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[Head injuries in the pediatric emergency department: a 5-year experience at the Pediatric Clinic of Modena].

We re-evaluated the cases of 436 children with minor head injury admitted in the paediatric department of Modena University Hospital in the years 1991-1995 in order to revise diagnostic and therapeutic protocols. The external lesions, the presence of loss consciousness, vomiting, vegetative reactions, late complications, skull X ray, TC scan and EEG were considered. Signs and symptoms at admission have been faced with instrumental findings and eventual late complications to evaluate the prognostic significance. External lesions and vomiting did not correspond to TC scan and EEG positivity or significant sequelae. A more close connection to these parameters was found when an history of immediate loss of consciousness after trauma, or presence of vegetative reactions. Skull X ray appeared useless both to judge the seriousness of the lesion and to formulate a prognosis. EEG appeared a sensible tool to evaluate the gravity of the trauma and its late consequences. TC has confirmed to be the unique instrument able to solve any diagnostic or prognostic doubt. When symptoms suggest a bad prognosis, diagnostic procedures should be limited to TC and EEG. By our point of view, patients that at admission have a normal neurological examination at the Glasgow Coma Scale, no significant symptoms and signs, an history of a minor impact dynamic and no signs of child abuse, can be discharged from the emergency department; in this case parents should be instructed how to do an observation at home in order to evaluate eventual complications.

Age Factors↗
PubMed2003

Structural studies on flavin reductase PheA2 reveal binding of NAD in an unusual folded conformation and support novel mechanism of action.

The catabolism of toxic phenols in the thermophilic organism Bacillus thermoglucosidasius A7 is initiated by a two-component enzyme system. The smaller flavin reductase PheA2 component catalyzes the NADH-dependent reduction of free FAD according to a ping-pong bisubstrate-biproduct mechanism. The reduced FAD is then used by the larger oxygenase component PheA1 to hydroxylate phenols to the corresponding catechols. We have determined the x-ray structure of PheA2 containing a bound FAD cofactor (2.2 A), which is the first structure of a member of this flavin reductase family. We have also determined the x-ray structure of reduced holo-PheA2 in complex with oxidized NAD (2.1 A). PheA2 is a single domain homodimeric protein with each FAD-containing subunit being organized around a six-stranded beta-sheet and a capping alpha-helix. The tightly bound FAD prosthetic group (K(d) = 10 nm) binds near the dimer interface, and the re face of the FAD isoalloxazine ring is fully exposed to solvent. The addition of NADH to crystalline PheA2 reduced the flavin cofactor, and the NAD product was bound in a wide solvent-accessible groove adopting an unusual folded conformation with ring stacking. This is the first observation of an enzyme that is very likely to react with a folded compact pyridine nucleotide. The PheA2 crystallographic models strongly suggest that reactive exogenous FAD substrate binds in the NADH cleft after release of NAD product. Nanoflow electrospray mass spectrometry data indeed showed that PheA2 is able to bind one FAD cofactor and one FAD substrate. In conclusion, the structural data provide evidence that PheA2 contains a dual binding cleft for NADH and FAD substrate, which alternate during catalysis.

Amino Acid Sequence↗
PubMed1983

The catalytic mechanism of glutathione reductase as derived from x-ray diffraction analyses of reaction intermediates.

