bluuebunny/crossref_metadata_2025 huggingface dataset:
Rational proteomics I. Fingerprint identification and cofactor specificity in the short‐chain oxidoreductase (SCOR) enzyme family
Authors: Duax William L. , Pletnev Vladimir , Addlagatta Anthony , Bruenn Jeremy , Weeks Charles M.
Published: November 2003

The short‐chain oxidoreductase (SCOR) family of enzymes includes over 2000 members identified in sequenced genomes. Of these enzymes, ∼200 have been characterized functionally, and the three‐dimensional crystal structures of ∼40 have been reported. Since some SCOR enzymes are involved in hypertension, diabetes, breast cancer, and polycystic kidney disease, it is important to characterize the other members of the family for which the biological functions are currently unknown. Although the SCOR family appears to have only a single fully conserved residue, it was possible, using bioinformatics methods, to determine characteristic fingerprints composed of 30–40 residues that are conserved at the 70% or greater level in SCOR subgroups. These fingerprints permit reliable prediction of several important structure‐function features including NAD/NADP cofactor preference. For example, the correlation of aspartate or arginine residues with NAD or NADP binding, respectively, predicts the cofactor preference of more than 70% of the SCOR proteins with unknown function. The analysis of conserved residues surrounding the cofactor has revealed the presence of previously undetected CH…O hydrogen bonds in the majority of the SCOR crystal structures, predicts the presence of similar hydrogen bonds in 90% of the SCOR proteins of unknown function, and suggests that these hydrogen bonds may play a critical role in the catalytic functions of these enzymes. Proteins 2003. © 2003 Wiley‐Liss, Inc.
A nonribosomal peptide synthetase involved in the biosynthesis of ampullosporins in Sepedonium ampullosporum
Authors: Reiber Kathrin , Neuhof Torsten , Ozegowski Jörg H. , Döhren Hans von , Schwecke Torsten
Published: November 2003

Recently, the saprophytic ascomycete Sepedonium ampullosporum strain HKI‐0053 was isolated from a basidiomycete on account of its premature induction of pigment formation in Phoma destructiva, a process often related to the neuroleptic activity of the inducing compound. The active substance was identified as the 15‐membered peptaibol type peptide Ampullosporin. Although to date more than 300 peptaibols have been discovered, their biosynthetic machinery has not been characterized yet. By improving the culture conditions it was possible to grow S. ampullosporum in a submerged culture and to increase Ampullosporin production by more than three times to 33 mg/l at reduced fermentation times. The appearance of two high molecular weight proteins, HMWP1 (1.5 MDa) and HMWP2 (350 kDa) was closely related to the production of Ampullosporin during the course of fermentation. Both proteins showed a cross‐reaction with antibodies against a core fragment of nonribosomal peptide synthetases (NRPSs). Biochemical characterization of the partially purified enzymes exhibited selectivity for the substrate amino acid α‐aminoisobutyric acid (Aib), substantiating their involvement in Ampullosporin biosynthesis. Our data suggest that Ampullosporin synthetase has been isolated, and provides the basis for the characterization of the entire biosynthetic gene cluster. Furthermore, this knowledge will enable the manipulation of its NRPS template, in order to engineer mutant strains of Sepedonium ampullosporum which could produce more potent analogues of Ampullosporin. Copyright © 2003 European Peptide Society and John Wiley & Sons, Ltd.
Optimal Robust Control of Underactuated Manipulators via Actuation Redundancy
Authors: Maciel Benedito C. O. , Terra Marco H. , Bergerman Marcel
Published: November 2003

In this article we focus on post‐failure control of a mechanical manipulator from the point of view of optimal control, and present a novel method for controlling the positions of the failed, passive joints in an optimal way. It used the so‐called coupling index as an optimization criterion to minimize the energy spent by the underactuated manipulator. Although the optimization is performed locally, the results indicate the validity and feasibility of the proposed theory. © 2003 Wiley Periodicals, Inc.
Force Transmissibility Performance of Parallel Manipulators
Authors: Chang Wen‐Tung , Lin Chen‐Chou , Lee Jyh‐Jone
Published: November 2003

In this paper, a new force transmission index called the mean force transmission index (MFTI) is proposed, and the force transmissibility analysis procedure is established for parallel manipulators. TheMFTIis an extended definition of the force transmission index (FTI) introduced by the authors previously. It is shown that theFTIis a function of the input velocity ratio (IVR) for a multi‐DOF mechanism of the same configuration. To represent the force transmissibility by a definite value, theMFTIis defined as the mean value of the normalizedFTIs function over the whole range of theIVR. The force transmissibility analysis of two planar parallel manipulators is illustrated using theMFTImethod. The result is compared with that of the Jacobian matrix method and the joint force index (JFI) method. It shows that, especially for symmetric parallel manipulators, an approximate inverse‐proportionality relationship exists between theJFIandMFTI, and between the maximum input torque/force andMFTI. It is concluded that theMFTIcan be used as a quantitative measure of the force transmissibility performance for parallel manipulators. In the end, a design optimization problem is studied by taking the global force transmission index as the objective function. © 2003 Wiley Periodicals, Inc.
Outcome of liver transplantation for familial amyloidotic polyneuropathy
Authors: Sharma Pratima , Perri Roman E. , Sirven Joseph E. , Zeldenrust Steven R. , Brandhagen David J. , Rosen Charles B. , Douglas David D. , Mulligan David C. , Rakela Jorge , Wiesner Russell H. , Balan Vijayan
Published: November 2003

