Dermographism secondary to trauma from a coral reef.
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Adult↗
Biomedical subjects
D B Huang
Publications and source records attributed to D B Huang.
West Nile virus rash on the palms and soles of the feet.
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Exanthema↗
Use of the Zung depression scale in patients with traumatic brain injury: 1 year post-injury.
OBJECTIVE: The purpose of this study was to examine if the physical disabilities of patients with traumatic brain injury (TBI) would influence the assessment of depression when using the Zung depression scale. METHOD: Patients with TBI (n=59) were assessed 1 year after injury for depression by both a psychiatrist and the use of the Zung depression scale. RESULTS: By psychiatric evaluation, seven of 17 (41%) patients with severe TBI and one of 20 (5%) of the patients with moderate TBI were diagnosed with major depressive disorder. With the Zung depression scale, 10 of 17 (59%) patients with severe TBI met the cut-off (scored >55) for depression, whereas none of the patients with moderate (n=20) or mild (n=22) TBI did. The mean (SD) scores of the somatic scale were 2.91 (0.93), 2.49 (0.92) and 1.25 (0.43) for each group. The mean scores of the affective scale were 2.58 (0.90), 1.85 (0.79) and 1.24 (0.46). For patients with moderate (p<0.05) and severe (p<0.10) TBI, scores on the somatic items exceeded scores on their affective items. No difference in somatic and affective scale scores was noted for the patients with mild TBI. CONCLUSION: The increased endorsement of somatic results may be the somatic difficulties associated with traumatic brain injury.
Adolescent↗
Thalidomide: dermatological indications, mechanisms of action and side-effects.
Thalidomide was first introduced in the 1950s as a sedative but was quickly removed from the market after it was linked to cases of severe birth defects. However, it has since made a remarkable comeback for the U.S. Food and Drug Administration-approved use in the treatment of erythema nodosum leprosum. Further, it has shown its effectiveness in unresponsive dermatological conditions such as actinic prurigo, adult Langerhans cell histiocytosis, aphthous stomatitis, Behçet's syndrome, graft-versus-host disease, cutaneous sarcoidosis, erythema multiforme, Jessner-Kanof lymphocytic infiltration of the skin, Kaposi sarcoma, lichen planus, lupus erythematosus, melanoma, prurigo nodularis, pyoderma gangrenosum and uraemic pruritus. This article reviews the history, pharmacology, mechanism of action, clinical uses and adverse effects of thalidomide.
Adult↗
Response of HIV-infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin.
The objective of this prospective pilot study was to evaluate the response of HIV-infected patients with asymptomatic syphilis to one of two intensive antibiotic treatment regimens. Thirty-one HIV-infected patients with serum rapid plasma reagin titre > or =1:4 and no clinical findings of syphilis were randomized to receive daily intramuscular injections of ceftriaxone or procaine penicillin (plus oral probenecid) for 15 days; 24 returned for follow-up study. Seven of 10 (70%) procaine penicillin-treated patients and 10 of 14 (71%) ceftriaxone-treated patients had a > or =4-fold decline in RPR (P=0.94); two penicillin-treated and one ceftriaxone-treated patient relapsed. Two patients failed ceftriaxone therapy. Three penicillin-treated, and two ceftriaxone-treated patients were serofast. Serological responses were similar in those patients with and without asymptomatic neurosyphilis. There was no difference in the serologic response to daily treatment with ceftriaxone vs that with procaine penicillin plus probenecid; both treatments were associated with comparatively high rates of serological non-response and relapse.
Adult↗
X-ray crystal structure of proto-oncogene product c-Rel bound to the CD28 response element of IL-2.
BACKGROUND: The proto-oncogene product c-Rel is a Rel/NF-kappaB family transcription factor that plays a critical role in lymphoid cell development and mediates CD28-induced expression of interleukin 2 (IL-2). The CD28 response element (CD28RE) in the IL-2 enhancer is nonameric and similar to the kappaB DNA target sites recognized by p65 homodimers. RESULTS: We have determined and refined the X-ray crystal structure of the c-Rel homodimer complexed to the CD28RE DNA site, 5'-AGAAATTCC-3', to 2.85 A resolution. The c-Rel homodimer binds CD28RE in a mode similar to that observed in the p65/IL-8 kappaB crystallographic complex. Binding studies reveal that the c-Rel homodimer recognizes the CD28RE with higher affinity as compared to other canonical kappaB sequences despite the nonconsensus A:T base pair at the 5' end of the CD28RE. Preferential recognition of the CD28RE by c-Rel results from the direct contacts between the protein and the DNA as well as intrasubunit interactions between the beta(f)-beta(g) loop in the dimerization domain and the DNA-contacting loop L1 of the N-terminal domain. Not only do these loops have different conformations in other Rel/DNA crystallographic complexes, but they also contain two of the five oncogenic point mutations found in v-Rel. CONCLUSIONS: The current structure indicates that a non-DNA-contacting loop in the dimerization domain and the DNA-contacting loop L1 may play critical roles in defining affinity and specificity. Two amino acid changes in these segments may account for the differential DNA binding by v-Rel as compared to that of c-Rel.
