Pressure-controlled hemorrhagic shock in mice: a new model of acute kidney injury

Critical Care (Impact Factor: 4.48). 03/2010; 14(Suppl 1). DOI: 10.1186/cc8754
Source: PubMed Central
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    ABSTRACT: We explored the hypothesis that marked decline in plasma zinc concentrations among critically ill children is related to shifts in metallothionein expression and inflammation. Prospective pilot study. Intensive care unit of tertiary care children's hospital. All children (<18 yrs) with unadjusted Pediatric Risk of Mortality III score >5 or at least one organ failure admitted to the pediatric intensive care unit from March through August 2006 were eligible for enrollment. After consent, blood samples were collected on days 1 and 3 of illness and analyzed for serum chemistries, plasma zinc and copper levels, metallothionein isoform expression, and cytokine levels. Twenty patients were enrolled, with median age of 2.9 yrs (interquartile range, 0.7-10.1). Male to female ratio was 1.2:1. All patients had low zinc levels (mean, 0.43; range, 0.26-0.66 mug/dL) on day 1 of pediatric intensive care unit admission, and remained low (mean, 0.51; range, 0.26-0.81 mug/dL) on day 3, even when corrected for hypoalbuminemia. In comparison, serum copper levels were normal. On day 1, there was a positive correlation between zinc levels and expression of MT-1A (p < 0.01), MT-1G (p = 0.02), and MT-1H (p = 0.03). Plasma zinc levels correlated inversely with C-reactive protein levels (r = -.75, p = 0.01) and interleukin-6 levels (r = -.53, p = 0.04) on day 3. On day 3, patients with two or more organ failures had significantly lower plasma zinc concentrations compared with patients with </=1 organ failure (p = 0.03). Plasma zinc concentrations are low in critically ill children. Plasma zinc correlated with measures of inflammation (C-reactive protein and interleukin-6) on day 3; low plasma zinc concentrations were associated with the degree of organ failure on day 3. These data serve as the basis for a larger study of shifts in plasma zinc concentrations in critically children to potentially identify patients who might benefit from zinc supplementation.
    Pediatric Critical Care Medicine 01/2009; 10(1):29-34. DOI:10.1097/PCC.0b013e31819371ce · 2.34 Impact Factor
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    ABSTRACT: This article details the development of an instrument designed to assess the impact of certain environmental stressors in the pediatric intensive care unit (ICU) on parents of hospitalized children. A theoretical framework based on stress theory and developed by the authors provided the framework for this project. This 62-item scale assessing seven dimensions of the PICU environment was developed in three stages. The first phase in the development of the instrument established the sampling domain of the items, supported content validity, conceptualized the dimensions, developed the scaling, and helped support stability over time. In the second phase of the project, the instrument was administered to 165 parents of children recently discharged from four midwestern ICUs to further evaluate reliability and validity. Results of factor analysis, internal consistency reliability, and construct validity analyses were used to revise the instrument. In the third phase of the project, the revised instrument was administered to 510 parents while their children were in one of five pediatric ICUs. Factor analysis provided seven orthogonal, invariant factors. An alpha coefficient of .95 was obtained for the total instrument; subscale coefficients ranged from .72 to .99 providing support for internal consistency and construct validity.
    Maternal-child nursing journal 02/1989; 18(3):187-98.
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    ABSTRACT: Empirical data about end-of-life decision-making practices are scarce. We aimed to investigate frequency and characteristics of end-of-life decision-making practices in six European countries: Belgium, Denmark, Italy, the Netherlands, Sweden, and Switzerland. In all participating countries, deaths reported to death registries were stratified for cause (apart from in Switzerland), and samples were drawn from every stratum. Reporting doctors received a mailed questionnaire about the medical decision-making that had preceded the death of the patient. The data-collection procedure precluded identification of any of the doctors or patients. All deaths arose between June, 2001, and February, 2002. We weighted data to correct for stratification and to make results representative for all deaths: results were presented as weighted percentages. The questionnaire response rate was 75% for the Netherlands, 67% for Switzerland, 62% for Denmark, 61% for Sweden, 59% for Belgium, and 44% for Italy. Total number of deaths studied was 20480. Death happened suddenly and unexpectedly in about a third of cases in all countries. The proportion of deaths that were preceded by any end-of-life decision ranged between 23% (Italy) and 51% (Switzerland). Administration of drugs with the explicit intention of hastening death varied between countries: about 1% or less in Denmark, Italy, Sweden, and Switzerland, 1.82% in Belgium, and 3.40% in the Netherlands. Large variations were recorded in the extent to which decisions were discussed with patients, relatives, and other caregivers. Medical end-of-life decisions frequently precede dying in all participating countries. Patients and relatives are generally involved in decision-making in countries in which the frequency of making these decisions is high.
    The Lancet 09/2003; 362(9381):345-50. DOI:10.1016/S0140-6736(03)14019-6 · 45.22 Impact Factor