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  • 1
    Electronic Resource
    Electronic Resource
    Copenhagen : International Union of Crystallography (IUCr)
    Acta crystallographica 57 (2001), S. 1498-1505 
    ISSN: 1399-0047
    Source: Crystallography Journals Online : IUCR Backfile Archive 1948-2001
    Topics: Chemistry and Pharmacology , Geosciences , Physics
    Notes: Cytochrome c2 from the purple photosynthetic bacterium Rhodospirillum centenum has been crystallized by the sitting-drop vapour-diffusion method. The crystals belong to the orthorhombic space group P212121, with unit-cell parameters a = 29.7, b = 59.9, c = 65.4 Å, and diffract to a resolution limit of 1.7 Å. The Fe-atom position was determined from its anomalous scattering contribution and a molecular-replacement solution was calculated. The correctness of the solution was confirmed by parallel isomorphous replacement studies. The resulting model has a type I cytochrome fold with two features, an extended α-helix and a surface-charge distribution, that are distinctive to this protein. The implications of these structural features for the ability of the cytochrome to serve as an electron carrier are discussed.
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  • 2
    Electronic Resource
    Electronic Resource
    Copenhagen : International Union of Crystallography (IUCr)
    Acta crystallographica 57 (2001), S. 1281-1286 
    ISSN: 1399-0047
    Source: Crystallography Journals Online : IUCR Backfile Archive 1948-2001
    Topics: Chemistry and Pharmacology , Geosciences , Physics
    Notes: The role of contact interactions in the crystallization of membrane proteins was assessed by mutation of amino-acid residues on the surface of the reaction center from Rhodobacter sphaeroides. Five single-site mutants were constructed, with changes in contact regions found in the trigonal and tetragonal forms but not the orthorhombic form. Crystallization trials for the tetragonal form yielded either no crystals or crystals with an altered morphology, whereas crystals grew in the other two forms, indicating that these interactions are essential for the stability of the tetragonal crystals. Changes in the structures determined by X-ray diffraction of trigonal crystals for each mutant were related to the quality of the diffraction. Significant differences in the resolution limit of the crystals were associated with the loss of specific interactions between neighboring proteins. The results suggest that the contact regions are crucial for obtaining highly ordered crystals of membrane proteins.
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 21 (1995), S. 95-96 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 22 (1996), S. 1052-1056 
    ISSN: 1432-1238
    Keywords: Mechanical ventilation ; Weaning ; Weaning criteria ; Weaning incidence ; ICU stay
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To analyze the clinical and economic consequences of the implementation of a weaning protocol in patients mechanically ventilated (MV) for more than 48 h. Design Comparative study Setting General intensive care unit (ICU) in a county hospital covering 360 000 inhabitants. Patients 51 patients weaned by a fixed protocol were studied prospectively and compared with 50 retrospective controls. Measurements The following variables were assessed: Acute Physiology and Chronic Health Evaluation (APACHE) II score, age, cause of respiratory failure, type of extubation (direct extubation or extubation using a weaning technique), number of days on MV before the weaning trial, weaning time, total duration of MV, complications (reintubations and tracheostomies), length of ICU stay, and mortality. Results The groups were comparble in terms of age, APACHE II score, and main cause of acute respiratory failure. Number of days on MV up to the weaning trial were similar in the two groups (8.4±7.7 in the protocol group vs 7.5±5.5 in the control group, NS). Most of the patients (80%) in the protocol group were directly extubated without a weaning technique, unlike the control group (10%) (p〈0.01). When a weaning technique was used, the weaning time was similar in both groups (3.5±3.9 days vs 3.6±2.2 days in the control group). Duration of MV was shorter in the protocol group (10.4±11.6 days) than in the control group (14.4±10.3 days) (p〈0.05). As a result, the ICU stay was reduced by using the weaning protocol (16.7±16.5 days vs 20.3±13.2 days in the control group,p〈0.05). We found no differences in reintubation rate (17 vs 14% in the control group) and need for tracheostomies (2 vs 8% in the control group). Conclusion The implementation of a weaning protocol decreased the duration of MV and ICU stay by increasing the number of safe, direct extubations.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1238
    Keywords: ARDS ; ALC ; Acute lung injury ; Consensus report ; Clinical trial
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The acute respiratory distress syndrome (ARDS), a process of non-hydrostatic pulmonary edema and hypoxemia associated with a variety of etiologies carries a high morbidity, mortality (10–90%) and financial cost. The reported annual incidence in the United States is 150000 cases, but this figure has been challenged and may be different in Europe. Part of the reason for these uncertainties is the heterogeneity of diseases underlying ARDS and the lack of uniform definitions for ARDS. Thus, those whose wish to know the true incidence and outcome on this clinical syndrome are stymied. The European American Consensus Committee on ARDS was formed to focus on these issues and on the pathophysiologic mechanisms of the process. It was felt that international coordination between North America and Europe in clinical studies of ARDS was becoming increasingly important in order to address the recent plethora of potential therapeutic agents for the prevention and treatment of ARDS.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 22 (1996), S. 1052-1056 
