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In-vitro selection of highly stabilized protein variants with optimized surface.

Thermostable proteins are of prime importance in protein science, but it has remained difficult to develop general strategies for stabilizing a protein. Site-directed mutagenesis based on comparisons with thermophilic homologs is rarely successful because the sequence differences are too numerous and dominated by neutral mutations. Here we used a method of directed evolution to increase the stability of a mesophilic protein, the cold shock protein Bs-CspB from Bacillus subtilis. It differs from its thermophilic counterpart Bc-Csp from Bacillus caldolyticus at 12 surface-exposed positions. To elucidate the stabilizing potential of exposed amino acid residues, six of these variant positions were randomized by saturation mutagenesis, the corresponding library of sequences was inserted into the gene-3-protein of the filamentous phage fd, and stabilized variants were selected by the Proside technique. Proside links the increased protease resistance of stabilized protein variants with the infectivity of the phage. Many strongly stabilized variants of Bs-CspB were identified in two selections, one in the presence of a denaturant and the other at elevated temperature. Several of them are significantly more stable than the naturally thermostable homolog Bc-Csp, and the best variant reaches Tm-Csp (the homolog from the hyperthermophile Thermotoga maritima) in stability. Remarkably, this variant differs from Tm-Csp at five and from Bc-Csp at all six randomized positions. This indicates that proteins can be strongly stabilized by many different sets of surface mutations, and Proside selects them efficiently from large libraries. The course of the selection could be directed by the conditions. In an ionic denaturant non-polar surface interactions were optimized, whereas at elevated temperature variants with improved electrostatics were selected, pointing to two different strategies for stabilization at protein surfaces.

Amino Acid Sequence↗

Tyrosine hydrogen bonds make a large contribution to protein stability.

The aim of this study was to gain a better understanding of the contribution of hydrogen bonds by tyrosine -OH groups to protein stability. The amino acid sequences of RNases Sa and Sa3 are 69 % identical and each contains eight Tyr residues with seven at equivalent structural positions. We have measured the stability of the 16 tyrosine to phenylalanine mutants. For two equivalent mutants, the stability increases by 0.3 kcal/mol (RNase Sa Y30F) and 0.5 kcal/mol (RNase Sa3 Y33F) (1 kcal=4.184 kJ). For all of the other mutants, the stability decreases with the greatest decrease being 3.6 kcal/mol for RNase Sa Y52F. Seven of the 16 tyrosine residues form intramolecular hydrogen bonds and the average decrease in stability for these is 2.0(+/-1.0) kcal/mol. For the nine tyrosine residues that do not form intramolecular hydrogen bonds, the average decrease in stability is 0.4(+/-0.6) kcal/mol. Thus, most tyrosine -OH groups contribute favorably to protein stability even if they do not form intramolecular hydrogen bonds. Generally, the stability changes for equivalent positions in the two proteins are remarkably similar. Crystal structures were determined for two of the tyrosine to phenylalanine mutants of RNase Sa: Y80F (1.2 A), and Y86F (1.7 A). The structures are very similar to that of wild-type RNase Sa, and the hydrogen bonding partners of the tyrosine residues always form intermolecular hydrogen bonds to water in the mutants. These results provide further evidence that the hydrogen bonding and van der Waals interactions of polar groups in the tightly packed interior of folded proteins are more favorable than similar interactions with water in the unfolded protein, and that polar group burial makes a substantial contribution to protein stability.

Amino Acid Substitution↗

Electrostatic stabilization of a thermophilic cold shock protein.

