Delay times and management of acute myocardial infarction in indigenous and non-indigenous people in the Northern Territory

OBJECTIVES: To investigate differences in presentation and management of Indigenous and non-Indigenous patients hospitalised with acute myocardial infarction (AMI). DESIGN: Retrospective review of hospital medical records. PARTICIPANTS AND SETTING: 122 patients with definite or possible AMI admitted to hospitals in the Top End of the Northern Territory (NT) in 1996. MAIN OUTCOME MEASURES: Percentage receiving thrombolytic therapy; delays from symptom onset to primary and emergency department presentations, first and diagnostic electrocardiograms, thrombolytic therapy and aspirin; drugs prescribed during hospitalisation. RESULTS: Thrombolytic therapy was given to 12/41 Indigenous patients (29%) and 38/81 non-Indigenous patients (47%) (P = 0.06). Presentation delay over 12 hours was the reason for not giving thrombolytic therapy for 14/29 Indigenous patients (48%) and 8/43 non-Indigenous patients (19%) (P < 0.01). Median delay times were longer for Indigenous patients for all six categories of delay, although the difference was significant only for delay to emergency department presentation (10:00 versus 3:26 hours; P < 0.01) and to diagnostic electrocardiogram (8:10 versus 3:50 hours; P < 0.01). Delays were also longer for patients from rural compared with urban areas. Once diagnosed, Indigenous patients were as likely as non-Indigenous patients to receive aspirin (93% versus 96%) and beta-blockers (70% versus 69%) and more likely to receive angiotensin-converting enzyme inhibitors (60% versus 40%; P = 0.03). CONCLUSIONS: Delays in presentation affect Indigenous people living in rural and urban areas as well as non-Indigenous people living in rural areas. Concerted efforts are needed to improve health service access in rural areas and to encourage Indigenous people with persistent chest pain to present earlier.     

Towards a pain-free venepuncture

A randomised, prospective trial was conducted to assess the efficacy of various means of alleviating the pain of subcutaneous lidocaine infiltration. One hundred and twenty-two patients were randomly allocated to different groups to receive buffered lidocaine 1%, warmed lidocaine 1% or infiltration by the counter-irritation technique. A visual analogue pain score was recorded at different stages of cannulation and results showed that pain scores were significantly lower in the group receiving buffered lidocaine 1% (p < 0.02) and in the counter-irritation group (p < 0.05). Thus buffering lidocaine 1% and administration of lidocaine 1% by the counter-irritation technique is effective in relieving the pain of lidocaine infiltration.     

Effect of Paternal Diet on Spermatogenesis and Offspring Health: Focus on Epigenetics and Interventions with Food Bioactive Compounds

Infertility is a growing public health problem. Consumption of antioxidant bioactive food compounds (BFCs) that include micronutrients and non-nutrients has been highlighted as a potential strategy to protect against oxidative and inflammatory damage in the male reproductive system induced by obesity, alcohol, and toxicants and, thus, improve spermatogenesis and the fertility parameters. Paternal consumption of such dietary compounds could not only benefit the fathers but their offspring as well. Studies in the new field of paternal origins of health and disease show that paternal malnutrition can alter sperm epigenome, and this can alter fetal development and program an increased risk of metabolic diseases and breast cancer in adulthood. BFCs, such as ascorbic acid, α-tocopherol, polyunsaturated fatty acids, trace elements, carnitines, N-acetylcysteine, and coenzyme Q10, have been shown to improve male gametogenesis, modulate epigenetics of germ cells, and the epigenetic signature of the offspring, restoring offspring metabolic health induced by stressors during early life. This indicates that, from a father’s perspective, preconception is a valuable window of opportunity to start potential nutritional interventions with these BFCs to maximize sperm epigenetic integrity and promote adequate fetal growth and development, thus preventing chronic disease in adulthood.     

Pregnenolone and its sulphate modulate GABAA-receptor-mediated contractile responses in the guinea-pig isolated ileum

Pregnenolone and its sulphate had concentration-dependent dual actions on gamma-aminobutyric acid (GABAA)-receptor-mediated ileal contractile responses, enhancing at 0.001-1 microM but inhibiting at 10 microM. There was a sinistral shift of the GABA dose-response curve in the presence of 0.01 microM pregnenolone, with a significant potentiation over the lower concentration range of GABA (3-30 microM), whilst 10 microM pregnenolone depressed the curve by 50% without a significant change in the EC50, in a manner resembling non-competitive inhibition with picrotoxin. Pregnenolone and its sulphate evidently have modulatory actions at ileal GABAA-receptor complexes in keeping with those seen using neurochemical studies in the central nervous system.     

广义负二项分布对钉螺分布的拟合

目的介绍并应用广义负二项分布研究湖北钉螺的分布规律，为定量化研究提供理论依据。方法随机抽取安徽省池州市贵池区秋浦河沿岸的4块滩地作为研究现场，2005年调查4块滩地的钉螺数据，2006年从中再随机抽取2块滩地进行调查。通过全局最大似然法分别拟合广义负二项分布和负二项分布，比较同一季节不同滩地和不同季节同一滩地的分布拟合结果。结果不同季节、不同滩地的钉螺密度是不同的，但其分布形状均是相似的正偏态分布，广义负二项分布能成功地拟合所有的钉螺数据。不同季节同一滩地问的广义负二项分布参数的变化不一致，同一季节不同滩地广义负二项分布的参数估计结果即使在钉螺密度相近的情况下也不相近，钉螺生存环境的微小差异可以通过广义负二项分布的参数灵敏反映。结论广义负二项分布比负二项分布能更好地反映钉螺分布的复杂性，其将在钉螺的定量化研究领域以及家庭聚集性疾病、寄生虫病和定量生态学的研究中具有重要意义。     

Two-year clinical outcomes following lower limb endovascular revascularisation for chronic limb-threatening ischaemia at a tertiary Asian vascular centre in Singapore

INTRODUCTIONPercutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore.METHODSPatients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months.RESULTSA total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status.CONCLUSIONPTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.     

煤尘抽提物诱发BALB/3T3A31-1-13细胞系形态转化的研究

本文用 BALB/3T3 A31-1-13细胞系研究了煤尘抽提物的转化活性。亚硝化和未亚硝化的煤尘抽提物都能诱发细胞发生转化且有剂量反应关系.但亚硝化煤尘抽提物的转化活性比未亚硝化者高。从转化集落分离出来的细胞具有赘生转化的一些特征,如细胞生长迅速、接触抑制消失和停泊不依赖性生长等.本文结果看来支持煤矿工胃癌高发原因的煤尘假说。