Familial amyloidotic polyneuropathy (FAP) is an autosomal dominant disorder caused by mutation in the transthyretin gene. The most common mutation is substitution of valine for methionine at position 30 (MET30). Liver transplantation (LT) is the preferred treatment. After LT, although many patients show stabilization or improvement in the disease, adverse outcomes have been reported in those who have malnutrition, long-standing disease, and non-MET (NMET) mutations at position 30. Our aim is to compare survival and outcome of symptoms associated with FAP after LT in patients with MET30 and NMET30 mutations. Medical records of all patients who underwent LT for amyloidosis at our institution were reviewed to obtain demographic information and clinical features, such as severity of neuropathy, diarrhea, orthostatic hypotension, and posterior wall or ventricle septal thickness before and after LT. Fifteen patients underwent LT for amyloidosis at our institution between 1990 and 2000 (MET30, n = 5; NMET30, n = 7; hereditary amyloidosis, n = 2; primary amyloidosis, AL type, n = 1). Patients with hereditary and primary amyloidosis were excluded from analysis. One- and 3-year survival rates after LT in MET30 patients were 100%. Before LT, five of five patients had sensorimotor neuropathy; five of five patients had diarrhea, and four of five patients had orthostatic hypotension. After LT, improvement or stabilization of neuropathy was seen in two of five patients; of diarrheal symptoms, in three of five patients; and of orthostatic hypotension, in three of four patients. One- and 3-year survival rates after LT in NMET30 patients were 100% and 85.7%, respectively. Before LT, six of seven patients had sensorimotor neuropathy, six of seven patients had diarrhea, and five of seven patients had orthostatic hypotension. After LT in this group, improvement or stabilization of neuropathy was seen in two of six patients; of diarrhea, in six of six patients; and of orthostatic hypotension, in five of five patients. Before LT, posterior wall and/or ventricle septal thickness was increased in two of five MET patients and seven of seven NMET patients. Five of seven NMET30 patients (71.4%) who received a combined liver and heart transplant had stabilization, and two patients in the NMET group and one patient in the MET group had progression of heart disease. Outcomes for LT for patients with FAP with MET or NMET mutations were similar. Earlier LT for patients with FAP with MET30 or NMET30 mutation would improve outcomes after LT.
FARMERS AND ‘PROSTITUTES’: TWENTIETH-CENTURY PROBLEMS OF FEMALE INHERITANCE IN KANO EMIRATE, NIGERIA
Authors: PIERCE STEVEN
Published: November 2003

This article focuses on the implications of an emir of Kano's decision to forbid women from inheriting houses and farms in 1923 and a successor's reversal of that policy in 1954. The earlier emir justified his policy by claiming that women inheritors were becoming prostitutes and the later one argued that women's re-enfranchisement would ameliorate the poverty of destitute elderly women. Both these events appear to have been radical innovations for their time and reflect continuous anxiety over women living outside of male control and a longer-term attack on women's public role. While the emirs' explanations do not fully comprehend the political logic of their decisions, both the proclamations and the way they were explained illustrate contradictions and ambiguities within Hausa conceptions of gender.
Bound water content of the lower oceanic crust estimated from modal analyses and seismic velocities of oceanic diabase and gabbro
Authors: Carlson R. L.
Published: November 2003

Hydrous minerals in the oceanic crust are known to carry bound water into subduction zones, but the water content of the lower oceanic crust is poorly constrained. Previous studies suggest that lower crustal diabases and gabbros contain 1–3 and 1–2 wt% H2O. This analysis, based on the modal mineralogy and seismic properties of oceanic diabase and gabbro samples, shows that the H2O content of diabase dike rocks ranges from 1–3%, with an average of 1.5%; in oceanic gabbros, the H2O content decreases with increasing seismic velocity, and gabbros that have velocities typical of the lower oceanic crust (6.7–7.0 km s−1) contain 0.2 to 0.7 wt% H2O, with a mean near 0.5 wt%.
Variability of snow accumulation and isotopic composition on Nevado Sajama, Bolivia
Authors: Hardy D. R. , Vuille M. , Bradley R. S.
Published: November 2003

High‐elevation ice caps develop an archive of atmospheric constituents and properties through the accumulation of snowfall. The timing of precipitation events, therefore, fundamentally governs the environmental information that ice core records can provide. These events are often highly seasonal, as are various postdepositional processes influencing the snow's physical and chemical properties. Knowledge of climatic conditions at an ice core site is essential to a full understanding of the ice core record. This work reports on 4 years of meteorological measurements near the summit of Nevado Sajama, an ice‐capped peak rising ∼2500 m above the South American Altiplano (elevation 6542 m), from which a 25,000‐year ice core record was recovered in 1997. On‐site measurements were combined with National Centers for Environmental Prediction/National Center for Atmospheric Research Reanalysis results and Altiplano station data to reconstruct 50‐year time series of air temperature, snowfall, and net accumulation at the summit. These time series were examined in the context of the Sajama δ18O profile over the same time interval. A strong relationship exists between Sajama δ18O and precipitation; both snowfall and net accumulation explain nearly half of the isotopic variance. In contrast, no significant association exists between air temperature and δ18O over this time period. The Sajama ice core record represents a relatively short proportion of time centered on the months of January or February, when net accumulation takes place, and cannot be interpreted in terms of annual mean conditions. On Sajama, interannual δ18O variability provides a sensitive measure of interannual precipitation variability, closely tied to ENSO and conditions in the equatorial Pacific Ocean.
Constructing the Self in Mental Health Practice: Identity, Individualism and the Feminization of Deficiency
Authors: Moulding Nicole
Published: November 2003

