bluuebunny/crossref_metadata_2025 huggingface dataset:
Reinstating the ‘Queen’: understanding philosophical inquiry in nursing
Authors: Pesut Barbara , Johnson Joy
Published: August 2010

Title.  Reinstating the ‘Queen’: understanding philosophical inquiry in nursing

Aim.  This paper is an introduction to the characteristics of philosophical inquiry.

Background.  Despite over a century of philosophical thinking in nursing, philosophical inquiry has yet to be positioned as contributing substantially to the field of nursing’s inquiry. There is a need to articulate the nature and characteristics of philosophical inquiry for researchers new to this perspective.

Method.  We begin by addressing a common question that surfaces when one begins a work that is philosophical in nature, how does one differentiate between nursing philosophy and nursing theory? We then address the nature and characteristics of philosophical inquiry. We conclude by considering the question of whether philosophical inquiry might be considered a form of qualitative inquiry.

Findings.  Unlike science, which relies upon investigative methods, philosophical inquiry relies upon the capacities to think and reason. Problems characteristic of philosophical inquiry include conceptual clarification, analysis of arguments and problems related to the ontology, epistemology and ethics of nursing. Although methodological approaches to philosophical inquiry are diverse, common tools include assumptions and the intellectual processes of conceptualizing, judging and reasoning within a context of wonder.

Conclusion.  Some have argued that to neglect philosophy in nursing is to place the discipline at risk. However, there is little guidance available to researchers new to this method of inquiry. By providing a beginning roadmap, our hope is that philosophical inquiry will take its place alongside scientific methods of inquiry with the goal of constructing robust knowledge for the discipline of nursing.
Stress and eustress in nursing students
Authors: Gibbons Chris , Dempster Martin , Moutray Marianne
Published: August 2010

Title.  Stress and eustress in nursing students

Aim.  This paper is a report of a study to identify experiences that led to both distress and eustress and to make recommendations to help students cope with course demands.

Background.  Much of the research on stress in nursing students is quantitative in focus and all draws on their experience of distress, with little attempt to understand experiences of eustress.

Method.  A series of focus groups were carried out with a volunteer sample of final year nursing students (n = 16) in the United Kingdom in 2007. The data were thematically analysed.

Findings.  The themes identified were clinical experience, support, learning and teaching experience and course structure. There were experiences within each that were perceived as sources of distress and eustress. Many of the sources of distress concur with earlier findings but they are more likely to be experienced and commented on because the demands of present‐day programmes and the profile of many nursing students mean that more effort is invested in meeting educational demands. The experiential learning and patient‐care opportunity that placements provided was an important source of eustress.

Conclusion.  Students who coped well drew on effective support networks and adopted a positive, optimistic perspective towards programme issues. Effective educators did not offer more time than those perceived as less effective but seemed more effective at tuning into students’ concerns, showing more empathy and offering clearer guidance.
The work of health visitors and school nurses with children with psychological and behavioural problems
Authors: Wilson Philip , Furnivall Judy , Barbour Rosaline S. , Connelly Graham , Bryce Graham , Phin Louise , Stallard Anna
Published: August 2010

Title.  The work of health visitors and school nurses with children with psychological and behavioural problems

Aim.  This paper is a report of a study to describe the workload of health visitors and school nurses in relation to children and young people with psychological, emotional or behavioural problems, and to identify perceived challenges, obstacles and sources of satisfaction associated with this aspect of their work.

Background.  There is little published information on the work performed by non‐specialist community nurses with children and young people who have psychological, emotional and behavioural problems.

Method.  We analysed data from a survey conducted in 2002 – 2003 of 1049 Scottish professionals working with children and young people. Data included quantitative responses and free‐text describing the cases seen by respondents. Responses from a sub‐sample of 71 health visitors and 100 school nurses were analysed using a combination of descriptive statistics and analysis of themes emerging from the text.

Findings.  Although community‐based nurses saw a relatively small number of children with psychological, emotional or behavioural problems each week, dealing with these problems took up a disproportionate amount of time. The commonest types of problem were self‐harm, externalizing behaviours and family difficulties. Few respondents had received specific training in child and adolescent mental health but most expressed a wish to receive such training.

Conclusion.  The work of health visitors and school nurses in caring for children with mental health problems is substantial and important. Development of their public health role should not be at the expense of this important contribution. There is a need for rigorous evaluation of nursing mental health interventions among children and young people.
Nursing students’ perceptions of the importance of caring behaviors
Authors: Khademian Zahra , Vizeshfar Fatemeh
Published: August 2010

Title.  Nursing students’ perceptions of the importance of caring behaviours

Aim.  This paper is a report of a study to determine the nursing students’ perceptions of the importance of caring behaviours.

Background.  Caring has been considered as the essence of nursing. It is believed that caring enhances patients’ health and well‐being and facilitates health promotion. Nursing education has an important role in educating the nurses with adequate caring abilities.