    ISSN: 1432-1238
    Keywords: Key words Mechanical ventilation ; Weaning ; Weaning criteria ; Weaning incidence ; ICU stay
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To analyze the clinical and economic consequences of the implementation of a weaning protocol in patients mechanically ventilated (MV) for more than 48 h. Design: Comparative study. Setting: General intensive care unit (ICU) in a county hospital covering 360 000 inhabitants. Patients: 51 patients weaned by a fixed protocol were studied prospectively and compared with 50 retrospective controls. Measurements: The following variables were assessed: Acute Physiology and Chronic Health Evaluation (APACHE) II score, age, cause of respiratory failure, type of extubation (direct extubation or extubation using a weaning technique), number of days on MV before the weaning trial, weaning time, total duration of MV, complications (reintubations and tracheostomies), length of ICU stay, and mortality. Results: The groups were comparable in terms of age, APACHE II score, and main cause of acute respiratory failure. Number of days on MV up to the weaning trial were similar in the two groups (8.4±7.7 in the protocol group vs 7.5±5.5 in the control group, NS). Most of the patients (80%) in the protocol group were directly extubated without a weaning technique, unlike the control group (10%) (p〈0.01). When a weaning technique was used, the weaning time was similar in both groups (3.5±3.9 days vs 3.6±2.2 days in the control group). Duration of MV was shorter in the protocol group (10.4±11.6 days) than in the control group (14.4±10.3 days) (p〈0.05). As a result, the ICU stay was reduced by using the weaning protocol (16.7±16.5 days vs 20.3±13.2 days in the control group, p〈0.05). We found no differences in reintubation rate (17 vs 14% in the control group) and need for tracheostomies (2 vs 8% in the control group). Conclusion: The implementation of a weaning protocol decreased the duration of MV and ICU stay by increasing the number of safe, direct extubations.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1238
    Keywords: Key words Reliability ; Severity of illness index ; MPM II system ; Intensive care ; Kappa ; Intraclass correlation coefficient
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the interobserver variability of the measurement of the MPM II system.¶Design: Random sample of an inception cohort.¶Setting: Fifteen adult medical and surgical intensive care units (ICUs) in Spain.¶Patients: A 5 % random sample (n = 119) of 2332 patients consecutively admitted in the ICU, aged 18 years or older.¶Interventions: Prospective data collection during the stay of the patient in the ICU. Repeated data collection, after the patient's hospital discharge.¶Measurements and main results: Demographic information, length-of-stay and vital status at both ICU and hospital discharge, as well as all variables necessary for computing the MPM II system were measured. Interobserver variability for categorical variables was measured computing the kappa index. For interval variables the interobserver variability was assessed by the intraclass correlation coefficient, the paired t-test, and linear regression.¶In the MPM II0 index, the variables coma, heart rate, systolic blood pressure, chronic renal insufficiency, metastatic neoplasm, acute renal failure, cardiac dysrhythmia and cardiopulmonary resuscitation, showed moderate or low levels of agreement. In the MPM II24 index, the variables coma or deep stupor, PaO2 and prothrombin time showed low or moderate interobserver agreement. Agreement for the MPM II probability of death was high, although the external observer obtained a lower estimation than the hospital observer.¶Conclusions: The MPM II severity system showed a high level of stability when used in groups of patients. Nevertheless, the observed variability in some variables means that it should be used with caution for individual patients.
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 26 (2000), S. 1019-1019 
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 13 (1987), S. 175-182 
    ISSN: 1432-1238
    Keywords: Miliary tuberculosis ; Adult respiratory distress syndrome ; Multiple organ system failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although, miliary tuberculosis is an unusual cause of severe acute respiratory failure, we describe nine patients with miliary tuberculosis who developed adult respiratory distress syndrome. This complication occurred in seven patients despite treatment with antituberculous drugs. In two patients who developed the syndrome, miliary tuberculosis was diagnosed only at postmortem. The presence of pulmonary hypertension in all cases and disseminated intravascular coagulation in seven cases suggests a possible pathophysiologic relationship with severe pulmonary vascular damage. The high mortality rate (88.8%) was associated with nonpulmonary organ system failure. Miliary tuberculosis should be considered in patients with adult respiratory distress syndrome of unknown etiology, and simple diagnostic procedures such as sputum, bronchial brushing, and gastric examination should be followed by invasive diagnostic procedures to confirm this etiology. Since untreated miliary tuberculosis is usually fatal, early recognition of this disease is of great importance, and specific therapy may play a lifesaving role.
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