The discursive production of the ‘self in the context of mental health care has potential implications for how the subjects of intervention come to understand and experience themselves. Eating disorders provide an illustrative example of the ways in which conceptualizations of the self that structure mental health practices can be gendered, because they are mainly diagnosed in women and dominant explanations of their origins are feminized. This discourse analytic study examines the gendered nature of mental health workers’ constructions of the eating-disordered self through the psychological construct of ‘identity’, examining the dominant discourses implicated in the feminization of deficient identity, and addressing the implications of this construction for mental health practice.
Pds5p regulates the maintenance of sister chromatid cohesion and is sumoylated to promote the dissolution of cohesion
Authors: Stead Kristen , Aguilar Cristina , Hartman Theresa , Drexel Melissa , Meluh Pamela , Guacci Vincent
Published: November 2003

Pds5p and the cohesin complex are required for sister chromatid cohesion and localize to the same chromosomal loci over the same cell cycle window. However, Pds5p and the cohesin complex likely have distinct roles in cohesion. We report that pds5 mutants establish cohesion, but during mitosis exhibit precocious sister dissociation. Thus, unlike the cohesin complex, which is required for cohesion establishment and maintenance, Pds5p is required only for maintenance. We identified SMT4, which encodes a SUMO isopeptidase, as a high copy suppressor of both the temperature sensitivity and precocious sister dissociation of pds5 mutants. In contrast, SMT4 does not suppress temperature sensitivity of cohesin complex mutants. Pds5p is SUMO conjugated, with sumoylation peaking during mitosis. SMT4 overexpression reduces Pds5p sumoylation, whereas smt4 mutants have increased Pds5p sumoylation. smt4 mutants were previously shown to be defective in cohesion maintenance during mitosis. These data provide the first link between a protein required for cohesion, Pds5p, and sumoylation, and suggest that Pds5p sumoylation promotes the dissolution of cohesion.
Critical function of endogenous XIAP in regulating caspase activation during sympathetic neuronal apoptosis
Authors: Potts Patrick Ryan , Singh Shweta , Knezek Malia , Thompson Craig B. , Deshmukh Mohanish
Published: November 2003

In sympathetic neurons, unlike most nonneuronal cells, growth factor withdrawal–induced apoptosis requires the development of competence in addition to cytochrome c release to activate caspases. Thus, although most nonneuronal cells die rapidly with cytosolic cytochrome c alone, sympathetic neurons are remarkably resistant unless they develop competence. We have identified endogenous X-linked inhibitor of apoptosis protein (XIAP) as the essential postcytochrome c regulator of caspase activation in these neurons. In contrast to wild-type neurons that are resistant to injection of cytochrome c, XIAP-deficient neurons died rapidly with cytosolic cytochrome c alone. Surprisingly, the release of endogenous Smac was not sufficient to overcome the XIAP resistance in sympathetic neurons. In contrast, the neuronal competence pathway permitted cytochrome c to activate caspases by inducing a marked reduction in XIAP levels in these neurons. Thus, the removal of XIAP inhibition appears both necessary and sufficient for cytochrome c to activate caspases in sympathetic neurons. These data identify a critical function of endogenous XIAP in regulating apoptosis in mammalian cells.
rabip4′ Is an Effector of rab5 and rab4 and Regulates Transport through Early Endosomes
Authors: Fouraux Michael A. , Deneka Magda , Ivan Viorica , van der Heijden Annemarie , Raymackers Jos , van Suylekom Denise , van Venrooij Walther J. , van der Sluijs Peter , Pruijn Ger J.M.
Published: November 2003

We describe the characterization of an 80-kDa protein cross-reacting with a monoclonal antibody against the human La autoantigen. The 80-kDa protein is a variant of rabip4 with an N-terminal extension of 108 amino acids and is expressed in the same cells. For this reason, we named it rabip4′. rabip4′ is a peripheral membrane protein, which colocalized with internalized transferrin and EEA1 on early endosomes. Membrane association required the presence of the FYVE domain and was perturbed by the phosphatidylinositol 3-kinase inhibitor wortmannin. Expression of a dominant negative rabip4′ mutant reduced internalization and recycling of transferrin from early endosomes, suggesting that it may be functionally linked to rab4 and rab5. In agreement with this, we found that rabip4′ colocalized with the two GTPases on early endosomes and bound specifically and simultaneously to the GTP form of both rab4 and rab5. We conclude that rabip4′ may coordinate the activities of rab4 and rab5, regulating membrane dynamics in the early endosomal system.
Nonmuscle Myosin IIA and IIB Have Distinct Functions in the Exocytosis-dependent Process of Cell Membrane Repair
Authors: Togo Tatsuru , Steinhardt Richard A.
Published: November 2003

