bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between haematozoan infections and reproduction in the Pied Flycatcher
Authors: SIIKAMÄKI P. , RÄTTI O. , HOVI M. , BENNETT G. F.
Published: December 2004

1. Parasites may affect breeding success of their host since they compete for the same resources as their hosts. Reproduction may also increase the susceptibility of a host to parasite infections owing to lowered resistance to parasites during breeding.

2. We studied the association between breeding performance and haematozoan parasite infection in the Pied Flycatcher (Ficedula hypoleuca) by using both natural data on reproduction and data from clutch size manipulations.

3. The most frequent blood parasites of the Pied Flycatcher in central Finland were Haemoproteus pallidus, Haemoproteus balmorali and Trypanosoma avium complex.

4. We did not find evidence that these haematozoan parasites have any debilitating effects on either reproduction or survival. The variation in reproductive effort did not seem to influence susceptibility to new blood parasite infections.

5. The intensity of Haemoproteus balmorali tended to increase in infected males as the brood size was artificially enlarged. Also, in females intensity of H. pallidus infection tended to increase with the level of clutch size manipulation. Thus, increased reproductive effort seems to debilitate the ability of Pied Flycatcher to control chronic infections.

6. Individuals with enlarged clutches/broods increased their reproductive effort at the expense of defence towards parasites. The cost of current reproduction may then be at least partly mediated by haematozoan infections.
Molecular genetic elucidation of the tripartite structure of the Schizosaccharomyces pombe 72 kDa TFIID subunit which contains a WD40 structural motif
Authors: Yamamoto Tohru , Poon David , Anthony Weil P. , Horikoshi Masami
Published: December 2004

Background: The multisubunit general transcription factor termed TFIID is comprised of the TATA box DNA binding protein TBP and several TBP‐associated factors termed TAFs. Current arguments regarding the mechanisms of regulation of transcription contend that TFIID makes multiple specific protein–protein interactions with numerous protein factors, and that these interactions are important for the regulation of transcriptional initiation. TAFs contain a variety of potential structural motifs and it has been speculated that these motifs participate directly in TAF function. However, to date the physiological significance of these putative structural motifs has not been systematically analysed in vivo.

Results: The essential gene encoding the Schizosaccharomyces pombe 72 kDa TFIID subunit is termed taf72+, which contains WD40 repeats, was cloned and sequenced. A comparison of the primary structure of this gene with its Drosophila and S. cerevisiae counterparts suggests the presence of regions that might play a role in TFIID function, due to the fact that significant portions of the sequences are highly conserved. Complementation analyses of a series of deletion mutants of this gene revealed that the most evolutionarily conserved regions of taf72+, including the WD40 repeats, are in fact indispensable for the viability.

Conclusions: The 72 kDa subunit of S. pombe TFIID, which contains putative WD40 repeats, consists of three distinct functional domains separated by intervening regions. The functional significance of the WD40 repeats is demonstrated by this in vivo study.
Simulating vegetation processes along the Kalahari transect
Authors: Woodward F. I. , Lomas M. R.
Published: December 2004

The Sheffield Dynamic Global Vegetation Model has simulated the structure and net carbon exchange of vegetation at five sites along the Kalahari transect where there is a strong gradient in precipitation from 299 to 918 mm yr−1. There has been a decline in precipitation of 8 mm yr−1 along the whole of the transect since about 1970. Simulations of vegetation dynamics and structure indicate that this decline has exerted a notable effect on the vegetation, with reductions in woody plant cover at the dry end of the transect and reductions in tree density at the wetter end. These changes were driven primarily by reductions in the net primary production and increased rates of mortality, with rather small impacts of fire.
Canopy scale measurements of CO2 and water vapor exchange along a precipitation gradient in southern Africa
Authors: Scanlon Todd M. , Albertson John D.
Published: December 2004

Short‐term measurements of carbon dioxide, water, and energy fluxes were collected at four locations along a mean annual precipitation gradient in southern Africa during the wet (growing) season with the purpose of determining how the observed vegetation–atmosphere exchange properties are functionally related to the long‐term climatic conditions. This research was conducted along the Kalahari Transect (KT), one in the global set of International Geosphere‐Biosphere Program transects, which covers a north–south aridity gradient, all on a homogenous sand formation. Eddy covariance instruments were deployed on a permanent tower in Mongu, Zambia (879 mm of rainfall per year), as well as on a portable tower in Maun (460 mm yr−1), Okwa River Crossing (407 mm yr−1), and Tshane (365 mm yr−1), Botswana for several days at each site. The relationships between CO2 flux, Fc, and photosynthetically active radiation were described well by a hyperbolic fit to the data at all locations except for Mongu, the wettest site. Here, there appeared to be an air temperature effect on Fc. While daytime values of Fc routinely approached or exceeded −20 μmol m−2 s−1 at Mongu, the magnitude of Fc remained less than −10 μmol m−2 s−1 when the air temperature was above 27°C. Canopy resistances to water vapor transfer, rc, displayed an overall decline from the wetter sites to the more arid sites, but the differences in rc could be almost exclusively accounted for by the decrease in leaf area index (LAI) from north to south along the KT. Ecosystem water use efficiency (WUE), defined as the ratio of net carbon flux to evapotranspiration, showed a general decrease with increasing vapor pressure deficit, D, for all of the sites. The magnitudes of WUE at a given D, however, were dissimilar for the individual sites and were found to be stratified according to the position of the sites along the long‐term aridity gradient. For example, Mongu, which has the wettest climate, has a much lower WUE for like levels of D than Tshane, which historically has the most arid climate. Given the similar inferred stomatal resistances between the sites, the disparate carbon uptake behavior for the grass vs. woody vegetation is the likely cause for the observed differences in WUE along the aridity gradient. The short‐term flux measurements provide a framework for evaluating the vegetation's functional adaptation to the long‐term climate and provide information that may be useful for predicting the dynamic response of the vegetation to future climate change.
Canopy structure in savannas along a moisture gradient on Kalahari sands
Authors: Scholes Robert J. , Frost Peter G. H. , Tian Yuhong
Published: December 2004