The cold shock protein Bc-Csp from the thermophile Bacillus caldolyticus differs from its mesophilic homolog Bs-CspB from Bacillus subtilis by 15.8 kJ mol(-1) in the Gibbs free energy of denaturation (DeltaG(D)). The two proteins vary in sequence at 12 positions but only two of them, Arg3 and Leu66 of Bc-Csp, which replace Glu3 and Glu66 of Bs-CspB, are responsible for the additional stability of Bc-Csp. These two positions are near the ends of the protein chain, but close to each other in the three-dimensional structure. The Glu3Arg exchange alone changed the stability by more than 11 kJ mol(-1). Here, we elucidated the molecular origins of the stability difference between the two proteins by a mutational analysis. Electrostatic contributions to stability were characterized by measuring the thermodynamic stabilities of many variants as a function of salt concentration. Double and triple mutant analyses indicate that the stabilization by the Glu3Arg exchange originates from three sources. Improved hydrophobic interactions of the aliphatic moiety of Arg3 contribute about 4 kJ mol(-1). Another 4 kJ mol(-1) is gained from the relief of a pairwise electrostatic repulsion between Glu3 and Glu66, as in the mesophilic protein, and 3 kJ mol(-1) originate from a general electrostatic stabilization by the positive charge of Arg3, which is not caused by a pairwise interaction. Mutations of all potential partners for an ion pair within a radius of 10 A around Arg3 had only marginal effects on stability. The Glu3-->Arg3 charge reversal thus optimizes ionic interactions at the protein surface by both local and global effects. However, it cannot convert the coulombic repulsion with another Glu residue into a corresponding attraction. Avoidance of unfavorable coulombic repulsions is probably a much simpler route to thermostability than the creation of stabilizing surface ion pairs, which can form only at the expense of conformational entropy.

Amino Acid Sequence↗

Visual, vestibular and voluntary contributions to human head stabilization.

We have investigated the ability of humans to stabilize their heads in space and assessed the influence of mental set and the relative importance of visual and vestibular cues. Ten normal subjects and 3 patients with bilateral vestibular loss were studied. Subjects were fixed firmly to the chair of a turntable facing a screen on which was projected a target spot. A 'gunsight' spot generated by a small projector fixed to the head provided feedback of head position. Four conditions were studied (1) Gunsight (GU): subjects were instructed to stabilize the head in space by superimposing the 'gunsight' spot on the fixed target spot while chair position was displaced according to a random pattern with a bandwidth from 0-1 Hz. (2) Imagined gunsight (IGU): identical to condition 1 except that the subject was blindfolded and so had to imagine the target position. (3) Mental arithmetic (MA): subjects did mental arithmetic while the chair was displaced. (4) Visual tracking (VT): subjects were instructed to track the target spot with the 'gunsight' spot while the chair was fixed and the target spot driven to follow the chair displacement trajectory used in conditions 1, 2 and 3. In GU normal subjects stabilized their head position extremely well (mean HEAD/CHAIR gain = 0.81). Significant stabilization was present in IGU although the gain (mean gain = 0.61) was reduced compared to GU. There was very little stabilization in MA (mean gain = 0.12). In VT, subjects tracked the target with about the same gain (mean gain = 0.68) as in IGU. By comparison, the vestibular patients could not perform IGU, for which their performance (mean gain = 0.08) was similar to MA (mean gain = 0.06). In GU (mean gain = 0.54), their performance was attributable to visual tracking (mean gain in VT = 0.50). For the frequency bandwidth in which subjects were tested, the results show that: When subjects were distracted by mental arithmetic, the contribution to head stability of the short latency cervico-collic (CCR) and vestibulo-collic (VCR) reflexes is negligible. As expected, vision plays an important role in stabilizing the head. Equally important are long latency stabilizing mechanisms whose onset times (140 ms) are shorter, but still comparable to that of vision. The latter mechanisms are of vestibular origin and their influence is under voluntary control so as to permit augmenting head stability compared to what it would be if vision acted alone.

Adult↗

Interrelationships between Rates of Microbial Production, Exopolymer Production, Microbial Biomass, and Sediment Stability in Biofilms of Intertidal Sediments.

