bluuebunny/crossref_metadata_2025_split huggingface dataset:
Four-Year Review of Burns as an Etiologic Factor in the Development of Long Bone Fractures in Pediatric Patients
Authors: Mayes Theresa , Gottschlich Michele , Scanlon Jennifer , Warden Glenn D. 
Published: November 2003

Abstract
Reduced bone density has been documented in children after burns. This loss of bone may place children at heightened risk for fractures. The medical records of all acutely injured patients with burns in excess of 40% TBSA burn admitted to our institution between January 1, 1997, through December 31, 2000, were reviewed for fracture incidence. Patients with fractures sustained during the course of initial trauma were not included in the review. One hundred four records were reviewed. These patients had a mean age of 6.7 ± 0.51 years, (range, 0.2 to 18.0) and a mean %TBSA burn of 59.9 ± 1.60 (range, 40 to 98) with a mean full-thickness %burn of 51.7 ± 2.16 (range, 0 to 95). Fifteen long bone fractures were documented in six patients during the review time frame. All fractures were initially suspected by physical therapy personnel upon regularly scheduled therapy sessions and subsequently verified by x-ray. All fractures identified by this review occurred in children less than 3 years of age. Most fractures were noted during the rehabilitation phase of injury (range, 73 to 283 days after burn) once wounds were more than 95% healed, except for one child, who sustained multiple fractures during the acute recovery phase at a referring hospital. A 5.8% incidence of fractures was noted in patients with burns in excess of 40% (6 of 104 admissions). The etiology of the fractures is unknown, although the hormonal milieu postburn, depressed vitamin D status, inadequate protein intake, and decreased weight-bearing activity are potential contributory factors. In addition, infants and toddlers tend to provide more resistance to therapy because of an inherent lack of cognition. This may account for the increased breaks in this population.
The Methamphetamine Burn Patient
Authors: Warner P. , Connolly J. P. , Gibran N. S. , Heimbach D. M. , Engrav L. H. 
Published: November 2003

Abstract
Early aggressive fluid resuscitation has significantly decreased the morbidity and mortality associated with volume losses from large burns. Although most patients are adequately resuscitated using the Parkland formula, we noted increased fluid requirements for shock resuscitation in patients involved in methamphetamine laboratory explosions. Because predominant users are young healthy individuals in their 20s and 30s, we had not anticipated burn shock resuscitation failures in this patient group. We reviewed our experience with burn patients with documented methamphetamine use to determine whether this patient group presents new dilemmas to the burn surgeon. A 2-year retrospective study of 30 patients (15 methamphetamine users, 15 controls) revealed that the methamphetamine burn patient requires two to three times the standard Parkland formula resuscitation. In this study, methamphetamine burns larger than 40% TBSA had a 100% mortality.
A Double-Blind Study of the Analgesic Efficacy of Oral Transmucosal Fentanyl Citrate and Oral Morphine in Pediatric Patients Undergoing Burn Dressing Change and Tubbing
Authors: Robert Rhonda , Brack Amanda , Blakeney Patricia , Villarreal Cynthia , Rosenberg Laura , Thomas Christopher , Meyer Walter J. 
Published: November 2003

Abstract
Burn wound care is extremely painful. The pain leads to added anxiety and therefore a distressing treatment that can negatively impact healing. Pain and anxiety management with oral transmucosal fentanyl citrate was compared with this institution's standard procedural pain medication, morphine. With a double-blinded, reverse crossover, time-randomized, and placebo-controlled design, the efficacy of morphine and fentanyl citrate was assessed with patients undergoing two consecutive days of tubbing. Pain and anxiety was assessed before, during, and after the tubbing procedure using the Faces Pain Rating Scale (Whaley and Wong, 1987) and the Fear Thermometer (Silverman and Kurtines, 1996). Data were analyzed with repeated measures analysis of variance. Pain and anxiety appeared better managed with fentanyl citrate. Generalization is limited by small sample size, yet findings warrant additional investigation.
The Safety of Adding Bupivacaine to the Subcutaneous Infiltration Solution Used for Donor Site Harvest
Authors: Fischer C. G. , Lloyd S. , Kopcha R. , Warden G. D. , McCall J. E. 
Published: November 2003