Method.  Ninety nursing students (response rate 75%) responded to a questionnaire consisting of 55 caring behaviours adapted from items on Caring Assessment Questionnaire (Care‐Q). Behaviours were ranked on a 5‐point Likert‐type scale. The caring behaviours were categorized in seven subscales: ‘accessibles’, ‘monitors and follows through’, ‘explains and facilitates’, ‘comforts’, ‘anticipates’, ‘trusting relationship’ and ‘spiritual care’. Data were collected in Iran in 2003.

Findings.  The students perceived ‘monitors and follows through’ (mean = 4·33, SD = 0·60) as the most and ‘trusting relationship’ (mean = 3·70, SD = 0·62) as the least important subscales. ‘To give patient’s treatments and medications on time’ and ‘to do voluntarily little things…’ were the most and least important caring behaviours, respectively. ‘Explains and facilitates’ statistically and significantly correlated with age (r = 0·31, P = 0·003) and programme year (r = 0·28, P = 0·025). Gender had no statistically significant influence on students’ perceptions of caring behaviours.

Conclusion.  Further research is needed, using longitudinal designs, to explore nursing students’ perceptions of caring behaviours in different cultures, as well as evaluation studies of innovations in curriculum and teaching methods to improve learning in relation to cultural competence and caring concepts.
Analysis of instruments measuring nurses’ attitudes towards research utilization: a systematic review
Authors: Frasure Jamey
Published: August 2010

Title.  Analysis of instruments measuring nurses’ attitudes towards research utilization: a systematic review

Aim.  This paper is a report of a systematic review describing instruments used to measure nurses’ attitudes towards research utilization.

Background.  Researchers need to have the tools to measure nurses’ attitudes. However, limited literature critically analyses instruments and the concepts that comprise nurses’ attitudes towards research utilization.

Data sources.  A search of the literature from 1982 to 2007 was performed using the Cumulative Index to Nursing and Allied Health Literature, Health and Psychosocial Instruments, PubMed and MEDLINE data bases. The search terms were nursing research, research utilization, instruments, and nurses’ attitudes. A total of 186 sources were identified, of which 25 were reviewed.

Methods.  Fourteen instruments met the criteria for in‐depth critical analysis of psychometric properties and concepts, and were included in the final review. Each instrument item was judged to be relevant to direct, indirect, persuasive and overall research utilization as defined by Estabrooks. Instruments were arranged from the strongest to the weakest reliability of the subscales to determine the instrument with the strongest psychometric properties.

Results.  Indirect and overall research utilization was measured by all of the instruments. Ten instruments measured direct research utilization and nine instruments measured persuasive research utilization. The Research Utilization in Nursing Survey by Estabrooks, as adapted by Kenny, was an instrument with strong psychometric properties measuring all four concepts of nurses’ attitudes towards using and participating in research and was clinically feasible.

Conclusion.  Many published instruments are available for use by nurse researchers to measure nurses’ attitude towards research utilization, but only one has been subjected to rigorous testing: the Research Utilization in Nursing Survey by Estabrooks.
Fluid compliance among patients having haemodialysis: can an educational programme make a difference?
Authors: Barnett Tony , Li Yoong Tang , Pinikahana Jaya , Si‐Yen Tan
Published: August 2010

Title.  Fluid compliance among patients having haemodialysis: can an educational programme make a difference?

Aim.  This paper is a report of a study to examine the effectiveness of a patient education programme on fluid compliance as assessed by interdialytic weight gain, mean predialysis blood pressure and rate of fluid adherence.

Background.  Patients with end stage renal disease who receive haemodialysis are often non‐compliant with their treatment regime, especially adherence to fluid restrictions.

Method.  An exploratory study was conducted in 2004–05 using a quasi‐experimental, single group design to examine the effectiveness of patient education on fluid compliance in a dialysis centre located in a major teaching hospital in Kuala Lumpur, Malaysia. Twenty‐six patients with an interdialytic weight gain of greater than 2·5 kg were identified as non‐compliant and recruited to the study. The intervention was carried out over a 2‐month period and included teaching and weekly reinforcement about diet, fluids and control of weight gain.

Findings.  Patients’ mean interdialytic weight gain decreased following the educational intervention from 2·64 kg to 2·21 kg (P < 0·05) and adherence to fluid restrictions increased from 47% to 71% following the intervention. Predialysis mean blood pressure did not improve following the intervention, although the maximum recording for predialysis systolic pressure dropped from 220 mmHg to 161 mmHg. Whilst no statistically significant associations were detected between interdialytic weight gain and age, educational level, marital status or employment status, women demonstrated a greater decrease in mean interdialytic weight gain than men.

Conclusion.  Nephrology nurses often have long‐term relationships with their patients and are ideally placed to provide ongoing education and encouragement, especially for those experiencing difficulties in adhering to fluid and dietary restrictions.
Chinese couples’ experiences during convalescence from a first heart attack: a focus group study
Authors: Wang Wenru , Thompson David R. , Chair Sek Y. , Twinn Sheila F.
Published: August 2010

Title.  Chinese couples’ experiences during convalescence from a first heart attack: a focus group study

Aim.  This paper is a report of a study to explore Chinese patients’ and partners’ experiences during early convalescence from a first heart attack.

Background.  There are important socio‐cultural differences between Chinese and western populations and comparatively little is known about the experiences of Chinese patients and partners living with a first heart attack.

