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Cerebral blood flow and oxygen consumption in acute brain injury with acute anemia: an alternative for the cerebral metabolic rate of oxygen consumption?

OBJECTIVE: To comparatively evaluate cerebral metabolic rate of oxygen consumption and a modification of it, cerebral consumption of oxygen, in patients with acute brain injury with acute anemia. DESIGN: Prospective, observational study. SETTING: Neuroscience intensive care unit (ICU) of a university hospital. PATIENTS: Adults (n = 62) with acute brain trauma, undergoing serial 133xenon studies of regional cerebral blood flow and global cerebral oxygen metabolism, along with other routine monitoring techniques. MEASUREMENTS AND MAIN RESULTS: In 173 combined studies of blood flow and oxygen metabolism, in the presence of spontaneous decreases in hemoglobin, cerebral metabolic rate of oxygen consumption and cerebral consumption of oxygen were comparatively evaluated in three groups with different hemoglobin levels. Cerebral metabolic rate of oxygen consumption was calculated as the product of averaged regional cerebral blood flow and arterio-jugular oxygen content difference, while cerebral consumption of oxygen was calculated as the product of averaged regional cerebral blood flow and the arterio-jugular oxyhemoglobin saturation difference, i.e., cerebral extraction of oxygen. Results indicated that a decrease of hemoglobin content is paralleled by a decrease in cerebral metabolic rate of oxygen consumption, even though the level of consciousness (coma score) is essentially unchanged across three hemoglobin groups. On the other hand, cerebral consumption of oxygen does not follow the decrease in hemoglobin and cerebral metabolic rate of oxygen consumption, thus demonstrating better stability to changing hemoglobin content. The low cerebral metabolic rate of oxygen consumption is due to a decrease in arterio-jugular oxygen content difference in anemia, while the cerebral extraction of oxygen does not follow the trend of the arterio-jugular oxygen content difference. CONCLUSIONS: In acute brain trauma with acute anemia, calculated arterio-jugular oxygen content difference and cerebral metabolic rate of oxygen consumption tend to be progressively lower, depending on the extent of anemia, which is in disagreement with coma scores. These changes in hemoglobin tend to have an inverse influence on cerebral consumption of oxygen, which, therefore, constitutes an alternative and independent measure of cerebral oxygen and independent measure of cerebral oxygen consumption under these limiting circumstances.

Acute Disease

Quantification of energy consumption in platelets during thrombin-induced aggregation and secretion. Tight coupling between platelet responses and the increment in energy consumption.

The involvement of metabolic energy in platelet responses was investigated by measuring the energy consumption during aggregation and secretion from dense, alpha- and acid-hydrolase-containing granules. Gel-filtered human platelets were stimulated with different amounts of thrombin (0.05-5.0 units X ml-1). At various stages during aggregation and secretion the energy consumption was measured from the changes in metabolic ATP and ADP following abrupt arrest of ATP resynthesis. Stimulation with 5 units of thrombin X ml-1 increased the energy consumption from 6.2 +/- 0.9 to 17.8 +/- 0.4 mumol of ATPeq. X min-1 X (10(11) platelets)-1 during the first 15 s. It decreased thereafter and returned to values found in resting cells after about 30 s. With 0.05 unit of thrombin X ml-1, the energy consumption accelerated more slowly and took at least 3 min before it normalized. A strong positive correlation was found between the velocities of the three secretion responses and the concurrent energy consumption (a) at different stages of the responses induced by a given dose of thrombin, and (b) at different secretion velocities initiated by different amounts of thrombin. When, at different stages of the responses, the extent of secretion was compared with the amount of energy that had been consumed, a strong linear correlation was found with the increment in energy consumption but not with the total energy consumption. This correlation was independent of the concentration of thrombin and indicated that complete secretion from dense, alpha- and acid-hydrolase-containing granules was paralleled by an increment of 4.0, 6.5 and 6.7 mumol of ATPeq. X (10(11) platelets)-1, respectively. An energy cost of 0.7 mumol of ATPeq. X (10(11) platelets)-1 was calculated for separate dense-granule secretion, whereas the combined alpha- and acid-hydrolase granule secretion required 5.3 mumol of ATPeq. X (10(11) platelets)-1. There was no correlation between energy consumption and optical aggregation. In contrast, the rate of single platelet disappearance, which is a measure for the early formation of small aggregates, correlated closely with the rate of energy consumption. Compared with secretion, however, the energy requirement of single platelet disappearance was minor, since 2mM-EDTA completely prevented this response but decreased the energy consumption only slightly. An increase of 0.5-1.0 mumol of ATPeq. X (10(11) platelets)-1 was seen before single platelet disappearance and the three secretion responses were initiated, indicating an increase in energy consuming processes that preceded these responses.(ABSTRACT TRUNCATED AT 400 WORDS)

