Alcohol and fatal injuries in Oklahoma

To assess the usefulness of medical examiner data in describing the relationship between alcohol use and fatal injuries, 1978-84 data from the Office of the Chief Medical Examiner (ME), State of Oklahoma, was examined. In each year in the study period, approximately 1,500 deaths resulted from unintentional injuries (UI) and 800 deaths resulted from intentional injuries (i.e., suicides and homicides). For persons who died on the same day they were injured, testing for blood alcohol ranged from 90% of homicide victims, to 73% of suicide victims and to 66% of UI victims. Alcohol was associated with 52% of homicides, 49% of UI and 40% of suicides. Alcohol was detected most often in samples from Hispanic men and from Native Americans of both sexes. This study suggests that state public health agencies and researchers should consider the use of ME data for epidemiologic information on the relationship between alcohol and injury-related mortality and for surveillance of these problems.     

The effect of glucose administration on carbohydrate metabolism after head injury

The role of intravenous infusion of glucose in limiting ketogenesis and the effect of glucose on cerebral metabolism following severe head injury were studied in 21 comatose patients. The patients were randomly assigned to alimentation with or without glucose. Systemic protein wasting, arterial concentrations of energy substrates, and cerebral metabolism of these energy substrates were monitored for 5 days postinjury. Both groups were in negative nitrogen balance, and had wasting of systemic proteins despite substantial protein intake. Blood and cerebrospinal fluid (CSF) glucose concentrations were highest on Day 1, but remained higher than normal fasting levels on all days of study, even in the patients who received no exogenous glucose. Although there were no differences in blood or CSF glucose concentrations in the two groups of patients, the glucose group had higher plasma insulin levels, with a mean +/- standard deviation of 14.8 +/- 7.3 microU/ml compared to 10.3 +/- 4.2 microU/ml in the saline group. The blood concentrations of beta-hydroxybutyrate, acetoacetate, pyruvate, glycerol, and the free fatty acids were higher in the saline group than in the glucose group. Cerebral oxygen consumption was similar in the two groups, while the cerebral metabolism of glucose and of the ketone bodies was dependent on whether glucose was administered. In the glucose group, glucose was the only energy substrate utilized by the brain. In the saline group, the ketone bodies beta-hydroxybutyrate and acetoacetate replaced glucose to the extent of 16% of the brain's total energy production. Cerebral lactate production and CSF lactate concentration were lower in the saline group. These studies suggest that administration of glucose during the early recovery period of severe head injury is a major cause of suppressed ketogenesis, and may increase production of lactic acid by the traumatized brain by limiting the availability of nonglycolytic energy substrates.     

CYCLOSPORIN A (CyA) MONITOrING BY CALCULATION OF AREA UNDER THE CURVE (AUC)

Background The introduction of CyA resulted in a significant prolongation in renal transplant survival but was complicated by the difficulty in distinguishing between transplant rejection and drug toxicity. More recently the conversion of stable transplant recipients to the microemulsion form of CyA resulted in significant nephrotoxicity at trough levels that were previously within the therapeutic range. We have studied AUC determinations as an alternative to trough monitoring for transplant recipients. Methods Fifty five renal transplant recipients underwent venesection prior to administration of their morning CyA dose (Pre) then 2 hours after the dose (post). The Pre (C0) and the post (C2) CyA levels were determined using the AXSYM system (Abbot) then the AUC determined from the equation where AUC = 1.84 X C0 + 4.39 X C2 + 312.66 (Keown et al 1996). Two or more AUC determinations were performed in 13 patients. The serum creatinine (Cr), age, sex, weight, CyA dose, calculated creatinine clearance (Cockcroft and Gault) and history of rejection were recorded at the time of CyA assay. Results 63 patient were studied (41 males & 22 females). The average age was 46 years (range 20‐72). The mean serum creatinine was 0.168 (range 0.07‐0.415). The C2 was the major determinant of the AUC with a correlation coefficient of 0.99 (R squared). The C0 had a weaker correlation with AUC (R squared 0.34). Serum Cr, total CyA dose, dose/kg did not correlate significantly with AUC. In individual patients who underwent multiple AUC determinations there was insufficient data to correlate with renal function. Conclusion The strong correlation between C2 and AUC suggests that a single 2 h CyA estimation is sufficient to determination the AUC using the equation AUC = 4.6 X C2 + 432. This will permit further studies of the role of CyA AUC to optimise immunosuppressive therapy without doubling the number and cost of CyA determinations.     

The taurine and hypotaurine content of human semen.

Taurine and hypotaurine levels were measured in human sperm and seminal fluid. Sperm taurine ranged from 17 nmol/mg DNA to 348 nmol/mg DNA, and hypotaurine from 0 nmol/mg DNA to 251 nmol/mg DNA. Seminal fluid contained 319 mumol/L to 1590 mumol/L of taurine, but no detectable hypotaurine. The coefficient of variation in multiple ejaculates from a single man for these components ranged from 12% for hypotaurine to 24% for seminal fluid taurine, indicating a relative constancy in their concentrations. Sperm hypotaurine content was significantly correlated with sperm morphology, sperm relative forward progression, the percentage of motile sperm, and the total number of sperm in the ejaculate. By contrast, sperm taurine content was negatively correlated with these parameters. The mean hypotaurine content of sperm from 8 fertile men was 149 +/- 92 nmol/mg DNA, four times higher than that of sperm from 9 infertile men, which was 35 +/- 19 nmol/mg DNA (P = 0.011). In contrast, the mean sperm taurine content of the fertile men was lower than that of the infertile men (83 +/- 33 nmol/mg DNA versus 168 +/- 119 nmol/mg DNA, respectively; P = 0.07). Seminal fluid taurine concentrations, however, were similar for both groups. Hypotaurine, an antioxidant, may play an important role in protecting sperm from reactive oxygen species. Higher concentrations of taurine in the sperm of infertile men suggest that accelerated oxidation of hypotaurine to taurine may accompany the observed decline in other sperm parameters.     

Technology assessment in healthcare: A means for pursuing the goals of biomedical engineering

The goals of biomedical engineering include the improvement of health and life quality of mankind. However, the contribution of biomedical engineering to those worthy ends must be more clearly related. Biomedical engineers should become more active in demonstrating to policymakers and other parties in healthcare the value of the contributions of healthcare technology. Technology assessment (TA) is a form of investigation designed to identify and evaluate the implications of technologies so as to inform policymaking. Among the important trends in TA that should be of special interest to biomedical engineers are the increasingly higher methodological standards for accepting evidence from clinical investigations, and the use of quality-of-life measures for determining how technologies affect people's lives.