Vesicle generation, recruitment, and exocytosis are essential for repairing disruptions of cell membranes. The functions of nonmuscle myosin IIA and IIB in this exocytotic process of membrane repair were studied by the antisense technique. Knockdown of myosin IIB suppressed wound-induced exocytosis and the membrane resealing process. Knockdown of myosin IIA did not suppress exocytosis at an initial wound and had no inhibitory effect on the resealing at initial wounds but did inhibit the facilitated rate of resealing normally found at repeated wounds made at the same site. COS-7 cells, which lack myosin IIA, did not show the facilitated response of membrane resealing to a repeated wound. S91 melanoma cells, a mutant cell line lacking myosin Va, showed normal membrane resealing and normal facilitated responses. We concluded that myosin IIB was required for exocytosis and therefore cell membrane repair itself and that myosin IIA was required in facilitation of cell membrane repair at repeated wounds. Myosin IIB was primarily at the subplasmalemma cortex and myosin IIA was concentrated at the trans-Golgi network consistent with their distinct roles in vesicle trafficking in cell membrane repair.
Overexpression of Vascular Endothelial Growth Factor Accelerates Early Vascularization and Improves Healing of Genetically Modified Cultured Skin Substitutes
Authors: Supp Dorothy M. , Boyce Steven T.
Published: November 2003

Cultured skin substitutes (CSS) lack a vascular plexus, leading to slower vascularization after grafting than split-thickness skin autograft. CSS containing keratinocytes genetically modified to overexpress vascular endothelial growth factor (VEGF) were previously shown to exhibit enhanced vascularization up to 2 weeks after grafting to athymic mice. The present study examines whether enhanced vascularization compared with controls persists after stable engraftment is achieved and analyzes VEGF expression, wound contraction, and engraftment. Control and VEGF-modified (VEGF+) CSS were grafted onto full-thickness wounds in athymic mice. VEGF expression was detected in VEGF+ CSS 14 weeks after grafting. Graft contraction was significantly lower in VEGF+ CSS compared with controls, suggesting more stable engraftment and better tissue development. Positive HLA-ABC staining, indicating persistence of human cells, was seen in 86.7% (13/15) of grafted VEGF+ CSS, compared with 58.3% (7/12) of controls. Differences in dermal vascularization between control and VEGF+ grafts were significant 1 week after surgery, but not at later times. However, the distribution of vessels was different, with more vessels in the upper dermis of VEGF+ grafts. These results suggest that VEGF overexpression in genetically modified CSS acts to accelerate early graft vascularization and can contribute to improved healing of full-thickness skin wounds.
Does Cartoon Movie Distraction Decrease Burned Children's Pain Behavior?
Authors: Landolt M. A. , Marti D. , Widmer J. , Meuli M.
Published: November 2003

The purpose of this study was to evaluate cartoon movie viewing as a practical and low-cost intervention to decrease burned children's pain behavior during dressing changes. Thirteen children, 4 to 12 years of age, with a mean TBSA burn of 7.9% were assessed using a reversal, single-subject experimental design. The experimental condition consisted of the presentation of a cartoon movie as a nonpharmacologic intervention in conjunction with a standardized analgesic medication. In the control condition children's pain was treated with the standardized analgesic medication only. Behavioral distress was measured during the first six dressing changes postburn with the Observational Scale of Behavioral Distress. No significant effect of cartoon movie distraction on observed behavioral distress in patients was found. Interrater reliability of the Observational Scale of Behavioral Distress was good (κ = .87–.98). Wound debridement was found to be the most painful part of the dressing change. A simple, easily applicable, and low-cost distraction intervention such as presenting cartoon movies does not seem to be sufficiently powerful to measurably reduce burned children's distress during dressing changes. Findings are based on purely observational data. Inclusion of self-report measures in future studies might reveal intervention effects on anxiety and subjective pain perception.
Venous Thrombosis Incidence in Burn Patients
Authors: Wahl W. L. , Brandt M. M. , Ahrns K. S. , Zajkowski P. J. , Proctor M. C. , Wakefield T. W. , Greenfield L. J.
Published: November 2003

There are few prospective data on the incidence of deep venous thrombosis (DVT) in burn patients. In an on-going prospective study, hospitalized burn patients 18 years or older with an expected hospital length of stay more than 72 hours were imaged with baseline venous duplex ultrasound of all extremities within the first 48 hours after admission and weekly until discharge. Patient demographics and clinical risk factors for DVT were assessed. At the time of submission, 40 patients met screening criteria, and 30 were enrolled. Ultrasound diagnosed seven patients with 11 acute DVT for an incidence of 23%. One pulmonary embolism was documented. DVT patients had a mean age of 49 ± 23 years with an average TBSA burn of 15 ± 4% compared with those without thrombosis with a mean age of 44 ± 17 years (P = NS) and TBSA burn of 18 ± 25% (P = NS). There were no statistically significant differences for DVT patients in terms of age, number of central line days, hospital length of stay, or TBSA burned. Given the preliminary findings of this small study, we believe that all hospitalized burn patients are at risk for DVT. On-going investigation will be helpful in defining level of risk and improved prevention strategies for thromboembolic complications in burn patients.
An Initial Experience with Telemedicine in Follow-up Burn Care
Authors: Redlick F. , Roston B. , Gomez M. , Fish J. S.
Published: November 2003

Following care in a burn unit, regular outpatient visits with burn specialists are required. The practical use of telemedicine in this context is unknown. The objective of this study was to evaluate patient and physician satisfaction with teleconsultations in follow-up burn care and to assess the costs and benefits of these teleconsultations. Fourteen teleconsultations were conducted between a burn physician and a patient at a remote site. Patients and the physician completed evaluation questionnaires for each teleconsultation. Time-related and financial costs of the consultation service were also determined. Patients were very satisfied with their teleconsultations and found them more economical and time efficient than in-person visits. The consulting physician felt teleconsultations were as satisfactory as clinic visits for the purposes of diagnosis and burn management. Our results support the ongoing use of telemedicine in the follow-up care of burn patients.
The Effect of Silicone Gel Sheets on Perfusion of Hypertrophic Burn Scars
Authors: Musgrave Melinda A. , Umraw Nisha , Fish Joel S. , Gomez Manuel , Cartotto Robert C.
Published: November 2003

