bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Psychometric Evaluation of the Pediatric Anesthesia Emergence Delirium Scale
Authors: Sikich Nancy , Lerman Jerrold 
Published: April 2004

Background
Emergence delirium has been investigated in several clinical trials. However, no reliable and valid rating scale exists to measure this phenomenon in children. Therefore, the authors developed and evaluated the Pediatric Anesthesia Emergence Delirium (PAED) scale to measure emergence delirium in children.

Methods
A list of scale items that were statements describing the emergence behavior of children was compiled, and the items were evaluated for content validity and statistical significance. Items that satisfied these evaluations comprised the PAED scale. Each item was scored from 1 to 4 (with reverse scoring where applicable), and the scores were summed to obtain a total scale score. The degree of emergence delirium varied directly with the total score. Fifty children were enrolled to determine the reliability and validity of the PAED scale. Scale validity was evaluated using five hypotheses: The PAED scale scores correlated negatively with age and time to awakening and positively with clinical judgment scores and Post Hospital Behavior Questionnaire scores, and were greater after sevoflurane than after halothane. The sensitivity of the scale was also determined.

Results
Five of 27 items that satisfied the content validity and statistical analysis became the PAED scale: (1) The child makes eye contact with the caregiver, (2) the child's actions are purposeful, (3) the child is aware of his/her surroundings, (4) the child is restless, and (5) the child is inconsolable. The internal consistency of the PAED scale was 0.89, and the reliability was 0.84 (95% confidence interval, 0.76-0.90). Three hypotheses supported the validity of the scale: The scores correlated negatively with age (r = -0.31, P <0.04) and time to awakening (r = -0.5, P <0.001) and were greater after sevoflurane anesthesia than halothane (P <0.008). The sensitivity was 0.64.

Conclusions
These results support the reliability and validity of the PAED scale.
Unanticipated Difficult Airway in Anesthetized Patients
Authors: Combes Xavier , Le Roux Bertrand , Suen Powen , Dumerat Marc , Motamed Cyrus , Sauvat Stéphane , Duvaldestin Philippe , Dhonneur Gilles 
Published: April 2004

Background
Management strategies conceived to improve patient safety in anesthesia have rarely been assessed prospectively. The authors undertook a prospective evaluation of a predefined algorithm for unanticipated difficult airway management.

Methods
After a 2-month period of training in airway management, 41 anesthesiologists were asked to follow a predefined algorithm for management in the case of an unanticipated difficult airway. Two different scenarios were distinguished: "cannot intubate" and "cannot ventilate." The gum elastic bougie and the Intubating Laryngeal Mask Airway (ILMA) were proposed as the first and second steps in the case of impossible laryngoscope-assisted tracheal intubation, respectively. In the case of impossible ventilation or difficult ventilation, the IMLA was recommended, followed by percutaneous transtracheal jet ventilation. The patient's details, adherence rate to the algorithm, efficacy, and complications of airway management processes were recorded.

Results
Impossible ventilation never occurred during the 18-month study. One hundred cases of unexpected difficult airway were recorded (0.9%) among 11,257 intubations. Deviation from the algorithm was recorded in three cases, and two patients were wakened before any alternative intubation technique attempt. All remaining patients were successfully ventilated with either the facemask (89 of 95) or the ILMA (6 of 95). Six difficult-ventilation patients required the ILMA before completion of the first intubation step. Eighty patients were intubated with the gum elastic bougie, and 13 required a blind intubation through the ILMA. Two patients ventilated with the ILMA were never intubated.

Conclusion
When applied in accordance with a predefined algorithm, the gum elastic bougie and the ILMA are effective to solve most problems occurring during unexpected difficult airway management.
Effects of Isoflurane Versus Fentanyl–Nitrous Oxide Anesthesia on Long-term Outcome from Severe Forebrain Ischemia in the Rat
Authors: Elsersy Hazem , Sheng Huaxin , Lynch John R. , Moldovan Maria , Pearlstein Robert D. , Warner David S. 
Published: April 2004

Background
This study examined long-term outcome from severe forebrain ischemia in the rat, as a function of anesthetic given during the ischemic injury.

Methods
Rats were subjected to 10 min of near-complete forebrain ischemia while anesthetized with either 1.4% isoflurane or 70% nitrous oxide-fentanyl. Neurologic and histologic outcomes were measured at 5 days, 3 weeks, or 3 months after ischemia.

