bluuebunny/crossref_metadata_2025 huggingface dataset:
Heteroqueer Ladies: Some Performative Transactions between Gay Men and Heterosexual Women
Authors: Mock Roberta
Published: November 2003

As theories of performativity struggle to disentangle and reconfigure the relationships between act and identity, a heterowoman who relishes the performance of femininity is still aware that she can be read as reactionary. Her choice of sexual partners seems to undermine the efficacy of similar strategies constructed by femme lesbians. One queer option for a heterosexual woman is to ‘act’ like a gay man. As more than one cultural commentator has pointed out, it appears that only a male drag queen can be a ‘lady’ these days. This particular woman does not want to change her biological sex to ‘be’ a gay man. She has learned how to be a ‘lady’ from the ‘feminized fags’ who may have learned from her mother. Their ironic distancing, camp connoiseurship, and parodic appropriation of the notion of a stable gender identity came as part of the package. As a result of this transaction, she acts as if she has balls under her dress. Such mimetic masquerades can be most easily recognized as resistant when performativity is ‘bound’ into a formalized performance. It is implicit that this artifice is not sustainable, nor is this desirable. ‘Doing’ queer means possessing the agency to defy and destabilize gendered behaviours, sexes, and sexualities through continuing and conscious decisions. This article explores the efficacy of heterosexual femme performances that attempt to challenge and subvert ideological normativities through their transactions with gay men.
Mycobacterium tuberculosisPhagosome Maturation Arrest: Mycobacterial Phosphatidylinositol Analog Phosphatidylinositol Mannoside Stimulates Early Endosomal Fusion
Authors: Vergne Isabelle , Fratti Rutilio A. , Hill Preston J. , Chua Jennifer , Belisle John , Deretic Vojo
Published: November 2003

Mycobacterium tuberculosis is a facultative intracellular pathogen that parasitizes macrophages by modulating properties of the Mycobacterium-containing phagosome. Mycobacterial phagosomes do not fuse with late endosomal/lysosomal organelles but retain access to early endosomal contents by an unknown mechanism. We have previously reported that mycobacterial phosphatidylinositol analog lipoarabinomannan (LAM) blocks a trans-Golgi network-to-phagosome phosphatidylinositol 3-kinase-dependent pathway. In this work, we extend our investigations of the effects of mycobacterial phosphoinositides on host membrane trafficking. We present data demonstrating that phosphatidylinositol mannoside (PIM) specifically stimulated homotypic fusion of early endosomes in an ATP-, cytosol-, and N-ethylmaleimide sensitive factor-dependent manner. The fusion showed absolute requirement for small Rab GTPases, and the stimulatory effect of PIM increased upon partial depletion of membrane Rabs with RabGDI. We found that stimulation of early endosomal fusion by PIM was higher when phosphatidylinositol 3-kinase was inhibited by wortmannin. PIM also stimulated in vitro fusion between model phagosomes and early endosomes. Finally, PIM displayed in vivo effects in macrophages by increasing accumulation of plasma membrane-endosomal syntaxin 4 and transferrin receptor on PIM-coated latex bead phagosomes. In addition, inhibition of phagosomal acidification was detected with PIM-coated beads. The effects of PIM, along with the previously reported action of LAM, suggest that M. tuberculosis has evolved a two-prong strategy to modify its intracellular niche: its products block acquisition of late endosomal/lysosomal constituents, while facilitating fusion with early endosomal compartments.
Global Phenotypic Analysis and Transcriptional Profiling Defines the Weak Acid Stress Response Regulon inSaccharomyces cerevisiae
Authors: Schüller Christoph , Mamnun Yasmine M. , Mollapour Mehdi , Krapf Gerd , Schuster Michael , Bauer Bettina E. , Piper Peter W. , Kuchler Karl
Published: November 2003

Weak organic acids such as sorbate are potent fungistatic agents used in food preservation, but their intracellular targets are poorly understood. We thus searched for potential target genes and signaling components in the yeast genome using contemporary genome-wide functional assays as well as DNA microarray profiling. Phenotypic screening of the EUROSCARF collection revealed the existence of numerous sorbate-sensitive strains. Sorbate hypersensitivity was detected in mutants of the shikimate biosynthesis pathway, strains lacking the PDR12 efflux pump or WAR1, a transcription factor mediating stress induction of PDR12. Using DNA microarrays, we also analyzed the genome-wide response to acute sorbate stress, allowing for the identification of more than 100 genes rapidly induced by weak acid stress. Moreover, a novel War1p- and Msn2p/4p-independent regulon that includes HSP30 was identified. Although induction of the majority of sorbate-induced genes required Msn2p/4p, weak acid tolerance was unaffected by a lack of Msn2p/4p. Ectopic expression of PDR12 from the GAL1-10 promoter fully restored sorbate resistance in a strain lacking War1p, demonstrating that PDR12 is the major target of War1p under sorbic acid stress. Interestingly, comparison of microarray data with results from the phenotypic screening revealed that PDR12 remained as the only gene, which is both stress inducible and required for weak acid resistance. Our results suggest that combining functional assays with transcriptome profiling allows for the identification of key components in large datasets such as those generated by global microarray analysis.
Repositioning of Muscle-specific Genes Relative to the Periphery of SC-35 Domains during Skeletal Myogenesis
Authors: Moen Phillip T. , Johnson Carol Villnave , Byron Meg , Shopland Lindsay S. , de la Serna Ivana L. , Imbalzano Anthony N. , Lawrence Jeanne Bentley
Published: November 2003

