THE IMPACT OF GUN CONTROL (BILL C-51) ON SUICIDE IN CANADA

Suicide is a multiply determined behavior, calling for diverse prevention efforts. Gun control has been proposed as an important component of society's response, and an opportunity for studying the effects of legislative gun control laws on suicide rates was provided by Canada's Criminal Law Amendment Act of 1977 (Bill C-51). This article reviews previous studies of the impact of this act on the total population of Canada and subpopulations by age and gender and, in addition, presents the results of 2 new studies: a different method of analysis, an interrupted time-series analysis, and the results of a multiple regression analysis that controls for some social variables. It appears that Bill C-51 may have had an impact on suicide rates, even after controls for social variables.     

Survival in Duchenne muscular dystrophy

Objective:

To determine the survival in a population of German patients with Duchenne muscular dystrophy.

Patients and methods:

Information about 94 patients born between 1970 and 1980 was obtained by telephone interviews and questionnaires. In addition to age of death or actual age during the investigation, data concerning clinical course and medical interventions were collected.

Results:

67 patients with molecularly confirmed diagnoses had a median survival of 24.0 years. Patients without molecular confirmation (clinical diagnosis only) had a chance of 67 % to reach that age. Grouping of our patient cohort according to the year of death (before and after 2000), ventilation was recognized as main intervention affecting survival with ventilated reaching a median survival of 27.0 years. For those without ventilation it was 19.0 years.

Conclusion and clinical relevance:

our study provides survival data for a cohort of DMD patients in Germany stratified by year of death. Median survival was 24.0 years in patients confirmed by molecular testing. Ventilated patients had a median survival of 27 years. We consider this piece of information helpful in the medical care of DMD patients.Key words: duchenne muscular dystrophy, survival, ventilation     

Incidence of ICD Lead Related Complications During Long-Term Follow-Up: Comparison of Epicardial and Endocardial Electrode Systems

The aim of this study was to evaluate the longterm stability of epicardial and endocardial lead systems for third-generation cardioverter defibrillators (ICDs) and to assess the usefulness of diagnostic tools. One hundred forty patients with 61 epicardial (43.6%) and 79 nonthoracotomy systems (56.4%) were followed for 2 5 ± 19 months. A total of 18 (12.9%) lead related complications were documented. Complications of epicardial systems were detected in 10 patients (16.4%) during a follow-up time of 36 ± 8 months: crinkling of patch electrodes in 6 patients (9.8%), insulation breakage of sensing electrodes in 2 patients (3.3%), and adapter defect in 2 patients (3.3%). Eight of the patients (10.1%) with transvenous-subcutaneous systems had lead related complications during a 13 ± 6 months follow-up: fracture of the subcutaneous patch lead in 2 patients (2.5%), dislodgment of the right ventricular lead in 2 patients (2.5%), dislodgment of the superior vena cava lead in 2 patients (2.5%), insulation breakage of sensing electrodes in 1 patient (1.3%), and connector defect in 1 patient (1.3%). There was no significant difference in the incidence of lead related complications between epicardial and endocardial systems (P > 0.05). Fractures, dislodgments, and crinklings were documented within the first 8 ± 5 months by regular chest X ray. Defects of insulation, adapter, or connector were detected 22 ± 10 months after implantation and were associated with delivery of multiple inappropriate ICD therapies. An operative lead revision was indicated for 4 epicardial (6.6%) and 6 endocardial (7.6%) lead systems. Conclusions: Endocardial lead systems offer a similar long-term stability as compared to epicardial had systems. Chest X ray is the most useful tool to detect lead fracture, dislodgment. and patch crinkling. Marker recordings or real-time electrograms have not been helpful in this series to identify patients with suspected lead defects prior to the experience of inappropriate ICD discharges.     

Ligand-specific and non-specific in vivo modulation of human epidermal cellular retinoic acid binding protein (CRABP)

Retinoic acid (RA) is bound intracellularly by a specific, low molecular weight protein (CRABP), that is unrelated to its nuclear receptor and whose function and regulation are still unknown. In the present study we were able to obtain an in vivo modulation of CRABP by different stimuli in one of the major target organs of RA: the human skin. We found increased CRABP after daily application during 4 days of natural or synthetic retinoids (RA, acitretin, isotretinoin, Ro137410, retinol), that have either a high affinity to CRABP or can be transformed into RA. Only Ro150778 with no affinity and no reported transformation had no effect. No macro- or microscopical changes could be observed with any of the tested compounds. Induction of inflammatory and hyperproliferative changes in the skin by topical dithranol treatment, UVB irradiation or scotch tape stripping also induced a significant increase of CRABP 3 days after exposure. Topical diflucortolone showed not only a tendancy to decrease intrinsic CRABP levels, but significantly reduced the retinoid stimulated rise of CRABP. Thus we conclude that the increase of CRABP in a fully differentiated adult tissue seems to be a biological phenomenon following processes of inflammation and proliferation with a lag of several days, while retinoids seem to be able to induce such a rise independently of, or before, the appearance of such processes. Corticosteroids seem to be inhibitors of this reaction. We discuss the hypothesis that CRABP might function as an intracellular 'buffer' in the case of RA overload.     

