Montreal Children's Hospital

About: Montreal Children's Hospital is a healthcare organization based out in Montreal, Quebec, Canada. It is known for research contribution in the topics: Population & Poison control. The organization has 3842 authors who have published 4816 publications receiving 200198 citations.

Extent, risk factors, and outcome of fluid overload after pediatric heart surgery*.

Abstract: Objectives: Fluid overload is associated with poor PICU outcomes in different populations. Little is known about fluid overload in children undergoing cardiac surgery. We described fluid overload after cardiac surgery, identified risk factors of worse fluid overload and also determined if fluid overload predicts longer length of PICU stay, prolonged mechanical ventilation (length of ventilation) and worse lung function as estimated by the oxygenation index. Design: Retrospective cohort study. Setting: Montreal Children's Hospital PICU, Montreal, Canada. Patients: Patients 18 years or younger undergoing cardiac surgery (2005–2007). Interventions: None. Measurements and Main Results: Cumulative fluid overload % was calculated as [(total fluid in – out in L)/admission weight (kg) × 100] and expressed as PICU peak cumulative fluid overload % throughout admission and PICU day 2 cumulative fluid overload %. Primary outcomes were length of stay and length of ventilation. The secondary outcome was oxygenation index. Fluid overload risk factors were evaluated using stepwise linear regression. Fluid overload-outcome relations were evaluated using stepwise Cox regression (length of stay, length of ventilation) and generalized estimating equations (daily PICU cumulative fluid overload % and oxygenation index repeated measures). There were 193 eligible surgeries. Peak cumulative fluid overload % was 7.4% ± 11.2%. Fluid overload peaked on PICU day 2. Lack of past cardiac surgery (p = 0.04), cyanotic heart disease (p = 0.03), and early postoperative fluids (p = 0.0001) was independently associated with higher day 2 fluid overload %. Day 2 fluid overload % predicted longer length of stay (adjusted hazard ratio, 0.95; 95% CI, 0.92–0.99; p = 0.009) and length of ventilation (adjusted hazard ratio, 0.97; 95% CI, 0.94–0.99; p = 0.03). In patients without cyanotic heart disease, worse daily fluid overload % predicted worse daily oxygenation index. Conclusion: Fluid overload occurs early after cardiac surgery and is associated with prolonged PICU length of stay and ventilation. Future fluid overload avoidance trials may confirm or refute a true fluid overload-outcome causative association.

Characterization and regulation of epidermal growth factor receptors in human placental cell cultures.

Abstract: We have confirmed that cultured human placental cells rapidly release hCG. Preincubation with epidermal growth factor (EGF) for 24 h significantly increased the amount of hCG released and also increased human placental lactogen release by these cells. To better understand the mechanisms of action of EGF on the feto-placental unit, we studied EGF receptor binding and regulation by examining the characteristics and specificity of EGF receptors in human placental syncytiotrophoblast cultures. Maximal [125I]EGF binding occurred at pH 7.5 and 4 C, and exhibited a high degree of specificity. In the presence or absence of Bacitracin at 4 C, specific binding values were similar, and labeled EGF was physically intact, as assessed by trichloroacetic acid precipitation or rebinding to human placental membranes. The percent specific binding was proportional to cell and ligand concentrations and was significantly increased in term (52.9 +/- 1.2%; n = 11) compared to early gestation placental cells (22.7 +/- 3.4%; n = 7; P less than 0.001). Both term and midterm EGF displacement curves generated curvilinear Scatchard plots, suggesting receptor heterogeneity. Pretreatment of cells with EGF resulted in a dose and time-dependent decrease in specific binding, which was maximal (80%) at 200 ng/ml EGF. This loss of binding was due to decreases in the number of both high and low affinity receptor sites, with no significant change in the apparent affinity. The induction of EGF receptor loss by EGF was a specific effect on the EGF receptor. Preincubation of these same cells with insulin caused a decrease in the number of insulin receptors, while the number of EGF receptors remained unaltered. Conversely, preincubation with EGF, in a dose that down-regulated EGF receptors, did not alter insulin receptor number or affinity. Down-regulation of EGF receptors was reversible, with 50% recovery by 16 h. However, cycloheximide (10 micrograms/ml) blocked EGF-induced down-regulation and receptor recovery. The presence of EGF receptors in human placental cells and the ontogenic changes found suggest that EGF may be involved in the regulation of fetal growth and development. These studies indicate the feasibility of using human placental cells in culture as a model system to probe hormone-cell interaction in the fetoplacental unit.

Cognitive Style in Adults Originally Diagnosed as Hyperactives.

Abstract: SUMMARY The cognitive styles of reflection-impulsivity, field-dependence-independence, and constricted-flexible control were studied in 70 hyperactive adults and 42 matched controls as part of a follow-up study. Results indicated that the hyperactive adults were more field-dependent and more constricted than the controls. They were also less accurate although they did not respond more quickly than the controls on a visual matching task. The educational implications of this are discussed.