The mode of binding of NADPH and oxidized glutathione to the flavoenzyme glutathione reductase has been determined by x-ray crystallography. Furthermore, two intermediates of the reaction have been produced in the crystal and have been structurally elucidated. All these analyses were done at 0.3 nm resolution. The results allow the stereochemical description of the mechanism of the enzyme. The dinucleotide NADPH is bound in an extended conformation with the nicotinamide ring stacking onto the re-face of the flavin part of FAD, and adenine located at the protein surface. The binding of NADPH results in the 2-electron reduced form of the enzyme, EH2. This form has also been analyzed without any ligand bound. In EH2 the redoxactive disulfide bridge of the protein, which lies at the si-face of the flavin ring, is opened and the sulfur of Cys-58 moves by about 0.1 nm into a position where it can attack one of the sulfurs of the substrate oxidized glutathione. This interchange leads to a mixed glutathione-protein disulfide, which can be stabilized in crystals and has been analyzed. By selectively reacting Cys-58 with iodoacetamide the crystalline enzyme can be blocked in its EH2 state. The imidazole of His-467' is near to all sulfurs taking part in the disulfide bridge exchange and is therefore certainly crucial for catalysis. The crystallographic results establish that electrons flow from NADPH to the substrate GSSG via flavin and the redoxactive protein disulfide bridge. This is consistent with the scheme that has been postulated from biochemical, spectroscopic, and model studies.

Binding Sites↗
PubMed1999

Lanthanoid Rhenium Aluminides with a High Content of Aluminum: LnRe(2)Al(10) (Ln = Ho-Lu) with a New Structure Type and NdRe(2)Al(10) with CaCr(2)Al(10)-Type Structure.

The title compounds were obtained by reaction of the elemental components with an excess of aluminum after dissolving the matrix in hydrochloric acid. The compounds LnRe(2)Al(10) (Ln = Ho-Lu) crystallize with a new structure type, which was determined from single-crystal X-ray data of LuRe(2)Al(10): Cmcm, a = 929.1(1) pm, b = 1027.7(2) pm, c = 2684.1(5) pm, Z = 12. The two different lutetium atoms of the structure are coordinated by four rhenium and 16 aluminum atoms, while the two rhenium positions are in distorted icosahedral coordination of two lutetium and 10 aluminum atoms. The 12 different aluminum atoms have between 12 and 14 neighbors, of which two are rhenium and one or two are lutetium atoms. The structure may be considered as a stacking variant of the recently determined structure of YbFe(2)Al(10). Both structures are related to that of ThMn(12). They contain hexagonally close-packed, puckered sheets similar to those known from the close-packed TiAl(3)-type structure. In LuRe(2)Al(10) and YbFe(2)Al(10) these sheets of the compositions Re(2)Al(6) and Fe(2)Al(6), respectively, alternate with less densely packed layers of the composition LnAl(4). The crystal structures of YbRe(2)Al(10) (LuRe(2)Al(10) type, a = 930.7(2) pm, b = 1029.3(2) pm, c = 2687.9(5) pm) and NdRe(2)Al(10) (CaCr(2)Al(10) type, a = 1293.7(1) pm, c = 517.4(1) pm) were also refined from single-crystal X-ray data. The refinements of the occupancy factors of these as well as those of 20 other intermetallic compounds with high aluminum content indicate a seemingly slightly lower (on average 2-3%) scattering power for the aluminum positions in all cases. This is ascribed to the differing electron distributions in the free and in the bonded aluminum atoms. The cell volume of YbRe(2)Al(10) indicates a mixed or intermediate +II/+III valence of the ytterbium atoms.

Journal Article↗
PubMed1998

Assessing tubal patency with transvaginal salpingosonography after the reversal of tubal ligation for female sterilization.