Method.  A qualitative study using focus groups was conducted in 2005 with 17 Chinese patients and their partners during convalescence from a first heart attack. The interviews were tape‐recorded and transcribed. Analysis was used to identify categories using established qualitative phenomenological techniques.

Findings.  Content analysis of the data revealed five major categories: enduring uncertainty; coping with changes; experiencing emotional reactions; living with medications and needing professional help.

Conclusion.  The experiences of Chinese patients and partners during early convalescence from a first heart attack are different from their western counterparts and are affected by cultural traditions. Findings from this study may provide useful pointers for health professionals to deliver culturally sensitive and appropriate support and education during early convalescence.
Older women nurses: health, ageing concerns and self‐care strategies
Authors: Gabrielle Sarah , Jackson Debra , Mannix Judy
Published: August 2010

Title.  Older women nurses: health, ageing concerns and self‐care strategies

Aim.  This paper is a report of a study of the health and ageing concerns and self‐care strategies of older female Registered Nurses currently working in direct care‐giving roles in acute public hospitals and community facilities.

Background.  Nursing is a rapidly ageing, and female‐dominated workforce. However, despite the ageing of the nursing workforce, little is known about the needs and health concerns of older nurses.

Method.  A feminist perspective was used and 12 female Registered Nurses aged 40–60 years, employed in various acute hospital and community health settings in Australia took part in qualitative interviews in late 2004. Narratives were audio taped, transcribed and analysed thematically.

Findings.  Two major themes were identified. The first theme –Aches and pains of ageing– had four subthemes: Neglecting self: ‘You don't think of yourself first’; Physical changes: ‘The body is wearing out’; Living with pain: ‘You just work around it’; and Tiredness: ‘I’m just tired all the time’. The second theme –Evolving lifestyles: works in progress – had three subthemes: The power of exercise: ‘I feel great…and I’m enjoying life’; Healthy eating: ‘Low fat, lots of fruit and veg, little processed food’; and Adapting to ageing: ‘I think it’s quite a good time of life’.

Conclusion.  Further research is needed to explore the need for protective work practices and promoting healthy lifestyle practices for ageing nurses. Managers need to recognize the changing health needs of older clinical nurses and offer, for example, flexible rostering and tailored exercise programmes to promote their health.
Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature
Authors: Simkhada Bibha , Teijlingen Edwin R. van , Porter Maureen , Simkhada Padam
Published: August 2010

Title.  Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature.

Aim.  This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries.

Background.  Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it.

Data sources.  A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English‐language publications were searched using relevant keywords, and reference lists were hand‐searched.

Review methods.  A systematic review was carried out and both quantitative and qualitative studies were included.

Results.  Twenty‐eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband’s education, marital status, availability, cost, household income, women’s employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women’s age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them.

Conclusion.  More qualitative research is required to explore the effect of women’s satisfaction, autonomy and gender role in the decision‐making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women’s overall (social, political and economic) status needs to be considered.
Movement behaviour within and beyond perceptual ranges in three small mammals: effects of matrix type and body mass
Authors: Prevedello Jayme Augusto , Forero‐Medina Germán , Vieira Marcus Vinícius
Published: August 2010

1. For animal species inhabiting heterogeneous landscapes, the tortuosity of the dispersal path is a key determinant of the success in locating habitat patches. Path tortuosity within and beyond perceptual range must differ, and may be differently affected by intrinsic attributes of individuals and extrinsic environmental factors. Understanding how these factors interact to determine path tortuosity allows more accurate inference of successful movements between habitat patches.

2. We experimentally determined the effects of intrinsic (body mass and species identity) and extrinsic factors (distance to nearest forest fragment and matrix type) on the tortuosity of movements of three forest‐dwelling didelphid marsupials, in a fragmented landscape of the Atlantic Forest, Brazil.

3. A total of 202 individuals were captured in forest fragments and released in three unsuitable matrix types (mowed pasture, abandoned pasture and manioc plantation), carrying spool‐and‐line devices.

4. Twenty‐four models were formulated representing a priori hypotheses of major determinants of path tortuosity, grouped in three scenarios (only intrinsic factors, only extrinsic factors and models with combinations of both), and compared using a model selection approach. Models were tested separately for individuals released within the perceptual range of the species, and for individuals released beyond the perceptual range.

5. Matrix type strongly affected path tortuosity, with more obstructed matrix types hampering displacement of animals. Body mass was more important than species identity to determine path tortuosity, with larger animals moving more linearly. Increased distance to the fragment resulted in more tortuous paths, but actually reflects a threshold in perceptual range: linear paths within perceptual range, tortuous paths beyond.

6. The variables tested explained successfully path tortuosity, but only for animals released within the perceptual range. Other factors, such as wind intensity and direction of plantation rows, may be more important for individuals beyond their perceptual range.