Measurements of tree canopy architecture were made at six savanna sites on deep, sandy soils, along a gradient of increasing aridity. There was substantial variation in the leaf area estimated within each site, using the same sample frame, but different measurement techniques. The trends in canopy properties in relation to the aridity gradient were consistent, regardless of the technique used for estimating the properties. The effective plant area index for the tree canopy (the sum of the stem area index and the leaf area index (LAI)) declined from around 2 to around 0.8 m2 m−2 over a gradient of mean annual rainfall from 1000 to 350 mm. Stems contributed 2–5% of the tree canopy plant area index. Since the tree canopy cover decreased from 50% to 20% over this aridity range, the leaf area index within the area covered by tree canopies remained fairly constant at 3–4 m2 m−2. Tree leaves tended from a horizontal orientation to a more random orientation as the aridity increased. On the same gradient, the leaf minor axis dimension decreased from around 30 mm to around 3 mm, and the mean specific leaf area decreased from 14 to 5 m2 kgha−1. There was good agreement between LAI observed in the field using a line ceptometer and the LAI inferred by the MODIS sensor on the Terra satellite platform, 2 months later in the same season.
Environmental factors during seed development of narrow‐leaved bird's‐foot‐trefoil (Lotus tenuis) influences subsequent dormancy and germination
Authors: Clua A. A. , Gimenez D. O.
Published: December 2004

Narrow‐leaved bird's‐foot‐trefoil (Lotus tenuis) is a perennial forage legume adapted to waterlogged and heavy and infertile soils and can replace alfalfa (Medicago sativa) in areas with these soils in Argentina. Its seeds are hard and water‐impermeable but the effects of environmental factors on seed dormancy and germination are not known. The objective was to evaluate the hypothesis that water availability during seed development and maturation affects the degree of hardseededness in L. tenuis by changing seed coat properties, conditioning water uptake through the seed coat; and subsequently affecting dormancy, germination and speed of germination. Seeds were harvested in December/January and in February in both 1993/1994 and 1994/1995 from a permanent pasture of L. tenuis growing in a Hapludol soil in San Miguel del Monte province of Buenos Aires. Environmental conditions of each anthesis‐harvest period were determined. Seeds of each harvest were subjected to chilling, washing and mechanical scarification. After 12 months seeds from each harvest were observed in a scanning electron microscope. The water deficit of the soil and relative humidity were greater in the second than the first anthesis‐harvest period in both seasons. In 1993/1994 the control treatment in December had a higher germination rate than the February control seeds (0·40 vs. 0·20) and a faster germination rate. Mechanical scarification and chilling significantly enhanced the germination rate (0·95) and its speed in seeds of both harvests. Low temperatures significantly enhanced germination rate, starting after 60 d for the seeds harvested in December, and 90 d for the seeds harvested in February. In 1994/1995 the results were similar but both the January and February control treatments had higher germination rates (0·60 vs. 0·40) than in the previous year. Seeds harvested in February were more dormant in both years. These differences could be explained by the conditions in February anthesis‐harvest period in both years that could have hastened the natural dehydration process of seed, changing integument structure and enhancing its impermeability.
Adhesion molecule expression and leucocyte trafficking following immunotherapy with recombinant interleukin‐2
Authors: MILES D.W. , HAPPERFIELD L.C. , BOBROW L.G. , RUBENS R.D.
Published: December 2004

The relevant anti‐tumour mechanisms of recombinant interleukin‐2 (rIL‐2) in vivo are unclear but an influx of T‐lymphocytes and macrophages has been noted in regressing lesions. One of the dose limiting toxicities of rIL‐2 is the development of a capillary leak syndrome attributed to widespread endothelial activation. Changes in expression of endothelial and leucocyte‐associated adhesion molecules were assessed in tumour and uninvolved skin in patients with metastatic breast cancer receiving rIL‐2. Increased expression of intracellular adhesion molecule‐1, its leucocyte‐associated ligand, leucocyte function associated molecule‐1, vascular cell adhesion molecule and its ligand, very late after activation antigen‐4 as well as members of the selectin family of adhesion molecules, were noted in uninvolved skin following rIL‐2. Expression of these adhesion molecules was noted in tumour stroma before rIL‐2 but little change was observed following rIL‐2 infusion. An influx of monocytes and T‐lymphocytes (expressing the IL‐2 receptor and of the memory subtype) and a lower number of neutrophils was noted in uninvolved skin following rIL‐2. Although monocytes and T‐lymphocytes were present in tumour stroma before rIL‐2 no changes were observed following infusion. The changes noted in the dermis contrast with those seen at tumour sites and may partly explain the low therapeutic index of rIL‐2.
Clear cell malignant myoepithelioma of the salivary glands
Authors: MICHAL M. , SKÁLOVÁ A. , SIMPSON R.H.W. , RYCHTEROVÁ V. , LEIVO I.
Published: December 2004

