Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation

BACKGROUND: Near-infrared spectroscopy (NIRS) can continuously and noninvasively monitor tissue oxygen saturation (StO2) in muscle and may be an indicator of shock severity. Our purpose was to evaluate how well StO2 predicted outcome in high-risk torso trauma patients presenting in shock. METHODS: The primary outcome in this prospective study was multiple organ dysfunction syndrome (MODS). StO2 data were obtained upon hospital arrival and for 24 hours along with other known predictors of hypoperfusion and clinical outcomes. Clinicians were blinded to StO2 measurements. RESULTS: Seven Level I trauma centers enrolled 383 patients, 50 of whom developed MODS. Minimum StO2 performed similarly to maximum base deficit (BD) in discrimination of MODS patients. The sensitivity for both measures (StO2 cutoff = 75%; BD cutoff = 6 mEq/L) was 78%, the specificity was 34% to 39%, the positive predictive value was 18% to 20% and the negative predictive value was 88% to 91%. StO2 and BD were also comparable in predicting death. CONCLUSIONS: NIRS-derived muscle StO2 measurements perform similarly to BD in identifying poor perfusion and predicting the development of MODS or death after severe torso trauma, yet have the additional advantages of being continuous and noninvasive.     

Persistence of lactase activity among Northern Europeans: A weighing of evidence for the calcium absorption hypothesis

Considered in this paper is a broad range of evidence bearing on the calcium absorption hypothesis that has been advanced to explain high frequencies of the gene for persistence of lactase activity (PLA) among adults in northern Europe. According to that hypothesis, lactase‐sufficient individuals in early northern Europe enjoyed a selective advantage over lactase‐deficient ones that led to high incidences of PLA in adults of the region. Northern Europeans, the hypothesis goes, suffered from a dietary shortage of vitamin D and, in addition, were unable to synthesize adequate vitamin D from the sun's ultraviolet radiation because of northern Europe's cloudiness and its location in higher latitudes. This led to chronic vitamin D deficiency along with a reduced ability to absorb calcium from milk and lactose‐rich dairy products. As a result, the deficiency diseases rickets—which affects infants and children and can leave a child with bowlegs and other bone defects—and osteomalacia—which weakens and deforms the bones of adults—were common in early northern Europe, and represented powerful selective forces that contributed to development of the highly depigmented skin that is typical of the region's peoples. In addition, the hypothesis goes, calcium absorption was enhanced by a process independent of vitamin D. Such enhancement, found especially or solely among lactase‐sufficient individuals, was brought on by ingestion of lactose in milk and milk products. Thus, persons who enjoyed high lactase activity through life were favored in the struggle for survival, which ultimately led northern European peoples to have among the highest incidences of PLA in the world.

In this article, evidence, much of it recent, is presented to show that lactase‐deficient humans are able to absorb calcium from milk as readily, or nearly as readily, as lactase‐sufficient humans. Evidence is also presented that rickets and osteomalacia occur in parts of the world that have an abundance of sunshine, whether originating from customs that limit exposure to sunshine or otherwise; that heavy cloud cover and high latitude need not result in vitamin D deficiency, rickets, and osteomalacia; that, indeed, osteological evidence from archeological sites in northern Europe indicates that rickets and osteomalacia were quite rare in antiquity; that those conditions appear to have become common in northern Europe only with the advent of the Industrial Revolution, too short a time to have been a significant factor in bringing on the high incidences of PLA that prevail today; and that, indeed, the calcium absorption hypothesis is not confirmed by historical, osteoarcheological, or bio‐medical evidence.     

Neutrophil Influx Measured in Nasal Lavages of Humans Exposed to Ozone

Neutrophils (PMNs) obtained by nasal lavage were counted to determine if ozone, an oxidant air pollutant, induces an acute inflammatory response in the upper respiratory tract (URT) of humans. Background data were obtained by the nasal lavages from 200 nonexperimentally exposed subjects. Then, using a known inflammatory agent for the URT, rhinovirus-type 39, the induction, peak, and resolution of an acute inflammatory response was shown to be documented by the nasal lavage PMN counts. To determine if ozone induces this response, 41 subjects were exposed to either filtered air or 0.5 ppm ozone for 4 hr, on 2 consecutive days. Nasal lavages were taken pre-, immediately post each exposure, and 22 hr following the last exposure. Lavage PMN counts increased significantly (p = .005) in the ozone-exposed group, with 3.5-, 6.5-, and 3.9-fold increases over the air-exposed group at the post 1, pre 2, and post 2 time points, respectively. Ozone induces an inflammatory response in the URT of humans, and nasal lavage PMN counts are useful to assay the inflammatory properties of air pollutants.     

Hypnotizability and trauma symptoms after burn injury

This study investigated the association of trauma symptoms and hypnotizability in 43 hospitalized survivors of burn injury. Three to 17 days after the injury, participants rated the frequency of intrusive and avoidance symptoms and were interviewed with the posttraumatic stress disorder module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-III-R. The Hypnotic Induction Profile was also administered at the postburn, hospital stage of recovery. Results indicated that when participants were divided into low, mid-range, and high hypnotizability categories, high hypnotizability was associated with more intrusive, avoidance, and arousal symptoms. Although causal relations cannot be assessed in this cross-sectional study, these results suggest that, as compared to the low and mid-range categories, high hypnotizables may experience a greater frequency of trauma symptoms after burn injury.