Promotion of vascular integrity in sepsis through modulation of bioactive adrenomedullin and dipeptidyl peptidase 3.

Sepsis represents one of the major medical challenges of the 21st century. Despite substantial improvements in the knowledge on pathophysiological mechanisms, this has so far not translated into novel adjuvant treatment strategies for sepsis. In sepsis, both vascular tone and vascular integrity are compromised, and contribute to the development of shock, which is strongly related to the development of organ dysfunction and mortality. In this review, we focus on dipeptidyl peptidase 3 (DPP3) and adrenomedullin (ADM), two molecules that act on the vasculature and are involved in the pathophysiology of sepsis and septic shock. DPP3 is an ubiquitous cytosolic enzyme involved in the degradation of several important signalling molecules essential for regulation of vascular tone, including angiotensin II. ADM is a key hormone involved in the regulation of vascular tone and endothelial barrier function. Previous studies have shown that circulating concentrations of both DPP3 and ADM are independently associated with the development of organ failure and adverse outcome in sepsis. We now discuss new evidence illustrating that these molecules indeed represent two distinct pathways involved in the development of septic shock. Recently, both ADM-enhancing therapies aimed at improving endothelial barrier function and vascular tone and DPP3-blocking therapies aimed at restoring systemic angiotensin responses have been shown to improve outcome in various preclinical sepsis models. Given the current lack of effective adjuvant therapies in sepsis, additional research on the therapeutic application of these peptides in humans is highly warranted.

Successful recovery after ventricular fibrillation in a patient with Kawasaki disease.

Kawasaki disease (KD) is an uncommon cause of sudden death in young adults in Europe. Angiographically, the disease is characterized by coronary artery aneurysms which can be fully obstructed by acute thrombosis or by progression of the disease. If diagnosis of KD is made, immediate investigation should be made to determine whether ischemia is occurring and if so, to establish optimal time for revascularisation or cardiac transplantation. We describe an 18-year-old Caucasian male who was not previously known to have KD and who suffered from an acute myocardial infarction complicated by ventricular fibrillation, caused by acute thrombosis of a coronary artery aneurysm.

Recommendations by clinicians for nausea and vomiting of pregnancy.

The purpose of this study was to assess both the current use of relief measures for nausea and vomiting of pregnancy among clinicians and the basis for their decisions regarding method of treatment. With the permission of conference sponsors, questionnaires on nausea and vomiting of pregnancy relief measures were distributed at a national conference for obstetrical health care providers. Of the 600 conference participants, 130 completed questionnaires. The findings of the study indicate that clinicians generally recommend eating small, frequent meals; that clinicians modify their recommendations slightly based on the severity of the symptoms; that clinicians perceive varying degrees of effectiveness of relief measures, with no one measure being totally effective; and that clinicians look to patients as the primary resource for information about nausea and vomiting of pregnancy.

Nausea and fatigue during early pregnancy.

Nausea and fatigue are uncomfortable, sometimes almost debilitating, symptoms of pregnancy. Anecdotally, fatigue seems worse as nausea increases. This descriptive correlational study investigated the relationship between nausea and fatigue during early pregnancy. Fifty-one women who received prenatal care at two obstetrics and gynecology nurse-midwifery practices in a large metropolitan area participated. Each women completed a nausea questionnaire, the Pearson-Byars fatigue feeling checklist, and a demographic data sheet at her first or second prenatal visit. Participants were at less than 17 weeks' gestation; 43 percent were pregnant for the first time, and 48 percent reported nausea at the time they completed the questionnaire. Women with severe nausea had higher levels of fatigue than those with no or mild and moderate nausea. Severity of nausea and level of fatigue were positively correlated, indicating that as nausea increased so did the severity of fatigue.

Patterns of nausea during first trimester of pregnancy.

This descriptive study examined pregnancy nausea to determine whether nausea occurred more frequently during the morning hours than during other times of day and if certain patterns of nausea exist. The 19 women who participated in the study kept daily diaries of their nausea experiences over a 7-day period, noting the time of occurrence. Nausea was reported most frequently during waking hours, ranging from 40.3% of the time between 7 p.m. and 10 p.m. and 43.9% between 3 p.m. and 6 p.m. Most nausea reported by subjects was mild, although 18% of the nausea reported between 11 p.m. and 2 a.m. was severe. Four patterns of nausea were identified: morning peak, evening peak, bimodal, and all day. Whereas some women displayed fairly consistent daily patterns of nausea, others reported variations in the occurrence or severity of nausea over the 7-day study period.

Promoting informed consent of women in labor.

Laboring women are increasingly being asked to participate in perinatal research. These women should be considered captive or special subjects who deserve greater protection of their rights. Essential elements of informed consent are reviewed. Specific guidelines are suggested for promoting informed consent for women in labor participating in clinical research.