Acetylglucosaminidase

Oxygen consumption by portal-drained viscera of cattle: comparison of analytical methods and relationship to whole body oxygen consumption.

Two experiments were conducted to compare methods of determining oxygen consumption by portal-drained viscera and to relate this consumption to total oxygen consumption by lactating dairy cows. Oxygen consumption was the product of portal blood flow (determined by dilution of dye infused into a mesenteric vein) and portal-arterial concentration differences of oxygen. In Experiment 1, portal-arterial concentrations of oxygen were determined in samples from three cows using equations based on blood pH, hemoglobin, partial pressure of carbon dioxide, and partial pressure of oxygen (method 1) or by direct oxygen determination with an oximeter (method 2). Overall, there were no differences in oxygen concentrations or oxygen consumption by portal-drained viscera between methods. In Experiment 2, oxygen consumption by portal-drained viscera (method 2) and total oxygen consumption were measured in two lactating cows. Oxygen consumption by portal-drained viscera accounted for 18% of total oxygen consumption.

Abdomen

Change in alcohol, tobacco and coffee consumption in pregnant women: evolution between 1988 and 1992 in an area of high consumption.

OBJECTIVE: Analyse the evolution of alcohol, tobacco and coffee consumption during pregnancy in a population characterized by a high level of consumption and a low socioeconomic situation. STUDY DESIGN: Data were obtained from two studies done with the same protocol and questionnaire in the Roubaix Public Maternity Hospital in 1988 (176 women) and 1992 (235 women); the two periods were compared using univariate tests and multiple logistic regression to control for social factors. RESULTS: Between 1988 and 1992, there was a clear decrease in alcohol consumption, a slight decrease in coffee consumption and an increase in tobacco use. These changes affected usual consumption as well as consumption during pregnancy. The increase in tobacco use was no longer significant after controlling for social factors. However, the decrease in alcohol consumption affected all women regardless of sociodemographic characteristics, and remained significant after controlling for these characteristics. CONCLUSION: Several factors support the hypothesis that the decrease in the reported alcohol consumption is real, for consumptions in the low to moderate range. However, it is difficult to identify the role of the several factors involved in this evolution: behaviour of the general population, attitude among pregnant women, information and sensitization of prenatal care providers. Besides, one negative aspect needs to be considered: the stability of the incidence of fetal alcohol syndrome, probably reflecting the stability of the proportion of very heavy consumers.

Alcohol Drinking

[Drug consumption in diabetes mellitus (III). Trends of hypoglycemic agents use and consumption in Tarragona, Catalonia, and Spain (1988- 1991). Group for the Study of Diabetes in Tarragona].