Previous reports of monomorphic clear cell carcinoma of the salivary glands have shown inconsistent results with immunohistochemistry, especially for S‐100 protein, and this has led to uncertainty about the nature of these tumours. We believe that much can be explained by considering this group as comprising not one but two separate neoplasms, one epithelial and the other myoepithelial. The former has been described as hyalinizing clear cell carcinoma—it generally occurs in the minor salivary glands, and strongly expresses cytokeratins but not S‐100 protein or α smooth muscle actin. In contrast, this study presents five primary malignant tumours of the major salivary glands also composed largely of a single population of clear cells, but displaying histological and immunohistochemical features of myoepithelial differentiation, such as the formation of collagenous spherules and expression of S‐100 protein and actin. A small number of similar tumours have been reported previously. We, therefore, believe that these neoplasms represent a clear cell variant of malignant myoepithelioma (myoepithelial carcinoma).
Insights into the regulation of immunoglobulin light chain gene rearrangements via analysis of the κ light chain locus in λ myeloma
Authors: Perfetti Vittorio , Vignarelli Maurizio C. , Palladini Giovanni , Navazza Valentina , Giachino Claudia , Merlini Giampaolo
Published: December 2004

Accumulating evidence indicates that B cells may undergo sequential rearrangements at the light chain loci, despite already expressing light chain receptors. This phenomenon may occur in the bone marrow and, perhaps, in germinal centers. As immunoglobulin (Ig)κ light chains usually rearrange before Igλ light chains, we analysed, by polymerase chain reaction, the Igκ locus of bone marrow mononuclear cells from 29 patients with Igλ myeloma to identify earlier recombinations in marrow plasma cells. The results demonstrated that Igκ alleles were inactivated via the kappa‐deleting element, presumably prior to Vκ‐Jκ rearrangement, in many cases. Eighteen alleles (16 myeloma clones, 55%) showed Vκ–Jκ rearrangements, with increased utilization of 5‵ distant Vκ and 3′ distant Jκ gene segments (Jκ4, 56%), an indication of multiple sequential rearrangements. In‐frame, potentially functional Vκ–Jκ rearrangements were found in approximately one‐third of available rearrangements (as expected by chance), each one in different myeloma clones: three were germline encoded, while one had several nucleotide substitutions, suggesting inactivation after the onset of somatic hypermutation. Three of four potentially functional Vκ–Jκ rearrangements involved Vκ4–1, a segment considered to be associated with autoimmunity. These findings provide insights into the regulation of light chain rearrangements and support the view that B cells may occasionally undergo sequential light chain rearrangements after the onset of somatic hypermutation.
Solitary maxillary central incisor as a new finding in CHARGE association: a report of two cases
Authors: HARRISON M. , CALVERT M. L. , LONGHURST P.
Published: December 2004

Two cases are reported of a solitary maxillary central incisor in children with CHARGE association. The implications of the finding are discussed, along with the suggested relationship to other craniofacial disorders in which solitary central incisors have been reported.
Mesiodentes in twins: a case report and a review of the literature
Authors: Seddon R. P. , Johnstone S. C. , Smith P. B.
Published: December 2004

This report describes 7‐year‐old Afro‐Caribbean monozygotic twin boys who both presented with bilateral unerupted mesiodentes palatal to the central incisors. There have been two previous similar reports. From this case and previous reports it was concluded that mesiodentes in monozygotic twins are likely to be concordant with respect to the number of supernumerary teeth. Unilateral mesiodens usually have been mirror imaged in each twin. Minor discordance between monozygotic twins is common with respect to the shape (conical, incisiform or tuberculate) and orientation (inverted or normal) of individual mesiodens within and between each twin.
Nursing knowledge, theory and method revisited
Authors: Booth Katie , Kenrick Maria , Woods Simon
Published: December 2004