The mechanism of action of topical silicone gel sheets on hypertrophic scars is not well understood and their effect on the blood flow within hypertrophic scars has not been investigated. The purpose of this study was to examine whether application of silicone gel sheets produced any acute effects on blood flow in hypertrophic burn scars. Perfusion of hypertrophic scars and adjacent normal skin was measured using a laser Doppler with and without application of silicone gel sheets. Continuous measurements were made for 5 minutes before gel application, for 30 minutes during gel application and for 5 minutes following gel removal. Surface temperature of the scar was continuously monitored. An occupational therapist, blinded to the perfusion level, rated each scar using the Vancouver Scar Scale. Eighteen scars and adjacent control sites in sixteen adult burn patients (11 male, 5 female; mean age: 42 ± 14 years) were evaluated. The mean scar age was 5.4 ± 3.7 months. The mean Vancouver Scar Scale was 5.5 ± 2.4. Hypertrophic scars demonstrated higher perfusion measurements at baseline compared to control areas (58.5 ± 19.3 flux units vs 25.0 ± 8.4 flux units;P < 0.001). Application of silicone sheeting gel did not significantly alter perfusion in either the hypertrophic scar or normal tissue from the baseline measurements. However, application of silicone gel sheeting did significantly increase the mean baseline surface temperature of the hypertrophic scar from 29 ± 0.8 °C to 30.7 ± 0.6 °C (P < 0.001). The mechanism of action of silicone gel sheeting probably does not involve an acute alteration in blood flow within the scar. However, surface temperature of the scar increased significantly following gel application, raising the possibility that temperature alteration is involved in the mechanism of action.
Laryngeal and Phonatory Status After Burn/Inhalation Injury: A Long Term Follow-Up Study
Authors: Casper Janina K. , Clark William R. , Kelley R. T. , Colton R. H.
Published: November 2003

Although persistent hoarseness has been recognized in patients who have sustained burn and/or smoke inhalation injuries, there is little documentation to support this observation. Furthermore, there is no quantification of either the pervasiveness of the problem or the severity of the dysphonia resulting. It was the intent of this study to examine the laryngeal condition and voice production of a group of patients who were long-term survivors of burns and inhalation injuries. Only 10 patients (8 male and 2 female) of a larger cohort were willing to return for this examination. They were ambulatory and did not require respiratory assistance, and it had been 16 to 25 years since their initial traumas. Videostrobolaryngoscopic examinations were performed and analyzed, measures of various acoustic and aerodynamic parameters were made, and severity of dysphonia was judged. Seven of the 10 subjects were rated by experienced listeners as having some degree of dysphonia. All subjects had some abnormality of the laryngeal mucosa. Stroboscopic examination was found to be helpful in identifying laryngeal abnormalities in at least half of the subjects. Early attention to these problems, many of which are treatable surgically or behaviorally or both could lead to an improved voice for the patient and for this reason an improved quality of life.
Regulating Acute Posttrauma Distress
Authors: Fauerbach James A. , Richter Linda , Lawrence John W.
Published: November 2003

The influence of emotion-approach and emotion-avoidance methods of coping on the development (cohort 1) and persistence (cohort 2) of posttraumatic stress symptoms was examined. The two coping methods and the frequency and intensity of intrusive, avoidant, and hyperarousal symptoms were assessed in separate series of 71 and 94 hospitalized acute burn-injured patients. In both samples, subjects who frequently used both mental distancing (emotion-avoidance) and venting emotions (emotion-approach), relative to subjects who used only one or neither of the two coping methods, had higher levels of posttraumatic stress disorder symptoms even when controlling for baseline symptoms. Higgins' (1997) motivational framework, incorporating the needs for controllability and predictability, and Wegner's (1994) theory of mental control are used to interpret the findings.
The Effect of Burn Nursing Units on Burn Wound Infections
Authors: Thompson James T. , Meredith J. Wayne , Molnar Joseph A.
Published: November 2003

Temporary closure of our burn unit allowed evaluation of the effect of a closed unit on infection rates. During renovations, burned patients were treated either in private ward rooms or in the intensive care unit by burn unit nursing staff using the same wound care practices as used in the burn unit. Data regarding burn severity and outcome were collected and compared for all patients treated before (Group A), during (Group B), and after (Group C) renovations. Burned surface area, average age, and hospital stay were statistically similar for each group. Incidence of infection differed significantly (P < 0.005) with 47% of Group B developing infection compared with 11 and 23% for Groups A and C respectively. Mortality rates were not significantly different. Despite consistent wound care the incidence of infection increased nearly two-fold to four-fold when patients were treated out of the unit. We recommend a temporary isolation unit during renovations if possible.
Early Tracheostomy Does Not Improve Outcome in Burn Patients
Authors: Saffle Jeffrey R. , Morris Stephen E. , Edelman Linda
Published: November 2003