Previous studies have shown that in a given cell type, certain active genes associate with SC-35 domains, nuclear regions rich in RNA metabolic factors and excluded from heterochromatin. This organization is not seen for all active genes; therefore, it is important to determine whether and when this locus-specific organization arises during development and differentiation of specific cell types. Here, we investigate whether gene organization relative to SC-35 domains is cell type specific by following several muscle and nonmuscle genes in human fibroblasts, committed but proliferative myoblasts, and terminally differentiated muscle. Although no change was seen for other loci, two muscle genes (Human β-cardiac myosin heavy chain and myogenin) became localized to the periphery of an SC-35 domain in terminally differentiated muscle nuclei, but not in proliferative myoblasts or in fibroblasts. There was no apparent change in gene localization relative to either the chromosome territory or the heterochromatic compartment; thus, the gene repositioning seemed to occur specifically with respect to SC-35 domains. This gene relocation adjacent to a prominent SC-35 domain was recapitulated in mouse 3T3 cells induced into myogenesis by introduction of MyoD. Results demonstrate a cell type-specific reorganization of specific developmentally regulated loci relative to large domains of RNA metabolic factors, which may facilitate developmental regulation of genome expression.
Transcardiopulmonary vs Pulmonary Arterial Thermodilution Methods for Hemodynamic Monitoring of Burned Patients
Authors: Küntscher Markus V. , Blome-Eberwein Sigrid , Pelzer Michael , Erdmann Detlev , Germann Günter
Published: November 2003

The objective of this study was to validate a new method of transcardiopulmonary thermodilution for assessment of cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI) and additional parameters such as intrathoracic blood volume index and extravascular lung water index (EVLWI) by comparison with conventional pulmonary artery catheter values in a severely burned population. The pulmonary artery measurements were performed continuously with the Vigilance system, and the transcardiopulmonary thermodilution with the PiCCO® system. One hundred thirteen measurements with each system on up to six consecutive days were taken in 14 severely burned patients (average TBSA, 49.6%; average ABSI, 10.3), aged 21 to 61 years (mean, 42.2 years) and compared intraindividually. An excellent correlation between the two methods was shown for CI (r = 0.80) and its derived parameters SVI and SVRI in states of low to normal cardiac output. The correlation was poor for cardiac indices greater then 5.5 up to their maximum values (r = 0.46). No correlation between index of oxygenation (PaO2/FiO2) vs EVLW I was observed. There was no difference between survivors and nonsurvivors, and between patients with and without inhalation injury in EVLWI. The method of transcardiopulmonary thermodilution is suitable to assess SVI, CI and SVRI under the special pathophysiologic condition of a major burn for low to normal cardiac output states. It is less reliable when cardiac output is high. The lower cost and less invasive nature are the advantages of the system compared with use of the pulmonary artery catheter. The role of intrathoracic blood volume index and EVLWI in cardiopulmonary monitoring of severely burned patients remains to be further determined.
A Comparison of Oral Transmucosal Fentanyl Citrate and Oral Oxycodone for Pediatric Outpatient Wound Care
Authors: Sharar S. R. , Carrougher G. J. , Selzer K. , O'Donnell F. , Vavilala M. S. , Lee L. A.
Published: November 2003

Analgesia for pediatric burn wound care in the outpatient clinic is constrained by time, personnel, and/or monitoring capabilities, yet may improve patient satisfaction and comfort, clinic efficiency, and patient throughput. The ideal analgesic in this increasingly common setting should be palatable, provide potent, rapid, and brief analgesia, and require minimal appropriate monitoring. Using a placebo-controlled, double-blind design we compared oral transmucosal fentanyl citrate (OTFC, ≈10 μg/kg) and oral oxycodone (0.2 mg/kg) in 22 pediatric outpatient wound care procedures (ages 5–14 years). Pulse oximetry, vital signs, side effects, patient pain scores, and observer scores for cooperation, anxiety, and sedation were recorded. OTFC and oral oxycodone resulted in similar outcome measures and vital signs, and no significant side effects. The taste of OTFC was preferred. We conclude that OTFC and oral oxycodone are safe and effective analgesics in the setting of monitored outpatient wound care in children, and that OTFC offers the advantage of improved palatability.
Epidemiology of Childhood Burn Injuries in Fars Province, Iran
Authors: Lari Abdolaziz Rastegar , Panjeshahin Mohammad-Reza , Talei Ali-Reza , Rossignol Annette MacKay , Alaghehbandan Reza
Published: November 2003

Childhood burn injuries are a major environmental agent responsible for significant morbidity and mortality in Iran. Thus, the objective of this study was to analyze the epidemiology and current causative factors of hospitalized burn injuries among the approximately 1.6 million children between the ages of birth through 15 years residing in the Fars province of Iran. These data will be used as a basis for developing a targeted preventive program to protect children from burns. Epidemiologic data for 760 children, aged 0 to 15 years, admitted to the two burn centers of Shiraz University of Medical Sciences, over a 4-year period, 1994 to 1998, were collected and analyzed. The overall hospitalization rate was 11.8 per 100,000 person-years (PY). The sex ratio (boys/girls) was 1.38. About 60% were children aged 7 years or younger. Children aged 2 years had the highest burn incidence rate (36.9/100,000 PY). A total of 77.4% of the children had body surface area burns less than 40%. Scalds accounted for 46.2% of the burns, whereas 42.9% were caused by flame. Most of the burn injuries occurred at home (93%). There were 31 burns from suicide attempts among children aged 11 to 15 years (1.4/100,000 PY), showing a major public health problem for these children in our society. During the period of the study, 131 children died of the consequences of burns (2/100,000 PY). The epidemiology of childhood burn injuries in the Fars province is similar to that reported in other economically developing countries. It is suggested that a public health education campaign on this issue would help to reduce the incidence of childhood burn injuries in this region.
Changes in Bone Marrow-Derived Myeloid Cells from Thermally Injured Rats Reflect Changes in the Progenitor Cell Population
Authors: Noel J. Gregory , Valente John F. , Ogle James D. , Cornelius James , Custer David A. , Li Bing Guo , Alexander J. Wesley , Ogle Cora K.
Published: November 2003