The upper few millimeters of intertidal sediment supports a varied biomass of microbial consortia and microphytobenthos. Many of these organisms release extracellular polymers into the surrounding sediment matrix that can result in sediment cohesion and the increased stability of the sediment. The relationship between the heterotrophic and autotrophic components of these biofilms is not well understood. A combination of mesocosm and field investigations were used to investigate the relationship between microbial production rate (algae and bacteria), the extracellular carbohydrates, biomass, and stability in conjunction with a variety of environmental factors. An inverse relationship was found between rates of algal production and sediment stability both in the field and in laboratory mesocosms, though the relationship was significant only in the field (P < 0.001). Stability of sediments increased with increasing bacterial production rate (P < 0.001). Positive correlations were found between sediment stability and a range of other variables, including algal biomass (P < 0.001), colloidal-S EPS (P < 0.001), colloidal-S carbohydrate (P < 0.01), colloidal-S EDTA (P < 0.01), and sediment water content (P < 0.001). Using the data acquired, a preliminary model was developed to predict changes in sediment stability. Chlorophyll a, water content, and colloidal-S EPS were found to be the most important predictors of stability in intact cores incubated under laboratory conditions. Differences observed in patterns of the surface (0-2 mm) distribution of colloidal-S carbohydrate and chlorophyll a when expressed on a dry weight or areal basis were attributed to effects of dewatering and concomitant changes in wet bulk density. The polymeric carbohydrate (colloidal-S EPS) component of the biofilms was not found to be a constant fraction of the colloidal-S carbohydrate extract, varying from 16 to 58%, and the percentage of polymer decreased logarithmically as chlorophyll a concentrations increased and the biofilms matured (P < 0.001). Changes in the relationships between these variables over the period of biofilm development and maturation highlight the difficulties in their use to predict sediment stability. Exopolymer concentrations were more closely correlated with algal biomass than with bacterial numbers. Rates of algal carbon fixation were considerably greater than those for bacteria, suggesting that the algae have a much greater potential for exopolymer production. It is suggested that the microphytobenthos secretions make a more important contribution to sediment stability.

Journal Article↗

Topographical and temporal stability of the P300.

Sixteen normal adults listened to a standard oddball auditory paradigm 3 times, each time separated by 15 min, and this protocol was then repeated 1-2 months later. Stability of the wave forms was measured between 250 and 500 msec for each subject and for each of 16 electrodes by the cross-correlation technique described by Glaser and Ruchkin (1976) and Gevins (1987) in which points on 2 digitized wave forms are paired to produce a correlation coefficient. For each subject, the correlation coefficient was generated for each electrode and then averaged across the 2 parietal and 2 central electrodes to produce a single stability measure for the central electrodes, while the cross-correlation coefficients for the 12 remaining electrodes were averaged for a peripheral stability measure. Three-way repeated measures ANOVAs were performed to determine the significance of cross-correlation coefficient differences. The stability over 15 min for the central electrodes was 0.80, indicating that the P300 was very stable over a short time. The peripheral electrodes were significantly less stable than the central electrodes (P = 0.001). The stability of the wave forms was virtually unchanged when assessed over 1 month (P = 0.9). The target wave forms were significantly more stable than the difference waves (target minus non-target) for both the central and peripheral electrodes (P = 0.04 and 0.01). When the 3 blocks within each session were averaged, there was a significant increase in stability (P less than 0.0005). The wave form cross-correlation coefficients can be used as a measure of the stability of a topographical map over time. The map of the target P300 wave form is very stable, showing no loss in stability from 15 min to 1 month, is more stable than the difference wave form and significantly increases in stability when separate trial blocks are averaged together.

Adult↗

Embedding in a collagen gel stabilizes the polarity of epithelial cells in thyroid follicles in suspension culture.

Separated thyroid follicles are stable in suspension culture in Coon's modified Ham's F12 medium containing 0.5% calf serum. They resemble follicles in vivo except for the absence of a basal lamina. However, the epithelial cells reverse polarity and the follicles invert when the serum concentration is raised to 5%. A number of substances, especially components of extracellular matrix, were added to the medium to ascertain if they could stabilize the follicles against inversion in 5% serum. Cellular and plasma fibronectin, gelatin, heat-denatured collagen, methylcellulose and laminin did not stabilize. The addition to the medium of as little as 50 micrograms/ml of acid-soluble collagen prepared from calf skin or rat tail tendons resulted in the formation of small clouds of gel. Follicles embedded within the gel were stabilized. Follicles in the same dish but not embedded in the gel inverted. Stabilization was not specific for collagen, since follicles embedded in a plasma clot were also stabilized. A gel was not sufficient for stabilization, since embedding in an agarose gel did not stabilize. Ultrastructural studies indicate that adherence to a limited number of gelled fibers of collagen covering only a small fraction of the basal plasma membrane may be sufficient to stabilize and that a basal lamina formed in the presence of laminin but without added collagen does not stabilize.