7. Simplistic scenarios considering only intrinsic or extrinsic factors are inadequate to predict path tortuosity, and to infer dispersal success in heterogeneous landscapes. Perceptual range represents a fundamental threshold where the effects of matrix type, body mass and individual behaviour change drastically.
Hospitalisation rates for ambulatory care sensitive conditions for persons with and without an intellectual disability‐a population perspective
Authors: Balogh R. , Brownell M. , Ouellette‐Kuntz H. , Colantonio A.
Published: August 2010

Background  There is evidence that persons with an intellectual disability (ID) face barriers to primary care; however, this has not been extensively studied at the population level. Rates of hospitalisation for ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. The objective of the study was to compare hospitalisation rates for ambulatory care sensitive conditions between persons with and without an ID in a publicly insured population.

Methods  Persons with an ID were identified among the general population of a Canadian province between 1999 and 2003. Using a list of conditions applicable to persons with an ID, rates of hospitalisations for ambulatory care sensitive conditions for persons with and without an ID were calculated and compared. Regression models were used to adjust for age, sex and place of residence. Hospitalisation rates for specific conditions were also compared, controlling for differences in disease prevalence where possible.

Results  Persons with an ID were consistently hospitalised for ambulatory care sensitive conditions at a higher rate than persons without an ID. Between 1999 and 2003 the adjusted rate ratio (RR) was 6.1 [95% confidence interval (CI) = 5.6, 6.7]. Rate ratios were highest when comparing persons with, to persons without, an ID between the ages of 30–39 (RR = 13.1; 95% CI = 10.6, 16.2) and among urban area dwellers (RR = 7.0; 95% CI = 6.2, 7.9). Hospitalisation rates for epilepsy and schizophrenic disorders were, respectively, 54 and 15 times higher for persons with compared with persons without an ID. Rate ratios for diabetes and asthma remained significant after controlling for the population prevalence of these diseases.

Conclusions  The large discrepancy in rates of hospitalisation between persons with and without an ID is an indicator of inadequate primary care for this vulnerable population. Decreasing the number of ambulatory care sensitive condition hospitalisations through specialised outpatient programmes for persons with an ID would potentially lead to better health, improved quality of life and cost savings. Future research should include potentially important factors such as disease severity, socio‐economic variables and measures of health service organisation in the analysis. International comparisons of ambulatory care sensitive condition hospitalisation rates could point to the benefits and limitations of the health service policy directions adopted by different countries.
A Novel Developmental Role for Kisspeptin in the Growth of Gonadotrophin‐Releasing Hormone Neurites to the Median Eminence in the Mouse
Authors: Fiorini Z. , Jasoni C. L.
Published: August 2010

The puberty‐ and fertility‐regulating neuropeptide kisspeptin (KISS1) exerts dramatic effects on the physiology of adult gonadotrophin‐releasing hormone (GnRH) neurones as a master regulator of mammalian reproduction. Given the action of KISS1 directly on adult GnRH neurones, and that KISS1 activates a signal transduction cascade involved in neurite growth in other neurones, we investigated whether KISS1 may play a role in the normal growth of GnRH neurites to the median eminence. A reverse transcription‐polymerase chain reaction demonstrated the expression of Kiss1 mRNA in the embryonic mediobasal hypothalamus, the target region for GnRH neurite termination, as early as embryonic day 13.5 (E13.5), a time when the first GnRH neurites are arriving. Complementary expression of the mRNA encoding the KISS1 receptor, Kiss1r, in the preoptic area (POA) at E13.5 was also observed, suggesting that POA‐resident GnRH neurones can respond to KISS1 from an early age. To examine the effects of KISS1 on GnRH neurite growth in isolation, E15.5 POA explants, containing GnRH neurones actively extending neurites, were grown in three‐dimensional collagen gels. In the presence of KISS1 (1 μm), both the number and length of GnRH neurites were increased significantly compared to controls without KISS1. The effects of KISS1 on GnRH neurite growth could be inhibited by pretreatment with the phospholipase C inhibitor U73122 (50 μm), indicating that embryonic and adult GnRH neurones respond to KISS1 with the same intracellular signalling pathway. KISS1 provided in a concentration gradient from a fixed source had no effect on GnRH neurite growth, indicating that KISS1 does not function as a long‐range chemoattractant. Taken together, these results identify KISS1 as a stimulator of GnRH neurite growth, and suggest that it influences GnRH neurites at close‐range to innervate the median eminence. These data add a novel developmental role to the repertoire of the functions of KISS1 in mammalian reproduction.
Histopathological characteristics of eruption mesenchymal calcified hamartoma: two case reports
Authors: Onishi Tomoyuki , Sakashita Suguru , Ogawa Tomohiro , Ooshima Takashi
Published: August 2010

Odontogenic calcified masses were present in the opercula of lower first molars that were delayed in eruption. The masses were relatively small, opaque, white in color with a smooth texture. Histopathological examinations revealed that they contained osteodentin, cementum, and pulp‐like components; however, not odontogenic epithelial cells or enameloid. Further, mesenchymal multinucleated giant cells and dysplastic dental matrices were observed in the connective tissues surrounding the masses. These clinical and histopathological findings disagree with the features of pericoronal odontogenic hamartoma lesions, including odontoma, ameloblastic fibroma, and ameloblastic fibro‐odontoma. Therefore, we propose to categorize this odontogenic mass as a new variety of hamartoma, eruption mesenchymal calcified hamartoma.
Upregulation of thymidine kinase activity compensates for loss of thymidylate synthase activity in Mycoplasma pneumoniae
Authors: Wang Liya , Hames Claudine , Schmidl Sebastian R. , Stülke Jörg
Published: August 2010