Bone marrow progenitor cells develop into mature tissue myeloid cells under the influence of colony-stimulating factors. Cytokines that are elevated post-thermal injury have been shown to influence this process. We hypothesize that thermal injury alters myelopoiesis at the level of the progenitor cell. These differences should be visible after in vitro cultures that include colony-stimulating factors. Prior to culture, bone marrow at postburn day 1 (PBD1) was assessed for cell surface markers and the levels of myeloid progenitors. After culture in granulocyte/macrophage-stimulating colony-stimulating factor, the cell surface markers of the cultured cells were determined. PBD1 marrow from thermally injured rats had more progenitor cells responsive to granulocyte/macrophage-stimulating colony-stimulating factor than did sham. Cultured PBD1 marrow produced more CD90br MYbr CD45dim CD4− MHCII− CD11bdim eosinophils than did sham. Cultured bone marrow from thermally injured animals produces myeloid cells with an altered phenotype. Similar changes in myelopoiesis may take place in vivo.
A Multicenter Review of Toxic Epidermal Necrolysis Treated in U.S. Burn Centers at the End of the Twentieth Century
Authors: Palmieri T. L. , Greenhalgh D. G. , Saffle J. R. , Spence R. J. , Peck M. D. , Jeng J. C. , Mozingo D. W. , Yowler C. J. , Sheridan R. L. , Ahrenholz D. H. , Caruso D. M. , Foster K. N. , Kagan R. J. , Voigt D. W. , Purdue G. F. , Hunt J. L. , Wolf S. , Molitor F.
Published: November 2003

Toxic epidermal necrolysis (TEN) is a potentially fatal disorder that involves large areas of skin desquamation. Patients with TEN are often referred to burn centers for expert wound management and comprehensive care. The purpose of this study was to define the presenting characteristics and treatment of TEN before and after admission to regional burn centers and to evaluate the efficacy of burn center treatment for this disorder. A retrospective multicenter chart review was completed for patients admitted with TEN to 15 burn centers from 1995 to 2000. Charts were reviewed for patient characteristics, nonburn hospital and burn center treatment, and outcome. A total of 199 patients were admitted. Patients had a mean age of 47 years, mean 67.7% total body surface area skin slough, and mean Acute Physiology and Chronic Health Evaluation (APACHE II) score of 10. Sixty-four patients died, for a mortality rate of 32%. Mortality increased to 51% for patients transferred to a burn center more than one week after onset of disease. Burn centers and nonburn hospitals differed in their use of enteral nutrition (70 vs 12%, respectively, P < 0.05), prophylactic antibiotics (22 vs 37.9%, P < 0.05), corticosteroid use (22 vs 51%, P < 0.05), and wound management. Age, body surface area involvement, APACHE II score, complications, and parenteral nutrition before transfer correlated with increased mortality. The treatment of TEN differs markedly between burn centers and nonburn centers. Early transport to a burn unit is warranted to improve patient outcome.
Treatment of Pain in Acutely Burned Children
Authors: Stoddard F. J. , Sheridan R. L. , Saxe G. N. , King B. S. , King B. H. , Chedekel D. S. , Schnitzer J. J. , Martyn J. A. J.
Published: November 2003

The child with burns suffers severe pain at the time of the burn and during subsequent treatment and rehabilitation. Pain has adverse physiological and emotional effects, and research suggests that pain management is an important factor in better outcomes. There is increasing understanding of the private experience of pain, and how children benefit from honest preparation for procedures. Developmentally appropriate and culturally sensitive pain assessment, pain relief, and reevaluation have improved, becoming essential in treatment. Pharmacological treatment is primary, strengthened by new concepts from neurobiology, clinical science, and the introduction of more effective drugs with fewer adverse side effects and less toxicity. Empirical evaluation of various hypnotic, cognitive, behavioral, and sensory treatment methods is advancing. Multidisciplinary assessment helps to integrate psychological and pharmacological pain-relieving interventions to reduce emotional and mental stress, and family stress as well. Optimal care encourages burn teams to integrate pain guidelines into protocols and critical pathways for improved care.
Effective Limitation of Blood Culture Use in the Burn Unit
Authors: Keen Angela , Knoblock Lyn , Edelman Linda , Saffle Jeffrey
Published: November 2003

