases, respectively.

Conclusion  Pitted keratolysis commonly affects young male patients wearing protective shoes for professional reasons, inducing a moist and warm environment. Hyperhidrosis, an unpleasant smell, and pain are the main clinical complaints.
Considering patient non‐participation in health care
Authors: Eldh Ann Catrine , Ekman Inger , Ehnfors Margareta
Published: August 2008

Objective  The aim of this study was to depict patient non‐participation as described by a diverse group with recent experiences of being patients.

Background  Patient participation is regarded as a primary condition for optimal quality of care, suggesting that non‐participation should be avoided. A common understanding of the concept of patient non‐participation is needed. A discrepancy in definitions of patient non‐participation has been found in health‐care interactions, health‐care classifications and health‐care research, and little is known of what patient non‐participation represents to patients.

Study design  A survey consisting of closed‐ended and open‐ended questions was administered to persons that had recently been patients to gather respondents’ descriptions of what they considered as patient non‐participation. Qualitative content analysis was used to analyse free‐text descriptions, and descriptive statistics were used for the close‐ended alternatives.

Findings  Lacking information (e.g. not being provided with appropriate information) and lacking recognition (e.g. not being listened to and/or lacking recognition as an individual with individual needs and concerns) were significant aspects of patient non‐participation. Furthermore, non‐participation encompassed facing organization‐centred, as opposed to patient‐centred, health care as well as feeling insecure in health care interactions.

Conclusion  The findings provide input for a better understanding of what patients experience as non‐participation. Organising for the caregivers to be able to thoroughly listen to the patients’ illness narratives would easily reduce the risk of patient’s experiencing what is described as non‐participation and would provide a sound base for patient learning needs.
BRCA mutation‐negative women from hereditary breast and ovarian cancer families: a qualitative study of the BRCA‐negative experience
Authors: Bakos Alexis D. , Hutson Sadie P. , Loud Jennifer T. , Peters June A. , Giusti Ruthann M. , Greene Mark H.
Published: August 2008

Background  When women from families with a known BRCA1 or BRCA2 mutation test negative for the family mutation, it is assumed that they will transition their personal cancer risk perception from high to average risk. However, there are scant data regarding the experience of mutation‐negative women after genetic testing disclosure, particularly related to the shift of risk perception from assumed mutation‐positive to actual mutation‐negative. This study was designed to explore cancer risk perception and the experience of being a mutation‐negative woman within a known BRCA1/2 mutation‐positive family.

Methods  We employed a qualitative descriptive design and convened a sample of 13 women who contributed in‐depth, semi‐structured telephone interviews (audio‐recorded and transcribed verbatim) and performed qualitative content analysis with NVivo 2.0 software.

Results  Six major content areas emerged from interview data: (i) rationale for initial involvement in the breast imaging study, (ii) rationale for continued participation, (iii) experience of living in a multiple‐case family, (iv) risk perception: the personal meaning of mutation‐negative status, (v) opinions regarding cancer aetiology and (vi) communication patterns between mutation‐negative and mutation‐positive family members.

Conclusions  Living in a hereditary breast and ovarian cancer family is a complex experience that affects cognitive, emotional and social functioning. Our findings indicate that mutation‐negative women may have unmet psychosocial needs that must be addressed by health‐care professionals, particularly in the primary‐care setting following genetic disclosure of a potentially reassuring result regarding their lack of the very high cancer risks associated with BRCA1/2 mutations.
Improving informed consent: pilot of a decision aid for women invited to participate in a breast cancer prevention trial (IBIS‐II DCIS)
Authors: Juraskova I , Butow P , Lopez A , Seccombe M , Coates A , Boyle F , McCarthy N , Reaby L , Forbes JF
Published: August 2008

Background  Patients and clinicians report difficulties with the process of informed consent to clinical trials and audiotape audits show that critical information is often omitted or poorly presented. Decision aids (DAs) may assist in improving consent.