BACKGROUND: To analyze the evolution of the use of drugs in diabetes, the consumption of hypoglycemic medication in the province of Tarragona, the autonomic community of Catalonia and Spain as a whole, was studied. A qualitative evaluation of the tendencies of prescription, as an indirect index of quality in the health care to diabetics was performed. METHODS: The sales of oral hypoglycemic medication (OH) and insulin (INS) were accounted for in the study environment between 1988-1991. To make consumption uniform a standardized unit of measure was used with defined daily doses (DDD)/1,000 inhabitants/day (Drug Utilization Research Group) of the different groups of drugs. Total consumption was obtained by a primary data source (Intercontinental Medical Statistics), and periodically compared with a secondary source (registry of public prescriptions within Tarragona). RESULTS: A progressive increase in the consumption of hypoglycemic drugs was observed: 16.1 to 21.2 DDD/1,000 inhabitants/day (31%) in Spain; 17.7 to 19.8 (12%) in Catalonia and 19 to 23 (21%) in Tarragona. The increase in consumption of INS in Tarragona (43%) was greater than that of OH (12%). In Catalonia, it was much greater (INS: 23%, OH: 7%) and was parallel in Spain (36% and 30%, respectively). The OH/INS index decreased in Catalonia and Tarragona (1.3 and 1.9 in 1991) and remained practically constant (2.3-2.4) in Spain. A global decrease was produced in the consumption of slow insulins with a significant increase in intermediate, premixed and fast insulins. A growing increase in glibenclamide much greater than the remaining sulphonylureas was seen, in addition there was a persistent and low use (less than 1 DDD/100 inhabitants/day) of biguanides. Significative variations of medication consumption were registered according to the territory analyzed. CONCLUSIONS: From 1988 to 1991 there has been an increase in the use of hypoglycemic drugs. The use of oral hypoglycemics has remained constant in relation to insulins in Spain and in Catalonia and, more so in Tarragona, there is a progressive inclination to the use of insulin. The evolution of consumption suggests important asymmetry in the quality of health care and denotes progression in the global educative offer to diabetics.

Diabetes Mellitus

Alcohol consumption in France: production, consumption, morbidity and mortality, prevention and education in the last three decades.

This paper examines trends in the French consumption of alcohol over the last three decades, and includes data on the production of alcoholic beverages, the consumption of different types of alcoholic and non-alcoholic beverages, morbidity and mortality related to the consumption of alcohol, and a brief description of French preventive and educational measures in this area. In the last 15 years, the average alcohol consumption has ceased growing and even began to decrease. Data are given comparing consumption trends in several European countries, as well as more detailed data of alcohol consumption and related phenomena in France by region, by sex, by age and by socio-economic status (the last two categories for men only). Finally, a schema of the social dynamics of alcohol consumption is presented.

Alcohol Drinking

Alcohol consumption in relation to food intake and smoking habits in the Dutch National Food Consumption Survey.

The interrelationships between alcohol consumption, energy and food intake and smoking habits were studied in 1145 men and 1171 women, aged 22-49 years, in the Dutch National Food Consumption Survey, in which a 48-h dietary record method was used. The aim of the study was to investigate the effects of alcohol consumption on dietary habits and smoking. A strong relationship between alcohol consumption and energy intake was found. The energy derived from alcohol was not compensated for by lower intake of other nutrients. There was no increase in Quetelet's index with increasing alcohol consumption, except for non-smoking men who were heavy drinking on midweek days. Possible explanations for this apparent lack of an overall effect of alcohol calories are discussed. Alcohol consumption was much higher on weekend days than on midweek days. No differences in nutrient intake were found between non-drinkers, moderate drinkers and heavy drinkers on midweek days. On weekend days, however, there was a slightly higher total fat and saturated fat intake in moderately drinking men. For women cholesterol intake was found to be higher in moderate and heavy drinkers. Finally, a strong positive relationship between alcohol consumption and smoking was observed. It is concluded that the observations with respect to energy and nutrient intake and smoking habits are not indicative of a healthier lifestyle in moderate alcohol users between 22 and 49 years of age. Consequently, the more favourable prognosis of moderate drinkers cannot be ascribed to a more healthy lifestyle.

Adult

A novel technique for rapid determination of energy consumption in platelets. Demonstration of different energy consumption associated with three secretory responses.

