Anatomy and physiology

Objective: To assess trends in selenium status in South Australians from 1977 to 2002.Design: Six cross-sectional surveys.Participants: 117 participants in 1977, 30 in 1979, 96 and 103 (separate surveys) in 1987, 200 in 1988, and 288 volunteer blood donors in 2002. A total of 834 healthy Australian adults (mean age, 42 years [range, 17–71 years]; 445 were male).Main outcome measures: Plasma and whole blood selenium concentrations.Results: The 2002 survey yielded a mean plasma selenium concentration of 103 μg/L (SE, 0.65), which reached the estimated nutritional adequacy level of 100 μg/L plasma selenium. Mean whole blood selenium declined 20% from the 1977 and 1979 surveys (mean whole blood selenium concentration, 153 μg/L) to the 1987, 1988 and 2002 surveys (mean whole blood selenium concentration, 122 μg/L). Plasma selenium was higher in men (P = 0.01), and increased with age in both men and women (P = 0.008).Conclusions: In healthy South Australian adults sampled from 1977 to 2002, whole blood and plasma selenium concentrations were above those reported for most other countries and in most previous Australian studies, notwithstanding an apparent decline in selenium status from the late 1970s to the late 1980s.

Graham H Lyons BAgricSc, MPH · James C R Stangoulis BAgricSc, PhD · Lyndon T Palmer BSc · Robin D Graham PhD, DAgricSc · Geoffrey J Judson BRurSc, PhD · Janine A Jones BCom/Eco, MStatSocAust

Shanthi Kannan,* Christine H Rowland,† Gregory I Hockings,† Peta M Tauchmann,‡ Edwin A Blackwell§ * Endocrine Advanced Trainee, † Endocrinologist, ‡ Nurse Educator, § Haematologist, Greenslopes Private Hospital, Brisbane, QLD. Correspondence: Dr Christine Rowland, Greenslopes Private Hospital, Newdegate Street, Greenslopes, Brisbane, QLD 4120. c.rowlandATmailbox.uq.edu.au To the Editor: Intravenous immunoglobulin preparations containing maltose (eg, Intragam P [CSL Limited]) can interfere with the readings of blood glucose monitors that use test strips with glucose dehydrogenase, such as Advantage (Roche).1 Glucose dehydrogenase is an enzyme of the Pyrroloquinolinequinone class which reacts with the disaccharide isomer maltose present in Intragam P at concentrations of 10 g/100 mL,2 resulting in falsely elevated blood glucose level results. Blood glucose monitors, such as Precision (Medisense products), Medisense (Medisense products)3 or Accutrend (Roche), that use the glucose oxidase system, do not react with maltose and can be safely used for patients receiving Intragam P. We have had two patients in whom capillary blood glucose levels were over-estimated. One was a 64-year-old woman with type 2 diabetes who was being treated with haemodialysis, and who received Intragam P for immune-mediated thrombocytopenic purpura. Before being admitted, her diabetes was reasonably controlled by 10 units of protophane twice daily. She received prednisone (100 mg/day) from Day 1 to Day 13 and Intragam P intravenously each day from Day 2 to Day 6 and from Day 14 to Day 18. While the patient was receiving Intragam P, the Advantage monitor gave persistently higher readings than both the Precision monitor and plasma glucose level measurements. The following paired readings were obtained: Advantage capillary glucose reading of 9.3 mmol/L while the plasma glucose level was 2.3 mmol/L; and Advantage capillary glucose reading of 24.4 mmol/L while the plasma glucose level was 10.4 mmol/L. During the second course of Intragam P we noted that readings with the Precision monitor were equivalent to the measured plasma glucose level. This patient developed hypoglycaemia because her insulin doses were increased on the basis of falsely elevated capillary glucose readings as measured on Advantage blood glucose strips. A Precision monitor was used for this patient until after the haemodialysis treatment which followed the final dose of Intragam P. After this time Advantage blood glucose readings approached those obtained with the Precision monitor. A second patient — a 35-year-old woman who was not known to have diabetes, but was having her glucose levels monitored while undergoing total parenteral nutrition — was given Intragam P for idiopathic thrombocytopenic purpura. While receiving Intragam P, capillary glucose levels by the Advantage monitor were elevated by 13–20 mmol/L compared with concurrent (and normal) plasma glucose level measurements. It has previously been reported that icodextrin, used in some peritoneal dialysis fluids, can have similar effects, as it is hydrolysed to oligosaccharides, including maltose, maltotriose and maltotetraose.4,5 The reaction with maltose has important clinical implications. Although it is stated in the product information for Advantage test strips that glucose readings may be affected by maltose levels over 16 mg/dL (0.89 mmol/L), clinicians may not be aware that Intragam P is in a maltose solution. For patients receiving Intragam P, the Advantage monitor is not suitable, and the Precision, Medisense or Accutrend blood glucose monitors, which use glucose oxidase which does not react with maltose, should be used instead. We have reported our experience to the Australian Red Cross Blood Service as an adverse event.