Thymidylate, an essential building block of DNA, is synthesized either from deoxyuridylate by thymidylate synthase (TS) or thymidine (dT) by thymidine kinase (TK). Thymidylate kinase (TMPK) phosphorylates dTMP to dTTP. Thymidine phosphorylase (TP) catalyses reversible phosphorolysis of dT. Using transposon mutagenesis M. pneumoniae TS gene (thyA/MPN320) was interrupted and requirement of these enzymes was studied. We found that TK activity and transcript levels and TP activity, but not TMPK or TS activity, are growth‐phase‐regulated, with induction at the exponential growth phase and a decline after the stationary phase. Inactivation of thyA results in upregulation of TK transcript and a 10‐fold increase in TK activity, reduced TMPK level and it had no effect on TP activity. The level of [3H]‐dT uptake and incorporation into DNA in the thyA mutant correlates with increases in TK activity, suggesting that dT uptake and metabolism is TK‐dependent and that upregulation of TK activity in the thyA mutant compensates for the lack of ThyA activity. [3H]‐dU uptake was low compared with dT, and incorporation of radioactivity into DNA in the thyA mutant indicates the presence of an alternative TS. Our results suggest that TK and TMPK are potential targets for the development of Mycoplasma‐specific antibiotics.
Proteobactin and a yersiniabactin‐related siderophore mediate iron acquisition in Proteus mirabilis
Authors: Himpsl Stephanie D. , Pearson Melanie M. , Arewång Carl J. , Nusca Tyler D. , Sherman David H. , Mobley Harry L. T.
Published: August 2010

Proteus mirabilis causes complicated urinary tract infections (UTIs). While the urinary tract is an iron‐limiting environment, iron acquisition remains poorly characterized for this uropathogen. Microarray analysis of P. mirabilis HI4320 cultured under iron limitation identified 45 significantly upregulated genes (P ≤  0.05) that represent 21 putative iron‐regulated systems. Two gene clusters, PMI0229‐0239 and PMI2596‐2605, encode putative siderophore systems. PMI0229‐0239 encodes a non‐ribosomal peptide synthetase‐independent siderophore system for producing a novel siderophore, proteobactin. PMI2596‐2605 are contained within the high‐pathogenicity island, originally described in Yersinia pestis, and encodes proteins with apparent homology and organization to those involved in yersiniabactin production and uptake. Cross‐feeding and biochemical analysis shows that P. mirabilis is unable to utilize or produce yersiniabactin, suggesting that this yersiniabactin‐related locus is functionally distinct. Only disruption of both systems resulted in an in vitro iron‐chelating defect; demonstrating production and iron‐chelating activity for both siderophores. These findings clearly show that proteobactin and the yersiniabactin‐related siderophore function as iron acquisition systems. Despite the activity of both siderophores, only mutants lacking the yersiniabactin‐related siderophore have reduced fitness in vivo. The fitness requirement for the yersiniabactin‐related siderophore during UTI shows, for the first time, the importance of siderophore production in vivo for P. mirabilis.
The TetR‐type transcriptional regulator FasR of Corynebacterium glutamicum controls genes of lipid synthesis during growth on acetate
Authors: Nickel Jens , Irzik Kristina , Van Ooyen Jan , Eggeling Lothar
Published: August 2010

The addition of fatty acids to either Escherichia coli or Bacillus subtilis elicits an elaborate cellular response of the lipid metabolism. We found that in Corynebacterium glutamicum the expression of accD1 encoding the β‐subunit of the essential acetyl‐CoA carboxylase is repressed in acetate‐grown cells without the addition of fatty acids. The TetR‐type transcriptional regulator NCgl2404, termed FasR, was identified and deleted. During growth on acetate, but not on glucose, 17 genes are differentially expressed in the deletion mutant, among them accD1, and fasA and fasB both encoding fatty acid synthases, which were upregulated. Determination of the 5′ ends of accD1, fasA, fasB and accBC together with the use of isolated FasR protein identified the FasR binding site, fasO, which is located within the accD1 and fasA transcript initiation site thus blocking transcription by RNA polymerase binding directly. The identified fasO motif is present in C. efficiens or C. diphtheriae, too, and it is actually similarly positioned in these bacteria within the 5′ ends of the accD1 and fasA transcripts, and a fasR orthologue is also present. The identification of the FasR‐fasO system in Corynebacteriaceae might indicate a conserved transcriptional control of the unique lipid synthesis in these mycolic acid‐containing bacteria.
Expression of cytokines and their regulation during amoebic liver abscess development
Authors: PACHECO‐YÉPEZ J. , GALVÁN‐MOROYOQUI J. M. , MEZA I. , TSUTSUMI V. , SHIBAYAMA M.
Published: August 2010