The objective of this study was to assess tubal patency using transvaginal salpingosonography (TSSG) among women treated by tubal ligation after sterilization and to compare these results with those obtained using X-ray hysterosalpingography (HSG). Twenty-one healthy women were recruited. Air was used as a contrast medium in TSSG and Omnipaque as a water-soluble contrast medium in the HSG examination. All women underwent at least one TSSG. If the woman did not become pregnant during the follow-up or had a miscarriage or tubal pregnancy, she was re-examined with a second TSSG and the results were compared with those of HSG undertaken during the same menstrual cycle. Because of the high pregnancy rate the final number of patients was reduced to 10. The observed agreement between the two TSSGs was 70%, which was low compared with our earlier results. The kappa coefficient was only 0.41. The sensitivity of TSSG for the detection of tubal occlusion was 54%. This can be explained by the fact that the mean time interval between the two TSSGs was long (5.5 months) and results were not therefore comparable or repeatable. We can conclude that the women with patent tubes became pregnant after the first TSSG while the women taking part in the second TSSG had impaired tubal function. There were more occluded tubes observed in the second TSSG than in the first. An analysis comparing the second TSSG with HSG produced better results. The observed agreement was 84%, kappa coefficient 0.67, demonstrating a good reproducibility of TSSG; the sensitivity of TSSG for the detection of tubal occlusion was 83%, specificity 85%, positive predictive value 91% and negative predictive value 75%. Thus, TSSG should be regarded as a reliable, rapid, safe and inexpensive method for testing tubal patency after reversal of tubal ligation for sterilization. It also allows simultaneous scanning of the uterine corpus, endometrium and ovaries and may have a clearing action on occluded tubes. TSSG can thus replace X-ray HSG in the primary evaluation of tubal status, even in this special group of patients.

Adult↗
PubMed2001

Novel oxorhenium and oxotechnetium complexes from an aminothiol[NS]/thiol[S] mixed-ligand system.

The simultaneous action of a bidentate aminothiol ligand, LnH, (n = 1: (CH3CH2)2NCH2CH2SH and n = 2: C5H10NCH2CH2SH) and a monodentate thiol ligand, LH (LH: p-methoxythiophenol) on a suitable MO (M = Re, 99gTc) precursor results in the formation of complexes of the general formula [MO(Ln)(L)3] (1, 2 for Re and 5. 6 for 99gTc). In solution these complexes gradually transform to [MO(Ln)(L)2] complexes (3, 4 for Re and 7, 8 for 99gTc). The transformation is much faster for oxotechnetium than for oxorhenium complexes. Complexes 1-4, 7, and 8 have been isolated and fully characterized by elemental analysis and spectroscopic methods. Detailed NMR assignments were made for complexes 3, 4, 7, and 8. X-ray studies have demonstrated that the coordination geometry around rhenium in complex 1 is square pyramidal (tau = 0.06), with four sulfur atoms (one from the L1H ligand and three from three molecules of p-methoxythiophenol) in the basal plane and the oxo group in the apical position. The L1H ligand acts as a monodentate ligand with the nitrogen atom being protonated and hydrogen bonded to the oxo group. The four thiols are deprotonated during complexation resulting in a complex with an overall charge of zero. The coordination geometry around rhenium in complex 4 is trigonally distorted square pyramidal (tau = 0.41), while in the oxotechnetium complex 7 it is square pyramidal (tau = 0.16). In both complexes LnH acts as a bidentate ligand. The NS donor atom set of the bidentate ligand and the two sulfur atoms of the two monodentate thiols define the basal plane, while the oxygen atom occupies the apical position. At the technetium tracer level (99mTc), both types of complexes, [99mTcO(Ln)(L)3] and [99mTcO(Ln)(L)2], are formed as indicated by HPLC. At high ligand concentrations the major complex is [99mTcO(Ln)(L)3], while at low concentrations the predominant complex is [99mTcO(Ln)(L)2]. The complexes [99mTcO(Ln)(L)3] transform to the stable complexes [99mTcO(Ln)(L)2]. This transformation is much faster in the absence of ligands. The complexes [99mTcO(Ln)(L)2] are stable, neutral, and also the predominant product of the reaction when low concentrations of ligands are used, a fact that is very important from the radiopharmaceutical point of view.

Amines↗
PubMed1996

Reoxygenation of anoxic peripheral nerve myelinated axons promotes re-establishment of normal elemental composition.

