more_vertA 42-year-old man was admitted to the trauma service with a single gunshot wound to the head. Upon diagnosis of brain death, he was referred for organ donation. The creatinine concentration was 1·00 mg/dL (estimated glomerular filtration rate [eGFR] 92·4 mL/min per 1·73 m2) and the urine output was more than 100 mL/h. Prior to recovery of organs for donation, the CT scan showed a horseshoe kidney (figure). The kidneys were fused at their lower poles with the isthmus overlying the aorta. Hepato-pancreatic anatomy was only notable for a replaced right hepatic artery.
Preference: Physiology and Anatomy
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[Articles] Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study
Despite a low-risk profile and few postoperative complications, patients in Africa were twice as likely to die after surgery when compared with the global average for postoperative deaths. Initiatives to increase access to surgical treatments in Africa therefore should be coupled with improved surveillance for deteriorating physiology in patients who develop postoperative complications, and the resources necessary to achieve this objective.
[Correspondence] Female physicians nominated for the Nobel Prize 1901–50
Recent contributions in The Lancet have discussed the under-representation of women at senior levels in medicine and the life sciences.1 This trend mirrors the gender gap in the number of Nobel Prize nominees and laureates in physiology or medicine. Drawing on sources from the archive of the Nobel committee in Sweden, we have found that the lion’s share of both nominators and nominees were men during the first half of the 20th century (archival material for the last 50 years is not yet available).
[Perspectives] Robin West breaks gender barriers in US football and baseball
Most 10-year-olds who break their arm focus on how many people they can get to sign their cast. But when Robin West broke her arm at that age, she focused on her x-rays. West studied the images of her fracture and then went home and looked up “surgical neck of the humerus” in her treasured paperback copy of Gray’s Anatomy, the 1976 edition. She’d asked her parents for it when she was in kindergarten, after spying her anaesthesiologist uncle’s copy. “I thought it was kind of cool”, she explains. About 40 years after she received her first copy of Gray’s Anatomy, West has what many people would consider to be a very cool career.
Alcohol damage could start at conception
New research that examines alcohol consumption’s long-term negative health effects and how they could start even from the time of conception has been published.
Published in the Journal of Developmental Origins of Health and Disease and the American Journal of Physiology is one of the first studies to look at alcohol in preconception rather than during pregnancy.
Professor Karen Moritz from The University of Queensland’s Child Health Research Centre UQ said the research using animal models found that exposure to alcohol around conception made male offspring more likely to seek a high fat diet more often as they aged.
“We found that exposure to alcohol resulted in male offspring having a sustained preference for high-fat food, which indicated the reward pathway in the brain was altered by alcohol exposure around conception,” Professor Moritz said.
“Surprisingly we found alcohol exposure at this time had no effect on alcohol preference in offspring of either sex later in life.”
In the study, which was conducted on rats, the equivalent of four standard drinks was consumed every day for four days either side of mating. Male offspring which were exposed to alcohol in this way developed elevated preferences for foods high in fat.
The Australian Guidelines to Reduce Health Risks from Drinking Alcohol has been developed by the National Health and Medical Research Council. No alcohol consumption is their current recommendation for pregnant women, and those who planning a pregnancy.
The dangers of consuming alcohol whilst pregnant are well documented and widely acknowledged. The message that there is no safe level of fetal alcohol exposure has been widely disseminated for the best part of the last decade.
More is emerging about the impact of alcohol consumption prior to conception. A separate but related study by UQ found that male offspring of mothers who had consumed alcohol around conception had five per cent more body fat than offspring of mothers who had not consumed alcohol around conception.
Professor Moritz said the study also found both male and female offspring were more likely to suffer from fatty liver when exposed to alcohol at conception.
“Our results highlight that alcohol consumption, even prior to a fertilised egg implanting in the uterus, can have lifelong consequences for the metabolic health of offspring,” she said.
The research highlights the vulnerability of the developing embryo. Previous studies have identified a link between paternal alcohol consumption around conception and epigenetic alterations.
Given that half of all Australian pregnancies are unplanned, the challenge remains reducing alcohol exposure in the early stages of unplanned pregnancies, when the mother may not even know she is pregnant.
The AMA recently raised its concern that the Government’s new National Drug Strategy did not focus on alcohol – even though alcohol-related harm alone is estimated to cost $36 billion a year.
AMA President Dr Michael Gannon has called for a national alcohol strategy.
The AMA position statement on Fetal Alcohol Spectrum Disorder is available here: position-statement/fetal-alcohol-spectrum-disorder-fasd-2016
The 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol can be found here: https://www.nhmrc.gov.au/guidelines-publications/ds10.
GEORGIA BATH AND MEREDITH HORNE
[World Report] Nobel Prize awarded for discoveries in circadian rhythm
The 2017 Nobel Prize in Physiology or Medicine was awarded to Jeffrey Hall, Michael Rosbash, and Michael Young. Talha Burki reports.
[Articles] Exenatide once weekly versus placebo in Parkinson’s disease: a randomised, double-blind, placebo-controlled trial
Exenatide had positive effects on practically defined off-medication motor scores in Parkinson’s disease, which were sustained beyond the period of exposure. Whether exenatide affects the underlying disease pathophysiology or simply induces long-lasting symptomatic effects is uncertain. Exenatide represents a major new avenue for investigation in Parkinson’s disease, and effects on everyday symptoms should be examined in longer-term trials.
[Obituary] Saidi Hassan
Surgeon and Chairman of the University of Nairobi’s Department of Human Anatomy. Born in Nairobi, Kenya, on Aug 3, 1965, he died of cancer in Nairobi on Aug 29, 2017, aged 52 years.
Rehydration study shows water still best choice
A Griffith Universitystudy has found that once food is consumed, water should be the drink of choice for most of us following a workout.
Ten endurance trained athletes aged between 18 and 30 cycled intensively for one hour on four separate occasions as a part of the small study that has been published in the peer-reviewed scientific journal Physiology and Behaviour.
Participants were provided with one beverage to drink as they desired following the exercise. The beverages included water (used on two of the trials), a carbohydrate-electrolyte (sports drink) Powerade or the milk-based drink Sustagen Sport.
In addition, on two occasions during recovery, the participants were given access to a variety of food which could also be voluntarily consumed.
“The fluid provided from all beverages was equally well retained, despite different consumption volumes, and resulted in participants’ body weights returning to near pre-exercise levels,” said Associate Professor Ben Desbrow from Griffith’s Menzies Health Institute Queensland.
“The findings from this study demonstrate that the consumption of food following exercise plays an important role in causing fluid retention when different beverages are consumed. The take home message was that when participants consumed a fluid containing calories (i.e. the Powerade or Sustagen Sport trials), their combined energy intake from the drink and food was greater than on the water trials.”
Associate Professor Desbrow said it was imperative, when making post-exercise nutrition recommendations, to consider beverage selection within the context of an individual’s broader health targets.
“For those with a weight loss goal, a calorie-free drink such as water is the perfect choice,” he said.
“It rehydrates equally effectively as other beverages, without supplying additional energy.”
MEREDITH HORNE
[Series] Evolutionary public health: introducing the concept
The emerging discipline of evolutionary medicine is breaking new ground in understanding why people become ill. However, the value of evolutionary analyses of human physiology and behaviour is only beginning to be recognised in the field of public health. Core principles come from life history theory, which analyses the allocation of finite amounts of energy between four competing functions—maintenance, growth, reproduction, and defence. A central tenet of evolutionary theory is that organisms are selected to allocate energy and time to maximise reproductive success, rather than health or longevity.