Costs of Military Eye Injury, Vision Impairment, and Related Blindness and Vision Dysfunction Associated with Traumatic Brain Injury (TBI) without Eye Injury Prepared by

2 TAKE AWAY MESSAGE Based on published data from 2000-2010, the total incident cost of eye injury in the military each year in this timeframe has been $2.282 billion, which represents superficial eye injury, nonsuperficial eye injury that does and does not result in permanent visual impairment or blindness, and vision impairment related to Traumatic Brain Injury (TBI). If we multiply the one-year costs by 11 to account for the period from 2000-2010, the total cost to the economy of all ocular injury and vision impairment related to TBI is$25.107 billion. Of that total, the costs incurred in the first year (all for superficial injury, initial medical care for non-superficial injuries, and rehabilitation for bilateral vision impairment) are $634 million. This is money that has already been spent. The present value of the projected Department of Veterans Affairs (VA) benefits for the remainder of the lives of all service members with ocular injuries in the 11 years under study is$188 million. The present value of the projected costs to the remainder of the economy over the remaining lifetimes of the service members with eye injuries or vision impairment due to TBI is $24.286 billion. This last cost is not to the federal government but to the economy and society as a whole

Aldosterone mediates the changes in hexose transport induced by low sodium intake in chicken distal intestine

In chickens, low Na+ diets markedly decrease the hexose transport in the rectal segment of the large intestine; transport in the ileum shows a lower, but significant reduction and transport in the jejunum is unaffected. These effects involve both apical (SGLT1) and basolateral (GLUT2) hexose transporters.The role of the renin-angiotensin-aldosterone axis (RAAS) in the epithelial response to Na+ intake was studied in chickens fed high-NaCl (HS) and low-NaCl (LS) diets. The Vmax of α-methyl-D-glucoside and D-glucose were determined in vesicles from the brush-border (BBMVs) and basolateral (BLMVs) membranes, respectively. The binding of phlorizin to BBMV and cytochalasin B to BLMV were used as indicators of the abundance of SGLT1 and GLUT2, respectively.In HS-adapted chickens, the serum concentration of aldosterone (means ± S.E.M.) was 35 ± 5 pg ml−1 (n = 6) and that of renin was 20 ± 2 ng ml−1 (n = 3). In LS-fed birds, these values were 166 ± 12 pg ml−1 (n = 6) and 122 ± 5 ng ml−1 (n = 3), respectively. Administration of captopril, the inhibitor of the angiotensin-converting enzyme (ACE), to LS-chickens lowered the aldosterone serum concentration without affecting the renin concentration. Captopril also prevented the reduction of apical and basolateral hexose transport in ileum and rectum characteristic of the intestinal response to LS adaptation.Administration of the aldosterone antagonist spironolactone to LS-adapted chickens did not affect the serum concentrations of aldosterone, but prevented the effects of LS intake on hexose transport in both apical and basolateral membranes. This suggests that the effects of aldosterone are mediated by cytosolic mineralcorticoid receptors.Administration of exogenous aldosterone to HS-fed birds induced hexose transport and binding properties typical of the LS-adapted animals. These findings support the view that aldosterone, besides its primary role in controlling intestinal Na+ absorption, can also modulate the expression of apical and basolateral glucose transporters in the chicken distal intestine

First dose of potential new medicines to humans: How animals help

The need for careful testing of new drugs in animal models before study in humans has been recognised by physicians since the First World War. Now, first human studies on new drugs are subject to detailed government guidelines, which in the European Union are presently being reinforced through the wide-ranging Clinical Trials Directive. However, despite their long history and widespread application, these guidelines are empirical and have been formulated with a paucity of critical scientific evidence. Here, we review the principles and the available, albeit limited, evidence that support the design and conduct of preclinical studies in a way that permits effective and safe first-dose studies of potential new medicines in humans

Intestinal/Multivisceral Transplantation

Intestinal/multivisceral transplantation has evolved from an experimental procedure to the treatment of choice for patients with irreversible intestinal failure and serious complications related to long-term parenteral nutrition. Children who are likely to suffer permanent intestinal failure and benefit from intestinal transplantation include those with a remaining small bowel length of less than 30–40 cm, absence of the ileocecal valve, colonic resection and malabsorptive syndromes. Indications for transplant include frequent severe bouts of catheter associated sepsis, threatened loss of vascular access and the development of liver cirrhosis from cholestasis. Children who are more likely to experience cholestasis from total parenteral nutrition include those who experience persistent hyperbilirubinemia (greater than 6 mg/dl despite enteral nutrition), those with recurrent sepsis and/or bacterial overgrowth and those with minimal tolerance of any enteral feeds in the first few months post resection. The 1 year survival rate after intestinal transplantation has markedly improved over the last several years but long term survival rates have remained unchanged. The improved short term survival rates have led to an increased prevalence of this patient population in intensive care units. Management of intestinal and multivisceral transplant recipients is uniquely challenging because of complications arising from the high incidence of transplant rejection and its treatment. In the ICU, the complexity of medical care for the transplant recipient requires a multidisciplinary approach with coordination by an intensivist in collaboration with the transplant surgeon, gastroenterologist, and other specialists