Previously we have shown that in vitro anoxia of rat peripheral nerve myelinated axons causes sequential deregulation of axoplasmic Na, K and Ca; i.e., an initial influx of Na and loss of K is coupled to subsequent Ca accumulation [7]. In the present study, we examined the ability of PNS axons to recover normal elemental composition following oxygen deprivation. Thus, electron probe X-ray microanalysis was used to determine the effects of post-anoxia reoxygenation on the concentrations of elements (i.e., Na, K, Cl, Ca, Mg, P and S) in rat posterior tibial nerve myelinated axons and Schwann cells. Results indicate that following 180 min of anoxia, peripheral nerve reoxygenation (60 and 120 min) promoted progressive recovery of normal elemental composition in axoplasm and mitochondria of small, medium and large diameter tibial nerve fibers. Our observations also indicate that small axons recovered normal elemental concentrations more rapidly than larger counterparts. Schwann cells and myelin exhibited only modest elemental disruption during anoxia from which reoxygenation promoted full reparation. The ability of peripheral nerve axons to restore normal elemental composition during post-anoxia reoxygenation is in marked contrast to the exacerbation of elemental deregulation which ensued during in vitro reoxygenation of anoxic rat CNS fibers [14]. This differential response to reoxygenation represents a fundamental difference in the pathophysiology of myelinated axons in the CNS and PNS.

Animals↗
PubMed1999

Abductor pollicis longus tendon interposition arthroplasty for carpometacarpal osteoarthritis of the thumb.

Thirty-eight thumbs in 35 patients with painful osteoarthritis of the thumb basal joint were treated by trapezium excision and abductor pollicis longus tendon interposition arthroplasty. Long-term results were obtained from all patients by subjective evaluation and 29 patients were re-examined 1 to 11 years after surgery (mean, 6 years). The overall result was excellent or good in 79% of the cases and 76% of the patients reported good or excellent pain relief. In 6 cases (16%) surgery provided no improvement. The range of shortening of the first ray was from 2 to 10 mm (mean, 7 mm). Grip and pinch strengths were measured, but the results were variable and consequently not informative. On the basis of our results we recommend abductor pollicis longus tendon interposition arthroplasty for the treatment of osteoarthritis of the thumb basal joint.

Adult↗
PubMed2001

Tetrachlorobis(N1-phenylacetamidino-kappaN2)rhenium(IV) at 11 K by X-ray diffraction and at 20 K by neutron diffraction.

The crystal structure of the title compound, [ReCl(4)(C(8)H(10)N(2))(2)], has been determined by X-ray diffraction at 11 K and by neutron diffraction at 20 K. The accurate and extensive data sets lead to more precise determinations than are available from earlier work. The agreement in atomic positional and displacement parameters at these very low temperatures is good. The results will facilitate re-examination of the magnetic structure of the complex. The Re atom lies on a special position and the molecule has twofold crystallographic symmetry.

Journal Article↗
PubMed1994

Crystallization and analyses of crystals of various chemotypes of R-form lipopolysaccharides from Salmonella spp.

Various chemotypes (Re, Rd2, Rd1P-, Rd1, RcP-, Rc, Rb3, Rb2, Rb1, and Ra) of R-form lipopolysaccharides (LPSs) of Salmonella spp. were crystallized by treatment with 70% ethanol containing 250 mM MgCl2, and crystals of the LPSs were observed electron microscopically and analyzed by electron diffraction and synchrotron X-ray diffraction. All the LPSs tested formed three-dimensional crystals showing very similar shapes; hexagonal plate, solid column, discoid, square or rectangular plate, lozenge plate and truncated hexangular or rectangular pyramid forms. Electron diffraction patterns from the hexagonal plate crystals of all these LPSs obtained by electron irradiation from the direction perpendicular to the basal plane showed that they consist of hexagonal lattices with the lattice constant of 4.62 A. The crystals of all the LPSs thus formed gave ring-like X-ray diffraction patterns because of their small sizes. The long-axis values were calculated from the X-ray diffraction patterns from crystals of all the LPSs in the low-angle region and they corresponded roughly to the length of the proposed primary chemical structures of the R cores of the LPSs. The volume occupied by a single molecule of all the LPSs were calculated from the molecular weights based on the proposed structures and the crystallographic data obtained by electron diffraction, X-ray diffraction, and density determination.