Amoebic liver abscess (ALA) is the most important extraintestinal complication of Entamoeba histolytica infection. Amoebic liver abscess development causes severe destruction of the liver tissue concomitant with a strong inflammatory reaction. We analyse the in situ expression of TNF‐α, IFN‐γ, IL‐1β, 1L‐8 and IL‐10 at different stages of ALA development in a susceptible animal model. Results showed that after inoculation, neutrophils (PMN) and some macrophages infiltrated the liver and were positive for TNF‐α and IFN‐γ at the acute phase of amoeba infection. The presence of these cytokines was transient and decreased as tissue damage progressed. In contrast, IL‐1β and IL‐8 were detected mainly in neutrophils and macrophages from the periods of acute infection to subacute and chronic infection and decreased when granulomas were formed. The IL‐10 was expressed in PMN and mononuclear cells and only during a short period at the onset of acute infection. The qRT‐PCR of mRNA revealed a relationship with the expression of the cytokines in cells found in the ALA. Furthermore, our data suggest that IL‐10 does not regulate local production of these cytokines. Our results indicate that an exacerbated inflammatory milieu is established and contributes to liver tissue damage and probably supports the survival of the parasites.
Cocktail of gp63 and Hsp70 induces protection against Leishmania donovani in BALB/c mice
Authors: KAUR T. , SOBTI R. C. , KAUR S.
Published: August 2010

The 63‐ kDa antigen of Leishmania donovani is a membrane‐anchored matrix metalloprotease that has been shown to be involved in the infection process. We have shown that this antigen alone generates a Th1 type of protective response that is partial but when the animals are primed with the antigen along with the Hsp70, the level of protection is raised significantly, which is demonstrated by a considerable reduction in parasite load of immunized animals when compared to the infected controls. Delayed‐type hypersensitivity responses to leishmanin were measured as an index of cell‐mediated immune response and were found to be higher in immunized animals when compared to the infected controls, the maximum being in the animals immunized with cocktail of both the antigens. Maximum IgG2a and minimum IgG1 levels were observed in this group of animals. These animals also generated maximum levels of IFN‐γ and IL‐2 and minimum levels of IL‐4 and IL‐10 pointing towards the generation of a protective Th1 response and the suppression of the Th2 type of immune response.
A case–control study of the risk factors for canine juvenile‐onset generalized demodicosis in the USA
Authors: Plant Jon D. , Lund Elizabeth M. , Yang Mingyin
Published: August 2010

Canine juvenile‐onset generalized demodicosis (JOGD) is a common skin disorder suspected to be associated with multiple risk factors, including breed predispositions. These risk factors have not been well documented in a large population. A retrospective case–control study was conducted by searching the electronic medical records of 1 189 906 dogs examined at 600 hospitals during 2006 in order to assess the risk factors associated with JOGD in the USA. Multivariate analyses were conducted using logistic regression to estimate the relative risk with the odds ratio for variables hypothesized to influence the risk for canine demodicosis. Breeds (odds ratio) found to have the greatest association with a diagnosis of JOGD were American Staffordshire terrier (35.6), Staffordshire bull terrier (17.1) and Chinese shar‐pei (7.2). Nonbreed risk factors (odds ratio) significantly associated with a diagnosis of JOGD were the diagnosis of pyoderma (5.5), coccidiosis (2.7) or hookworms (1.5), short coat (1.9) and nonenrolment in a preventative care wellness plan (1.5). Documenting these risk factors may help veterinarians to prioritize differential diagnoses and will aid in the design of prospective studies to elucidate the pathogenesis of demodicosis in dogs.
Unusual Clinical Presentation of Epidermotropic Cutaneous Lymphoma:Small Hypopigmented Macules
Authors: Dabski Krzysztof , Stoll Howard L. , Milgrom Halina
Published: August 2010

ABSTRACT: A 35‐year‐old black woman developed numerous vitiligo‐like small hypopigmented macules on the upper and lower extremities. Histologically the lesions were consistent with epidermotropic mycosis fungoides or pagetoid reticulosis. The patient is presented because of a clinical picture unusual for either of the above microscopic diagnoses.
Prognosis of Atopic Dermatitis
Authors: Lammintausta Kaija , Kalimo Kirsti , Raitala Riitta , Forsten Yrsa
Published: August 2010

Abstract: The course and development of atopic symptoms were followed up in 801 atopic dermatitis patients, in 207 allergic rhinitis or asthma patients, and in 517 control subjects. The patients were studied in the Dermatology Clinic during their teens and the follow‐up studies were carried out at the ages of 22–41. Persistent or frequently relapsing dermatitis occurred in 77–91% of those who suffered from severe or moderate atopic dermatitis during their teens and in more than one half of those patients who only had mild dermatitis at the corresponding age. Atopic dermatitis had started in 13–17% of allergic rhinitis/asthma patients. At the time of the follow‐up examination, severe dermatitis was seen in only six percent and moderate symptoms in 35% of atopic dermatitis patients. Dermatitis was generally seen in multiple loci: on the face, hands, extremities, and body. Deterioration of dermatitis in autumn and winter was experienced by one third to 88% of the atopic dermatitis patients. Psychic stress was experienced as a major aggravating factor in one half to two thirds of atopic dermatitis patients. Prick test positivity occurred in 62–89% of the dermatitis patients. Animal allergens, molds, grasses, birch, and house dust mite were the most common allergens. Associations between evident allergen exposure and deterioration of the dermatitis occurred in individual cases.
ORGAN‐SPECIFIC AUTOANTIBODIES IN VITILIGO PATIENTS AND THEIR RELATIVES
Authors: MANDRY ROCÍO C. , ORTÍZ LUIS J. , LUGO‐SOMOUNOS AÍDA , SÁNCHEZ JORGE L.
Published: August 2010

