UK guidelines for the use of inhaled nitric oxide therapy in adult ICUs. American-European Consensus Conference on ALI/ARDS.

Objective: Although unlicensed, inhaled nitric oxide (NO) therapy is now widely used in the United Kingdom. Our aim was to produce guidelines for the clinical application of inhaled NO in adult intensive care practice, based upon the current level of published information.

Methods: The published data regarding the use of inhaled NO in the acute respiratory distress syndrome and right-sided cardiac failure was presented, analysed and discussed.

The effects of nitric oxide and peroxynitrite on interleukin-8 and elastase from lipopolysaccharide-stimulated whole blood.

Unlabelled: Inhaled nitric oxide is now widely used in the treatment of hypoxemia and pulmonary hypertension in critically ill patients. Interleukin-8 (IL-8) and neutrophil elastase are important markers of the onset and severity of acute lung injury. We studied the effects of nitric oxide and peroxynitrite on IL-8) and elastase accumulation in lipopolysaccharide-activated whole blood.

Differential effects of Wilms tumor WT1 splice variants on the insulin receptor promoter.

The Wilms tumor gene WT1 has been implicated in the early development of the kidney. Mutations in WT1 are found in a small fraction of Wilms tumor, a pediatric nephroblastoma, and Denys-Drash syndrome, characterized by genitourinary abnormalities. The WT1 gene product functions as a transcriptional repressor of growth factor-related genes.

Changes in inflammatory mediators during orthotopic liver transplantation.

Transplantation is associated with an inflammatory rejection response. Graft reperfusion causes typical haemodynamic and biochemical responses. In this study we have investigated the relationship between these haemodynamic responses and changes in circulating inflammatory mediators after graft reperfusion in 10 consecutive patients undergoing orthotopic liver transplantation.

Effect of ciprofloxacin on the accumulation of interleukin-6, interleukin-8, and nitrite from a human endothelial cell model of sepsis.

Objective: To determine the effect of the quinolone antibiotic ciprofloxacin, on interleukin-6, interleukin-8, and nitrite production by human endothelial cells.

Design: Controlled cell culture experiments examining the immunomodulatory effects of an antibiotic.

Setting: University research laboratory attached to a large teaching hospital.

Effect of exogenous nitric oxide and superoxide on interleukin-8 from human polymorphonuclear leucocytes.

Patients with acute inflammatory lung injury are commonly treated with inhaled nitric oxide. Nitric oxide has profound immunoregulatory effects. Increased concentrations of the cytokine interleukin-8 (IL-8) in bronchoalveolar lavage fluid has been associated with disease severity.

Use of inhaled nitric oxide in British intensive therapy units.

The use of inhaled nitric oxide in the critically ill has increased significantly over the past few years but little published information exists on standards for current practice. Sixty-four intensive therapy units in the UK were surveyed by questionnaire from which 54 (84.4%) satisfactory replies were received.

The efficacy of exit site povidone-iodine ointment in the prevention of early peritoneal dialysis-related infections.

Infections are the main complications of peritoneal dialysis, and currently there is no established method for prevention. A prospective, randomized, single-blind study was performed to evaluate the efficacy of regular application of povidone-iodine ointment at the catheter site (during the entire time on the study) in peritoneal dialysis. One hundred twenty patients were randomized; three were excluded for not completing the study.

Combination oral antioxidant supplementation reduces blood pressure.

1. Hypertension affects 30% of adults and low intakes of antioxidants have been associated with increased risk of hypertension and cardiovascular disease. To investigate the effect of short-term high-dose antioxidant supplementation on blood pressure in hypertensive and normotensive outpatients, we undertook a randomized, double-blind, crossover design placebo-controlled study.

The effects of intravenous antioxidants in patients with septic shock.

Oxidative stress is implicated in septic shock. We investigated the effect of intravenous antioxidant therapy on antioxidant status, lipid peroxidation, hemodynamics and nitrite in patients with septic shock. Thirty patients randomly received either antioxidants (n-acetylcysteine 150 mg/kg for 30 min then 20 mg/kg/h plus bolus doses of 1 g ascorbic acid and 400 mg alpha-tocopherol) or 5% dextrose.