Animals↗

The role of histidines 26 and 33 in the structural stabilization of cytochrome c.

Comparative studies of the importance of the two histidines of rat cytochrome c that are not ligands of the heme iron, for the stability of the protein, were carried out by site-directed mutagenesis. Histidine 26 was substituted by valine and the resulting effects on the stability of the Met-80-sulfur to heme iron bond to changes in pH and temperature, and of the global stability of the protein to unfolding in urea solutions, were measured. It is suggested that the loss of the hydrogen bond between the His-26 imidazole and the backbone amide of Asn-31 caused the observed decreases in local stability; and that, in addition, the elimination of the hydrogen bond between this imidazole and the carbonyl of Pro-44 resulted in an increase of the mobility of the lower loop (residues 41-47) on the right side of the protein and of its distance from the middle loop (residues 26-31), probably leading to greater hydration of the interior right side of the molecule. These changes resulted in a decrease in the global stability of the protein. Further mutation of Asn-52 to Ile led to a total recovery of the wild-type stability of the sulfur-iron bond, and a partial restoration of the global stability of the protein. Substitution of Phe for His-33 did not alter the sulfur-iron bond but caused a pronounced increase in the global stability of the protein. It is suggested that this effect results from hydrophobic interaction of the Phe-33 side chain with the lower loop on the right side of the protein. Such an interaction also explains the observation that the same mutation reversed the loss of global stability caused by substitution of Val to His-26, but did not restore the strength of the sulfur-iron bond that this mutation had brought about.

Amino Acid Sequence↗

Regulation of vasoactive intestinal polypeptide and galanin mRNA stabilities.

The stabilities of vasoactive intestinal polypeptide (VIP) and galanin mRNAs were examined in a human neuroblastoma cell line (NBFL) treated with agents that alter second-messenger pathways. VIP and galanin mRNA stabilities were estimated by the decay of steady-state levels of transcripts following transcriptional arrest with actinomycin D or 5,6-dichloro-1-beta-D-ribofuranosylbenzimidazole (DRB). In the presence of actinomycin D, phorbol ester treatment stabilized VIP mRNA while treatment with adenylate cyclase activators, calcium ionophore, or CNTF did not. In the presence of DRB, VIP mRNA was not stabilized in phorbol ester-treated cells but instead was stabilized in cells treated with adenylate cyclase activators. With either transcriptional inhibitor, stability of galanin mRNA was not significantly altered. The difference in the behavior of VIP mRNA in the presence of actinomycin D and DRB may result from their different mechanisms of action-actinomycin D intercalates into nucleic acids while DRB is a kinase inhibitor. Using an assay for RNA stability that did not require transcriptional inhibitors, an in vitro transcribed VIP RNA fragment was relatively stable in extracts from phorbol ester-treated cells. Although treatment with phorbol ester alone resulted in stabilization of VIP mRNA, treatment with a combination of phorbol ester and adenylate cyclase activator, calcium ionophore, or CNTF did not-implying a complex interaction of these second-messenger pathways in the regulation of RNA stability.

Galanin↗

Genetic and environmental contributions underlying stability in childhood obsessive-compulsive behavior.