There is little data to support the use of blood culture (BC) testing in the burn patient. Clinical signs (fever, leukocytosis) may not reliably indicate infection; moreover, BC's are expensive, invasive and plagued by false positive results. A policy of critical evaluation of lab utilization was instituted in our burn unit in 1993. By 1997 the use of blood culture testing had decreased by 50%. A retrospective analysis of our change in BC utilization was undertaken to derive practice guidelines for usage of this test. Methods: 47 patients with BC testing in 1997 were compared to a cohort of 47 patients from 1993, representing a total of 441 BC episodes. Results: Comparison of 1993 and 1997 patients revealed no significant differences in patient characteristics or outcomes. The mean white blood cell count and maximum temperature on the day of culture were identical for both positive and negative BC episodes. However, BC's drawn during a state of shock were twice as likely to be positive. Patients who experienced positive BC's had larger burns, received more antibiotics, had more indwelling catheters, and had longer lengths of ventilator support and hospital stays. Conclusions: Higher patient acuity or the presence of indwelling catheters increases the likelihood of a positive BC. Substantial limitation of BC's without observed changes in length of stay, ventilator days, or mortality suggests that this test can be safely limited without compromising patient outcomes.
Development and Initiation of Computer Generated Documentation for Burn Patient Care
Authors: Heistein J. B. , Coffey R. A. , Buchele B. A. , Gordillo G. M.
Published: November 2003

Burn care is costly, complex, and poorly reimbursed. Capturing evaluation and management codes is an essential step in obtaining reimbursement for services rendered. For surgeons used to billing on the basis of Current Procedural Terminology codes, this represents a significant paradigm shift. In an effort to document the care provided and increase compliance with billing standards, we created computerized history and physical examination notes and progress notes specifically for burn patients. Drop down menus are included to answer directed queries, which allows the majority of the documentation to be completed with a point and click of the mouse. The note is completed by the house staff except for the “assessment and plan,” which are entered by the attending physician who reviews and then electronically signs the note. A log of electronically signed notes is generated weekly for billing purposes. The use of these computerized documents has been reviewed and approved by the coding and quality assurance specialists within our billing organization. We believe these tools maximize the efficiency of documenting burn patient care, while minimizing the effort necessary to comply with evaluation and management guidelines. The aim of this study was to test the new computerized method at our institution to see whether it would improve documentation for evaluation and management services provided to burn patients. The results prove that this new system accomplished the goal we had set.
Use of Integra® Artificial Skin Is Associated With Decreased Length of Stay for Severely Injured Adult Burn Survivors
Authors: Ryan Colleen M. , Schoenfeld David A. , Malloy Maryanne , Schulz John T. , Sheridan Robert L. , Tompkins Ronald G.
Published: November 2003

Mortality and length of stay (LOS) of survivors was examined retrospectively in 270 adults with acute burns ≥20% of body surface area to determine the effect of Integra® Dermal Regeneration Template treatment on outcome. No difference in mortality was found between patients who received Integra® (30%; n = 43) and patients who did not (30%; n = 227). Surviving Integra® patients (n = 30) stayed longer, but they were more extensively injured than survivors who did not receive Integra® (n = 158), and therefore longer hospitalizations were expected. In a subgroup analysis, mean LOS of Integra® patients with two or more mortality risk factors (age > 60 years, burn size >40% body surface area, or inhalation injury; n = 15) was 63 days compared with 107 days in patients with two or more risk factors (n = 29) who did not receive Integra® (P = .014). Integra® use in severely injured burned adults was associated with a marked decrease in LOS.
Dermatome Setting for Autografts to Cover INTEGRA®
Authors: Fang P. , Engrav L.H. , Gibran N.S. , Honari S. , Kiriluk D.B. , Cole J.K. , Fleckman Philip , Heimbach D. M. , Bauer G.J. , Matsumura H. , Warner P.
Published: November 2003

Using the INTEGRA® Dermal Regeneration Template requires the outer silastic layer to be replaced with an autograft. We followed the manufacturer's directions for epidermal autografting and frequently obtained shredded, useless grafts and, therefore, it seemed important to determine the proper dermatome setting. We evaluated dermatome settings from 0.002 to 0.012 inches. First, with feeler gauges, we verified the dermatome settings. Second, we harvested skin at various dermatome settings and measured the thickness histologically. We found that 1) the dermatome settings are reasonably accurate; 2) harvesting useful sheets at 0.002 and 0.004 inches is virtually impossible; 3) the variability of histologic graft thickness is enormous; and 4) a dermatome setting of 0.006 inches yields useful grafts. We no longer use the term epidermal autografting but rather ultrathin split-thickness grafting. To harvest these grafts, we now merely set the dermatome to 0.006 inches and make whatever midcourse corrections are necessary to obtain translucent grafts.
An Assessment of Burn Prevention Knowledge in a High Burn-Risk Environment: Restaurants
Authors: Piazza-Waggoner C. , Adams C.D. , Goldfarb I. W. , Slater H.
Published: November 2003

Our facility has seen an increase in the number of cases of children burned in restaurants. Fieldwork has revealed many unsafe serving practices in restaurants in our tristate area. The current research targets what appears to be an underexamined burn-risk environment, restaurants, to examine server knowledge about burn prevention and burn care with customers. Participants included 71 local restaurant servers and 53 servers from various restaurants who were recruited from undergraduate courses. All participants completed a brief demographic form as well as a Burn Knowledge Questionnaire. It was found that server knowledge was low (ie, less than 50% accuracy). Yet, most servers reported that they felt customer burn safety was important enough to change the way that they serve. Additionally, it was found that length of time employed as a server was a significant predictor of servers' burn knowledge (ie, more years serving associated with higher knowledge). Finally, individual items were examined to identify potential targets for developing prevention programs.
Eczema Mimicking Child Abuse: A Case of Mistaken Identity
Authors: Heider T. Ryan , Priolo Diane , Hultman C. Scott , Peck Michael D. , Cairns Bruce A.
Published: November 2003