With the approach of the 21st century, nursing is having to respond to diverse influences which are remoulding the professional landscape. Not least of these is the changing status of western economies which underpins a drive towards evidence‐based practice and an increased emphasis on multidisciplinary approaches to health care delivery. Certainty in health care is now a thing of the past. Central to the way the nursing profession embraces the future is its underlying philosophy: that which articulates professional values and shapes practice, research, education and management. In a time of change it is therefore essential to revisit the philosophical framework which underpins nursing. The debate in nursing research and theory appears to have stressed the polarization of viewpoints. It may be the case that feminist writers, ethnographers, positivist researchers and nursing theorists, in defending their own points of view, diminish rather than enhance professional dialogue. This paper reviews the nature of this debate within nursing and considers the implications that a dichotomous position may have for knowledge, theory and research method within the current context of health care. It then suggests a philosophical framework which could be relevant and accessible across the whole spectrum of nursing activity. In so doing, the paper aims to contribute to the discussion around epistemology and method in a way which encompasses the diversity found within the broad church of nursing.
Combining the analyses of three qualitative data sets in studying young caregivers
Authors: Lackey Nancy R. , Gates Marie F.
Published: December 2004

Adolescent care of the adult with cancer led the authors to choose three qualitative methods to describe this unexplored phenomenon. In this study, phenomenology, ethnography and unstructured survey were combined to provide a more complete picture of the phenomenon. Data from interviews with 11 youngsters within seven family units, observations, and unstructured questionnaire, demographic data form and field notes were analysed and combined. The processes used in designing and conducting the study and analysing the data, rather than the findings, are emphasized. The data obtained by using these three methods have laid the foundation for further nursing research on caregiving by youngsters and raise questions about combining analyses of three qualitative data sets.
Tension neck and evaluation of a physical training course among office workers in a bank corporation
Authors: Klemetti Margita , Santavirta Nina , Sarvimäki Anneli , Björvell Hjördis
Published: December 2004

The purpose of this study was to investigate the effects of a physical training course in a group of patients (n=74) suffering from chronic tension neck. All participants in the course were employed by a bank corporation in Helsinki, Finland. A comparable control group (n=77) consisted of office workers with tension neck from the same bank corporation who did not attend any training course. The outcome was analysed 6 months after the course. Pain and disability in the neck and shoulder region did not vary significantly between the group which participated in the training course and the control group. The experimental group had increased the amount of physical workout compared to the control group (83.7% vs 69.0%,P= 0.0448). Also, regarding the frequency of relaxation and stretching exercises the two groups differed significantly: the experimental group had continued to perform exercises more often (P= 0.0434). The frequency of sick leave days did not significantly differ between the groups, but the office workers in the experimental group had more periods of extended sick leave (> 10 days) and the controls had more frequent short sick leaves. The experimental group did increase their physical workout significantly compared with the controls, but no differences were detected regarding pain and disability. In order to gain more benefit more attention should be paid to the educational part of the training courses in order to enhance the patients'self‐care abilities. Also, strategies to alleviate psychosocial problems and organized relaxation exercises could decrease muscle tension in the neck in office workers.
Major strain and coping strategies as reported by family members who care for aged demented relatives
Authors: Almberg Britt , Grafström Margareta , Winblad Bengt
Published: December 2004

This study is based on a previous investigation into 46 caregivers' experience of burden and burnout when caring for a demented elderly relative. The aim of this study was to describe caregivers who develop or experience burnout (group A) and caregivers without experience of burnout (group B) and how they cope with major strain. The interviews focused on the caregivers' descriptions of their major strain (the demented person's memory difficulties and change in behaviour and the caregivers' experiences of their feelings of loss and their new role) and what they did, thought and felt in these situations. The interviews were coded and categorized and a chi‐square test was performed. It was found that those in group A more often used an emotion‐focused strategy (grieving, worrying and self‐accusation). They were also the only ones using wishful thinking and stoicism as strategies. Those in group B used a problem‐focused strategy more often (confronting the problem, seeking information and seeking social support). Another interesting finding was that the caregivers in group B frequently used the emotion‐focused strategy of acceptance in combination with seeking information and seeking social support. To mix approaches like these seems to be an effective choice of strategy. It was also found that the caregivers' gender seems to have an effect on the coping strategy. The demented person's domicile did not, however, appear to result in any significant difference.
Evaluation of a nurse‐led continence service in the south‐west of Glasgow, Scotland
Authors: McGhee Mari , O'Neill Ken , Major Kirsten , Twaddle Sara
Published: December 2004

This paper reports the results of a pilot study of a nurse‐led continence promotion service in both the community and a local nursing home. Telephone and written referrals were made to the service from 28 primary care teams in Glasgow, Scotland. In the nursing home all patients were assessed and an appropriate management plan implemented. A full assessment was carried out in all community patients, including an appraisal of contributory factors, urinalysis and diaries of food and drink intake. A management plan suited to the patient was then implemented. Patients' levels of incontinence in both arms of the study were assessed objectively using the Lagro‐Janssen method. The cost incurred in both arms of the study were measured. There was a 69% improvement in the level of incontinence in the community group compared with 30% in the residents wing and 13% in the hospital wing. The savings in the nursing home amounted to pound;4152 in the residents' wing and £1959 in the hospital wing. In summary, a nurse dedicated to urinary incontinence in the community allows improved management, a greater level of awareness and results in resource savings, whilst increasing patient accessibility to a service.
A cost‐effectiveness analysis of home care and community‐based nursing homes for stroke patients and their families
Authors: Chiu Lian , Shyu Woei‐Cherng , Chen Tchen‐Ru Jayne
Published: December 2004

