Subnuclear renal tubular vacuoles in alcohol use disorder

Subnuclear vacuoles in the proximal renal tubules have been reported as a histologic sign of ketoacidosis. Originally described in diabetic ketoacidosis, renal vacuoles can be found in other ketogenic states such as alcoholic ketoacidosis (AKA), starvation, and hypothermia, underpinned by deranged fatty acid metabolism. A retrospective analysis of 133 deaths associated with alcohol use disorder (AUD) examined at autopsy between 2017 and 2020 was undertaken. This study aimed to determine the prevalence of subnuclear vacuoles in deaths of those with AUD and their specificity for deaths from AKA, and to elucidate what demographic, biochemical, and pathologic findings are associated with subnuclear vacuoles. In each case, vitreous humor biochemistry including electrolytes, glucose, and beta-hydroxybutyrate (BHB) was analyzed alongside postmortem hemoglobin A1c and renal and liver histology. Renal histology was graded for the presence of vacuoles as absent (0), scanty (1), or easily identifiable (2). Liver histology was graded for steatosis and for fibrosis if Masson trichrome staining was available. Vacuoles were commonly seen in the deaths of those with AUD. They were seen in deaths due to AKA but were not specific to that cause of death. With vacuoles present, lower vitreous sodium (139 vs. 142 mmol/L; p = 0.005), higher vitreous BHB (1.50 vs. 1.39 mmol/L; p = 0.04), severe hepatic steatosis, and severe hepatic fibrosis were seen, compared with those without renal vacuoles.     

Survival of Very High Blood Alcohol Concentration Without Consequential Damage in a Patient Without a Previous Substance Use Disorder

Intoxications with alcohol may lead to death depending on (maximum) blood alcohol concentration (BAC) and accompanying factors such as liver function, tolerance, and comedication. Death may occur due to ethanol‐induced respiratory depression and/or aspiration of gastric content (due to an impaired gag reflex); thus, securing of the airway and ventilation is occasionally necessary. A case of a 58‐year‐old female patient with depression who demonstrated a very high BAC of 8.68 gm/L (0.868%) following ingestion of large amounts of alcohol with suicidal intent is presented. Intubation and ventilation were life‐saving, and the patient did not develop any physical or consequential damage. As the patient had not regularly used alcohol or any other psychotropic agent, tolerance could be ruled out. This case emphasizes the necessity of rapid securing of the airway in patients with alcohol intoxication and respiratory depression and, furthermore, illustrates the large interindividual differences regarding ethanol susceptibility.     

Collaborative Governance in the Reform of Western Australia's Alcohol and Other Drug Sector

Collaborative governance involves processes and structures for policy development and decision making with particular relevance for health and social services. We examined collaborative governance in the reform of Western Australia's alcohol and other drug sector, applying Emerson et al.'s (2012) integrative framework. A documentary review and group interviews with government, sector, and consumer representatives were involved. Contextual factors included increased service funding, and the development of a partnership approach. Drivers for collaboration involved leadership and financial incentives for policy implementation. Key stakeholders across government and the sector reported a mutually supportive and constructive relationship and increased capacity, and they shared an agenda for change. The integrative framework was a useful structure for the explication of collaborative governance, although financial arrangements were not addressed.     

The role of religious coping on problematic alcohol consumption by police officers

Problematic alcohol consumption by police officers is well documented in the literature. It also shows that critical incident stress is correlated with this behavior. A separate body of research indicates that religious coping exerts a moderate protective effect on various types of problematic behavior, including problematic alcohol consumption. We merge these literatures in an effort to determine if religious coping reduces problematic alcohol consumption by police officers and whether it mitigates the positive relationship between critical incident stress and problematic drinking. Data from the Police Stress and Domestic Violence in Police Families in Baltimore, Maryland, 1997–1999 are analyzed to examine these propositions (n = 1004). Results indicate that police officers with higher levels of religious coping were in fact less likely to report problematic alcohol consumption. However, religious coping did not mitigate the positive relationship between critical incident stress and problematic alcohol consumption. The implications of our findings and suggestions for future research are discussed.     

基于超高效液相色谱-高分辨质谱联用技术研究苦参醇提物致大鼠肝毒性的尿液代谢组

目的 观察苦参醇提物（Sophora flavescens alcohol extract,SFAE）对大鼠尿液代谢轮廓的影响,探讨SFAE可能的肝毒性机制。方法 将雄性SD大鼠分为3组,每组6只,分别灌胃给予SFAE 0、1.25、2.5 g/kg,14 d后,采用超高效液相色谱-高分辨质谱（ultra-performance liquid chromatography-high resolution mass spectrometry,UPLC-HRMS）检测大鼠尿液中代谢物的变化。采用主成分分析（principal components analysis,PCA）和正交偏最小二乘法判别分析（orthogonal partial least squares discriminant analysis,OPLS-DA）对组间代谢物进行多元统计分析,筛选潜在的生物标志物,并分析相关的代谢通路。结果 3组大鼠尿液中代谢物在14 d后得到很好的区分,发现并鉴定出15个主要的差异代谢物,其中N6,N6,N6-三甲基-L-赖氨酸、胆酸、甘氨胆酸、脱氧胆酸、马尿酸和肌酸与肝脏毒性关系密切,二氢鞘氨醇和酮戊二酸表达水平降低,其余13种差异代谢物表达水平升高,苦参主要干扰大鼠体内胆汁酸代谢、能量代谢和氨基酸代谢等代谢通路。结论 SFAE对大鼠产生肝毒性,且肝毒性与给药剂量呈正相关。