BACKGROUND: Little is known about the stability of obsessive-compulsive (OC) behavior during childhood. The objective of this study is to determine the developmental stability of pediatric OC behavior and the genetic and environmental influences on stability in a large population-based twin sample. METHODS: Maternal and paternal ratings on the 8-item Obsessive Compulsive Scale of the Child Behavior Checklist (CBCL-OCS) on Dutch mono- and dizygotic twin pairs from 8083 families were collected at ages 7, 10, and 12 years. Using a longitudinal twin design, stability of OC behavior and genetic and environmental influences on stability were determined. Using cutoff criteria, persistent, resilient, and new onset cases were identified in this sample. RESULTS: OC behavior assessed by the CBCL-OCS showed a moderate stability with phenotypic correlations of around .50 for boys and for girls. Stability of OC behavior was influenced by genetic factors, by environmental factors shared by children growing up in the same family, and by non-shared environmental factors. Stability for OCS was lower when categorical data were analyzed than when quantitative definitions were used. CONCLUSIONS: OC behavior is moderately stable in childhood. Stability of OC behavior is influenced by genetic, shared, and non-shared environmental factors.

Child↗

The effect of the walking speed on the stability of the anterior cruciate ligament deficient knee.

BACKGROUND: The reasons behind the development of future pathology in individuals with anterior cruciate ligament deficiency are unknown. This is due to the lack of appropriate methods to assess functional dynamic knee stability. In this study, we investigated the effect of walking speed on the functional dynamic stability of the anterior cruciate ligament deficient knee. We defined functional dynamic stability as local stability or the sensitivity of the knee to small perturbations. The natural stride-to-stride variations that exist during locomotion reflect exactly the presence of these perturbations. We hypothesized that speed will affect local stability in the deficient knee, especially when compared with the contralateral intact. METHODS: Ten subjects with unilateral deficiency walked on a treadmill at their self-selected speed, 20% faster, and 20% slower, while kinematic data were collected (50 Hz) for 100 consecutive footfalls for each condition. The largest Lyapunov Exponent of the resulted knee joint flexion-extension time series was calculated to quantify local stability. FINDINGS: The deficient knee was significantly more locally unstable than the contralateral knee. Furthermore, increases in walking speed did not affect local stability for our subject population. INTERPRETATIONS: The altered local stability may render the deficient knee less adaptable to the ever-changing environmental demands. This may explain the increased future pathology found in these knees. However, future efforts should attempt to evaluate this speculation using longitudinal studies. We also propose that the tools utilized in this study can be used eventually to assess functional dynamic knee stability in clinical gait analysis.

Adult↗

Knowledge acquisition and development of accurate rules for predicting protein stability changes.

Knowing the mechanisms by which protein stability change is one of the most important and valuable tasks in molecular biology. The conventional methods of predicting protein stability changes mainly focus on improving prediction accuracy. However, it is desirable to extract domain knowledge from large databases that is beneficial to accurate prediction of the protein stability change. This paper presents an interpretable prediction tree method (named iPTREE) that produces explanatory rules to explore hidden knowledge accompanied with high prediction accuracy and consequently analyzes the factors influencing the protein stability changes. To evaluate iPTREE and the knowledge upon protein stability changes, a thermodynamic dataset consisting of 1615 mutants led by single point mutation from ProTherm is adopted. Being as a predictor for protein stability changes, the rule-based approach can achieve a prediction accuracy of 87%, which is better than other methods based on artificial neural networks (ANN) and support vector machines (SVM). Besides, these methods lack the ability in biological knowledge discovery. The human-interpretable rules produced by iPTREE reveal that temperature is a factor of concern in predicting protein stability changes. For example, one of interpretable rules with high support is as follows: if the introduced residue type is Alanine and temperature is between 4 degrees C and 40 degrees C, then the stability change will be negative (destabilizing). The present study demonstrates that iPTREE can easily be used in the application of protein stability changes where one requires more understandable knowledge.

Algorithms↗

Interaction of aldehydes with collagen: effect on thermal, enzymatic and conformational stability.

