Preeclampsia is a pregnancy-specific disorder characterized by hypertension and excess protein excretion in the urine. It is an important cause of maternal and fetal morbidity and mortality worldwide. The disease is almost exclusive to humans and delivery of the pregnancy continues to be the only effective treatment. The disorder is probably multifactorial, although most cases of preeclampsia are characterized by abnormal maternal uterine vascular remodeling by fetally derived placental trophoblast cells. Numerous in vitro and animal models have been used to study aspects of preeclampsia, the most common being models of placental oxygen dysregulation, abnormal trophoblast invasion, inappropriate maternal vascular damage and anomalous maternal-fetal immune interactions. Investigations into the pathophysiology and treatment of preeclampsia continue to move the field forward, albeit at a frustratingly slow pace. There remains a pressing need for novel approaches, new disease models and innovative investigators to effectively tackle this complex and devastating disorder.
IntroductionPatients in intensive care units (ICUs) often receive sedation for prolonged periods. In order to better understand the impact of sub-optimal sedation practice on outcomes, we performed a systematic review, including observational studies and controlled trials which were conducted in sedated patients in the ICU and which compared the impact of changes in or different protocols for sedation management on economic and patient safety outcomes.MethodsWe searched Medline, Embase and CINAHL online literature databases from 1988 to 15th May 2008 and hand searched conferences. English-language studies set in the ICU, in sedated adult humans on mechanical ventilation, which reported the impact of sedation practice on cost and resource use and patient safety outcomes, were included. All abstracts were reviewed twice by two independent reviewers, with all conflicts resolved by a third reviewer, to check that they met the review inclusion criteria. Full-text papers of all included studies were retrieved and again reviewed twice against inclusion criteria. Data were doubly extracted from studies. Study aims, design, population, and outcomes including duration of mechanical ventilation, length of stay in ICU and hospital, costs and rates of mortality and adverse events were extracted. Due to heterogeneity between study designs and outcomes reported, no quantitative data synthesis such as meta-analysis was possible.ResultsIncluded studies varied in design, patient population and aim, with the majority being before-after studies. Overall, studies showed that improvements in sedation practice, such as the introduction of guidelines and protocols, or daily interruption of sedation, were associated with improvements in outcomes including ICU and hospital length of stay, duration of mechanical ventilation, and costs. Mortality and the incidence of nosocomial infections were also reduced.ConclusionsSystematic interventions to improve sedation practice and maintain patients at an optimal sedation level in the ICU may improve patient outcomes and optimize resource usage.
Previous studies have suggested an involvement of catecholamines in the control of several larval behaviors, such as feeding, locomotion, and induction of settling and metamorphosis. In the present study we employed aldehyde-induced, blue-green fluorescence to indicate catecholamines in cells within representatives of two bivalve families, the Pectinidae (Placopecten magellanicus) and the Mytilidae (Mytilus edulis). Larvae were examined at different stages of development before and also shortly after settlement. The general distribution of fluorescent cells was similar in the two species. By midveliger stage, several fluorescent cells and fibers were located along the outer rim of each velar lobe, and a pair of flask-shaped cells was located lateral to the mouth. A single fiber from near the mouth projected to a region beneath the apical tuft. In the pediveliger, the cells by the mouth were joined by an additional two to four fluorescent cells. The developing foot also contained numerous such cells, some of which had processes that penetrated the epithelium on the "sole" and bore ciliated terminals. Fluorescent somata were also located around the edge of the mantle. Centrally projecting fibers appeared to terminate in the pedal and abdominal ganglia, which also contained a few fluorescent somata. After settlement, the velar lobes and resident fluorescent somata disappeared, but fluorescent cells in the foot persisted as this latter organ grew. Fluorescent cells within the developing gill were connected with the abdominal ganglia by means of fibers. Control preparations labeled with antibodies raised against serotonin indicated that the aldehyde-induced fluorescence was not due to the presence of indoleamines. The present study not only confirms previous chromatographic evidence suggesting the presence of catecholamines in the larvae of bivalve molluscs, but also identifies putative neuronal circuits that may control various larval behaviors.
IntroductionPatients in intensive care units (ICUs) are generally sedated for prolonged periods. Over-sedation and under-sedation both have negative effects on patient safety and resource use. We conducted a systematic review of the literature in order to establish the incidence of sub-optimal sedation (both over- and under-sedation) in ICUs.MethodsWe searched Medline, Embase and CINAHL (Cumulative Index to Nursing and Allied Health Literature) online literature databases from 1988 to 15 May 2008 and hand-searched conferences. English-language studies set in the ICU, in sedated adult humans on mechanical ventilation, which reported the incidence of sub-optimal sedation, were included. All abstracts were reviewed twice by two independent reviewers, with all conflicts resolved by a third reviewer, to check that they met the review inclusion criteria. Full papers of all included studies were retrieved and were again reviewed twice against inclusion criteria. Data were doubly extracted. Study aims, design, population, comparisons made, and data on the incidence of sub-optimal, optimal, over-sedation or under-sedation were extracted.ResultsThere was considerable variation between included studies in the definition of optimal sedation and in the scale or method used to assess sedation. Across all included studies, a substantial incidence of sub-optimal sedation was reported, with a greater tendency toward over-sedation.ConclusionsOur review suggests that improvements in the consistent definition and measurement of sedation may improve the quality of care of patients within the ICU.
This study aims to learn whether the annual clinical and laboratory screening of nursing home residents provides significant information about their chance of dying during the following year. In August 1984, a comprehensive clinical data base was compiled for 176 male residents of this VA nursing home. During the next 14 months, 12 men were discharged to other locations and were dropped from the study; among the remaining 166, who comprised the study group of this report, 24 died. The most common immediate causes of death were infections (67%) and cardiac disorders (25%). Twenty of the deaths occurred after transfer to the acute hospital services. Among the 67 items in the clinical data base (including absence or presence of 17 diagnoses and 16 drugs), eight were significantly correlated with death rate. Age and functional impairment were directly related, and inversely related were the following: body weight as percent of ideal, triceps skin fold, hematocrit, hemoglobin, serum albumin, and serum cholesterol. Multivariate analysis showed cholesterol and hematocrit to be the most informative of the eight mortality predictors and to correlate with death independently of age and functional level. Subgroups defined on the basis of combinations of mortality-related attributes differed many fold in their death rates. For example, men with cholesterol less than or equal to 156 mg/dl and hematocrit less than or equal to 41% died at a rate 42 times the rate of men with values above both thresholds. For each mortality-related attribute, death rate varied with the level of the attribute. This relationship extended into the generally accepted "normal ranges" for cholesterol, hematocrit, hemoglobin, and albumin.
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