Background. Recent data have supported an autoimmune etiology of vitiligo. Genetic factors also seem to play an important role in this disorder. The purpose of this study was to determine the presence and frequency of organ‐specific autoantibodies in vitiligo patients and their relatives.

Methods. Twenty patients with vitiligo and two first or second degree relatives of each patient were interviewed and their sera analyzed for the presence of antithyroglobulin (ATg), antithyroid microsomal (ATM), antiparietal cell (APC), and antiadrenal (AAd) autoantibodies. The sera of 20 normal patients were used as control.

Results. A significantly increased frequency of ATg, ATM, and APC antibodies was found in vitiligo patients when compared to normal controls. First and second degree relatives had significantly increased frequencies of ATg and ATM. A high incidence of autoimmune/endocrine diseases was found in the patients' relatives, including a 25% prevalence of vitiligo.

Conclusions. These findings not only support an autoimmune etiology for vitiligo, but also highlight the strong genetic contribution to this pigmentary disorder.
ALOPECIA AREATA: IMMUNOHISTOCHEMISTRY AND ULTRASTRUCTURE OF INFILTRATE AND IDENTIFICATION OF ADHESION MOLECULE RECEPTORS
Authors: GHERSETICH ILARIA , CAMPANILE GRAZIA , LOTTI TORELLO
Published: August 2010

Background. Alopecia areata (AA) is a noncicatricial alopecia with still unknown pathogenesis, but increasing evidence suggests that an immunologic process might be responsible for the disease.

Materials and Methods. Nineteen patients with AA were studied with ten of them in the progressive phase of the disease and nine in the stabilized phase. Biopsies of both affected and unaffected skin were taken. For immunohistochemistry, monoclonal antibodies directed against CD3, CD4, CD8, CD10a, CD36, and HLA‐DR antigens, were used, as well as antibodies directed against adhesion molecules icam‐1, ELAM‐1 and LFA‐1. For electron microscopy (EM), specimens were fixed in glutaraldehyde‐sodium cacodylate buffer, post‐fixed in osmium tetroxide, and stained with uranyl acetate. For statistical analysis, sections from involved and uninvolved skin of each patient for each antibody, the sign test, Fisher's F‐test, and the Tukey‐Kramer test were used.

Results. There was a rich infiltrate of CD4+ cells and CD1a+ cells, particularly in the perivascular zone of both unaffected and affected skin (here in the perivascular and in the peribulbar zone) in the progressive phase of AA. In the stabilized phase the infiltrate was scant, both in unaffected and affected skin and limited to the peribulbar area. Receptors of adhesion molecules (ICAM‐2, ELAM‐I, LFA‐1) were strongly expressed, mainly at the microvascular level in both unaffected and affected skin in the progressive phase, but were only weakly or not at all expressed in the stabilized phase, again in unaffected and affected skin. Ultrastructural data confirmed the immunohistochemical findings and showed close contacts between infiltrating lymphocytes and Langerhans'‐lineage cells mainly in the progressive phase.

Conclusions. Our results suggest that: 1) an immunologic process, apparently carried out by CD4+ lymphocytes and by dendritic CD1a+ and CD36+ cells, may play a key role at least in the early phase of the disease involving primarily microvessels and later on the bulbar area; 2) the expression of adhesion molecule receptors is involved at the beginning of the disease by mediating the adherence of leukocytes to endothelial cells and subsequent trafficking into the dermis.
SILICONE GRANULOMA IN ACRAL SKIN IN A PATIENT WITH SILICONE‐GEL BREAST IMPLANTS AND SYSTEMIC SCLEROSIS
Authors: ANDERSON DAREN R. , SCHWARTZ JOSEPH , COTTRILL CAROLYN M. , McCLAIN STEVE A. , ROSS JEFFREY S. , MAGIDSON JORY G. , KLAINER ALBERT , BISACCIA EMIL
Published: August 2010

A 68‐year‐old white woman was referred to us by her rheumatologist for possible participation in a clinical study of photopheresis for scleroderma. In February 1993, she noticed edema of her distal phalanges, Raynaud's phenomenon in both hands, flu‐like symptoms, fatigue, intermittent diarrhea, abdominal pain, tearing in both eyes, dyspnea on exertion, dysphagia, and odynophagia. Bilateral silicone‐gel breast implants had been placed 12 years before; 2 months before her present evaluation, they were removed and found to be ruptured.

Physical examination revealed edema, limited to the fingers and hands bilaterally, and slight induration of the skin on the dorsum of both hands and distal forearms. The remainder of the physical examination was normal.