Abstract
Pain is a major problem for patients with burns. Donor sites are a significant source of this pain. In this investigation we hypothesized that bupivacaine infiltration of the donor site before skin harvest would prove to be a safe technique as determined by the measurement of blood levels of bupivacaine at various time intervals after infiltration. Fourteen patients were enrolled and studied. Average age was 14.3 ± 3.1 years, weight was 43.1 ± 9.1 kg, and donor site size was 6.3 ± 2.0% TBSA. Mean dose of bupivacaine infused was 1.86 ± 0.21 mg/kg. Maximum mean bupivacaine blood level was 0.39 ± 0.09 μg/ml. The highest level measured in any one patient was 1.2 μg/ml; 4.0 μg/ml is considered to be the safe upper limit in children. Time to maximum blood level was 8.9 ± 1.7 hours after infusion. Twelve of the 14 patients had measurable blood levels of bupivacaine at 24 hours after infusion. The maximum bupivacaine level was found to correlate significantly with both the mg/kg of bupivacaine infused (r = .60, P = .04) and the donor site size (r = 0.81, P = 0.002). Bupivacaine at a dose of slightly less than 1.9 mg/kg added to donor site infiltration solution is safe, as demonstrated by low blood levels and the absence of clinical signs of toxicity.
Correlation of Bronchoalveolar Lavage with Radiographic Evidence of Pneumonia in Thermally Injured Children
Authors: Ramzy Peter I. , Jeschke Marc G. , Wolf Steven E. , Swischuk Lennard , Heggers John P. , Herndon David N. 
Published: November 2003

Abstract
The diagnosis of pneumonia in the critically ill patient is very difficult because the usual signs and symptoms are unreliable in the intensive care setting. Bronchoalveolar lavage (BAL) is a diagnostic tool with a reported sensitivity of 70%. The purpose of this study was to determine the efficacy and specificity of BAL in severely burned pediatric patients. An analysis was performed in which BAL cultures were compared and correlated to chest radiographs. Patient characteristics, such as age, sex, burn size, depth of burn, and the presence of inhalation injury were evaluated. Over a period of 18 months, 58 thermally injured children were identified who underwent 101 BALs. The mean age was 6.5 ± 5 years, mean TBSA was 39 ± 27%, and inhalation injury was diagnosed in 20 patients (35%). Of 101 BALs, 48 were positive, and of the 101 chest radiographs, 20 demonstrated signs of pneumonia. Ten of those were associated with a positive BAL and 10 with a negative BAL. Thus, the positive predictive value of BAL was 21%, whereas the negative predictive value was 81%. Interestingly 80% of patients with tracheobronchitis from inhalation injury demonstrated a positive BAL. We conclude that in pediatric burn patients BAL correlates poorly with radiographic signs of pneumonia.
Platelet-Monocyte Complexes Support Monocyte Adhesion to Endothelium by Enhancing Secondary Tethering and Cluster Formation
Authors: da Costa Martins P. , van den Berk N. , Ulfman Laurien H. , Koenderman L. , Hordijk P.L. , Zwaginga J.J. 
Published: November 2003

Objective—Adhesion of monocytes to endothelium can be supported by monocyte-monocyte interactions resulting in the formation of cell aggregates at the vessel wall (clusters). Since platelets that are bound to the injured vessel wall support monocyte adhesion and platelet activation in the circulation leads to formation of platelet-monocyte complexes (PMCs), we examined whether adhesion of PMCs to the vessel wall enhances monocyte clustering.Methods and Results—The effect of PMC formation in monocyte adhesion and clustering on human umbilical vein endothelial cells (HUVECs) was studied in vitro with a perfusion system. In the presence of 10% to 20% PMCs, monocyte adhesion and cluster formation to stimulated HUVECs increased 2-fold above levels obtained with pure monocytes. While the observed effects increased with higher PMC levels, blocking-monoclonal antibodies directed against platelet-associated P-selectin or monocyte P-selectin glycoprotein ligand-1 (PSGL-1) reversed adhesion and clustering to control values. In the presence of PMCs, blocking L-selectin decreased adhesion by 25%. When PMCs were present, clustering was only supported by L-selectin at higher shear. These data indicate that monocyte adhesion to the vessel wall is enhanced by PMC-mediated monocyte secondary tethering. These interactions are mainly mediated by P-selectin and PSGL-1.Conclusion—PMCs in the circulation might be proatherogenic, and prevention of their formation is a possible therapeutic goal.
Hoxa9 influences the phenotype but not the incidence of Mll-AF9 fusion gene leukemia
Authors: Kumar Ashish R. , Hudson Wendy A. , Chen Weili , Nishiuchi Ritsuo , Yao Qing , Kersey John H. 
Published: November 2003