Results
At 5 days, isoflurane-anesthetized rats had less damage than did fentanyl-nitrous oxide-anesthetized rats (mean +/- SD, percent alive hippocampal CA1 neurons = 58+/-29 vs. 20+/-16, respectively; P = 0.011). This was accompanied by improved motor function in the isoflurane group (P = 0.002). At 3 weeks, there was no difference between groups for either outcome variable (percent alive CA1 neurons = 35+/-26 and 36+/-28 for isoflurane and fentanyl-nitrous oxide, respectively). Similarly, at 3 months, there was no difference between groups (percent alive CA1 neurons = 56+/-27 and 60+/-27 for isoflurane and fentanyl-nitrous oxide, respectively). Morris water maze performance at 3 months was similar between anesthetic groups and was also similar to sham performance. The percent alive CA1 neurons in the fentanyl-nitrous oxide group increased with duration of recovery (P = 0.004). There were no differences among isoflurane groups over time (5 days vs. 3 weeks, P = 0.26; 5 days vs. 3 months, P = 0.99; 3 week vs. 3 months, P = 0.32).

Conclusions
This study found no change in the percent alive CA1 hippocampal neurons as a function of duration of recovery from severe forebrain ischemia in isoflurane anesthetized rats. In contrast, the percent alive CA1 neurons in fentanyl-nitrous oxide-anesthetized rats tripled over 3 months of recovery. The natural history of long-term responses to forebrain ischemia requires further study before conclusions can be drawn with respect to the permanence of isoflurane neuroprotection.
Folding mechanism of the (H3–H4)2histone tetramer of the core nucleosome
Authors: Banks Douglas D. , Gloss Lisa M. 
Published: April 2004

AbstractTo further understand oligomeric protein assembly, the folding and unfolding kinetics of the H3–H4 histone tetramer have been examined. The tetramer is the central protein component of the core nucleosome, which is the basic unit of DNA compaction into chromatin in the eukaryotic nucleus. This report provides the first kinetic folding studies of a protein containing the histone fold dimerization motif, a motif observed in several protein–DNA complexes. Previous equilibrium unfolding studies have demonstrated that, under physiological conditions, there is a dynamic equilibrium between the H3–H4 dimer and tetramer species. This equilibrium is shifted predominantly toward the tetramer in the presence of the organic osmolyte trimethylamine‐N‐oxide (TMAO). Stopped‐flow methods, monitoring intrinsic tyrosine fluorescence and far‐UV circular dichroism, have been used to measure folding and unfolding kinetics as a function of guanidinium hydrochloride (GdnHCl) and monomer concentrations, in 0 and 1 M TMAO. The assignment of the kinetic phases was aided by the study of an obligate H3–H4 dimer, using the H3 mutant, C110E, which destabilizes the H3–H3′ hydrophobic four‐helix bundle tetramer interface. The proposed kinetic folding mechanism of the H3–H4 system is a sequential process. Unfolded H3 and H4 monomers associate in a burst phase reaction to form a dimeric intermediate that undergoes a further, first‐order folding process to form the native dimer in the rate‐limiting step of the folding pathway. H3–H4 dimers then rapidly associate with a rate constant of ≥107M−1sec−1to establish a dynamic equilibrium between the fully assembled tetramer and folded H3–H4 dimers.
The NMR solution structure of the 30S ribosomal protein S27e encoded in gene RS27_ARCFU of Archaeoglobus fulgidis reveals a novel protein fold
Authors: Herve du Penhoat Catherine , Atreya Hanudatta S. , Shen Yang , Liu Gaohua , Acton Thomas B. , Xiao Rong , Li Zhaohui , Murray Diana , Montelione Gaetano T. , Szyperski Thomas 
Published: April 2004