Many skin conditions can mimic child abuse by burning. Multidisciplinary evaluation of suspicious burns helps prevent both the underreporting and the misdiagnosis of child abuse by burning. We report a case of pediatric eczema mimicking an abusive burn.
The Efficacy of Honey in Inhibiting Strains of Pseudomonas Aeruginosa From Infected Burns
Authors: Cooper R. A. , Halas E. , Molan P. C.
Published: November 2003

Because there is no ideal therapy for burns infected with Pseudomonas aeruginosa, there is sufficient need to investigate the efficacy of alternative antipseudomonal interventions. Honey is an ancient wound remedy for which there is modern evidence of efficacy in the treatment of burn wounds, but limited evidence for the effectiveness of its antibacterial activity against Pseudomonas. We tested the sensitivity of 17 strains of P. aeruginosa isolated from infected burns to two honeys with different types of antibacterial activity, a pasture honey and a manuka honey, both with median levels of activity. All strains showed similar sensitivity to honey with minimum inhibitory concentrations below 10% (vol/vol); both honeys maintained bactericidal activity when diluted more than 10-fold. Honey with proven antibacterial activity has the potential to be an effective treatment option for burns infected or at risk of infection with P. aeruginosa.
THE 2002 CLINICAL RESEARCH AWARD
Authors: Gottschlich Michele M. , Jenkins Marilyn E. , Mayes Theresa , Khoury Jane , Kagan Richard J. , Warden Glenn D.
Published: November 2003

Early enteral support is believed to improve gastrointestinal, immunological, nutritional, and metabolic responses to critical injury; however, this premise is in need of further substantiation by definitive data. The purpose of this prospective study was to examine the effectiveness and safety of early enteral feeding in pediatric patients who had burns in excess of 25% total body surface area. Seventy-seven patients with a mean percent total body surface area burn of 52.5 ± 2.3 (range 26–91), percent full thickness injury of 44.7 ± 2.8 (range 0–90), and age ranging from 3.1 to 18.4 (mean 9.3 ± 0.5) were randomized to two groups: early (feeding within 24 hours of injury) vs control (feeding delayed at least 48 hours postburn). Nutrient intake was measured daily, indirect calorimetry was performed biweekly, and blood and urine samples were obtained for the assay of cortisol, glucagon, insulin, gastrin, epinephrine, norepinephrine, dopamine, triiodothyronine, tetraiodothyronine, albumin, transferrin, prealbumin, retinol-binding protein, glucose, nitrogen balance, and 3-methylhistidine throughout the study period. Three protocol violations occurred, and two patients were transferred to another hospital; these patients were excluded from the study. No patient in either group experienced tube feeding aspiration. No differences were evident in infection, diarrhea, hospital length of stay, or mortality outcomes. A higher incidence of reportable adverse events coincided with early feeding (22 vs 8%), but this was not statistically significant. The delayed feeding group demonstrated a significant caloric deficit during postburn week (PBW) 1 (P < .0001) and PBW2 (P = .0022). Serum insulin (P = .0004) and triiodothyronine (P =.0162) were higher in the early fed group during PBW1. A decrease in 3-methylhistidine output (suggesting a decrease in protein breakdown) was also evident during PBW1 (P = .0138). No other significant trends in study outcome variables were noted. In conclusion, provision of enteral nutrients shortly after burn injury reduces caloric deficits and may stimulate insulin secretion and protein retention during the early phase postburn. These data, however, do not necessarily reaffirm the safety of early enteral feeding, nor do they associate earlier feeding with a direct improvement in endocrine status or a reduction in morbidity, mortality, hypermetabolism, or hospital stay. Future studies are needed to establish precise feeding implementation times that maximize clinical benefit while minimizing morbidity in the critically injured burn patient.
THE 2002 LINDBERG AWARD
Authors: Patterson D. R. , Ptacek J. T. , Carrougher G. , Heimbach D. M. , Sharar S. R. , Honari S.
Published: November 2003

Very little has been published on treating acute pain in children younger than the age of 3 for burns or any other trauma etiology. This study prospectively monitored the pain behavior and opioid analgesic intake of 31 pediatric burn patients (mean age = 23.71 months; SD = 15.75). Twelve of those children were randomized to conditions in which they either received opioid analgesics pro re nata (ie, as needed, pain contingent) or on a regular basis. The two groups did not show differences in demonstrable pain but, interestingly, they received equivalent does of opioid analgesics. As such, the pro re nata group was likely medicated largely on a regularly scheduled basis. For most of the remaining (nonrandomized) subjects, physicians ordered regularly scheduled opioid analgesics, suggesting that this practice has become largely institutionalized in the study setting. Information on pediatric opioid analgesic dosing and pain measurement strategies for nonverbal subjects can be derived from the findings.
Evaluation of a Peer Consultation Program for Burn Inpatients
Authors: Williams Rhonda M. , Patterson David R. , Schwenn Clay , Day Jeanette , Bartman Mark , Engrav Loren H.
Published: November 2003

A burn survivor may provide unique psychological support to patients who have been burned more recently and enhance their adjustment to burn injury. The purpose of this study was to describe the peer consultation/burn survivor support program at a large regional burn center in the Northwest United States. Over the course of 17 months, three specially trained peer consultants who had survived their own burn injuries in the past made 167 visits to 108 patients, who, in turn, completed evaluation forms for each visit. Findings indicated that patients reported that the peer consultants approached them in an appropriate manner, answered their questions, and provided useful support and information.
Epidemiological Study of Self-Inflicted Burns in Tehran, Iran
Authors: Lari Abdolaziz Rastegar , Alaghehbandan Reza
Published: November 2003