Stabilization of type I rat tail tendon (RTT) collagen by various aldehydes, viz. formaldehyde, gluteraldehyde, glyoxal and crotanaldehyde was studied to understand the effect of each on the thermal, enzymatic and conformational stability of collagen. The aldehydes have been found to increase the heat stability of rat tail tendon collagen fibres from 62 to 77-86 degrees C. The increase in thermal stability was found to be in a species dependent manner. The variation in the thermal stability of collagen brought about by aldehydes was in the order of formaldehyde > gluteraldehyde > glyoxal > crotanaldehdye. The aldehydes also impart a high degree of stability to collagen against the activity of the degrading enzyme, collagenase. The order of enzymatic stability brought about by aldehydes follows the same trend as the thermal stability brought about by them. This shows that the number of cross-links formed influence both the thermal and enzymatic stability in the similar manner. The effect of various aldehydes on the secondary structure of collagen was studied using circular dichroism and it was found that the aldehydes lead to changes in the amplitude of the circular dichroic (CD) spectrum but did not alter the triple helical conformation of collagen. The secondary structure of collagen is not significantly altered on interaction with different aldehydes.

Aldehydes↗

Domain interactions in the Fab fragment: a comparative evaluation of the single-chain Fv and Fab format engineered with variable domains of different stability.

Recombinant antibody fragments, most notably Fab and scFv, have become important tools in research, diagnostics and therapy. Since different recombinant antibody formats exist, it is crucial to understand the difference in their respective biophysical properties. We assessed the potential stability benefits of changing the scFv into the Fab format, the influence of the variable domains on the stability of the Fab fragment, and the influence of the interchain disulfide bond in the Fab fragment. To analyze domain interactions, the Fab fragment was broken down into its individual domains, several two-domain assemblies and one three-domain assembly. The equilibrium denaturation properties of these constructs were then compared to those of the Fab fragment. It was found that mutual stabilization occurred across the VH/VL and the CH1/CL interface, whereas the direct interaction between the V) and the CL domain had no influence on the stability of either domain. This observation can be explained by the different interfaces used for interaction. In contrast, the whole CH1CL and VHVL unit showed significant mutual stabilization, indicating a high degree of cooperation between the VH/VL and CH1/CL interface. The interchain disulfide bond in the Fab fragment plays an essential role in this stabilization. In addition to the effects of domain association on the thermodynamic (equilibrium) stability, Fab fragments differ from scFv fragments of similar equilibrium stability by having a very slow unfolding rate. This kinetic stabilization may increase significantly the resistance of Fab fragments against short time exposure to adverse conditions.

Disulfides↗

Point mutations in protein globular domains: contributions from function, stability and misfolding.

Several contrasting hypotheses have been formulated about the influence of functional and conformational properties, like stability and avoidance of misfolding, on the evolution of protein globular domains. Selection at functional sites has been suggested to be detrimental to stability or coupled to it. Avoidance of misfolding may be achieved by discarding misfolding-prone sequences or by maintaining a stable native state and thus destabilizing partially or fully unfolded states from which misfolding can take place. We have performed a hierarchical analysis of a large database of point mutations to dissect the relative contributions of function, stability and misfolding in the evolution of natural sequences. We show that at catalytic sites, selection for function overrules selection for stability but find no evidence for an anticorrelation between function and stability. Selection for stability plays a secondary role at binding sites, but is not fully coupled to selection for function. Remarkably, we did not find a selective pressure against misfolding-prone sequences in globular proteins at the level of individual positions. We suggest that such a selection would compromise native-state stability due to a correlation between the stabilities of native and misfolded states. Stabilization of the native state is the most frequent way in which natural proteins avoid misfolding.

Amyloid↗

The effect of aging on postural stability: a cross sectional and longitudinal study.