AbstractIdentification of the targets of mixed lineage leukemia (MLL) fusion genes will assist in understanding the biology of MLL fusion gene leukemias and in development of better therapies. Numerous studies have implicated HOXA9 as one of the possible targets of MLL fusion proteins. To determine if HOXA9 was required for leukemia development by MLL fusion genes, we compared the effects of the Mll-AF9 knock-in mutation in mice in the presence or absence of Hoxa9. Both groups of mice showed myeloid expansion at 8 weeks and then developed myeloid leukemia with a similar incidence and time course. The leukemia in the mice lacking Hoxa9 generally displayed a more immature myeloid phenotype than that in the mice that were wild-type for Hoxa9. Gene expression profiling revealed that expression of Mll-AF9 led to overexpression of Hoxa5, Hoxa6, Hoxa7, Hoxa9, and Hoxa10. Thus, genes of the Hox-a cluster are important in defining the phenotype but not the incidence of Mll-AF9 leukemia. These results demonstrate that the Mll-AF9 fusion gene disrupts the expression of several Hox genes, none of which as a single gene is likely to be necessary for development of leukemia. Instead, we propose that the “Hox code” minimally defined by the Hoxa5-a9 cluster is central to MLL leukemogenesis.
Hemolytic anemia and severe rhabdomyolysis caused by compound heterozygous mutations of the gene for erythrocyte/muscle isozyme of aldolase, ALDOA(Arg303X/Cys338Tyr)
Authors: Yao David C. , Tolan Dean R. , Murray Michael F. , Harris David J. , Darras Basil T. , Geva Alon , Neufeld Ellis J. 
Published: November 2003

AbstractAldolase (E.C. 4.1.2.13), a homotetrameric protein encoded by the ALDOA gene, converts fructose-1,6-bisphosphate to dihydroxyacetone phosphate and glyceraldehyde-3-phosphate. Three isozymes are encoded by distinct genes. The sole aldolase present in red blood cells and skeletal muscle is the A isozyme. We report here the case of a girl of Sicilian descent with aldolase A deficiency. Clinical manifestations included transfusion-dependent anemia until splenectomy at age 3 and increasing muscle weakness, with death at age 4 associated with rhabdomyolysis and hyperkalemia. Sequence analysis of the ALDOA coding regions revealed 2 novel heterozygous ALDOA mutations in conserved regions of the protein. The paternal allele encoded a nonsense mutation, Arg303X, in the enzyme-active site. The maternal allele encoded a missense mutation, Cys338Tyr, predicted to cause enzyme instability. This is the most severely affected patient reported to date and only the second with both rhabdomyolysis and hemolysis.
Malignancy in patients with sickle cell disease
Authors: Schultz William H. , Ware Russell E. 
Published: November 2003

AbstractMalignancy in patients with sickle cell disease (SCD) has been previously reported, but the types of cancer and its incidence remain undefined. With the advent of hydroxyurea therapy, there is concern about increasing the cancer risk for patients with SCD. The International Association of Sickle Cell Nurses and Physician Assistants identified 52 cases of cancer (49 patients) among 16,613 patients with SCD followed at 52 institutions. The median age at malignancy diagnosis was 34 years (range, 14 months–62 years). Twenty‐one cases (40%) occurred in pediatric patients, primarily leukemia (n = 7) or Wilms' tumor (n = 5), with 15 children surviving. Most adults had solid tumors, especially carcinomas, and only nine were known to be alive. Three patients received hydroxyurea before the diagnosis of malignancy. These data provide essential baseline information for the accurate interpretation of future reports of malignancy in patients with SCD, especially those receiving hydroxyurea therapy. Am. J. Hematol. 74:249–253, 2003. © 2003 Wiley‐Liss, Inc.
Acute renal failure after intravenous anti‐D immune globulin in an adult with immune thrombocytopenic purpura
Authors: Chun Nancy S. , Savani Bipin , Seder Richard H. , Taplin Mary Ellen 
Published: November 2003