Early tracheostomy (ET) has been claimed to reduce ventilator support or intensive care unit or hospital length of stay in intensive care unit patients. This study was performed to assess the potential benefits of ET in burn patients. From October 1996 to July 2001, we evaluated all intubated and acutely burned adults using a formula to predict the probability of prolonged ventilator dependence. We randomized each patient with a probability of prolonged ventilator dependence more than 0.5 to ET, performed on the next operative day, or to conventional therapy (CON), which consisted of continued endotracheal intubation as needed, with tracheostomy (TRACH) performed on postburn day (PBD) 14 if necessary. During this period, 44 patients were randomized, 23 to CON and 21 to ET. Groups did not differ in age, total burn size, or inhalation injury, although ET patients had larger full-thickness burns. ET patients underwent TRACH at a mean of PBD 4 vs PBD 14.8 for CON patients (P < .01). ET patients had a significant improvement in PaO2/FiO2 ratios within 24 hours following TRACH (139 ± 15 vs 190 ± 12;P < .01). There were no differences in ventilator support, length of stay, incidence of pneumonia, or survival. However, six CON patients (26%) were successfully extubated by PBD 14 compared with one ET patient (P < .01). Although tracheostomy offers some advantages in terms of patient comfort and security, routine performance of ET in burn patients does not improve outcomes, nor does it result in earlier extubation. This may be partly caused by the comfort and convenience of tracheostomy.
A Prospective, Randomized Comparison of the Volume Diffusive Respirator® vs Conventional Ventilation for Ventilation of Burned Children
Authors: Carman B. , Cahill T. , Warden G. , McCall J.
Published: November 2003

The Volume Diffusive Respirator® (VDR) is a high-frequency time cycled pressure ventilator that can ventilate, oxygenate, and promote secretion removal. The VDR provides ventilation at lower airway pressures than those required for conventional ventilation in the pressure control mode (PCV). A prospective, randomized, institutional review board–approved study was conducted comparing the VDR to PCV in burned children with respiratory failure from all causes. Methods: Pediatric burn patients requiring ventilation were stratified by presence of inhalation injury and ventilated by VDR or PCV to achieve predefined arterial blood gases. Results: Sixty-four patients were prospectively assigned ventilator type; 32 to VDR, 32 to PCV. Data are reported as mean + SEM. Patient age was 7.4 + 0.7 years, TBSA was 56 + 3%, and number of patients with inhalation injuries was 55 (86%). Maximum peak inspiratory pressure with the VDR was significantly less than with PCV (30.9 + 0.8 cm H2O vs 39.5 + 1.8 cm H2O, P < 0.05) and the best PaO2/FIO2 ratio was significantly higher with the VDR compared with PCV (563 + 15 vs 507 + 13, P < 0.05). No patient in the VDR group had evidence of barotrauma compared with two in the PCV group. Five patients in the PCV group died compared with two in the VDR group. Conclusion: Patients ventilated with the VDR required significantly lower peak inspiratory pressure and achieved a significantly higher PaO2/FIO2 ratio compared with PCV. This demonstrates the VDR is a safe and effective method of ventilation for pediatric burn patients and it offers advantages when compared with conventional ventilation.
Comparison of Patient Satisfaction and Self-Reports of Pain in Adult Burn-Injured Patients
Authors: Carrougher Gretchen J. , Ptacek J. T. , Sharar Sam R. , Wiechman Shelley , Honari Shari , Patterson David R. , Heimbach David M.
Published: November 2003

Procedural and background pain scores were assessed prospectively and compared with treatment goals and satisfaction scores in 84 adult (67 men and 17 women) burn-injured patients treated at a single, tertiary care medical center. We hypothesized that patient satisfaction with pain management plans would be highest among those patients who were experiencing the least pain and also among patients whose experiences most closely matched their treatment analgesic goals. Twice-weekly patient self-reports of worst and average procedural pain, background pain, treatment goals (the level of procedural pain and background pain patients reported that they would be satisfied as experiencing), and overall satisfaction with pain management plans were assessed using 10-point Graphic Rating Scales. Data concerning adjunctive treatments were also obtained. Opioid equivalents, representing pain medications administered, were compared. The majority of patients perceived that “no pain” during burn wound care was an unrealistic goal, a perception that was consistent throughout hospitalization. As hypothesized, average procedural pain levels demonstrated a negative association with patient satisfaction, indicating that patients with the highest levels of procedural pain also reported the lowest level of satisfaction. Opioid analgesic dosing was not significantly associated with ratings of procedural pain or treatment goals. Our findings support the hypothesis that patient satisfaction with pain management is highest in those who experience the least amount of burn care pain and do not support the hypothesis that satisfaction is highest in those whose pain experiences most closely match treatment analgesic goals.
Iatrogenic Burns by Warming Bottles in the Neonatal Period
Authors: Möhrenschlager Matthias , Weigl Lorenz B. , Haug Susanne , Schnopp Christina , Cremer Hansjörg , Ring Johannes , Abeck Dietrich
Published: November 2003

The cases presented in this article highlight the dangers of applying warming bottles to neonates. Warming devices as cool as 42°C (107.6°F) can burn an infant.
Personality, Coping, Chronic Stress, Social Support and PTSD Symptoms Among Adult Burn Survivors
Authors: Lawrence John W. , Fauerbach James A.
Published: November 2003