Crystallization↗
PubMed2001

Redescription of Symphurus diabolicus, a poorly-known, deep-sea tonguefish (Pleuronectiformes: Cynoglossidae) from the Galápagos Archipelago.

Symphurus diabolicus, previously known only from the holotype collected in 501 m west of Isla San Cristobal (Chatham Island), Galápagos Archipelago, is re-described based on the holotype (112.6 mm SL) and 19 additional specimens (61.1-123.5 mm SL) recently collected from deep waters around the Galápagos Archipelago. Symphurus diabolicus is characterized by: an elongate body; narrow head with pointed snout; 1-3-2 ID pattern; 106-110 dorsal-fin rays; 89-96 anal-fin rays; 12 caudal-fin rays; 57-59 total vertebrae; 5 hypurals; extremely small scales; no pupillary operculum; large, prominent eyes, with migrated eye near dorsal margin of head; relatively short postorbital head length; relatively long snout and predorsal lengths; black peritoneum visible through abdominal wall on both sides of body; uniform olive green to dark brown ocular-side coloration with series of prominent, darker brown, elliptical to rectangular, blotches (not usually forming crossbands) along body at bases of dorsal and anal fins; and uniformly whitish or light yellow blind side. Symphurus diabolicus appears to be endemic to the Galápagos Archipelago, and is relatively common (captured at 16 different localities) at depths of 308 to 757 m (observed as shallow as 245 m) in this region. Examination of this expanded series of specimens confirms the validity of S. diabolicus and provides characters to distinguish it from S. microlepis Garman, a similar species known only from the holotype taken at approximately 530 m off Pacific Panama.

Animals↗
PubMed2005

[The last period of surgical site infection after pulmonary resection for lung cancer with hemodialysis; report of a case].

An 80-year-old man had been on maintenance hemodialysis for nondiabetic chronic renal failure from June 1996. He underwent investigation of an abnormal chest X-ray and was referred to our hospital with a diagnosis of squamous cell carcinoma in the upper lobe of the right lung. On February 20, 2003, right upper lobectomy was performed. The postoperative course was uneventful and he was discharged on postoperative day 13. Two weeks later he was readmitted with a wound infection. Although he received antibiotics, drainage, and wound lavage, his fever persisted and chest X-ray showed inflammatory changes in the right lower lung field. He was placed on mechanical ventilation for dyspnea. After this, his respiratory function became stable and he could be weaned from the ventilator within 2 weeks. The subsequent course was uneventful and he was discharged 1 month after re-admission. This patient needed ventilation due to weakness caused by wound infection. Such infection is uncommon but can be fatal for a compromised host, so we administered antibiotics for 3 days until the wound closed.

Aged↗
PubMed1990

[Minor strut fracture of the Björk-Shiley mitral valve].

In May, 1982, a 49-year-old man underwent mitral valve replacement (MVR) in our hospital with a 31 mm Björk-Shiley prosthesis for mitral regurgitation. He had been doing well until his episode of palpitation and dyspnea of sudden onset, and was transferred to our ICU with severe cardiogenic shock in Aug, 1986. Chest X-ray film revealed pulmonary edema and breakage of the valve with migration of the disc and the minor strut of the prosthesis. He was operated upon 5 hours after the onset of his complaints. The minor strut was removed from the left upper pulmonary vein and mitral valve re-replacement was done with a 29 mm Björk-Shiley Monostrut valve. The disc which had dislocated into the abdominal aorta was also recovered on the twenty-third post operative day. His postoperative course was uneventful. Immediate diagnosis and subsequent re-operation is absolute indication for rescue from acute cardiac failure due to mechanical failure of any prosthetic valve.

Heart Valve Prosthesis↗
PubMed1995

Partially folded states of proteins: characterization by X-ray scattering.