A prospective study designed for 336 hospitalized patients with stroke and their families, who were followed from the discharge day to the third month after being discharged, was carried out in order to compare the costs and effectiveness of home care with the community‐based nursing homes for stroke patients with different physical function disabilities in terms of ADL scores and their families. The ADL scores of the patients with severe physical function disability did not improve with or without long‐term care; however, the patients with moderate physical function disability were significantly improved at the end of the third month, even without interventions from long‐term care. The family costs of the patients in nursing homes were substantially lower than the costs for the patients who stayed at home, and the relationship of the family costs of the patients cared for in their own homes was proportional to the patients'physical function status. The labour input from family caregiving accounted for at least 60% of the total family costs of the patients who stayed at home, and the paid for long‐term care services accounted for at least 60% of total family costs when the patients stayed in nursing homes. The multiple linear regression demonstrated that the degree of caregiving from families was a predictor of the amount of the costs families incurred for patients with severe physical function disability; as a result the ADL scored on discharge significantly influenced the average total family costs for the patients cared for in their own homes.
A nursing journey through discursive praxis
Authors: Warelow Philip J.
Published: December 2004

This paper argues that conceiving nursing as a form of praxis, encompasses amongst other things, the critical reflection upon one's nursing practice in order to work out and understand internal and external constructions of personal theories. This reflective examination will demonstrate the implicit knowing that nurses develop as a result of their personal, day to day practice. Highlighting this knowing and incorporating the richness of their practice experience becomes the basis for their own personal nursing praxis.
A descriptive study of the readability of patient information leaflets designed by nurses
Authors: Mumford Mary E.
Published: December 2004

Written patient information materials can be valuable communication tools for teaching and reinforcing the verbal message, especially in the present climate of today's health service where patients are in hospital for such short times. They are only useful if the patient is able to read and understand them, otherwise they become an expensive waste of resources. Various studies have shown that many healthcare information leaflets are written at university or postgraduate level and would cause problems with understanding for many people reading them. This study set out to examine the readability of nurse‐designed written information leaflets using the Flesch Reading Ease score and the FOG and SMOG readability formulae. This descriptive study used a sample of 24 leaflets designed by trained nurses in a large teaching hospital. The results produced a mean grade of 11.3 with a range of 8.9 to 14.8. This was similar to the results of other studies and meant that patients may have difficulty comprehending the information. It would appear that little progress has been made in 40 years in this area and potential reasons are discussed. Advantages and disadvantages of readability formulae and other guidelines available for developing information leaflets are explored. Recommendations for further research are made.
Does low temperature cause the dominance of Acacia on the central Australian mountains? Evidence from a latitudinal gradient from 11° to 26° South in the Northern Territory, Australia
Authors: Bowman D.M.J.S. , Connors G.T.
Published: December 2004

A latitudinal gradient, from the central north coast of the Northern Territory (11°S) to the South Australian State border (26°S), was defined to subsample a large 20 m×20 m quadrat data set (N>2000 quadrats) collected during the course of the Northern Territory 1:106 vegetation mapping programme. The mean and standard error of a range of environmental data, and structural and floristic variables pertaining to woody species were calculated for fifteen cells (3.5°E wide and 1°S long) on the transect using a total of 1050 quadrats. It was found that the interrelated measures of mean canopy height, mean canopy cover and mean total basal area steadily declined from the north coast to reach their minimum levels at 18.5°S. There was little variation in these variables south of this latitude. This pattern is probably controlled by precipitation given that there is a highly significant (r2=98%) negative exponential decay of mean annual rainfall with latitude for ten meteorological stations on or near the transect, and that the southern limit of the summer monsoon rains is at about 18°S. The mean percentage of the woody species quadrat richness attributable to Acacia species was found to increase at around 18.5°S. However, the mean Acacia basal area and the percentage of the total basal area composed of Acacia basal area increased at 21.5°S. At this latitude the mean Eucalyptus basal area, the percentage of the total basal area made up of Eucalyptus species, and the mean percentage of woody species quadrat richness composed of Eucalyptus species all decreased to minimum levels. South of 21.5°S mean landscape elevation ranges between 400 and 700 m above sea level while north of this latitude mean landscape elevation ranges 10–300 m above sea level. The combined effects of continentality and environmental lapse rates result in a highly significant (r2=82%) negative exponential decay of mean July (winter) minimum temperature with latitude for the five climate stations on the transect for which data are available. Mean slope angle, rock cover, surface soil gravel content and surface soil clay content were unrelated to any of the above patterns. It is suggested that the sharp change‐over in Eucalyptus to Acacia dominance at 21.5°S is related to minimum temperature, but this hypothesis requires testing with detailed ecophysiological studies. None the less, the local dominance of Acacia shirleyi at 16.5°S suggests that environmental history also may have a strong influence on the contemporary latitudinal distribution of Acacia and Eucalyptus in the northern half of the Australian continent. Regrettably, few data are available to evaluate critically the importance of long‐term environmental change on current distributional patterns of Acacia and Eucalyptus.
Comparison of nutritional risk screening tools in patients on admission to hospital
Authors: Corish C. A. , Flood P. , Kennedy N. P.
Published: December 2004

Background and aims  Undernutrition has been frequently reported in patients on admission to hospital. Because this is not always detected promptly, screening for nutritional risk on admission has been widely advocated. Although there is no universally accepted ‘gold standard’ for defining undernutrition, the definition used by McWhirter, J.P. & Pennington, C.R. [(1994) Br. Med. J.308, 945] has been widely used by clinical nutrition specialists. This study aimed to compare the efficacy of two frequently used nutritional risk screening tools in detecting undernutrition according to this definition.

