Attachment and mentalization among survivors of sexual abuse: A questionnaire survey.

Knowledge of the long-term consequences of child sexual abuse (CSA) is crucial to further develop preventive strategies and treatment programs. The aim of this study is to investigate attachment and mentalizing ability in people who have experienced CSA. Attachment style, measured with the Experiences in Close Relationships-Relationship Structures Questionnaire (ECR-RS), and mentalization, measured with the Reflective Functioning Questionnaire (RFQ), were examined through a quantitative questionnaire survey in a sample of 49 individuals who had experienced CSA, and a control group of 612 with no history of CSA. The CSA group was, to a greater extent, identified with insecure attachment style. In addition, participants with insecure attachment were more likely to use hypomentalizing compared to individuals identified with a secure attachment. No significant association was found between attachment style and the relationship between the victim and the offender or the length of traumatic episodes.

Urine neutrophil gelatinase-associated lipocalin and urine output as predictors of the successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury.

BACKGROUND: Continuous renal replacement therapy (CCRT) is a frequently used modality for the support of intensive care patients with acute kidney injury (AKI). Nevertheless, there are no objective criteria for the discontinuation of CRRT. The purpose of this study was to investigate whether urine neutrophil gelatinase-associated lipocalin (uNGAL) alone or in combination with urine output could be used as a diagnostic test for renal function recovery in ICU patients on CRRT. METHODS: This was a single-centre prospective observational study including patients with acute kidney failure needing CRRT. Sixty-nine patients were enrolled, and 54 completed the study. Of the 54 patients, 22 recovered renal function (REC), defined as dialysis independency at 72 h from discontinuation, while 32 patients did not (NREC). Urine NGAL was measured at 0, 6, 12, and 24 h after CRRT discontinuation. The cumulated urine output was measured for 24 h prior to discontinuation and at 6, 12, and 24 h after discontinuation. Missing uNGAL values were calculated by interpolation. The Youden's index was used to calculate cut-off values in order to define uNGAL and urine output single variable and 2-variable diagnostic tests with the optimum prediction of successful CRRT discontinuation. RESULTS: Baseline characteristics at CRRT initiation were similar between groups. Compared to the NREC group, the REC group had significantly higher urine output (p < 0.0001) and lower uNGAL (p < 0.001) at all time points, except for uNGAL at 24 h (p < 0.24). The best uNGAL predictor for successful CRRT discontinuation was uNGAL at 6 h after discontinuation (predictive value 80%). The best single predictor was cumulated urine output 24 h before discontinuation (predictive value 85%). The combinations of uNGAL at 6 h (cut-off 1650 µg/L) with cumulated urine output 24 h prior to discontinuation (cut-off 210 ml) proved to be the superior tests (using either "or" or "and"), with predictive values of 93% (successful CRRT discontinuation) and 92% (dialysis dependency). CONCLUSIONS: With a predictive value of 93%, the combination of uNGAL at 6 h after and the cumulated urine output 24 h prior to CRRT cessation proved to be the best diagnostic test for successful CRRT discontinuation in ICU patients. CLINICAL TRIAL REGISTRATION: N/A.

[Complete tachyphylaxis for vasopressin in a patient with subarachnoid haemorrhage].

In this case report, we present a 28-year-old woman who was admitted to a neuro-intensive care unit with sub-arachnoid haemorrhage. She was intubated and haemodynamically unstable. Over five days the need for norepinephrine reached the level of 1.2 µg/kg/min to insure a sufficient cerebral perfusion pressure. Epinephrine and vasopressin were without effect in raising the blood pressure. On suspicion of tachyphylaxis the norepinephrine infusion was stopped, and no decline in blood pressure was observed. After two days without use of any vasopressor agents, the efficacy of norepinephrine returned to normal.