AIMS OF THE STUDY: Only a good knowledge of the effects of age on postural stability allows differentiating between physiological aging and pathologies leading to its impairment. The aims of this study were to define the posturographic parameters which best reflected the effects of aging on postural stability and to determine the slope of postural stability impairment related to aging. PATIENTS AND METHODS: Postural stability of 50 normal volunteers aged 25-83 years (55.4) was studied with one Kistler force plate. Subjects were asked to stand for 30 s on two-legged stance, eyes open then closed. The center of pressure displacement (COPd) and velocities (COPv), in the antero-posterior (x) and the medio-lateral (z) axis, the sway axis, and the integral of COP displacement vs. time were computed. Eleven subjects were retested at 3 and 6 months to estimate the reliability of posturographic measurements. In addition, 28 subjects aged 25-83 years (60.2) were retested 2.2 years after their first posturographic assessment. RESULTS: COPxv best reflected postural stability impairment with aging. Closure of the eyes increased the variance of the results. This change was higher in subjects more than 60 years old: 0.019-0.157 cm2 s(-2) than in younger ones: 0.011-0.043 cm2 s(-2). Retesting at 3 and 6 months showed a reliability of 79%. According to the cross-sectional part of the study, the slope of postural stability impairment with aging was estimated at 0.0038 cm/s/year. These results were confirmed by the longitudinal part of the study, which showed that COPxv increased from 0.66-0.75 cm/s/year (P = 0.0001) (slope = 0.0041 cm/s/year). CONCLUSION: (1) Measurement of COPxv, on two-legged stance, is a simple and reliable way to assess postural stability. (2) Thanks to both a cross sectional and a longitudinal study, the rate of postural stability impairment due to aging was precisely estimated, which will be useful to help distinguishing between the part of postural stability impairment attributable to aging from the one due to neuro-degenerative diseases.

Adult↗

The use of a lateral stabilizer increases the incidence of wound trouble following the Nuss procedure.

BACKGROUND: A lateral stabilizer has been used to prevent bar displacement during the Nuss procedure for pectus excavatum repair in pediatric patients. We experienced wound troubles in patients who had a stabilizer placed within them. The aim of this study was to examine the effect of a lateral stabilizer and other clinical factors on wound troubles after the Nuss procedure. METHODS: 53 patients with pectus excavatum underwent repair by the Nuss procedure. Preoperative clinical data, operative data, and postoperative complications were examined in all patients. RESULTS: A lateral stabilizer was placed in 29 of the 53 patients. Short-term results were excellent in 42 patients (79.2%). Postoperative complications involved pneumothorax requiring drainage in two patients, atelectasis in one patient, pleural effusion in three patients, deterioration of scoliosis in one patient, erythema in one patient, persistent pain in two patients, bar displacement in four patients, and local wound complications (Seroma with dermatitis due to pressure damage) in five patients. All seromas with dermatitis due to pressure damage were initially aseptic around lateral stabilizers and became infected in four patients after resection of the seroma or spontaneous perforation. Removal of both the pectus bar and lateral stabilizer was performed in two of those four patients and the lateral stabilizer was removed in the other two patients to prevent catastrophic infection such as empyema or mediastinitis. The use of a lateral stabilizer increases the incidence of wound trouble (p = 0.041). CONCLUSIONS: Although the Nuss procedure has evolved into an effective method for pectus excavatum repair, the use of a lateral stabilizer increases the incidence of wound difficulties.

Adolescent↗

Adding loads to occupied wheelchairs: effect on static rear and forward stability.

OBJECTIVE: To determine the extent to which loads added in different positions affect the static rear and forward stability of an occupied wheelchair. DESIGN: Controlled, cross-over study. INTERVENTION: Loads from 0 to 10kg (in 1-kg increments) were added to five positions: high rear (HR), low rear (LR, beneath the seat and behind the crossbrace), on the lap (LAP), low anterior (LA, beneath the seat and anterior to the crossbrace), and on the footrests (FR). We also used a computer model to evaluate the relationship between stability and load, with a range of loads (0 to 100kg, in 10-kg increments) beyond the loads that were practical to test empirically. OUTCOME MEASURE: On a tilting platform, we measured the static stability (in degrees) of a wheelchair occupied by an anthropomorphic test dummy (ATD). RESULTS: The greatest increase in rear stability was with FR loads, changes of 64% and 227% for 10-kg and 100-kg loads, respectively. Only HR loads reduced rear stability, by 32% and 64%. The greatest increase in forward stability was with LR loads, by 13% and 92%. The greatest reduction in forward stability was with FR loads, by 10% and 149%. To minimize the effect of added loads on stability, the LAP and LA positions would be preferred. CONCLUSION: Added loads affect wheelchair stability as a function of the load magnitude. The extent and direction of the effect is profoundly influenced by load position.

Accidents↗