According to our study protocol, a skin biopsy specimen from the dorsum of the right hand was taken, but all other laboratory investigations were refused. Histopathologic examination revealed multiple clear spaces of varying sizes in the dermis and multinucleated macrophages containing small refractile particles, characteristic of silicone granuloma (Figs. 1 and 2); however, the specimen showed no evidence of scleroderma. X‐ray energy dispersive analysis by scanning electron‐microscopy confirmed the presence of elemental silicon in the small refractile particles.

The patient did not receive any treatment after her diagnosis and shortly thereafter, she was lost to follow‐up.
Wells' syndrome related to tetanus vaccine
Authors: Moreno Marta , Luelmo Jesus , Monteagudo Manuel , Bella Rosa , Casanovas Arnau
Published: August 2010

A 69‐year‐old woman was admitted to the Surgery Department of our hospital in November 1993 because of persistent erythematous skin lesions suspected clinically to be infectious cellulitis‐ Two months before admission she had noticed a red itchy pruriginous plaque, neasuring 10 × 5 cm, on her left buttock that had become larger in spite of treatment with oral antimicrobials. One month before entry, two more lesions flared up on her right buttock and left groin that soon became infiltrated. She did not notice any systemic symptoms. Past history of urticaria, atopy, tinea infection, or insect bites was not recalled. Two months before the first skin lesion erupted, the second dose of a tetanus vaccine had been given to the patient.

The patient's temperature was 36.5°C on admission. On physical examination the patient appeared well and there were no systemic abnormalities. Examination of the skin revealed a red indurated plaque covering her left buttock and another one measuring 4 × 5 cm on the right buttock. A red nodular lesion, 3 × 2 cm in size, on her left groin was also noticed (Fig. 1).

Laboratory investigation revealed a total white count of 9.7 × l03mm3, with 68% neutrophils and 22% lymphocytes. Erythrocyte sedimentation rate was 110/h. Her erythrocyte count was 3.33 × 106mm3. Blood glucose, kidney and liver function tests, and complement were all normal, and a polyclonal hypergammaglobulinemia of 23 g/L was seen on immunoelectrophoresis. Antinuclear antibodies (ANA) and alpha‐1‐antitrypsin antibodies were negative. Parenteral antibiotic therapy with penicillin and clindamycin was started with no improvement. After surgical debridement, no purulent exudate was found.

A skin biopsy specimen of an infiltrated plaque was taken, showing an inflammatory infiltrate of lymphocytes and eosinophils, mostly perivascular, in the superficial and deep dermis, but especially in the deep subcutaneous tissue, with histiocytes and clusters of eosinophilic granules on the collagen fibers. Eosinophilic cellulitis (Wells' syndrome) was diagnosed and therapy with 20 mg/day of prednisone was started immediately. The skin lesions improved in a few days and the dose was tapered 3 weeks after starting therapy with oral steroids. She has not experienced any recurrence.
Vitiligo following the resolution of psoriatic plaques during PUVA therapy
Authors: Halcin Cynthis , Hann Seung‐Kyung , Kauh Young C.
Published: August 2010

Vitiligo Is an acquired idiopathic disorder, involving 1–4% of tiie world population and characterized by depigmented white patches of the skin that lack the dopa‐positive melanocytes.It has been associated with physicai trauma and, systemic and cutaneous diseases. Among the many dermatoses, psoriasis has been reported to be associated with vitiiigo in the same individuals independently, or vitiligo may precede the formation of psoriasis at the same location. Currently, psoralen plus ultraviolet A iight (PUVA) is one of the efficacious treatments of psoriasis and vitiligo with side‐effects of hypopigmentation and vitiligo‐like lesions. We describe a patient with psoriasis vuigaris in whom vitiligo appeared in the same areas and configurations as his psoriatic plaques as they resolved while being treated with topicai PUVA.

A 19‐year‐old Caucasian man was referred for treatment of his psoriatic flare. His medical history revealed a vitiiigo patch on his right calf at age five. At age 14, he developed initially psoriatic plaques on his knees and elbows which then gradually spread to the legs, arms, hands, trunk, scalp, and the genitai area. The only therapy used was a mid‐potency topical steroid ointment with some reiief. Recently the condition had deteriorated enough to seek medical attention.

Physical examination revealed sharply demarcated erythematous, silvery‐white scaly papules, patches and plaques of various sizes on trunk, extremities, palms, buttocks, and penis. The patient received topical PUVA with 0.1% trimethoxalen cream for 3 months. Uitravioiet A light (UVA) was applied at 0.1 J/cm with an increment of 0.1 J/cm at each session as tolerated. At approximately the tenth session, depigmented lesions were noted around the margins of the regressing psoriatic plaques. This progressed continually until the vitiligous‐like lesions completely replaced the resolved psoriatic piaques in exactiy the same configurations (Fig. 1).

Skin biopsies of the depigmented areas revealed parakeratosis, hypogranulosis, acanthosis, and a sparse iymphocytic infiitrate around dilated tortuous capillaries in the upper corium (Fig. 2). Also a Fontana‐Masson stain showed an absence of melanocytes as may be seen in vitiligo (Fig. 3).