Self-inflicted burns have been considered a serious mental health problem throughout the world and especially in economically developing countries. The aim of this study was to identify the epidemiologic features and current etiological factors of suicide by burning in Tehran, Iran, to develop effective prevention programs. Over a period of 2 years from March 1997 to March 1999, of the 1,236 patients aged 14 years and older who were admitted to Tohid Burn Center in Tehran, Iran, 110 (8.9%) had attempted suicide by self-immolation. The median age was 25 years (range: 14–68 years) and the median extent of the burns was 71% TBSA (range: 20–100%). Forty-eight patients had a previous psychiatric diagnosis (43.6%). Depression was the most common psychiatric diagnosis by history. The method most commonly used was a flame with the addition of a flammable liquid (frequently kerosene). Also, most of the patients (70%) were of a low socioeconomic class. Overall, self-inflicted burns should be considered an increasing mental health problem in our society. Therefore, it is necessary to implement prevention programs and strategies to reduce the incidence rate of this problem.
Pediatric Pain Control Practices of North American Burn Centers
Authors: Martin-Herz Susanne Pelley , Patterson David R. , Honari Shari , Gibbons Janet , Gibran Nicole , Heimbach David M.
Published: November 2003

This study investigated pediatric pain control practices in North American Burn Centers using a mail-in survey. Questions were asked regarding pain control practices, pain assessment methods, and perceived treatment efficacy for inpatients and outpatients in four age groups. Eighty-two centers responded with 111 surveys. Intravenous morphine was the most frequently used analgesic for wound care pain. The most common background pain medications were intravenous morphine, acetaminophen with codeine, and acetaminophen alone. The use of long-acting medications increased with increasing age. Additional areas reported in the text include nonpharmacologic and pharmacologic adjuvants, treatment of itching, pain assessment, outpatient pain management, and efficacy of pain control and assessment practices. There have been great advances in pediatric burn pain control and assessment in recent years, but room for improvement remains. This study provides a basis for evaluation and comparison among burn centers. It further highlights areas that may warrant additional study and intervention.
Comparison of Silver Sulfadiazine 1%, Mupirocin 2%, and Fusidic Acid 2% for Topical Antibacterial Effect in Methicillin-Resistant Staphylococci-Infected, Full-Skin Thickness Rat Burn Wounds
Authors: Acikel Cengiz , Oncul Oral , Ulkur Ersin , Bayram Ismail , Celikoz Bahattin , Cavuslu Saban
Published: November 2003

Silver sulfadiazine 1%, mupirocin 2%, and fusidic acid 2% were compared to assess the antibacterial effect of a once-daily application on experimental rat 15% full-skin thickness burn wounds seeded 24 hours earlier with a 108 standard strain of methicillin-resistant staphylococci. The quantitative counts of seeded organism in burn eschar and subjacent muscle were determined at postburn day 7, beside the cultures of blood and lung biopsies. All tested topical agents were equally effective against methicillin-resistant Staphylococcus aureus in reducing local burn wound bacterial count and preventing systemic infection.
Cholinergic Projection from the Basal Forebrain and Cerebral Glucose Metabolism in Rats: A Dynamic PET Study
Authors: Ouchi Yasuomi , Fukuyama Hidenao , Ogawa Masafumi , Yamauchi Hiroshi , Kimura Jun , Magata Yasuhiro , Yonekura Yoshiharu , Konishi Junji
Published: November 2003

To investigate the influence of cholinergic projections from the basal forebrain on cerebral cortex metabolism, we evaluated the cerebral metabolic rate of glucose (CMRGlu) after selective inhibition of cholinergic neurons in the rat basal forebrain using the pyruvate dehydrogenase complex inhibitor 3-bromopyruvic acid (BPA), and compared the results with those obtained after lesioning the basal forebrain with ibotenic acid, as well as with those from a sham-operated control group. CMRGlu was measured using positron emission tomography (PET) with [18F]-2-fluoro-2-deoxy-D-glucose (FDG). Three days after surgery, CMRGlu and k3 (phosphorylation of FDG) were reduced similarly in the frontal cortex on the BPA-injected side and in the ibotenic acid-treated group, whereas K1 (transport rate of FDG from the plasma to brain) showed no marked changes. At 3 weeks postoperatively, the CMRGlu and k3 of the frontal cortex in both groups recovered to levels similar to those of the sham-operated group. The main difference between the BPA and ibotenic acid groups was that CMRGlu showed mild reduction on the side contralateral to the operation in the former, while such reduction was confined to the ipsilateral hemisphere in the latter. The present results indicate that the cholinergic system in the basal forebrain regulates cerebral cortex glucose metabolism through direct excitation of cortical neurons.
Forebrain Ischemia Increases Glut1 Protein in Brain Microvessels and Parenchyma
Authors: McCall Anthony L. , Van Bueren Antonia M. , Nipper Valerie , Moholt-Siebert Melissa , Downes Hall , Lessov Nikola
Published: November 2003