Aims  This study piloted a DA booklet for a high priority breast cancer prevention trial, IBIS‐II DCIS, which compares the efficacy of an aromatase inhibitor (anastrozole) with tamoxifen in women who have had surgery for ductal carcinoma in situ (DCIS).

Method  Thirty‐one Australian women participating in the IBIS‐I breast cancer prevention trial and who are currently in follow‐up agreed to read the IBIS‐II DCIS participant information sheet and the DCIS DA booklet, complete a set of standardized questionnaires, and provide feedback on the DA via a semi‐structured phone interview.

Results  Women found the DA helpful in deciding about trial participation, reporting that it aided their understanding over and above the approved IBIS‐II DCIS participant information sheet and was not anxiety provoking. Women’s understanding of the rationale and methods of clinical trials and the IBIS‐II DCIS trial was very good; with more than 80% of items answered correctly. The only areas that were not understood well were the concepts of randomization and blinding.

Conclusions  This study suggests that the DA will be acceptable to and valued by potential participants in the IBIS‐II DCIS study. The revised DA is currently being evaluated prospectively in a randomized controlled trial. If successful, such DAs could transform the consent process to large clinical trials and may also reduce dropout rates.
Engaging the public in priority‐setting for health technology assessment: findings from a citizens’ jury
Authors: Menon Devidas , Stafinski Tania
Published: August 2008

Objectives  To assess the feasibility of using a citizens’ jury to elicit public values on health technologies and to develop criteria for setting priorities for health technology assessment (HTA).

Methods  Sixteen individuals were selected from 1600 randomly sampled residents of the Capital Health Region in Alberta, Canada. They participated in a 2½ day jury which comprised presentations by ‘expert witnesses’, who represented innovators, patients, health‐care policy‐makers and clinicians, as well as a series of small and large group priority‐setting exercises based on actual examples of technologies that had recently been considered for assessment by local and national HTA bodies. The session was audio‐taped, and transcripts were independently reviewed by two researchers using content analytical techniques in order to ensure that no important concepts expressed by individual jurors were missed during group development of the final list of priority‐setting criteria. Jurors evaluated the process by completing self‐administered, semi‐structured questionnaires at the end of the session. Responses were analysed using qualitative methods.

Results  The jury identified 13 criteria, which they subsequently ranked in order of importance. The top two criteria included ‘potential to benefit a number of people’ and ‘extends life with quality’. Based on feedback from questionnaires, jurors valued the opportunity to become engaged in such a process, and expressed interest in participating in future juries.

Conclusions  Citizens’ juries offer a feasible approach to involving the public in priority‐setting for HTA. Furthermore, technologies that may benefit a number of people and improve quality of life appear to be of greatest importance to the public.
Citizens’ juries in planning research priorities: process, engagement and outcome
Authors: Gooberman‐Hill Rachael , Horwood Jeremy , Calnan Michael
Published: August 2008

Background  Involving members of the public in setting priorities for health research in becoming increasingly common practice. One method used in public involvement exercises is the citizens' jury.

Objective  This article examines some challenges and benefits of citizens' juries, including issues relating to process, public engagement and outcome.

Design  In Bristol, UK, a citizens' jury was held with the aim of identifying local priorities for research into health and social care. This jury is used as an example through which key issues in public involvement and jury processes are explored.

Setting and Participants  The Bristol Citizens' Jury comprised 20 members of the public (`jurors'), an oversight panel and a steering group. The jurors met at 11 consecutive sessions during 2006 over a period of 16 weeks, which culminated in a written report. All the sessions were audio‐recorded, five sessions were observed and video‐recorded, and 16 jurors completed written feedback forms at the end of the jury process.

Findings and conclusion  In this article we discuss degree and timing of public involvement in the process of health research; the role of context; representation of communities; processes of deliberation and knowledge production; and how constraints of time and cost may affect public involvement. It was clear that jurors who took part in the Bristol Citizens' Jury were engaged and committed. This engagement may be related to jurors' belief in their ability to shape future research alongside concern about the relevance of the issues under discussion. Opposing emotions of tension and harmony are a crucial part of the deliberation process.