This paper presents a longitudinal study of the relationship between personality, coping, chronic stress, social support and posttraumatic stress disorder (PTSD). A hypothesized model of the relationship between the predictor variables and PTSD symptoms was proposed. Path analyses was completed to test the model. One hundred fifty-eight adult burn survivors completed questionnaires measuring each of the variables in the hospital. Of those 124 and 94 completed the PTSD measure at 1 month and 6 months postdischarge, respectively. The hypothesized model fit the data at each time point with slight variations. The model accounted for 46 and 29% of the variance of PTSD symptoms at hospitalization and 1 month. Neuroticism was the most important personality dimension in predicting PTSD. Avoidant Coping and Social Support mediated a high percentage of the relationship between Neuroticism and PTSD. The best predictor of PTSD symptoms at 1 and 6 months was PTSD symptoms at hospitalization.
Ischemia-Induced Neuronal Damage: A Role for Calcium/Calmodulin-Dependent Protein Kinase II
Authors: Waxham M. Neal , Grotta James C. , Silva Alcino J. , Strong Roger , Aronowski Jaroslaw
Published: November 2003

Calcium/calmodulin-dependent protein kinase II (CaM-kinase) is a central enzyme in regulating neuronal processes. Imbalances in the activity and distribution of this enzyme have been reported following in vivo ischemia, and sustained decreases in activity correlate with subsequent neuronal death. In this report, mice that had been rendered deficient in the alpha subunit of CaM-kinase using gene knock-out technology were utilized to determine whether this enzyme is causally related to ischemic damage. Using a focal model of cerebral ischemia, we showed that homozygous knock-out mice lacking the alpha subunit exhibited an infarct volume almost twice that of wild-type litter mates. Heterozygous mice exhibited slightly less damage following ischemia than did homozygous mice, but infarct volumes remained significantly larger than those of wild-type litter mates. We conclude that reduced amounts of the alpha subunit of CaM-kinase predisposes neurons to increased damage following ischemia and that any perturbation that decreases the amount or activity of the enzyme will produce enhanced susceptibility to neuronal damage.
Frequency-Dependent Changes of Regional Cerebral Blood Flow during Finger Movements
Authors: Sadato Norihiro , Ibañez Vicente , Deiber Marie-Pierre , Campbell Gregory , Leonardo Marc , Hallett Mark
Published: November 2003

To study the effect of the repetition rate of a simple movement on the distribution and magnitude of neuronal recruitment, we measured regional CBF (rCBF) in eight normal volunteers, using positron emission tomography and 15O-labeled water. An auditory-cued, repetitive flexion movement of the right index finger against the thumb was performed at very slow (0.25 and 0.5 Hz), slow (0.75 and 1 Hz), fast (2 and 2.5 Hz), and very fast (3 and 4 Hz) rates. The increase of rCBF during movement relative to the resting condition was calculated for each pair of movement conditions. Left primary sensorimotor cortex showed no significant activation at the very slow rates. There was a rapid rise of rCBF between the slow and the fast rates, but no further increase at the very fast rates. The right cerebellum showed similar changes. Changes in the left primary sensorimotor cortex and the cerebellum likely reflect the effect of the movement rate. The posterior supplementary motor area (SMA) showed its highest activation at the very slow rates but no significant activation at the very fast rates. Changes correlating with those in the SMA were found in the anterior cingulate gyrus, right prefrontal area, and right thalamus. The decreases in CBF may reflect a progressive change in performance from reactive to predictive.
Heat-Shock Protein and C-fos Expression in Focal Microvascular Brain Damage
Authors: Lindsberg Perttu J. , Frerichs Kai U. , Sirén Anna-Leena , Hallenbeck John M. , Nowak Thaddeus S.
Published: November 2003

Cortical brain damage was produced in rats by a focal pulse from a Nd-YAG laser, and evolution of the lesion was evaluated at 30 min, and 2, 8, and 24 h with respect to microvascular perfusion, blood–brain barrier (BBB) permeability, and expression of both the heat-shock/stress protein, hsp72, and the c- fos proto-oncogene transcription factor. A double-labeling fluorescence technique employing intravenously injected Evans blue albumin (EBA) and fluorescein-labeled dextran was used to map and measure BBB damage and microvascular perfusion in fresh frozen brain sections. Hsp72 and c- fos mRNAs were localized by in situ hybridization, and the respective proteins were identified by immunocytochemistry. Parallel sections were stained for glial fibrillary acidic protein and for routine histologic examination. Striking hsp72 mRNA expression was evident by 2 h in an ∼300 μm wide rim surrounding an area of expanding BBB damage. Increased hsp72 mRNA was observed only in regions of preserved microcirculation, where the hsp72 protein was subsequently localized exclusively in the vasculature at 24 h after the insult. Hsp72-positive endothelial cells spanned the narrow margin between the lesion and histologically normal, glial fibrillary acidic protein (GFAP)-positive cortical tissue. There was no hsp72 expression in the area of subcortically migrating edema fluid. Inductions of c- fos mRNA and Fos protein were not strikingly evident around the focal brain lesion, but were observed transiently throughout the injured hemisphere at 30 min and 2.5 h, respectively, indicating that spreading depression was triggered by the focal injury. These results are in striking contrast to those previously obtained from studies of models of focal ischemic or traumatic brain injury, which are characterized by a complex pattern of glial and neuronal hsp72 expression in the periphery of an infarct, and which suggest that the tightly demarcated lesion produced by the Nd-YAG laser lacks these components of graded injury that are evident following other types of focal brain damage.
Secondary Elevation of Extracellular Neurotransmitter Amino Acids in the Reperfusion Phase following Focal Cerebral Ischemia
Authors: Matsumoto Keigo , Lo Eng H. , Pierce Allen R. , Halpern Elkan F. , Newcomb Robert
Published: November 2003

