Quantitation of urinary protein excretion is used extensively for diagnostic and prognostic purposes and to assess the effects of therapy. The method most commonly used to measure urinary protein relies on 24-hour urine collections, which are time consuming, cumbersome, and often inaccurate. We reasoned that the urinary protein/creatinine ratio in a single voided urine sample should correlate well with the quantity of protein in timed urine collections. In a study of 46 specimens we found an excellent correlation between the protein content of a 24-hour urine collection and the protein/creatinine ratio in a single urine sample. The best correlation was found when samples were collected after the first voided morning specimen and before bedtime. We conclude that the determination of the protein/creatinine ratio in single urine samples obtained during normal daylight activity, when properly interpreted by taking into consideration the effect of different rates of creatinine excretion, can replace the 24-hour urine collection in the clinical quantitation of proteinuria. In the presence of stable renal function, a protein/creatinine ratio of more than 3.5 (mg/mg) can be taken to represent "nephrotic-range" proteinuria, and a ratio of less than 0.2 is within normal limits.

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Background: Preference for formula versus breast feeding among women of Chinese descent remains a concern in North America. The goal of this study was to develop an intervention targeting Chinese immigrant mothers to increase their rates of exclusive breastfeeding.

The high mortality rate of patients afflicted with adult respiratory distress syndrome (ARDS) may be due, in part, to the hemodynamic changes and the barotrauma accompanying mechanical ventilation, especially when high positive pressure and oxygen tension are used. Recent experimental evidence suggests that prognosis may be improved by suspending ventilation: in the apneic condition, oxygenation can be maintained by transalveolar oxygen diffusion, while extracorporeal carbon dioxide removal (ECCO2R), achieved with membrane lungs, assures CO2 homeostasis. This technology, however, requires high blood flow rates, and is available only to very few specially equipped centers. We report results of experiments in dogs using an alternative approach to ECCO2R during apnea. Dissolved CO2 was converted to bicarbonate by the systemic infusion of NaOH at the rate of 0.15 mM/kg/min; the generated bicarbonate was then removed by hemodialysis against a bicarbonate-free dialysate, at a blood flow rate of 200 ml/min. Sodium and fluid balance were maintained by ultrafiltration. Observations in five dogs confirm that systemic pCO2, TCO2, and pH can be maintained well within physiologic ranges, and that prolonged apnea followed by full recovery can be achieved with this methodology. Because of the wide availability of dialysis equipment and expertise, and of lower extracorporeal blood flow requirements, ECCO2R by alkali administration and hemodialysis offers a potentially attractive alternative approach to the use of membrane lungs in the apneic therapy of ARDS.