Glucose transport into nonneuronal brain cells uses differently glycosylated forms of the glucose transport protein, GLUT1. Microvascular GLUT1 is readily seen on immunocytochemistry, although its parenchymal localization has been difficult. Following ischemia, GLUT1 mRNA increases, but whether GLUT1 protein also changes is uncertain. Therefore, we examined the immunocytochemical distribution of GLUT1 in normal rat brain and after transient global forebrain ischemia. A novel immunocytochemical finding was peptide-inhibitable GLUT1 immunoreactive staining in parenchyma as well as in cerebral microvessels. In nonischemic rats, parenchymal GLUT1 staining co-localizes with glial fibrillary acidic protein (GFAP) in perivascular foot processes of astrocytes. By 24 h after ischemia, both microvascular and nonmicrovascular GLUT1 immunoreactivity increased widely, persisting at 4 days postischemia. Vascularity within sections of brain similarly increased after ischemia. Increased parenchymal GLUT1 expression was paralleled by staining for GFAP, suggesting that nonvascular GLUT1 overexpression may occur in reactive astrocytes. A final observation was a rapid expression of inducible heat shock protein (HSP)70 in hippocampus and cortex by 24 h after ischemia. We conclude that GLUT1 is normally immunocytochemically detectable in cerebral microvessels and parenchyma and that parenchymal expression occurs in some astroglia. After global cerebral ischemia, GLUT1 overexpression occurs rapidly and widely in microvessels and parenchyma; its overexpression may be related to an immediate early-gene form of response to cellular stress.
Brain Temperature Alters Hydroxyl Radical Production during Cerebral Ischemia/Reperfusion in Rats
Authors: Kil Ho Yeong , Zhang Jing , Piantadosi Claude A.
Published: November 2003

Selective neuronal cell death in the CA, pyramidal cells of the hippocampus and neurons of the dorsolateral striatum as a consequence of brain ischemia/reperfusion (IR) can be ameliorated with brain hypothermia. Since postischemic injury is mediated partially by chemical production of reactive oxygen species (ROS), decreased ROS production may be one of the mechanisms responsible for cerebral protection by hypothermia. To determine if ischemic brain temperature alters ROS production, reversible IR was produced in rats by occlusion of both carotid arteries with hemorrhagic hypotension. After 15 min of ischemia, circulation was restored for 60 min. Brain temperature was maintained during ischemia at either 30, 36, or 39°C and kept at 36–37°C after reperfusion. Using cerebral microdialysis, we measured nonenzymatic hydroxylation of salicylate by HPLC with electrochemical detection in the hippocampus. CBF was also compared among the groups during IR. The results were that normothermic animals during reperfusion had persistently increased levels of the salicylate hydroxylation product, 2,3-dihydroxybenzoic acid (2,3-DHBA), reaching 251% of control at 60 min. This increase in 2,3-DHBA production was potentiated after 60 min of reperfusion (406% of control) with ischemic hyperthermia. In hypothermic ischemia, 2,3-DHBA production at 60 min was attenuated to 160% of control. CBF decreased to ∼5% of baseline value during ischemia, but increased three- to four-fold relative to control in all three groups. Therefore, the effects of ischemic brain temperature on 2,3-DHBA production did not correlate with changes in CBF during IR. We conclude that brain-temperature-related changes in OH · production are readily detected in the rat and decreased ROS generation may contribute to cerebral protection afforded by hypothermia during brain ischemia.
Absence Seizures Induce a Decrease in Cerebral Blood Flow: Human and Animal Data
Authors: Nehlig Astrid , Vergnes Marguerite , Waydelich Rosita , Hirsch Edouard , Charbonne Robert , Marescaux Christian , Seylaz Jacques
Published: November 2003

Our previous studies on cerebral metabolic activity in genetic absence epilepsy rats from Strasbourg (GAERS) were in favor of decreased functional activity during absences and normal or increased interictal activity. To ascertain that hypothesis, in the present study we performed continuous measurements of CBF in both children with typical absence epilepsy and GAERS, using Doppler ultrasonography and laser-Doppler flowmetry, respectively. CBF fluctuations during absences were recorded in four children between 5 and 6 years of age and 16 adult GAERS. In both children and animals, CBF measured in the middle cerebral artery and cortical capillaries, respectively, significantly decreased by a median value of 20–24% under basal levels during spontaneous absences. In GAERS, CBF levels were continuously decreased during haloperidol-induced absence status epilepticus, while they were not affected by ethosuximide. Conversely, convulsive seizures induced in rats either by kainate or Picrotoxin led to a 175–664% increase in CBF levels. In conclusion, the present data show that during spontaneous absences, CBF decreases under basal levels in both cortical capillaries (GAERS) and the middle cerebral artery (children). Moreover, these fluctuations occur in vessels with normal vascular reactivity, are not mediated by changes in Po2, Pco2, or arterial blood pressure, and represent rather a response to reduced metabolic demand.
Oxygen Radicals Do Not Play a Role in Arteriolar Dilation during Cortical Spreading Depression
Authors: Meng Wei , Busija David W.
Published: November 2003

This study examined the role of oxygen radicals in pial arteriolar changes during cortical spreading depression (CSD). CSD was induced by microinjection of 5% KCl in anesthetized adult rabbits. Pial diameter was measured with a closed cranial window and intravital microscopy. During control CSD (n = 12), the dilation amplitude and area were 55 ± 14% and 693 ± 69 mm2 (baseline = 76 ± 14 μm), respectively. Oxygen radical scavengers, superoxide dismutase (SOD; 105 U/ml, topical application; n = 5) or oxypurinol (50 mg/kg i.v.; n = 7), did not alter the dilation amplitude and area or change onset latency during CSD. Further, SOD and oxypurinol did not prevent NG-nitro-L-arginine from attenuating arteriolar dilation during CSD (n = 12). We conclude that oxygen radicals do not play a role in the transient dilation of cerebral arterioles during CSD.
Induction of Spreading Depression in the Ischemic Hemisphere following Experimental Middle Cerebral Artery Occlusion: Effect on Infarct Morphology
Authors: Back Tobias , Ginsberg Myron D. , Dietrich W. Dalton , Watson Brant D.
Published: November 2003