AbstractThe Archaeoglobus fulgidis gene RS27_ARCFU encodes the 30S ribosomal protein S27e. Here, we present the high‐quality NMR solution structure of this archaeal protein, which comprises a C4 zinc finger motif of the CX2CX14‐16CX2C class. S27e was selected as a target of the Northeast Structural Genomics Consortium (target ID: GR2), and its three‐dimensional structure is the first representative of a family of more than 116 homologous proteins occurring in eukaryotic and archaeal cells. As a salient feature of its molecular architecture, S27e exhibits a β‐sandwich consisting of two three‐stranded sheets with topology B(↓), A(↑), F(↓), and C(↑), D(↓), E(↑). Due to the uniqueness of the arrangement of the strands, the resulting fold was found to be novel. Residues that are highly conserved among the S27 proteins allowed identification of a structural motif of putative functional importance; a conserved hydrophobic patch may well play a pivotal role for functioning of S27 proteins, be it in archaeal or eukaryotic cells. The structure of human S27, which possesses a 26‐residue amino‐terminal extension when compared with the archaeal S27e, was modeled on the basis of two structural templates, S27e for the carboxy‐terminal core and the amino‐terminal segment of the archaeal ribosomal protein L37Ae for the extension. Remarkably, the electrostatic surface properties of archaeal and human proteins are predicted to be entirely different, pointing at either functional variations among archaeal and eukaryotic S27 proteins, or, assuming that the function remained invariant, to a concerted evolutionary change of the surface potential of proteins interacting with S27.
Structural and stability effects of phosphorylation: Localized structural changes in phenylalanine hydroxylase
Authors: Miranda Frederico Faria , Thórólfsson Matthías , Teigen Knut , Sanchez‐Ruiz Jose M. , Martínez Aurora 
Published: April 2004

AbstractPhosphorylation of phenylalanine hydroxylase (PAH) at Ser16 by cAMP‐dependent protein kinase increases the basal activity of the enzyme and its resistance to tryptic proteolysis. The modeled structures of the full‐length phosphorylated and unphosphorylated enzyme were subjected to molecular dynamics simulations, and we analyzed the energy of charge–charge interactions for individual ionizable residues in the final structures. These calculations showed that the conformational changes induced by incorporation of phosphate were localized and limited mostly to the region around the phosphoserine (Arg13–Asp17) and a region around the active site in the catalytic domain that includes residues involved in the binding of the iron and the substrate L‐Phe (Arg270 and His285). The absence of a generalized conformational change was confirmed by differential scanning calorimetry, thermal‐dependent circular dichroism, fluorescence spectroscopy, and limited chymotryptic proteolysis of the phosphorylated and unphosphorylated PAH. Our results explain the effect of phosphorylation of PAH on both the resistance to proteolysis specifically by trypsin‐like enzymes and on the increase in catalytic efficiency.
Preoperative assessment of liver function: a comparison of 99mTc‐Mebrofenin scintigraphy with indocyanine green clearance test
Authors: Erdogan Deha , Heijnen Bob H.M. , Bennink Roelof J. , Kok Mariël , Dinant Sander , Straatsburg Irene H. , Gouma Dirk J. , Van Gulik Thomas M. 
Published: April 2004

Background/aims: The indocyanine green (ICG) clearance test is the most frequently used test for preoperative assessment of liver parenchymal function but has its limitations. The aim of this study was to investigate the correlation between ICG clearance test and the liver uptake of 99‐Technetium‐labelled (99mTc)‐Mebrofenin (99mTc‐Mebrofenin) as measured with hepatobiliary scintigraphy.Methods: Fifty‐four patients were diagnosed as hepatocellular carcinoma (n=9), hilar tumours (n=20) and 25 patients with non‐parenchymal tumours including colorectal metastasis (n=15) and miscellaneous tumours (n=10). One day prior to operation, hepatobiliary 99mTc‐Mebrofenin scintigraphy was performed after intravenous injection of 85 MBq and the 15‐min clearance rate of ICG (ICG‐C15) was measured.Results: The mean ICG‐C15 was 86.86±1.19% (SEM). The mean 99mTc‐Mebrofenin uptake rate was 12.87±0.52%/min. A significant correlation was obtained between 99mTc‐Mebrofenin uptake rate by scintigraphy and ICG‐C15 (r=0.73, P<0.0001). The mean clearance capacity of the right liver segments (79.83±1.63, range 47.75–95.97%) was larger than that of the left segments (20.24±1.55, range 6.51–52.51%).Conclusion: 99mTc‐Mebrofenin uptake rate as assessed by scintigraphy is an efficient method for determining liver function and correlates well with ICG clearance. At the same time, 99mTc‐Mebrofenin scintigraphy provides information of segmental functional liver tissue, which is of additional use when planning liver resection.
Therapeutic effect of photodynamic therapy using PAD‐S31 and diode laser on human liver cancer cells
Authors: Date Masataka , Fukuchi Kazuhide , Namiki Yoshihisa , Okumura Akihiko , Morita Shosuke , Takahashi Hiroshi , Ohura Kiyoshi 
Published: April 2004