AbstractIntravenous anti‐D immune globulin (anti‐D IGIV) is indicated for the treatment of immune thrombocytopenic purpura (ITP) in nonsplenectomized patients who are Rh(D)‐positive. Recent reports have described episodes of intravascular hemolysis (IVH) and acute renal failure (ARF) after anti‐D IGIV. We report the first adult patient with ITP who required and received dialysis after IVH and ARF complicating treatment with anti‐D IGIV. Whether the transfusion of 2 units of Rh(D)‐positive red cells, indicated for the resulting anemia, exacerbated the IVH and renal failure is unclear. Three weeks after the administration of anti‐D IGIV (13 days after two hemodialysis treatments), the patient's renal function had returned to normal. This case highlights the infrequent but potentially serious side effects of anti‐D IGIV and the need to monitor a patient's renal function closely if there is evidence of IVH after infusion of anti‐D IGIV. If red cell transfusion is indicated, we recommend the use of Rh(D)‐negative red cell products. Am. J. Hematol. 74:276–279, 2003. © 2003 Wiley‐Liss, Inc.
Teaching medical histology at the University of South Carolina School of Medicine: Transition to virtual slides and virtual microscopes
Authors: Blake Charles A. , Lavoie Holly A. , Millette Clarke F. 
Published: November 2003

AbstractWe describe how the histology course we teach to first‐year medical students changed successfully from using glass slides and microscopes to using virtual slides and virtual microscopes. In 1988, we taught a classic medical histology course. Subsequently, students were loaned static labeled images on projection slides to introduce them to their microscope glass slides, and we made laser disks of histological images available in the teaching lab. In 2000, we placed the static labeled images and laboratory manual on the Web. We abandoned the Web‐based approach in 2001. Faculty selected specific areas on microscope glass slides in student collections for scanning at a total magnification of 40, 100, 200, or 400. Christopher M. Prince of Petro Image, LLC, scanned the glass slides; digitized, encoded, and compressed (95%) the images; and placed them on CD‐ROMs. The scanned images were viewed up to a magnification of 400 using the MrSID viewer (LizardTech software) and the computer as a virtual microscope. This viewer has many useful features, including effective microscope and telescope functions that provide greater versatility for sample study and speed in localizing structures than was possible with the actual microscope. Image detail is indistinguishable from that viewed under the light microscope at equivalent magnifications. Static labeled images were also placed on CD‐ROMs to introduce students to the virtual slides. Students could view all the images on their CD‐ROMs at any time and in any place with their laptop computers without going online. Students no longer rented light microscopes in 2002. Both students and faculty have shown strong support for using this approach to teaching histology during the past 2 years. Anat Rec (Part B: New Anat) 275B:196–206, 2003. © 2003 Wiley‐Liss, Inc.
Chromatin remodeling by ATP‐dependent molecular machines
Authors: Lusser Alexandra , Kadonaga James T. 
Published: November 2003

AbstractThe eukaryotic genome is packaged into a periodic nucleoprotein structure termed chromatin. The repeating unit of chromatin, the nucleosome, consists of DNA that is wound nearly two times around an octamer of histone proteins. To facilitate DNA‐directed processes in chromatin, it is often necessary to rearrange or to mobilize the nucleosomes. This remodeling of the nucleosomes is achieved by the action of chromatin‐remodeling complexes, which are a family of ATP‐dependent molecular machines. Chromatin‐remodeling factors share a related ATPase subunit and participate in transcriptional regulation, DNA repair, homologous recombination and chromatin assembly. In this review, we provide an overview of chromatin‐remodeling enzymes and discuss two possible mechanisms by which these factors might act to reorganize nucleosome structure. BioEssays 25:1192–1200, 2003. © 2003 Wiley Periodicals, Inc.
The blood coagulation system as a molecular machine
Authors: Spronk Henri M.H. , Govers‐Riemslag José W.P. , ten Cate Hugo 
Published: November 2003

AbstractThe human blood coagulation system comprises a series of linked glycoproteins that upon activation induce the generation of downstream enzymes ultimately forming fibrin. This process is primarily important to arrest bleeding (hemostasis). Hemostasis is a typical example of a molecular machine, where the assembly of substrates, enzymes, protein cofactors and calcium ions on a phospholipid surface markedly accelerates the rate of coagulation. Excess, pathological, coagulation activity occurs in “thrombosis”, the formation of an intravascular clot, which in the most dramatic form precipitates in the microvasculature as disseminated intravascular coagulation. Thrombosis occurs according to a biochemical machine model in the case of atherothrombosis on a ruptured atherosclerotic plaque, but may develop at a slower rate in venous thrombosis, illustrating that the coagulation machinery can act at different velocities. The separate coagulation enzymes are also important in other biological processes, including inflammation for which the rapid conversion of one coagulation factor by the other is not a prerequisite. The latter role of coagulation enzymes may be related to the old and probably maintained function of the coagulation machine in innate immunity. BioEssays 25:1220–1228, 2003. © 2003 Wiley Perioicals, Inc.
Macromolecular complexes that unwind nucleic acids
Authors: von Hippel Peter H. , Delagoutte Emmanuelle 
Published: November 2003