A novel method has been developed for rapid and quantitative determination of the rate of energy consumption in platelets. In platelets suspended in a cyanide-containing medium. ATP resynthesis is abruptly blocked by addition of 2-deoxyglucose and D-glucono-1,5-lactone. We demonstrate that the subsequent changes in the levels of cytoplasmic ATP and ADP reflect the velocity of energy consumption in the platelets immediately before addition of the inhibitors. Despite the arrest in ATP resynthesis the platelets remain responsive to stimulation by thrombin (5 units x ml-1) which triggers the secretion of the contents of dense, alpha- and acid hydrolase granules. Unstimulated platelets were found to consume about 3.5 and 0.5 mumol of ATP equivalents x min-1 x (10(11) cells)-1 at 37 degrees C and 15 degrees C, respectively; the thrombin-treated platelets consumed respectively 16 and 2 mumol of ATP equivalents x min-1 x (10(11) cells)-1 at these temperatures. When the velocity of energy consumption was varied by (a) changing the temperature and (b) preincubation with glyco(geno)lytic inhibitors, it was found to be linearly related to the initial rate of secretion from the three types of granules. The precise nature of this relationship differed between the three types of secretion responses and indicated an increasing requirement for metabolic energy for secretion from the three types of granules in the order: dense granule less than alpha-granule less than acid hydrolase granule. The results obtained with changes in temperature were superimposable on those obtained with the glyco(geno)lytic inhibitors for dense granule secretion and alpha-granule secretion, suggesting an apparent coupling between energy consumption and the rate of these secretion responses. The rate of secretion of acid hydrolase was always higher when energy consumption was varied by temperature changes than when glyco(geno)lytic inhibitors were used, probably as a result of metabolic changes prior to induction of secretion. On the basis of these experiments, we calculated an incremental energy consumption during complete secretion of dense, alpha- and acid hydrolase granule contents of 2.5, 4.2 and 6.7 mumol of ATP equivalents x (10(11) platelets)-1, respectively.

Adenosine Triphosphate

Co-variation between biological markers and self-reported alcohol consumption. A two-year study of the relationship between changes in consumption and changes in the biological markers gamma-glutamyl transpeptidase (GGT) and average volume per erythrocyte (MCV) among problem drinkers.

Co-variations between self-reported alcohol consumption and the biological markers MCV (average volume per erythrocyte) and GGT (gamma-glutamyl transpeptidase) over a 2-year period were studied in a group of 84 men and 53 women recruited to out-patient treatment by advertisements in the press. Upon admission, the drinking pattern of the participants during the preceding year was registered in detail. The participants were also medically examined, and blood samples taken. All the participants were followed up by new personal interviews, medical examinations and new blood sampling after 3, 9, 25 and 21 months. For the group as a whole, alcohol consumption was significantly lower at the end of the observation period than at admission. GGT was also decreased, but not MCV. Both self-reported consumption and the values for the biological markers showed large inter-individual and intra-individual variations during the observation period. The biological markers seemed to co-vary to a limited degree with changes in reported consumption. Both GGT and MCV seemed to have a low sensitivity but a high specificity to changes in consumption. Both markers also seemed to be somewhat more useful in identifying decreases than increases in consumption. The markers GGT and MCV should be used with caution in connection with therapeutic counselling to individuals.

Adult

[Health status of the economically active population and drug consumption. II. Analysis of drug consumption].

The authors pay attention to one of the indicators of the health status of the economically active population--to the consumption of drugs. The analysis was based on outpatient records on health and disease in a selected group of 2,080 patients (25.9% of the basic group) in relation to sex, age and work capacity. The drug consumption of persons unable to work was cca 40% of the total drug consumption, whereby a higher consumption was recorded in women. With advancing age the drug consumption in diseases not associated with work incapacity rises markedly. Age practically does not influence the drug consumption on account of diseases causing work incapacity.