Amino Acid Sequence↗
Human methadone self-administration: effects of diazepam pretreatment.
The effect of diazepam on methadone self-administration was examined. Five methadone-maintained patients with a history of benzodiazepine abuse were recruited. Patients were stabilized on 80 mg of methadone per day. After stabilization patients participated in methadone self-administration sessions. During each session, 128 presses (fixed ratio 128) of 1 button delivered 10 ml of 0.054 mg/ml methadone solution. The same number of button presses on a 2nd button delivered 10 ml of vehicle. Forty-five min prior to the self-administration session, 0 (placebo), 5, 10, or 20 mg per 70 kg body weight diazepam was administered. Ratings of drug liking, goodness, strength, and high were collected 5, 30, 60, 90, and 150 min after the end of the self-administration session. Diazepam pretreatment significantly decreased the amount of methadone consumed. The 10- and 20-mg diazepam doses significantly increased reports of good, like, strong, and high.
Adult↗
Emergence of trimethoprim-resistant Escherichia coli in healthy persons in the absence of prophylactic or therapeutic antibiotics during travel to Guadalajara, Mexico.
Thirty-nine healthy US students without diarrheal disease and who had not received prophylactic or therapeutic antibiotics were monitored for emergence of trimethoprim-resistant gram-negative fecal flora for a 3-week period after arrival in Guadalajara, Mexico. During this time period, most students showed no change in total fecal gram-negative bacteria (p > 0.05) but showed an increasing level of trimethoprim (TMP) resistance (p < 0.01) among fecal coliforms. Escherichia coli was the TMP-resistant organism isolated in 18 of 39 (46%) healthy students. These 18 TMP-resistant E. coli were also resistant to ampicillin (44%), azithromycin (11%), chloramphenicol (39%), ciprofloxacin (11%), doxycycline (89%), erythromycin (100%), furazolidone (72%), levofloxacin (17%), trimethoprim-sulfamethoxazole (89%) and trovafloxacin (17%). In the absence of prophylactic and therapeutic antibiotics, increased acquisition of TMP-resistant gram-negative fecal flora in this developing country is probably due to poor sanitary conditions and the recurrent and heavy exposure to antimicrobial-resistant indigenous flora as a result of contaminated food and drink.
Adolescent↗
Increased fecal IgE among infants in a rural community of Egypt: an analysis of associated risk factors.
Newborns in rural Bilbeis, Egypt were followed to 1-year of age to document the incidence and risk factors associated with the development of fecal IgE. Factors associated with increased fecal IgE included infants aged 3-6 months (relative risk (RR) = 3.28, 95 per cent confidence intervals (CI) = 1.03-13.60, p < 0.05) and mother being vaccinated antenatally (RR = 2.17, CI - 1.01-4.61, p < 0.05). Decreased fecal IgE was observed with consumption of rice (RR = 0.37, CI = 0.12-0.94, p < 0.05), biscuits (RR = 0.43, CI = 0.15-0.99, p < 0.05), potatoes (RR = 0.39, CI = 0.11-0.98, p < 0.05), and fruits and vegetables (RR = 0.20, CI = 0.02-0.80, p < 0.05). After multivariate adjustment, increased risk was observed with consumption of milk pudding (RR = 7.48, CI = 1.54-36.20, p < 0.05) and wet-nursed infants (RR = 2.77, CI = 1.17-6.54, p < 0.05). Infants who were completely breastfed (RR = 0.13, CI = 0.02-0.68, p < 0.05) and infants' family owning a television set (RR = 0.29, CI = 0.12-0.67, p < 0.05) were less likely to develop fecal IgE. Our findings indicate that prelacteal feeding with certain foods, early supplementation of breastfeeding, and sociodemographic factors are associated with increased fecal IgE.
Analysis of Variance↗
Impact of breast-feeding on Giardia lamblia infections in Bilbeis, Egypt.