Central venous line sepsis in the intensive care unit. A study comparing antibiotic coated catheters with plain catheters.

A randomized controlled clinical trial was undertaken to evaluate the efficacy of antibiotic bonded lines in the reduction of central venous catheter infection. One hundred and seventy-six plain and bonded catheters were inserted into one hundred and ten patients in an intensive care unit, many of whom were admitted with evidence of sepsis. The catheters used in the study group, which had been pre-treated by the manufacturers with the cationic surfactant tridodecylmethylammonium chloride, were bonded with vancomycin 1 g made up in 10 ml of water immediately prior to insertion.

Inotropic agents in the critically ill.

Inotropic agents are commonly used in critically ill patients. This heterogeneous group of drugs are potentially hazardous if used without a good understanding of cardiovascular physiology and pathophysiology and without due attention to some general principles for their use. We suggest guidelines for the administration of these agents in all clinical settings.

Xanthine oxidase activity and free radical generation in patients with sepsis syndrome.

Objective: To determine xanthine oxidase activity, free radical concentrations, and lipid peroxidation in patients with sepsis syndrome compared with noninfected critically ill patients.

Design: A prospective observational study.

Setting: A nine-bed intensive care unit in a university teaching hospital trust.

Neutrophil adhesion molecule expression and response to stimulation with bacterial wall products in humans is unaffected by parenteral nutrition.

1. Total parenteral nutrition is associated with a high incidence of septic complications. This may be partly due to neutrophil dysfunction induced by the parenteral nutrition.

Brain nitric oxide synthase activity is decreased by intravenous anesthetics.

Nitric oxide is produced from L-arginine in a variety of cells, and in neuronal tissue, by the action of nitric oxide synthase. Inhibitors to nitric oxide synthase reduce the threshold for anesthesia and anesthetics reduce nitric oxide synthase activity in neutrophils. We investigated the effect of four intravenous anesthetics and an anticonvulsant on rat brain nitric oxide synthase activity using the stoichiometric conversion of oxyhemoglobin to methemoglobin by nitric oxide.

Plasma antioxidant potential in severe sepsis: a comparison of survivors and nonsurvivors.

Objective: To determine the plasma antioxidant potential of patients in the intensive care unit (ICU) with severe sepsis and secondary organ dysfunction and relate these findings to outcome.

Design: A prospective, cohort study.

Setting: A nine-bed ICU in a university teaching hospital.

Repression of the insulin receptor promoter by the tumor suppressor gene product p53: a possible mechanism for receptor overexpression in breast cancer.

There is strong evidence to suggest that insulin and insulin-like growth factor (IGF)-I may be important for tumor growth. Both the insulin and IGF-I receptors (IGF-IR) are overexpressed in breast cancer, and antibody blockade of the IGF-IR inhibits the growth of some breast cancer cell lines. Furthermore, expression of an insulin receptor (IR) in a normal mammary epithelia] cell line causes insulin-dependent transformation.

Obstructive jaundice causes reduced expression of polymorphonuclear leucocyte adhesion molecules and a depressed response to bacterial wall products in vitro.

Background: Obstructive jaundice is associated with an increased incidence of infection and endotoxaemia, which may result from impaired host immunity. Neutrophil adhesion to vascular endothelium is a key part of the inflammatory response.

Aims: To investigate neutrophil adhesion molecule expression and activation in obstructive jaundice.

Soluble E-cadherin concentrations in patients with systemic inflammatory response syndrome and multiorgan dysfunction syndrome.

We have assessed the role of the cell-cell adhesion molecule, E-cadherin, in the pathogenesis of multiorgan failure in 24 intensive care patients with sepsis and varying degrees of organ dysfunction, compared with 21 healthy subjects. Plasma soluble E-cadherin (sE-cadherin) was measured by enzyme immunoassay. The median concentration of sE-cadherin in normal subjects was 3.

Altered insulin receptor messenger ribonucleic acid splicing in liver is associated with deterioration of glucose tolerance in the spontaneously obese and diabetic rhesus monkey: analysis of controversy between monkey and human studies.

There are two insulin receptor (IR) isoforms (designated type A and type B), derived from alternative splicing of exon 11 of the IR gene. Recently, we reported (Huang Z., Bodkin N.