Development of the Crash Injury Research and Engineering Network.

The Crash Injury Research and Engineering Network has developed a computer database and wide area network for data sharing and analysis among 8 trauma centers. The computer database extends the National Highway Traffic Safety Administration's National Automotive Sampling System with medical- and trauma-related variables in a relational/object database system. The medical data include injury location details, injury subclassification systems, and medical images for better biomechanical injury evaluation. Key data elements are migrated to a core repository so that all centers can review the status of case acquisition across the network. Cases, whole or in part, may be migrated between centers so that individual center expertise may be shared in evaluating the cause of injury. Electronic rounds, where cases are reviewed simultaneously across multiple centers, are possible.

Short duration therapy for Helicobacter pylori in Western Australia: the impact of metronidazole resistance.

BACKGROUND: Limited Australian data are available on either short duration therapy for Helicobacter pylori infection, or the impact of metronidazole resistance on the outcome of treatment. AIM: To compare the efficacy of two treatment regimens and determine the influence metronidazole resistance has on clearing H. pylori infection. METHODS: Eighty patients with H. pylori infection proven at upper gastrointestinal endoscopy, none of whom had previously received therapy for H. pylori, were randomised to one week therapy with either bismuth subcitrate one tablet qid, tetracycline 500 mg qid and metronidazole 400 mg tds (BTM), or lansoprazole 30 mg bd, amoxycillin 500 mg qid and metronidazole 400 mg tds (LAM). Effectiveness of therapy was measured by C14-urea breath test at six weeks. RESULTS: On an intention-to-treat basis, clearance of infection was achieved in 17 of 32 (53%; 95% CI: 35-71%) evaluable patients receiving BTM and 32 of 46 (70%, 54-82%) patients receiving LAM (p = 0.16). Metronidazole resistance was found in 32 of 65 (49%) patients in whom H. pylori was isolated by culture. On a per-protocol basis, of patients who had metronidazole sensitive strains of H. pylori 23 of 24 (96%) cleared infection after therapy with either BTM or LAM, compared with 14 of 24 (58%) who were metronidazole resistant (p = 0.004). Clarithromycin resistance was not found in 45 patients tested. CONCLUSIONS: In Western Australia clearance rates of H. pylori infection, after one week of BTM or LAM, are lower than in other published series. The high incidence of metronidazole resistance is the main determinant of our relatively poor eradication rates.

Rainbow trout red cells in vitro.

Washed rainbow trout erythrocytes incubated at 14 degrees C in Eagle's minimal essential medium and Cortland saline displayed sharp reductions in volume and water content, nucleoside triphosphate, K+ and Cl- concentrations. Mg2+ and, to a lesser extent, Na+ concentrations increased. Cellular to medium Cl- ratios were indicative of membrane hyperpolarization. Morphological irregularities were also observed. Oxygen consumption and hemoglobin system organization were not grossly affected. Supplementation with pyruvate stabilized nucleoside triphosphate concentrations for at least 24 hr, and reduced rates of volume and compositional change to some extent. Addition of norepinephrine at physiologically realistic levels led to stabilization of Cl- content and reductions in Mg2+ accumulation and water loss. Transient but modest increases in K+ and Ca2+ were coupled, under these circumstances, with some decrease in Na+ concentration. Factors which may contribute to the dysfunctional status of these cells in vitro are discussed.