A total of 152 infants were followed from birth to 1 year of age in a rural community of Egypt to document Giardia lamblia infection and to determine the effect of breast-feeding on enteric infections by this protozoan. Asymptomatic Giardia infections persisted as long as 4 months, with a mean duration of excretion of 7.18 weeks. The incidence of asymptomatic infection was 4.5 episodes per child-year. Exclusively breast-fed infants had lower risk for asymptomatic (odds ratio [OR] = 0.66, 95% confidence interval [CI] = 0.45-0.96, P < 0.05) and symptomatic infections (relative risk [RR] = 0.50, 95% CI = 0.27-0.90, P < 0.05). Furthermore, breast-fed infants had fewer clinical manifestations, including mucus in stool (23.8% versus 76.2%, P = 0.08), loss of appetite (17.6% versus 82.3%, P < 0.05), and abdominal tenderness (17% versus 82.9%, P < 0.05) compared with infants who were not exclusively breast-fed. Breast-feeding should be considered as an effective means to prevent Giardia infections and should be encouraged in regions where G. lambia is highly endemic.
Animals↗
Sociodemographic, environmental and clinical risk factors for developing persistent diarrhoea among infants in a rural community of Egypt.
The study documents the incidence of persistent diarrhoea and its sociodemographic, household, environmental and clinical risk factors. One hundred and fifty-two newborns were followed for the first 12 months of life in Bilbeis, Egypt. The household of each participant was surveyed at baseline and was visited twice a week. The study infants experienced persistent diarrhoea at a rate of 0.51 episode/case per year. Development of persistent diarrhoea was associated with water storage in mud-containers (Odds ratio [OR] = 4.36, confidence interval [CI] 1.4-14.8), pump-water supply (OR = 3.5, CI 1.2-10.2), and absence of a latrine in the household (OR = 2.74, CI 1.01-7.38). Detection of faecal IgE (OR = 3.32, CI 1.0-10.9) and high stool frequency (OR = 2.95, CI 1.1-7.8) appeared as important clinical predictors for the onset of persistent diarrhoea. The incidence of persistent diarrhoea among young infants in Bilbeis, Egypt, was high. Sociodemographic, environmental and clinical parameters were important risk factors for the development of persistent diarrhoea.
Chronic Disease↗
Major leg wound complications after saphenous vein harvest for coronary revascularization.
BACKGROUND: Major leg wound complications after coronary artery bypass graft procedures are infrequent and few are reported in the literature. We present our experience in treating 23 patients with major leg wound complications after coronary revascularization procedures. METHODS: A retrospective review of 3,525 bypass procedures with saphenous vein grafts performed over a 10-year period was conducted. Ten potential risk factors for those who developed major leg wound complications were analyzed and compared with the entire cohort of patients undergoing similar bypass procedures during the same period. RESULTS: Lower extremity wound complications occurred in 145 patients (4.1%), 23 of whom (0.65%) required additional surgical interventions (62 total). There were 32 wound debridements, 8 skin grafts, 11 vascular procedures, 5 amputations, 3 fasciotomies, 2 free tissue transfers, and 1 fasciocutaneous flap. Of ten variables evaluated by multivariate analysis, female gender, peripheral vascular disease, and postoperative intraaortic balloon pump use were identified as significant independent predictors of major leg wound complications (p < 0.0001). CONCLUSIONS: The causes of major leg wound complications after saphenous vein harvest for coronary artery bypass graft procedures are multifactorial. To minimize these complications, we recommend vascular evaluations before saphenous vein harvest, attention to proper surgical technique, and careful harvest site selection.
Aged↗
Successful treatment of Fusarium solani ecthyma gangrenosum in a child with acute lymphoblastic leukemia in relapse.
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Amphotericin B↗
Characterization of the dimer interface of transcription factor NFkappaB p50 homodimer.
Dimers of the Rel/NFkappaB transcription factor family form with differential stabilities through the combinatorial association of five polypeptides: p50, p52, p65, cRel, and RelB. Here, we have characterized the nature of the monomer-dimer equilibrium of the p50 homodimer. Sedimentation equilibrium studies show that the equilibrium constant for p50 dimer dissociation is in the low micromolar range. Using the X-ray crystal structure of the p50 homodimer as a guide, we have created site-directed alanine mutations at ten dimer-forming residues in p50 and measured their effects on p50 homodimerization. Characterization of these alanine mutants by a series of chemical crosslinking, size-exclusion chromatography, and sedimentation equilibrium experiments shows that the most critical residue in stabilizing the p50 dimer interface is Y267. Sedimentation equilibrium experiments show that an alanine substitution at position 267 destabilizes the dimer interface by 2.0 kcal/mol. Alanine substitutions at two other positions, L269 and V310, significantly destabilize the p50 dimer interface. These two residues are observed to mediate critical interactions in the crystal structure. Together, these three residues constitute the "hot-spot" of protein-protein interaction in p50 dimerization. Of the four charged residues in the dimer interface, R252, D254, E265, and D302, only D302 contributes significantly to p50 dimer stability. D254 appears to slightly destabilize the subunit interface. Although residues H304, R305, and F307 occupy positions at the hydrophobic core of the interface and appear to be involved in multiple interactions in the X-ray crystal structure, alanine substitutions at these positions do not significantly reduce the affinity for p50 dimerization. Upon evaluating the roles of these amino acid residues at the p50 dimer interface, we propose that differential contributions of a few key residues dictate the selectivity of dimer formation within the Rel/NFkappaB family.