Adult

Lithium effects on adjunctive alcohol consumption. I: Comparison with adjunctive water consumption.

Chronic administration of lithium chloride (20 mEq/l, in drinking water) produced an earlier onset of the adjunctive consumption of both water and alcohol. Terminal consumption levels, however, were unaffected by either lithium or the liquid available for consumption. The rate of increase, once drinking was initiated, was slower for lithium subjects than it was for controls. Under extinction conditions, adjunctive alcohol consumption showed no evidence of decline for either lithium or control subjects. Water consumption by control subjects did decrease considerably as a result of extinction. Subjects receiving lithium, however, maintained their intake of water at terminal adjunctive drinking levels.

Alcohol Drinking

Detection of the relationship between moderate alcoholic beverage consumption and serum levels of estradiol in normal postmenopausal women: effects of alcohol consumption quantitation methods and sample size adequacy.

The purpose of this study was to evaluate the detectability of an effect of moderate alcoholic beverage consumption on the biologic correlate of postmenopausal estradiol levels. Total weekly consumption and beverage-specific intake were assessed using both self-reported usual consumption information and prospective food record data. In terms of total weekly drinks, discrepancies were observed in 35 of the 101 women who reported alcohol use; no consistent pattern of overreporting/underreporting was seen. Although the two alcohol estimates were highly correlated, the relationship between estradiol levels and total weekly alcohol intake was found to be detectable when alcohol consumption based on the food record data was analyzed, but not when the self-report data were examined in a two-tailed hypothesis-testing situation. Evaluating the association between postmenopausal estradiol levels and the two estimates of alcohol intake in random samples of varying sample sizes generated from the mother population of 128 normal postmenopausal women confirmed the finding that the prospectively obtained alcohol data better predict the relationship. Based on the results of this study, it must be concluded that self-reported usual alcohol consumption data must be used with caution when examining an association between alcohol intake and a biologic effect.

Alcohol Drinking

[Food consumption and the nutritional status of schoolchildren of the Community of Madrid (CAENPE): general methodology and overall food consumption. Consumo de alimentos y estado nutricional de la población escolar].

The CAENPE study (Food Consumption and Nutritional State of the School Population) was a transversal observational study funded and promoted by the Directorate-General of Food Hygiene in the Ministry of Health, implemented in 1991-93, with the main aim of quantifying food consumption in the school population (6-14 years of age) in the Regional Community of Madrid, together with an anthropometric study and nutritional analysis of that population. This project sets our the General Methodology for the study, paying particular attention to the sampling design, to ensure that the sample is representative of the community, and the results of the overall consumption of food and its comparison with recommended diet and other population studies. Quantification shows a high and rising consumption of meat, meat products, sweets, snacks and prepared dishes, suitable consumption of eggs, legumes and fruit and a notable lack of greens, vegetables and potatoes. The basic results underline the need to introduce educational measures with practical effect on home and school menus.

Adolescent

Changes in cerebral oxygen consumption are independent of changes in body oxygen consumption after severe head injury in childhood.

This study examines the relation between cerebral O2 consumption (CMRO2) and the O2 consumption of the rest of the body (BVO2) after severe head injury. Seventy nine serial measurements of whole body O2 consumption, CMRO2, plasma adrenaline, T3, and glucagon concentrations were made in 15 children with severe head injuries receiving neurointensive care. Body O2 consumption was measured with indirect calorimetry and CMRO2 with the Kety-Schmidt technique. There was no evidence of a significant relation between CMRO2 and BVO2. Within each child there were statistically significant positive relations between BVO2 and adrenaline, T3, and glucagon. By contrast, there was only a weak significant positive relation between CMRO2 and T3. In conclusion, CMRO2 and BVO2 seem to be determined independently after severe head injury. Thus therapeutic measures aiming to reduce CMRO2 need to be specific to the brain and it should not be assumed that measures which decrease whole body energy expenditure will necessarily have the same effect on CMRO2.

Adolescent