Abstract:  Background/aims: Photodynamic therapy (PDT) is an effective local cancer treatment which a photosensitizer is administered and the tumor is irradiated with light. We examined the effect of PDT using PAD‐S31 as the photosensitizer, and the 670 nm diode laser on human hepatocellular carcinomas (HCCs).Methods: Huh‐7, HepG2 and Hep3B cell lines were used in the all experiments. Cell viability was determined by a modified MTT assay. Two methods were used for the determination of apoptosis: terminal deoxynucleotidyl transferase (TdT)‐mediated dUTP nick‐end labeling assay and detection of fragmented mono‐ and oligo‐nucleosomes by enzyme‐linked immunosorbent assay. The caspase activity was measured by fluorometric assay. Cytochrome c in cytosolic fraction was determined using a human cytochrome c immunoassay. Xenografts of human oral HCC cells were generated in KSN S1c nude mice.Results: In vitro PDT showed excellent cytotoxicity that was a function of laser energy, drug concentration and time to the hepatoma cell lines. The combined use of PAD‐S31 and laser irradiation showed excellent anti‐tumor activity without severe side‐effect against human hepatoma xenografts in nude mice. PDT‐mediated cell death occurred predominantly by apoptosis in vitro and in vivo. Furthermore, this treatment initiates early cytochrome c release, followed by late caspase‐3 and ‐9 activation.Conclusion: Our study demonstrates that PDT using PAD‐S31 and the diode laser induces apoptosis that is mediated by cytochrome c release and caspase activation in human liver cancer cell lines. It is expected that this therapy will be clinically useful for the treatment of patients with HCC.
Serum levels of tumor necrosis factor‐α correlate with severity of hepatic encephalopathy due to chronic liver failure
Authors: Odeh M. , Sabo E. , Srugo I. , Oliven A. 
Published: April 2004

Background: Several studies have shown that serum levels of tumor necrosis factor‐α (TNF) are significantly elevated in patients with acute and chronic liver diseases, where these elevations are independent of the etiology of the underlying disease. Serum levels of TNF are significantly higher in patients with cirrhosis than in those without cirrhosis, reaching the highest levels in decompensated cirrhosis. It has also been shown that plasma levels of TNF correlate with the severity of hepatic encephalopathy (HE) in fulminant hepatic failure. However, still there are no published data regarding the relationship between blood levels of TNF and the presence or severity of HE in patients with chronic liver failure.Aim: The aim of this study is to determine the relationship between serum levels of TNF and clinical grades of HE in patients with liver cirrhosis.Methods: Using a commercially available high‐sensitivity enzyme‐linked immunosorbent assay kit, serum levels of TNF were measured in 74 patients with liver cirrhosis in various clinical grades of HE (grades 0–4).Results: The mean±SEM values of serum levels of TNF at presentation in patients with grade 0 of HE (n=23), grade 1 (n=12), grade 2 (n=14), grade 3 (n=16), and grade 4 (n=9) were 4.50±0.46, 9.10±1.0, 12.98±1.22, 21.51±2.63, and 58.26±19.7 pg/ml, respectively. A significant positive correlation was found between serum levels of TNF and the severity of HE (P<0.0001).Conclusion: Serum levels of TNF correlate positively with the severity of HE in patients with chronic liver failure.
Effect of carnosine on runt‐related transcription factor‐2/core binding factor α‐1 and Sox9 expressions of human periodontal ligament cells
Authors: Ito‐Kato Emi , Suzuki Naoto , Maeno Masao , Takada Tsuyoshi , Tanabe Natsuko , Takayama Tadahiro , Ito Koichi , Otsuka Kichibee 
Published: April 2004