Amino Acid Sequence↗
Reconstructive surgery in children after meningococcal purpura fulminans.
BACKGROUND/PURPOSE: Purpura fulminans (PF) is a serious, often life-threatening disease. As more children are surviving their disease, surgeons are presented with increasing numbers of multiple and complicated wounds as sequelae of PF. The purpose of this paper is to review the management of nine cases of PF, and present the reconstruction method in treating bilateral exposed elbow and knee joints. METHODS: All cases of pediatric patients with PF and treated by the division of plastic and reconstructive surgery between 1986 and 1998 were reviewed. RESULTS: Seven children (78%) had meningococcal PF, and one (11%) had PF after Haemophilus influenza septicemia. PF developed in one (11%) but with no growth in either blood or cerebrospinal fluid cultures. Five children (56%) required amputation procedures. Two children (22%) required knee disarticulation. Two patients (22%) had free myocutaneous flap transfers for bone coverage. One (11%) had PF involving the face. CONCLUSIONS: Meningococcal PF is a rare, often life-threatening disease generally of childhood. More children are surviving their diseases but with devastating sequelae. Successful reconstructive treatment outcome of these children requires a multidisciplinary team approach involving multiple specialties. The goal is to preserve function, maintain maximal length, and salvage limbs when possible. Flexibility and innovation are necessary in treating these multiple and complicated wounds.
Amputation, Surgical↗
Construction, expression, purification and functional analysis of recombinant NFkappaB p50/p65 heterodimer.
NFkappaB plays an important role in mediating the gene expression of numerous cellular processes such as growth, development, the inflammatory response and virus proliferation. The p50/p65 heterodimer is the most abundant form of the NFkappaB dimers and plays a more elaborate role in gene regulation. Biochemical research on p50/p65 NFkappaB has not benefited however from the availability of easily purified recombinant protein. We report two methods for the large scale expression and purification of recombinant NFkappaB p50/p65 heterodimer. The first utilizes a bacterial double expression vector which contains two ribosomal binding sites to facilitate the coexpression of the polypeptides in the p50/p65 NFkappaB heterodimer. The second method uses a mixed protein refolding strategy. Both methods yield crystallizable protein. Electrophoretic mobility shift assays confirm that the DNA binding affinity is independent of the method used to purify the protein. These methods will facilitate the numerous studies on various NFkappaB/Rel family members.
Binding Sites↗
The use of tissue expanders in staged abdominal wall reconstruction.
Reconstruction of large abdominal wall defects not amenable to primary closure remains a challenging problem. Various reconstructive techniques have been described in the surgical literature each with its advantages and disadvantages. In this report the authors describe their experience in treating 11 patients with large abdominal wall defects utilizing prosthetic mesh in conjunction with tissue expanders. Between 1986 and 1997 there were 6 pediatric and 5 adult patients treated with this method. The etiology included three congenital omphaloceles, five cases of necrotizing fasciitis, and three gunshot wounds. All patients initially required insertion of prosthetic mesh to bridge their large abdominal wall defects. This was followed by staged abdominal wall reconstruction with tissue expanders and prosthetic mesh. None of the patients had mesh infection or extrusion, and none developed enteric fistula or recurrent hernia. The tissue expansion process was well tolerated by all patients. One patient had partial exposure of the tissue expander due to thinning of the expanded skin. Our results suggest that the use of tissue expanders provides reliable, well-vascularized soft-tissue coverage and minimizes potential mesh-related complications in abdominal wall reconstruction.
Abdominal Muscles↗
Intrathoracic application of the reverse latissimus dorsi muscle flap.
The use of the reverse latissimus dorsi muscle flap based on its paraspinous perforators for posterior trunk wound coverage has been described previously. However, few studies have reported its intrathoracic application. In this study the authors present their experience in treating 3 patients with various intrathoracic defects using the reverse latissimus dorsi muscle flap. There were 1 male and 2 female patients who ranged in age from 4 to 74 years (mean, 49 years). The etiology included an infected aortic graft, a bronchopleural fistula, and a recurrent congenital diaphragmatic hernia. Follow-up ranged from 2 to 24 months. Successful outcomes were achieved in all 3 patients, and there was no recurrence or wound complication identified. Their results demonstrate the versatility and reliability of the reverse latissimus dorsi muscle flap in treating low posterior intrathoracic defects.
Aged↗