The purpose of this study was to evaluate amino acid neurotransmitter dynamics in the reperfusion phase after transient cerebral ischemia. In vivo microdialysis was used to measure extracellular amino acid levels in a rabbit model of focal ischemia. During 30 min of transient ischemia (n = 5), small but significant (p < 0.05) increases in glutamate, aspartate, γ-aminobutyric acid (GABA), and taurine were noted. These elevations rapidly returned to baseline levels upon recirculation and remained constant for up to 5.5 h of reperfusion. In rabbits subjected to 2 h of transient ischemia (n = 5), two phases of amino acid release were seen. During ischemia, large (5- to 50-fold) elevations in glutamate, aspartate, GABA, and taurine occurred, as expected. These elevations rapidly normalized upon unocclusion. However, significant (p < 0.05) secondary elevations in glutamate, aspartate, and GABA occurred after 2–4 h of reperfusion. Regression analysis demonstrated significant correlations between primary (ischemic) and secondary (reperfusion) efflux. In permanent ischemia (n = 5), amino acid levels remained elevated throughout the entire experiment. Secondary elevations in excitatory amino acids may further contribute to the excitotoxic cascade during reperfusion.
Cerebral Metabolism following Neonatal or Adult Hemineodecortication in Cats: I. Effects on Glucose Metabolism Using [14C]2-Deoxy-D-Glucose Autoradiography
Authors: Hovda David A. , Villabianca Jaime R. , Chugani Harry T. , Phelps Michael E.
Published: November 2003

In the cat, cerebral hemispherectomy sustained neonatally results in a remarkable degree of recovery and/or sparing of function as compared with the effects of a similar lesion but sustained in adulthood. We have proposed that this effect is due to a combination of reduced neuronal loss within partially denervated structures and a lesion-induced reorganization of corticofugal projections arising from the remaining intact hemisphere in the neonatally lesioned animal. The current study was designed to assess the physiological consequences of these anatomical changes utilizing [14C]2-deoxy-D-glucose autoradiography. A total of 17 adult cats were studied. Seven animals served as intact controls, five received a left cerebral hemineodecortication as neonates (NH; mean age 11.4 days), and five sustained the same lesion in adulthood (AH). Histological analysis indicated that the lesion was very similar between the two age groups and essentially represented a unilateral hemineodecortication. Local CMRglc (LCMRglc; μmol 100 g-1 min-1) values were calculated for 50 structures bilaterally and indicated that in the remaining intact contralateral (right) cerebral cortex (including all areas measured), AH cats exhibited a significantly (p < 0.05) lower level of LCMRglc (ranging from 20 to 72 μmol 100 g-1 min-1) than NH (ranging from 49 to 81 μmol 100g-1 min-1). In comparison, the rates of NH cats within the cerebral cortex were very similar to those seen in intact animals (ranging from 48 to 119 μmol 100 g-1 min-1). Ipsilateral to the lesion in AH cats, the structures spared by the resection, including the basal ganglia and thalamus, exhibited LCMRglc rates of between 23 and 69 μmol 100 g-1 min-1, which were significantly lower (p < 0.05) than in NH cats (range 47–72 μmol 100 g-1 min-1). Considering all structures, both age-at-lesion groups exhibited a lower level of metabolism compared with similar measurements for intact control animals (LCMRglc range 45–75 μmol 100 g-1 min-1). However, this depression of glucose metabolism was more pronounced in the AH cats (p < 0.05). These results indicate that following neonatal hemineodecortication, LCMRglc is maintained at a higher level in many regions of the brain than in animals that sustain the same resection in adulthood. This higher level of glucose metabolism in NH animals suggests that the lesion-induced anatomical reorganization of structures not directly injured by the lesion plays a functional role that is probably responsible for the greater degree of recovery and/or sparing of function in these early lesioned cats.
Hemodynamic Simulation Study of Cerebral Arteriovenous Malformations. Part 2. Effects of Impaired Autoregulation and Induced Hypotension
Authors: Nagasawa Shiro , Kawanishi Masahiro , Kondoh Susumu , Kajimoto Sachiko , Yamaguchi Kazunobu , Ohta Tomio
Published: November 2003

The hemodynamic changes occurring during obliteration procedures for arteriovenous malformations (AVM) have not been fully elucidated. Therefore, we undertook a simulation study using a compartmental flow model to investigate the role of altered autoregulatory conditions in the development of hyperperfusion during obliteration of large high-flow AVM. Induced hypotension was also simulated to evaluate its usefulness in reducing the incidence and severity of the event. As the AVM flow was decreased during the obliteration procedures, feeder pressure increased and drainer pressure decreased, with a concomitant increase in the perfusion pressure in the brain tissue surrounding the AVM. Cerebral blood flow (CBF) remained constant at 50 ml 100 g−1 min−1 in the presence of autoregulation and increased to 67 ml 100 g−1 min−1 in its absence. When the lower limit of the autoregulatory pressure range (LAR) was shifted from 60 to 50 or 40 mm Hg, the flow volume increased markedly from 67 to 77 ml 100 g−1 min−1 or to 92 ml 100 g−1 min−1 after complete obliteration. Decrease in LAR would be a cause of the hyperperfusion. Induced systemic hypotension was found to be effective in reducing the magnitude of these hemodynamic changes, when induction was appropriately performed in a stepwise fashion. A simulation study is useful in clarifying the various hemodynamic changes that develop during the treatment of AVM.