High values of the pulmonary artery wedge pressure in patients with acute lung injury and acute respiratory distress syndrome

OBJECTIVE: To determine the incidence and severity of pulmonary artery wedge pressure (PAWP) elevation in patients with ALI/ARDS. In addition, to examine the effects of clinical variables on the presence of a high PAWP (>18 mmHg) and the effect of an elevated PAWP on mortality. DESIGN AND PATIENTS: Post hoc analysis of 120 patients with or at high risk of ARDS, enrolled in a randomized controlled trial of pressure- and volume-limited ventilation. Patients with or at high risk of congestive heart failure were excluded from the original study. SETTING: Eight tertiary intensive care units. MEASUREMENTS AND RESULTS: Pulmonary artery catheters were inserted at the discretion of the attending physician, and PAWP was collected every 8 h when present. Of 120 subjects 71 (59%) had a pulmonary artery catheter (44 at randomization, 27 later). The mean maximum PAWP reading among patients was 22.5 mmHg (95% CI 21.2-23.8) and mean median was 16.6 mmHg (95% CI 15.6-17.5). Patients who met standard criteria for ARDS were more likely to develop a high PAWP. In a multivariate stepwise logistic regression model a persistently elevated PAWP (median >18 mmHg) was a strong predictor of mortality after correction for baseline differences (OR estimate 6.82; 95% CI 1.66-37.81). CONCLUSIONS: We conclude that in this group of patients a PAWP higher than 18 mmHg is common. Mandating a PAWP of 18 mmHg or less may negatively impact clinical trials in which ARDS is an inclusion/exclusion criteria or an endpoint.     

Octamethylcyclotetrasiloxane exhibits estrogenic activity in mice via ERalpha

Octamethylcyclotetrasiloxane (D4) is a low molecular weight cyclic silicone used in the synthesis of larger silicone polymers and in the formulation of a variety of personal care products. The effects of oral D4 exposure in mice on serum estradiol levels, uterine wet weight, and uterine peroxidase activity were investigated. Additionally, in vitro estrogen receptor binding activity was evaluated. Serum estradiol levels decreased in a dose-dependent manner after exposure to 100 mg/kg to 1000 mg/kg D4. Studies with adrenalectomized animals demonstrated that the decreased serum estradiol levels were not due to elevated serum corticosterone levels. Uterine wet weights in ovariectomized mice were significantly increased in a dose-dependent manner by exposure to 250-1000 mg of D4/kg, but not by exposure to other silicone compounds tested (hexamethylcyclotrisiloxane, decamethylcyclopentasiloxane, decamethyltetrasiloxane, and octaphenylcyclotetrasiloxane). Uterine peroxidase activity, a marker for estrogenic activity, was also significantly increased in D4-exposed mice, but not in mice exposed to the other siloxanes. Pretreating mice with the estrogen receptor antagonist ICI 182,780 completely blocked the D4-induced increase in uterine weight, and ovariectomized estrogen receptor-alpha knockout mice showed no increases in uterine weights when orally exposed to D4 or estradiol. In an in vitro estrogen receptor binding assay, D4 showed significant competition with (3)H-estradiol for binding to estrogen receptor-alpha, but not estrogen receptor-beta. The data presented here indicate that D4 has weak estrogenic activity, and that these effects are mediated through estrogen receptor-alpha.     

Group support for couples coping with a cardiac condition

BACKGROUND/RATIONALE: Support groups of peers were designed to convey support specific to stressful situations encountered by persons with a first-time myocardial infarction and by their spouse or partners. There were no previous published support intervention studies focused on the couple. Survivors and spouses (n=28) participated in a pilot study which tested the effect of a 12-week support group intervention. DESIGN: The support groups for couples were cofacilitated by a peer and professional. The facilitators recorded field notes, while participants completed weekly diaries about the intervention activities. Following the intervention, participants were interviewed individually and facilitators were interviewed jointly about the perceived effect of the intervention and influencing factors. This article focuses on the facilitators' and participants' perceptions of intervention processes and outcomes. FINDINGS: Support processes in the group included social comparison, social learning, and social exchange. Three types of support--emotional, information, and affirmation--were provided. All participants were satisfied with the support intervention and referred to the positive effect on their coping, confidence, outlook, and spousal relationship. Factors that influenced the intervention effect were participant input, cofacilitation, similarity of group members, and the provision of information and support. CONCLUSIONS: Future interventions could consider similarity of peers, leadership, and optimum timing and duration.     

Stress, emotional skill, and illness in children: the importance of distinguishing between children's and parents' reports of illness

This study examined relationships of stress (negative event frequency during the last year) to reports of illness among 92 children, aged 10 to 13 years. Children's health status was reported separately by children and parents, and children's skill in identifying and communicating their feelings was tested for direct and buffering relationships on illness reports. Analyses controlled for demographics and negative affect of both children and parents, and children's verbal ability was also tested for confounding. Results showed that stress correlated positively with children's poor health, whether the children's health status was reported by children or by parents. Children's emotional skill was correlated with better health when health was reported by children, but with worse health when health was reported by parents. Further, moderator analyses indicated that the relationship between negative event frequency and children's poor health as reported by parents held only for children with high levels of skill in identifying and communicating feelings. These findings suggest that negative life events impair children's health, but that the health reports of children and parents are quite different, and parents' views may be affected by children's skill in communicating their internal states.