Electrical Proarrhythmia: Induction of Inappropriate Atrial Therapies due to Far-Field R Wave Oversensing in a New Dual Chamber Defibrillator

R Wave Far-Field Sensing in Dual Chamber Defibrillators . This case report describes delivery of atrial therapies during a sinus tachycardia in a new dual chamber implantable cardioverter defibrillator inappropriately caused by far-field oversensing of ventricular beats in the atrial channel. Upon classification of the PR interval pattern, the rate criterion for an atrial tachycardia was fulfilled, and the device initiated high-frequency burst pacing as the first stage of programmed tiered atrial therapies. Atrial fibrillation subsequently was induced by high-frequency burst pacing, and eventually a programmed 10-J shock was delivered for successful termination of atrial fibrillation. The phenomenon of far-field oversensing of ventricular beats could be repeatedly observed during exercise testing and abolished by decreasing the atrial sensitivity.     

Quantitative Tissue Doppler Echocardiography: Physiological Nonuniformity of Left Ventricular Transmural Myocardial Wall-Motion Velocities and Gradients

Tissue Doppler echocardiography (TDE) is a new method by which transmural myocardial function can be studied noninvasively. In order to investigate physiology and reproducibility, 24 young, healthy volunteers were examined by M-mode TDE. Nonuniformity of transmural tissue layer velocities became apparent: Subendocardial and subepicardial velocities of the anteroseptal myocardial wall (AW) were 3.5 ± 0.7 and 1.3 ± 0.5 cm/sec (P < 0.0001 , t- test), whereas in the posterolateral wall (PW) values of 3.6 ± 0.6 and 1.2 ± 0.4 cm/sec (P < 0.0001 , t- test ), respectively, were revealed. The ratios, termed "myocardial velocity gradients" as a new indicator of left ventricular performance, were 3.1 ± 1.0 and 3.4 ± 1.1, respectively. AW and PW did not differ (N.S.). Tolerance borders did not overlap, and intraobserver variability did not reach intersubject variability (P < 0.0001, F-ratio test). TDE provides new and more sophisticated insights into left ventricular performance. It seems to be accurate and reliable and therefore worth introducing into the clinical arena.     

TRYPTOPHAN METABOLISM IN ALCOHOLISM. TRYPTOPHAN BUT NOT EXCITATORY AMINO ACID AVAILABILITY TO THE BRAIN IS INCREASED BEFORE THE APPEARANCE OF THE ALCOHOL-WITHDRAWAL SYNDROME IN MEN

Tryptophan (Trp) metabolism and disposition and excitatory andother amino acid concentrations were determined in alcohol-dependentsubjects in relation to the alcohol-withdrawal syndrome (AWS).Parameters were examined in 12 alcohol-dependent male subjects,undergoing elective upper digestive tract tumour resection,and 12 age-, gender-, and medication-matched controls on threeoccasions: pre-operatively, post-operatively, and immediatelybefore (i.e. within 24 h of) the appearance of the AWS. No significantdifferences were observed between controls and alcoholic subjectson the first or second of these occasions. On the third occasion,within 24 h of the appearance of the AWS, alcoholics showeda dramatic elevation (117%) in free serum Tip concentrationand a consequent increase (111%) in the ratio of [free Trp]/[competingamino acids], which is an accurate predictor of Trp entry intothe brain. Increases were also observed on this third occasionin concentrations of total Trp (49%), cortisol (123%), and norharman(137%). Concentrations of glutamate, glycine, aspartate, serine,and taurine did not differ significantly within or between thecontrol and alcohol-dependent groups of subjects on any of thethree occasions. The possible significance of the Trp and relatedmetabolic changes in relation to the behavioural features ofthe AWS is discussed.     

Increased Anxiety in Partners of Patients with a Cardioverter-Defibrillator: The Role of Indication for ICD Therapy, Shocks, and Personality

Background: The partner of the implantable cardioverter‐defibrillator (ICD) patient serves as an important source of support for the patient, which may be hampered if the partner experiences increased distress. We examined (1) potential differences in anxiety and depressive symptoms in ICD patients compared to their partners, and (2) the extent to which the partner's personality is a more important determinant of partner distress than patient clinical characteristics, using a prospective design. Methods: Consecutively implanted ICD patients (n = 196) and their partners (n = 196) completed a set of psychological questionnaires at baseline and 6 months after implantation. Results: Analysis of variance with repeated measures showed that partners had significantly higher levels of anxiety compared to patients (F(1,390) = 16.431; P < 0.001) but not depressive symptoms (F(1,390) = 0.186; P = 0.67). There was a significant overall reduction in anxiety (F(1,390) = 79.552; P < 0.001) and depressive symptoms (F(1,390) = 39.868; P < 0.001) over 6 months, with group (i.e., patient vs partner) exerting a stable effect on anxiety (F(1,390) = 0.966; P = 0.33) and depressive symptoms (F(1,390) = 0.025; P = 0.87). These results remained in adjusted analysis. Determinants of anxiety and depressive symptoms in partners included secondary prophylaxis in patients (Ps < 0.001–0.002), Type D personality of the partner (Ps < 0.001–0.001), secondary prophylaxis by shock interaction (P = 0.002; anxiety only), and secondary prophylaxis by Type D interaction (Ps = 0.001–0.003). Conclusions: Partners had higher levels of anxiety but not depression than ICD patients. Partner distress could be attributed not only to the partner's personality, but also to patient clinical characteristics, primarily secondary prophylaxis for ICD therapy. These results indicate that information on the clinical characteristics of the patient in addition to partner characteristics may help identify partners at risk of distress.