Posts Tagged ‘motor vehicles accidents’

Spinal cord injury: Amazing News

Friday, June 1st, 2012

I read an incredible article in The New York Times yesterday; scientists in a Swiss lab have been able to overcome an experimental spinal cord injury in rats, enabling them to walk again. Today I found the original scientific publication and decided it was a major breakthrough, well worth translating into human terms and language.

There may be rocks below

Let's start with the human statistics; there are about 12,000 non-fatal, but severe spinal cord injury (SCI) cases in the United States every year. Half of those SCI lead to chronic paralysis and a quarter of a million people with significant SCI were alive in the US in 2010. Most of those suffered their injury when they were relatively young and 80% of them are male.

Motor vehicle accidents account for roughly 40% of those cases; the next most common cause is termed "falls," but a typical story for a fall would be a young guy who dives into a pool or a water-filled abandoned quarry, not knowing its actual depth, and strikes the bottom or a rock.

I found a thoughtful blog post on diving. The author gave five suggestions of which one is clearly the most important: "Think First." The others included "Steer up," "Hands up and out" and "Control your dive." The last was also crucial, "Don't drink or take drugs and dive."

Let's go back to the rats. The article was published online in Science and is densely packed with medical terminology (I'd suggest you read the NYT article). The rodents had a partial severing of their spinal cords at two different levels, leaving normal tissue in between and connecting the parts of the spine involved. This corresponds to somewhere between 25% and 33% of human spinal injuries. A week after their SCI, the rats began training for 30 minutes a day.

They were fitted with little vests, held upright on their rear legs and given a goal, a piece of cheese to move toward. At the same time their spines were stimulated electrically above and below the spinal areas partially cut and they got a chemical infusion of several drugs that affect nerve cell activity.

The initial voluntary steps began after 2-3 weeks of daily training and, at that point, the time of exercise was gradually increased. Five to six weeks after the initial SCI all the rats could initiate full weight-bearing steps while the combined electrical and chemical stimulation was being applied. Eventually they could climb stairs and avoid obstacles. They also had anatomic evidence of new neuron (nerve cell) connections around the injury and, higher up, in the brain stem.

Control rodents placed on treadmills did not recover the ability for voluntary motion.

A neurologist from UCSF who was not involved in the research study was quoted as saying, "There's a huge potential to refine this model to mimic more humanlike conditions."

A Stanford medical school website captures the essence of what's going on; this is neural plasticity, the building of new wiring patterns in the nervous system.

Is it possible?

A simpler comment would be that this research, if extended and then repeated in human subjects, may possibly bring hope to some of those afflicted with spinal cord injuries and maybe even diseases. Perhaps some who otherwise would have been wheelchair bound will be able to walk again.

It's not at all clear to me that this will work in people who had a SCI some time ago and it doesn't appear to be applicable to those who have a complete transection (total severing) of the cord.

Time, as always, will tell.



Drinking and driving

Wednesday, August 3rd, 2011

lots of choices, all with alcohol

Twenty-four years ago I was the brand new Deputy Chief of Staff at our largest Air Force medical center. My counterpart at the Army's hospital across town called and asked if I'd like to attend a party. I said, "Sure, what's the occasion?"

His commander had just gotten a second star and, as a new major general, would be moving to DC soon. His immediate boss was going to get the one-star job running the medical center. That never happened. I don't know the exact details, but was told one drink too many led to an off-color comment to the wrong person and then to a lost opportunity.

I got sensitized, through this episode, to drinking at events and, of course, to drinking and driving. I was in a culture where wine and beer flowed freely at parties, but decided I'd be a one-drink person. My wife and I were outliers sometimes; a friend who was a fellow commander when I moved up to lead a small hospital once told me, "I got picked up CWI last night."

"I know what DWI means; what's CWI?"

He replied, "Crawling while intoxicated." Actually he was joking, while telling his story of leaving a party at the commanding general's home and feeling unsteady while slowly walking to his own quarters, two houses down.

The Wall Street Journal on July 2, 2011, had an article titled "Testing the Limits of Tipsy." Our US legal limit for driving used to be a blood alcohol concentration (BAC) of 0.15%; now it's 0.08%. In much of Europe it's 0.05%; in India it's 0,03% and in China it's 0.02%. That exceedingly low BAC limit may turn out to be the most realistic, especially on crowded streets and roads.

But the results can be bad, even to metal bodies

Our alcohol-related traffic fatalities have fallen by 50% since 1980, but still account for one-third of all deaths on the highway. Your BAC after drinking depends on a number of factors: your weight, age, prior drinking history, rate of consumption, if you're also eating (consuming food may slow absorption of alcohol, but some foods help more than others) and menstrual cycle (women apparently metabolize alcohol a little more rapidly just after ovulating).

Once you've absorbed alcohol, your BAC falls roughly 0.015% per hour (for either gender), so it may take a long time to reach a "safe" level, if there is such a thing. As you age your liver tends to metabolize alcohol more slowly; on the other hand, an elevated BAC may affect younger brains more adversely.

Having read this, I'll plan to continue our long-standing policy: when we go to a function one of us is the "designated drinker," and usually has only one drink at that. The other is the designated driver. We've occasionally each had a glass of an event where we'll be eating and not driving for a number of hours. It may be time to re-evaluate that policy.

On holidays like New Years Eve, when we know others will be drinking more than we do, we get off the roads early.