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Diabetes mellitus is associated with endothelial dysfunction and oxidative stress (OS). We investigated whether these abnormalities are interrelated in children and adolescents with type 1 diabetes mellitus (T1DM) and if early OS markers predictive of vascular dysfunction can be identified. Thirty-five T1DM patients were matched for sex, age, height, and weight with nondiabetic subjects as healthy controls (CO). Flow-mediated dilatation (FMD), carotid intima media thickness (IMT), and OS status in fasting blood were measured. Diabetic children had impaired FMD (6.68 Ϯ 1.98 versus 7.92 Ϯ 1.60% in CO, p ϭ 0.004), which was more pronounced in boys. The degree of FMD impairment was not related to the lower plasma levels of antioxidants or to the higher glucose, glycation, lipids, and peroxidation products. Erythrocyte superoxide dismutase activity, copper/zinc superoxide dismutase (Cu/Zn SOD), was higher in diabetic subjects (1008 Ϯ 224 versus 845 Ϯ 195 U/g Hb in CO, p ϭ 0.003) and was positively associated with FMD. After correcting for diabetes and gender, the subgroup of children with high Cu/Zn SOD (Ͼ955 U/g Hb) had a significantly better FMD (p ϭ 0.035). These results suggest that higher circulating Cu/Zn SOD could protect T1DM children and adolescents against endothelial dysfunction. Low Cu/Zn SOD is a potential early marker of susceptibility to diabetic vascular disease. (Pediatr Res 62: 456-461, 2007) D iabetes mellitus is an important risk factor for atherosclerosis and both the incidence and mortality of cardiovascular disease are increased in diabetic patients (1). Among the various pathophysiological mechanisms mediating the atherosclerotic process, both oxidative stress (OS) and endothelial dysfunction occur at an early stage in animal models of diabetes (2).Oxidative stress is defined as the change in the pro-oxidant/ antioxidant balance in favor of the former, potentially leading to biologic damage to macromolecules and cell dysfunction (3). As a result of hyperglycemia, excessive pro-oxidants (free radicals and reactive oxygen species) are formed via autooxidation of glucose, nonenzymatic glycation and formation of advanced glycation end products, increased flux through the polyol and hexosamine pathways, and activation of protein kinase C. These processes also lead to decreased antioxidant defenses. Brownlee (4) has linked all these abnormalities to the excessive production of superoxide by the mitochondria.In children with type 1 diabetes mellitus (T1DM), increased OS has been reported to be present even shortly after diagnosis (5). Other reports showed the parallelism between OS and abnormal markers of endothelial cell function (such as ESelectin and ICAM-1) in young T1DM patients, suggesting a link between these two abnormalities (6). Ultrasound testing of skin microcirculation and of brachial artery flow-mediated dilatation (FMD) have demonstrated early endothelial dysfunction in diabetic children and adolescents (7).Since it has been shown that foam cell accumulation in the vascular w...

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The chest pain unit (CPU) provides a service for patients at moderate-to-low risk for acute coronary syndrome (ACS). Although the number of CPUs has continued to grow worldwide, little has been written on the specific role and contribution of nursing in CPUs. The stay of patients in the CPU can be divided into six stages: triage, diagnosis, treatment, observation/monitoring, discharge, and follow-up. CPU nurses are in a unique position to promote evidence-based practice during all of these stages. Deeper insight into the unique role of nurses in CPUs will promote understanding of what type of knowledge, skills, and attitudes are required to provide the services that will contribute to improved quality of care for chest pain patients.

A critical pathway can effectively and safely reduce LOS, increase patient satisfaction, and improve adherence to the guidelines for managing patients with chest pain. Anxiety is not statistically significantly reduced by this intervention.