Methods  Both the Nutrition Risk Index [Veterans Affairs Total Parenteral Nutrition Co‐operative Study Group (1991) N. Engl. J. Med.325, 525] and the Nutrition Risk Score [Reilly H.M. et al. (1995) Clin. Nutr.14, 269] were used to screen for undernutrition in 359 admissions to two acute teaching hospitals in Dublin. Undernutrition was defined as a Body Mass Index below 20 kg m−2 and a triceps skinfold thickness or mid‐arm muscle circumference below the 15th percentile. Comparison of stratification of nutritional risk by the two screening tools was carried out.

Results  Both screening tools identified over 40% (Nutrition Risk Index, 44%; Nutrition Risk Score, 46%) of all patients assessed as at nutritional risk on admission. However, one‐third of the undernourished patients were classified as at no nutrition risk by the Nutrition Risk Index, while almost one‐fifth of those undernourished were classified as at low risk by the Nutrition Risk Score. The degree of nutritional risk differed with the screening tool used, the Nutrition Risk Score classifying 29% of all patients as high risk while the Nutrition Risk Index classified only 5% as in the high risk category.

Conclusions  Although a large proportion of patients on admission were classified as being at nutritional risk, the degree of risk was significantly different depending on the screening tool used. Both nutritional risk screening tools evaluated in this study failed to recognize many cases of undernutrition. Evaluation of the efficacy of nutritional screening tools should be promoted as seriously as the development of such tools.
Prevalence study of the randomized controlled trials in the Journal of Intellectual Disability Research: 1957–1994
Authors: Duggan L. M. , Morris M. , Adams C. E.
Published: December 2004

Systematic reviews of care are increasingly potent guides to clinical practice, and it is important that all relevant randomized controlled trials (RCTs) are identified by those within the speciality of learning disability who produce such works. All RCTs in the Journal of Intellectual Disability Research and its predecessor were identified by hand‐searching (1957–1994), and the frequency, origin, intervention and quality of reporting of randomization were described. Electronic searches for the trials were undertaken for the years 1974–1994, and the quality of indexing was inspected and tested. These electronic searches were then compared to a ‘gold standard’ search. Fifty‐six RCTs were identified. None contained the word ‘randomized’ in the title and only nine mentioned it in the abstract. Out of the 37 RCTs published between 1974 and 1994, 36 are in PsycLIT and 37 in MEDLINE. One MEDLINE record contained the wrong abstract. The methodological phrases used in the electronic records were poor, and thus, the precision of electronic searches, using both databases, was low. This international journal contains many relevant RCTs from around the world, involving several types of interventions. Unfortunately, these trials cannot be readily accessed electronically using methodological phrases designed to find RCTs. Improved quality of indexing would facilitate identification of RCTs and their dissemination.
The role of macrophage migration inhibition factor in toxic epidermal necrolysis
Authors: Halevy Sima , Livni Ella
Published: December 2004

Patient A A 60‐year‐old man developed toxic epidermal necrolysis (TEN) following several weeks of treatment with two kinds of drug: co‐trimoxazole and acetazolamide. On the basis of time relationship data, both drugs could be considered as the inducers of the cutaneous reaction.1 Guide fables indicated that co‐trimoxazole is one of the most common inducers of TEN, whereas acetazolamide has been reported as a possible uncommon inducer of TEN.1–3 Drug intake was stopped, and treatment with prednisone (120 mg/day) was instituted, followed by a gradual tapering of the dosage. A month later, complete remission of the skin lesions was observed. A macrophage migration inhibition factor (MIF) test was performed towards the drugs taken, in an attempt to identify the offending drug. The macrophage migration inhibition factor (MIF) test was positive towards co‐trimoxazole and negative for acetazolamide. Positive MIF responses towards co‐trimoxazole were not recorded in ten control patients (control I) treated with the drug with no manifestations of drug eruption.

Patient B TEN was diagnosed in an 84‐year‐old man treated prior to the appearance of the eruption with two kinds of drug: furosemide, which had been taken for several weeks, and nitrofurantoin, which had been taken for 3 months. On the basis of time relationship data, furosemide was suspected to be the offending drug; however, guide tables indicated nitrofurantoin as a possible inducer of TEN,3 whereas the role of furosemide (a sulfa drug) as an inducer of TEN has not yet been reported. Drug intake was stopped, and following supportive treatment, without the addition of corticosteroids, the skin lesions disappeared 3 weeks later. A MIF test was performed towards furosemide and nitrofurantoin. The MIF test was positive towards furosemide and negative for nitrofurantoin. Positive MIF responses towards furosemide were not recorded in seven control patients (control II) treated with the drug with no manifestations of drug eruption.