Shanthi Kannan · Christine H Rowland · Gregory I Hockings · Peta M Tauchmann · Edwin A Blackwell

Tissue engineering involves the use of cells (either adult, mesenchymal or embryonic stem cells) coupled with biological or artificial matrices or scaffolds which guide the cells during repair or regeneration of the tissue. Recently discovered and isolated growth factors can promote either adult or stem-cell growth and differentiation along selected pathways to re-form and repair skeletal tissues in adults. Bone repair enhancement and ...

Barry W Oakes MB BS, MD

To the Editor: Preparations containing isoflavone phytoestrogens are widely used as an alternative therapy for treating symptoms of the menopause. Although Australian government regulations strictly control the components of alternative therapies, adherence to the stated amounts of the components in alternative therapies is not routinely assessed. Isoflavones exist in two forms — aglycone (the free form) and glycosylated or glycone (the conjugated form) — the relative proportions of which vary between preparations. As glycosylation contributes considerably to the mass of isoflavone molecules, it is relevant to consider the total amount of potentially available isoflavone in alternative therapy preparations. Isoflavone-containing preparations which had a recommended daily dose on their labels were purchased at random from pharmacies around Sydney during September 1999. Where possible, products from more than one manufacturing batch were purchased and all products were well within their stated shelf life. The tablets, capsules or powder were removed from their packaging to conceal their identity and randomly allocated to numbered plastic bags by the hospital pharmacy department. The samples were then sent to PhytoChem Technologies Inc (Chelmsford, Mass, USA), an independent reference laboratory for the assay of isoflavones. There, isoflavones were extracted within four months of purchase (and before their stated use-by date) from 500 mg of each specimen after dissolution in 70% methanol. Glycosylated and free isoflavones were assayed in duplicate by gradient high-pressure liquid chromatography, with detection of isoflavones at 254 nm using a Waters 996 series photodiode detector with a limit of detection of 0.2 µg/mL. The identity of chromatogram peaks was confirmed by UV–V spectral analysis, and by comparison with standards. The mobile phase was acetonitrile, and adequate peak separation, linearity, accuracy and reproducibility were demonstrated. The total amount of available aglycone isoflavones in each sample was estimated (see Table). Only two products (Phytolife and Promensil) had total isoflavone contents close to the stated amount, and the content of the Phytolife product was variable. Estimated aglycone contents of preparations demonstrated that glycosylated isoflavones contributed substantially to the stated content of the product. A previous study of isoflavone-containing preparations marketed in the United States produced similar results to ours.1 Consumers may wish to consider not only whether an alternative therapy is of use, but also whether the product they purchase contains what they expect. Actual and stated isoflavone content of commercially available preparations Manufacturer Product No. of batches assayed Stated isoflavone content (mg) in recommended daily maximum dose of product Actual total isoflavone content per daily dose (mg) Estimated aglycone isoflavone content per daily dose (mg) Blackmores Phytolife one a day 5 40 41.02 ± 6.12 25.75 ± 6.04 Bioglan Soy powder plus 4 68 48.75 ± 1.42 30.44 ± 0.86 Earths Own Soy + calcium 1 68 42.52 25.67 Health Direction Femme phase 1 235 mg soy protein* 0.29 0.20 Herron Phyto source 1 22.5 16.27 9.93 Natural Nutrition Menopause 1 60 0.56 0.51 Natural Nutrition Phytobalance 3 90 58.12 ± 6.26 34.96 ± 3.79 Novogen Promensil 4 40 40.12 ± 1.98 38.38 ± 1.20 Pretorius Maxi soy plus red clover wild yam and calcium 4 68 50.36 ± 1.64 31.24 ± 1.13 Wagner Probiotics Femme soy plus with red clover 2 27 30.76 ± 0.12 19.65 ± 0.05 * Soy protein has a high isoflavone content. Values are the mean ± standard deviation. Total isoflavones = glycone plus aglycone. Estimated available aglycone isoflavones = weight of aglycone isoflavones plus weight of glycone isoflavones corrected for glycone content.

Jan B Howes · Laurence G Howes

The Research Enterprise Funding Australia's basic biomedical research of 1993 and 1994 The meshing of two databases of scientific publications -- the Wellcome Trust's Research Outputs Database, and the Research Evaluation and Policy Project's database of Australian publications -- allows a detailed analysis of the funding agencies providing external (as opposed to intramural) support for Australia's basic biomedical research. This analysis shows the success Australian researchers are having in attracting funding from overseas, and the high citation rates achieved by publications with external funding. Linda Butler MJA 1999; 171: 629-633 Introduction - Characteristics of basic biomedical research funding - Comparison of funded and unfunded publications - The impact of funded research - Conclusions - References - Authors' details - - More articles on Economics

Linda Butler