Background:  Previous studies have reported that β‐alanyl‐l‐histidine (carnosine) enhanced the process of wound healing by stimulating effusion at the initial stage of inflammation, and also enhanced runt‐related transcription factor‐2/core binding factor α‐1 (RUNX2/Cbfa1), Sox9, bone morphogenetic protein‐2 (BMP‐2) and BMP‐7 expressions of human periodontal ligament cells.Objectives:  In order to clarify the relationship between RUNX2/Cbfa1 or Sox9 expressions and BMP‐2 or BMP‐7 expressions enhanced by carnosine, we determined the effect of carnosine on the expression of BMP receptors and activation of their downstream signaling molecules in human periodontal ligament cells.Material and methods:  Human periodontal ligament cells were cultured with α‐minimum essential medium containing 10% fetal bovine serum with or without 10−4 or 10−5 m carnosine for up to 10 days. The gene expression of BMP receptors, RUNX2/Cbfa1 and Sox9 was measured using semiquantitative reverse transcription‐polymerase chain reaction. Phosphorylation of Smad1 was determined using a western blot analysis.Results:  Alkaline phosphatase activity increased in cultures with carnosine. Among the BMP receptors, expression of ActR‐I and BMPR‐II increased in cultures with carnosine, whereas expression of BMPR‐IA, BMPR‐IB, ActR‐IIA and ActR‐IIB was not affected. Culture with carnosine increased phosphorylation of Smad1, a signal‐transducing molecule for BMP‐2 and BMP‐7. Noggin reduced carnosine‐induced up‐regulation of RUNX2/Cbfa1 and Sox9 mRNA, suggesting that BMPs were responsible for up‐regulating RUNX2/Cbfa1 gene expression in human periodontal ligament cells.Conclusion:  These results suggest that carnosine enhance RUNX2/Cbfa1 and Sox9 expression of human periodontal ligament cells via the autocrine action of BMP‐2 or BMP‐7 produced by the cells.
When Numbers Began to Count for Health Policy: A Review Essay*
Authors: Johansson Sheila Ryan 
Published: April 2004

Books reviewed in this article: Jack M. Hollander, The Real Environmental Crisis: Why Poverty, Not Affluence, Is the Environment's Number One Enemy Glenn Firebaugh, The New Geography of Global Income Inequality Nancy E. Riley and James Mccarthy, Demography in the Age of the Postmodern Catherine Campbell, ‘Letting Them Die’: Why HIV/AIDS Intervention Programmes Fail Konstantinos Kapparis, Abortion in the Ancient World
The Development of Organization Structure in the Family Firm
Authors: Barry Bernard 
Published: April 2004

Where the family does play an important part in business it is often a reflection of the economic immaturity of the population, the absence of a tradition of impersonal service in industry and the vulnerability of employees who have no kinship ties to the firm.1 —United Nations There has always been, and there will always be, a place for smaller companies and for the family business.2 —Sir Frederick Catherwood
East Meets West: Innovative Forms of Foreign Trade Finance Between Italian Family Enterprises and Emerging SMEs in Romania
Authors: McKibbin Paul , Pistrui David 
Published: April 2004

The collapse of the USSR has created an opportunity for the rebirth of entrepreneurship and family business. Unfortunately, the transition economies of the former Soviet Bloc often lack the financial resources required to upgrade operations. This paper examines how an innovative form of finance, with historical roots in East-West European trade, helps drive the expansion of transition enterprises in the emerging markets of Eastern Europe, and at the same time provides export-led growth particularly for family-based small and medium-sized enterprises (SMEs) in the more developed nations of Western Europe. The technique, called forfaiting, allows businesses to control some of the risks that are inherent in dealing with emerging markets. We present a forfaiting model that demonstrates the way in which these singular transactions divide localized (transaction-oriented) risks from those risks that are associated with political instability, macroeconomic changes, environmental volatility, and force majeure. We follow this with presentations of actual examples of how forfaiting is being used between Italian family businesses and newly emerging private enterprises in Romania.
Social Embeddedness, Overt and Covert Power, and Their Effects on CEO Pay: An Empirical Examination Among Family Businesses in India
Authors: Veliyath Rajaram , Ramaswamy Kannan 
Published: April 2004

The literature on CEO compensation reflects two common biases: (a) the dominant use of the agency theory perspective and (b) the almost exclusive use of U.S. and U.K samples. Agency theory views compensation as a consequence of the incentive contracts and the processes of corporate governance. However, little is known about the determinants of CEO compensation in developing countries. Considering that foreign direct investment of U.S. multinational enterprises increased 10-fold over the past decade, mostly in developing economies, there is a great need to understand the dynamics of pay setting in these foreign contexts. Overall, there is an imperative need to explore alternative theoretical perspectives as well as investigate nontraditional contexts to broaden existing theoretical premises. In an attempt to address this need, this study investigates the CEO's social embeddedness and overt and covert power as determinants of CEO pay in a sample of Indian family-controlled firms. Using a time-series, cross-sectional regression analysis, we find family shareholding and the percentage of inside directors on the board (identified as bases of overt power for the CEO) to be the predominant influences on CEO pay. By contrast, some of the identified bases of covert power, such as the CEO's tenure, age, education, and firm diversification, are not significant. Surprisingly, controls for firm size and performance also exhibit no influence on CEO pay. These findings offer a useful point of reference against which results from western studies can be compared to formulate more holistic theories of CEO pay.