Partially folded states of proteins are found to occur with a wide variety of degrees of unfolding, ranging from the compact molten globule to the fully unfolded forms, depending on solvent conditions and the specific protein involved. Small to intermediate angle X-ray scattering from partially folded states of proteins yields low resolution scattering profiles that may be used to explore the degree of folding of a protein under given solution conditions. By Monte Carlo simulation of a highly simplified homopolymer model, we show that such partially folded states will yield a characteristic scattering profile that may be written as a linear superposition of scattering from a compact core and of scattering from random coil loops that emerge from this core. We also find a term resulting from interference of X-rays scattering from the core with those scattering from the loops. This interference term oscillates in sign and tends to enhance the core portion of the scattering profile. We compare the model calculations of the scattering profile with measurements of the scattering profile as a function of salt concentration for cytochrome c at pH 2. Because of our characterization of the scattering profiles, we suggest that these results may be re-interpreted in terms of the presence of a range of partially folded states as a function of pH and salt concentration, and that the observed scattering profiles are consistent with the characterization of the partially folded states in terms of random coil loops emerging from a compact core with the loop fraction increasing as the salt concentration is decreased. This characterization is consistent with data on amide protection against H-2H exchange of compact regions within partially folded states observed for a number of proteins, including cytochrome c.

Computer Simulation↗
PubMed1997

Three-dimensional structure of Escherichia coli branched-chain amino acid aminotransferase at 2.5 A resolution.

The X-ray crystallographic structure of the branched-chain amino acid aminotransferase from Escherichia coli was determined by means of isomorphous replacement using the selenomethionyl enzyme as one of the heavy atom derivatives. The enzyme is a homo hexamer with D3 symmetry, and the polypeptide chain of the subunit is folded into two domains (small and large domains). The coenzyme, pyridoxal 5'-phosphate, resides at the domain interface, its re-face facing toward the protein. The active site structure shows that the following sites can recognize branched-chain amino acids and glutamate as substrates: (1) a hydrophobic core formed by Phe36, Tyr164, Tyr31*, and Val109* for a branched-chain; (2) Arg97 for an acidic side chain of glutamate; and (3) Tyr95 and two main chain NH groups of Thr257 and Ala258 for the alpha-carboxylate of substrates. Although the main chain conformation of the active site is homologous to that of D-amino acid aminotransferase, many of the active site residues are different between them.

Alanine Transaminase↗
PubMed2001

Tungsten-containing formate dehydrogenase from Desulfovibrio gigas: metal identification and preliminary structural data by multi-wavelength crystallography.

The tungsten-containing formate dehydrogenase (W-FDH) isolated from Desulfovibrio gigas has been crystallized in space group P2(1), with cell parameters a = 73.8 A, b = 111.3 A, c = 156.6 A and beta = 93.7 degrees. These crystals diffract to beyond 2.0 A on a synchrotron radiation source. W-FDH is a heterodimer (92 kDa and 29 kDa subunits) and two W-FDH molecules are present in the asymmetric unit. Although a molecular replacement solution was found using the periplasmic nitrate reductase as a search model, additional phasing information was needed. A multiple-wavelength anomalous dispersion (MAD) dataset was collected at the W- and Fe-edges, at four different wavelengths. Anomalous and dispersive difference data allowed us to unambiguously identify the metal atoms bound to W-FDH as one W atom with a Se-cysteine ligand as well as one [4Fe-4S] cluster in the 92 kDa subunit, and three additional [4Fe-4S] centers in the smaller 29 kDa subunit. The D. gigas W-FDH was previously characterized based on metal analysis and spectroscopic data. One W atom was predicted to be bound to two molybdopterin guanine dinucleotide (MGD) pterin cofactors and two [4Fe-4S] centers were proposed to be present. The crystallographic data now reported reveal a selenium atom (as a Se-cysteine) coordinating to the W site, as well as two extra [4Fe-4S] clusters not anticipated before. The EPR data were re-evaluated in the light of these new results.

Crystallography, X-Ray↗