AbstractIn this essay, we consider helicases, defined as enzymes that use the free energies of binding and hydrolysis of ATP to drive the unwinding of double‐stranded nucleic acids, and ask how they function within, and are “coupled” to, the macromolecular machines of gene expression. To illustrate the principles of the integration of helicases into such machines, we consider the macromolecular complexes that direct and control DNA replication and DNA‐dependent RNA transcription, and use these systems to illustrate how machines centered around coupled polymerase–helicase systems can be regulated by small changes in the interactions of their functional components. BioEssays 25:1168–1177, 2003. © 2003 Wiley Periodicals, Inc.
The spliceosome: the most complex macromolecular machine in the cell?
Authors: Nilsen Timothy W. 
Published: November 2003

AbstractThe primary transcripts, pre‐mRNAs, of almost all protein‐coding genes in higher eukaryotes contain multiple non‐coding intervening sequences, introns, which must be precisely removed to yield translatable mRNAs. The process of intron excision, splicing, takes place in a massive ribonucleoprotein complex known as the spliceosome. Extensive studies, both genetic and biochemical, in a variety of systems have revealed that essential components of the spliceosome include five small RNAs–U1, U2, U4, U5 and U6, each of which functions as a RNA, protein complex called an snRNP (small nuclear ribonucleoprotein). In addition to snRNPs, splicing requires many non‐snRNP protein factors, the exact nature and number of which has been unclear. Technical advances, including new affinity purification methods and improved mass spectrometry techniques, coupled with the completion of many genome sequences, have now permitted a number of proteomic analyses of purified spliceosomes. These studies, recently reviewed by Jurica and Moore,1 reveal that the spliceosome is composed of as many as 300 distinct proteins and five RNAs, making it among the most complex macromolecular machines known. BioEssays 25:1147–1149, 2003. © 2003 Wiley Periodicals, Inc.
New tight frames of curvelets and optimal representations of objects with piecewise C2 singularities
Authors: Candès Emmanuel J. , Donoho David L. 
Published: November 2003

AbstractThis paper introduces new tight frames of curvelets to address the problem of finding optimally sparse representations of objects with discontinuities along piecewise C2 edges. Conceptually, the curvelet transform is a multiscale pyramid with many directions and positions at each length scale, and needle‐shaped elements at fine scales. These elements have many useful geometric multiscale features that set them apart from classical multiscale representations such as wavelets. For instance, curvelets obey a parabolic scaling relation which says that at scale 2−j, each element has an envelope that is aligned along a “ridge” of length 2−j/2 and width 2−j.We prove that curvelets provide an essentially optimal representation of typical objects f that are C2 except for discontinuities along piecewise C2 curves. Such representations are nearly as sparse as if f were not singular and turn out to be far more sparse than the wavelet decomposition of the object. For instance, the n‐term partial reconstruction f obtained by selecting the n largest terms in the curvelet series obeys

This rate of convergence holds uniformly over a class of functions that are C2 except for discontinuities along piecewise C2 curves and is essentially optimal. In comparison, the squared error of n‐term wavelet approximations only converges as n−1 as n → ∞, which is considerably worse than the optimal behavior. © 2003 Wiley Periodicals, Inc.
Statistical sensitivity analysis of packed column reactors for contaminated wastewater
Authors: Fassò A. , Esposito A. , Porcu E. , Reverberi A. P. , Vegliò F. 
Published: November 2003

AbstractIn this article we consider the statistical sensitivity analysis of heavy metal biosorption in contaminated wastewater packed column reactors. In particular, the model describes the biosorption phenomenon using the Advection Dispersion Reaction equation under rapid local equilibrium. This allows computer simulation with random input parameters chosen from appropriate probability distributions. In order to have a statistical framework for analyzing the simulated data and assessing input importance, we introduce heteroskedastic and multivariate sensitivity analysis, which extends standard sensitivity analysis. Copyright © 2003 John Wiley & Sons, Ltd.