This study was undertaken to test whether transient depolarizations occurring in periinfarct regions are important in contributing to infarct spread and maturation. Following middle cerebral artery (MCA) occlusion we stimulated the ischemic penumbra with recurrent waves of spreading depression (SD) and correlated the histopathological changes with the electrophysiological recordings. Halothane-anesthetized, artificially ventilated Sprague–Dawley rats underwent repetitive stimulation of SD in intact brain (Group 1; n = 8) or photothrombotic MCA occlusion coupled with ipsilateral common carotid artery occlusion (Groups 2 and 3, n = 9 each). The electroencephalogram and direct current (DC) potential were recorded for 3 h in the parietal cortex, which represented the periinfarct border zone in ischemic rats. In Group 2, only spontaneously occurring negative DC shifts occurred; in Group 3, the (nonischemic) frontal pole of the ischemic hemisphere was electrically stimulated to increase the frequency of periinfarct DC shifts. Animals underwent perfusion-fixation 24 h later, and volumes of complete infarction and scattered neuronal injury (“incomplete infarction”) were assessed on stained coronal sections by quantitative planimetry. Electrical induction of SD in Group 1 did not cause morphological injury. During the initial 3 h following MCA occlusion, the number of spontaneous periinfarct depolarizations in Group 2 (7.0 ±1.5 DC shifts) was doubled in Group 3 by frontal current application (13.4 ± 2.7 DC shifts; p < 0.001). The duration as well as the integrated negative amplitude of DC shifts over time were significantly greater in Group 3 than in Group 2 rats (duration, 5.7 ± 3.8 vs. 4.1 ± 2.5 min; p < 0.05). Histopathological examination disclosed well-defined areas of pannecrosis surrounded by a cortical rim exhibiting selectively damaged acidophilic neurons and astrocytic swelling in otherwise normal-appearing brain. Induction of SD in the ischemic hemisphere led to a significant increase in the volume of incomplete infarction (19.0 ± 6.1 mm3 in Group 3 vs. 10.3 ± 5.1 mm3 in Group 2; p < 0.01) and of total ischemic injury (100.7 ± 41.0 mm3 in Group 3 vs. 66.5 ± 24.7 mm3 in Group 2; p < 0.05). The integrated magnitude of DC negativity per experiment correlated significantly with the volume of total ischemic injury ( r = 0.780, p < 0.0001). Thus, induction of SD in the ischemic hemisphere accentuated the development of scattered neuronal injury and increased the volume of total ischemic injury. This observation may be explained by the fact that, with limited perfusion reserve, periinfarct depolarizations are associated with episodic energy failure in the acute ischemic penumbra.
A New Model of Transient Cerebral Ischemia in Neonatal Rats
Authors: Mitsufuji Nobuto , Yoshioka Hiroshi , Okano Sozo , Nishiki Tetsuo , Sawada Tadashi
Published: November 2003

A new model of transient cerebral ischemia in 10-day-old rats is described. Under microscopic guidance, the right external and internal carotid arteries were electrically coagulated. A solid 0.47 mm diameter nylon thread was inserted into the right common carotid artery toward the ascending aorta up to 10–12 mm from the upper edge of the sternomastoid muscle (preischemic rats). A 60-min cerebral ischemia was induced by clamping the left external and internal carotid arteries (ischemic rats), followed by 3-h recirculation. 31P magnetic resonance (MRS) spectroscopic studies revealed that severe intracellular acidosis occurred and ATP disappeared completely for at least the last 20 min of ischemia. Cerebral blood flow (CBF), measured by the hydrogen clearance technique, decreased to ∼11% of the preischemic level in the frontal cortex soon after the induction of ischemia. On resuscitation, ATP recovered completely and the preischemic intracellular pH level was restored within 180 min. CBF had recovered to ∼30% of the preischemic level at 5 min after resuscitation. The CBF recovery was not complete even at 180 min after resuscitation. With this model, the effects of pure ischemia without hypoxia on the neonatal brain and the process of recovery from transient ischemia can be studied.
Influence of Respiration and Changes in Expiratory Pressure on Cerebral Haemoglobin Concentration Measured by near Infrared Spectroscopy
Authors: Elwell C. E. , Owen-Reece H. , Wyatt J. S. , Cope M. , Reynolds E. O. R. , Delpy D. T.
Published: November 2003

Near infrared spectroscopy (NIRS) was used to measure the changes in concentration of cerebral oxy-and deoxygenated haemoglobin ([HbO2] and [Hb]) in six healthy adult volunteers spontaneously breathing against increased expiratory pressures (IEPs) between 0 and 20 cm H20. During expiration, an increase in [HbO2] was recorded, accompanied by a smaller decrease in [Hb], producing a small increase in total cerebral haemoglobin concentration ([Hbsum]). The mean ± SD change in [Hbsum] at the maximum IEP of 20 cm H2O was 1.2 ± 0.7 μmol L−1 (equivalent to 1.4%). Changes in [Hbsum] correlated with IEP level ( r = 0.95) and changes in MABP ( r = 0.96). The results suggest that homeostatic mechanisms do not maintain cerebral blood volume or flow constant over the period of a single breath in normal adults.