The MIF test technique The MIF test was performed according to the modified method of Livni et al.4 A migration index of 0.80 or less at one or more of the drug concentrations was considered to be a positive MIF test.

Statistical analysis Statistical analysis of MIF test results in TEN patients and controls was performed using Fisher's exact test (F.E.T.). The occurrence of positive MIF responses towards drugs recorded in TEN patients (2/4) was significantly higher (P<0.05) than that recorded in the controls (0/17). The MIF test results in TEN patients and controls are summarized in Table 1.
From melanotic to amelanotic lentigo maligna: an aggressive variant presenting as an inflammatory lesion
Authors: Kiene Petra , Christophers Enno
Published: December 2004

A 79‐year‐old woman presented to us with an erythematous macule of the left cheek, approximately 4 cm in diameter. She reported slow enlargement of the lesion over the previous 12 months. Clinically the lesion showed irregular borders and changing erythematous discoloration, as well as slight scaling. The diagnosis at the time of presentation was rosacea‐like dermatitis. The lesion was situated besides and within the site of a skin transplant.

The patient's medical history revealed a first excision of a pigmented lentigo maligna 17 years previously (Fig. 1). Multiple recurrences of the pigmented lentigo maligna had been treated surgically 13, 6, 5, and 2 years prior to the latest clinical consultation, showing the clinical and histologic features of pigmented lentigo maligna.

Because of this medical history, biopsies were performed which exhibited the histologic characteristics of amelanotic lentigo maligna. To confirm the melanocytic nature of the tumor cells, immunohistochemical analyses were carried out using S‐100 protein (Dako, Germany), HMB45 (Dako, Germany), and NK/C3 (Biogenex, USA) antibodies and the ABC method (Vectastain, USA) with 3‐amino‐9‐ethylcarbazol (AEC) as the chromogen. The cells expressed all three markers (Fig. 2), while the Fontana stain for melanin pigment failed to indicate the pigment.

Histologically, as seen in Fig. 3, the first lentigo maligna excised demonstrates deposits of melanin pigment in melanophages and pigmented tumor cells, as well as a lichenoid and perifollicular infiltrate of lymphocytes and some macrophages. The histologic specimen shown in Fig. 4 demonstrates the biopsy taken 17 years later, where no melanin pigment can be observed within the tumor cells, which show a pagetoid infiltrating pattern of the epidermal layers. The inflammatory infiltrate is comparable with that seen in the first specimen, while regression was not observed. The solar elastosis of the upper dermis has markedly progressed.
Atypical acropustulosis in infancy
Authors: Truong Alizabeth L. , Esterly Nancy B.
Published: December 2004

A 20‐month‐old white girl had a 4‐month history of an intensely pruritic widespread eruption that began as crops of 1–3‐mm papules and vesicles predominantly on her hands and feet. These lesions evolved into pustules after 24–48 h. Identical lesions would then erupt over large areas of her scalp, trunk, and extremities. Her primary care physician initially interpreted this eruption as chickenpox complicated by impetigo, and also considered a diagnosis of scabies. Antiscabetics, topical steroids, oral antibiotics, and antihistamines failed to control the eruption or alleviate the pruritus which interrupted sleep and her dally activities. The lesions waxed and waned, with new crops developing every 2–3 weeks and fading slowly before the next crop appeared.

There was no history of significant exposure to pets or insects. The patient was otherwise in reasonable health and without systemic symptoms. No other children in her day care center nor any family members had a similar eruption. The family history was negative for skin disorders.

On physical examination, there was an extensive pustular eruption, most pronounced on the hands and feet (Fig. 1), but also involving the legs (Fig. 2), chest, and scalp, which was remarkable for the confluent, crusted lesions. There was sparing of the intertriglnous areas.

Burrows were absent. Cultures of the pustules for fungi and bacteria were negative, as were KOH and scabies preparations.

Our clinical impression was acropustulosis of infancy. Because of some unusual features of presentation, namely the late age of onset, the widespread distribution, and the severity of the eruption, we obtained a 3‐mm punch biopsy of an intact pustule from the right foot. Histopathologic examination of the biopsy specimen revealed a subcorneal, unilocular pustule containing small clusters of neutrophils invading the intact epithelium (Fig. 3). Hyperplasia and spongiosis of the surrounding epidermis were also noted. There was a sparse mononuclear infiltrate in the papillary dermis, occasionally in a perivascular distribution. Eosinophils were absent. Periodic acid‐Schiff (PAS) stain was negative for fungal elements. These histologic findings were considered to be representative of acropustulosis of infancy.

Prior to starting dapsone therapy, initial laboratory studies, including a complete blood count with differential, platelet count, liver function tests, blood urea nitrogen, creatinine, and G‐6‐PD level, were obtained and determined to be within normal limits. Dapsone therapy was initiated at 1 mg/kg/day for 1 week and then increased to 2 mg/kg/day. She showed a dramatic response to therapy with clearing of all lesions. The dapsone dose was then slowly reduced over the next few months and discontinued after 11 months without recurrence of the disorder. She was carefully monitored and at no time experienced untoward effects from this medication.
Aggressive peripheral T‐cell lymphoma containing Epstein–Barr virus genomes
Authors: Okuyama Ryuhei , Takahashi Kazuhiro , Ohi Tomonori , Mochizuki Mamoru , Tagami Hachiro
Published: December 2004

A 42‐year‐old woman presented in December 1995 with a half‐year history of asymptomatic erythematous plaques with firm induration on her extremities (Fig. 1). In the biopsy specimen, they were composed of medium‐ to large‐sized pleomorphic lymphoid cells with nuclear atypia and frequent mitoses, which extensively infiltrated the dermis and subcutis (Fig. 2a). There were also large phagocytic cells filled with nuclear dusts and erythrocytes (Fig. 2b). Immunohistochemlcal staining performed on paraffin‐embedded sections using the labeled streptavidine‐biotin‐immunoperoxidase technique revealed that the atypical lymphoid cells were positive for CD3, a T‐cell marker, but negative for CD20, a B‐cell marker. Large phagocytic cells were positively stained with PGM1, a macrophage marker. Unfortunately, we could not obtain further information concerning the gene rearrangement or immunostaining of the T‐cell receptor because only paraffin‐fixed samples were available.

A complete blood cell count revealed mild thrombocytopenia, but it was otherwise within normal limits. Atypical cells were absent in the peripheral blood and bone marrow. The serum level of lactate dehydrogenase was elevated at 1402 lU/L. Antibodies to human T‐lymphotrophic virus (HTLV–1) were negative. The titers of antibodies to human Epstein‐Barr virus (EBV) were as follows: viral capsid antigen (VCA) IgM type, <10; VCA IgG type, 640; early antigen (EA) IgG, 40; EBV‐determined nuclear antigen (EBNA), 40.

Under a diagnosis of T‐cell lymphoma, we suspected the association of the lymphoma cells with EBV infection from the moderately high titers of antibodies to EBV, and performed in situ hybridization for EBV‐encoded nuclear RNAs (EBER). After hybridization, the detection of specifically bound fluorescein (FITC)‐conjugated antisense RNA probes (Dako, Kyoto, Japan) was achieved by anti‐FITC monoclonal antibody conjugated with alkaline phosphatase. More than 90% of lymphoid cells exhibited EBER‐positive nuclei, and almost all of the infiltrating cells in the same area expressed CD3 and CD45RO. No signal was observed for sense RNA probes, and suitable control specimens from EBV‐positive and EBV‐negative cases were used as controls for EBV detection.

Together with a rapid exacerbation of the skin tumors, a marked protrusion of the left eye appeared, behind which computed tomographic (CT) scan demonstrated the presence of a mass. CT scan of the abdomen also revealed large masses compatible with lymphoma. The patient was treated with cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP). However, the response to this therapeutic regimen was transient with only a brief remission interval, and the patient died of progressive disease 2 months after starting the chemotherapy.
Generalized epidermolytic hyperkeratosis in a child born to a parent with systematized epidermolytic linear epidermal nevus
Authors: Reddy Belum Siva Nagi , Thadeus Joseph , Kumar Sangeetham Krishan Ashok , Jaishanker Telanseri , Garg Bhagat Ram
Published: December 2004

A 5‐month‐old girl was born with generalized erythematous skin covered with fine scales. Two days after she was born blisters started appearing over several places on the skin, resulting in multiple denudations. Later, over a period of 2–3 weeks, her skin started becoming rough, thickened, and covered with verrucous scales. The patient is the product of a full‐term normal delivery, is born to nonconsanguinous parents, and had normal developmental milestones. None of her family members had had similar episodes, although her father had had verrucous linear epidermal nevus since his childhood.

On examination her entire skin was erythematous, thickened, and covered with rough verrucous scales arranged in a rippled pattern (Fig. 1a), more prominent in the flexural areas. Multiple erosions and a few flaccid vesicles and bullae were seen over the trunk and extremities (Fig, 1b), and islands of normal‐looking skin were seen over the recently healed erosions. Scales were less marked over the face. Mucous membranes, skin appendages, palms, and soles were not affected. The rest of her systemic examination revealed no other abnormality.

Routine laboratory investigations including haemogram, Veneral Disease Research; Laboratory test (VDRL), and radiologic skeletal survey were normal. Histopathologic examination of the lesional skin and also the normal‐looking skin revealed the picture of epidermolytic hyperkeratosis showing features of hyperkeratosis and hypergranulosis with prominent vacuolar degeneration of the upper epidermis extending to the middle of the stratum spinosum (Fig. 2), Dermis was normal but for a mild edema and nonspecific perivascular inflammatory infiltrate.

Dermatologic evaluation of her father revealed bilateral, asymmetric, thick, warty papules, and plaques arranged in a linear pattern following the lines of Blaschko over the trunk and extremities (Fig. 3), The rest of the skin and systemic examination was normal. A skin biopsy of the verrucous plaque over the back showed typical features of epidermolytic hyperkeratosis similar to his daughter (Fig. 4), and normal histology was observed from the skin section obtained from normal‐looking skin.