P188 Aboriginal and Torres Strait Australians have significantly worse coronary disease, risk factors and 4 year outcomes compared with non-indigenous Australians

Introduction

The Aboriginal and Torres Strait Islander (ATSI) population in Australia appear to present with coronary disease more frequently, have worse risk factors, worse coronary disease and poorer outcomes, however there is limited data available on this population.  The ATSI population represent 8% of the Cairns total population. We undertook to compare these findings and four-year outcomes in ATSI versus non-indigenous patients aged < 50 years old undergoing coronary angiography.

Methods

 

We collected data on all patients aged < 50 years old, who underwent coronary angiography at Cairns Hospital over a two-year period (2014-2016), from the Queensland Coronary Outcomes Registry. Data of patient risk factors and 4 year outcomes were collected using electronic hospital medical records and electronic discharge summaries available on all Queensland patients. Patients residing outside Queensland were excluded.

Results

From 2014-2016, a total of 555 patients < 50 years old underwent coronary angiography. The average age was 43. 322 (58.0%) patients were male and 233 (42.0%) were female. 271 patients (48.8%) identified as ATSI. 

Coronary risk factors - 42.4% of ATSI patients had diabetes vs 13.7 in the non-indigenous group, 58.7% of ATSI patients vs 43.7% had hyperlipidaemia, 61.3% of ATSI patients vs 39.8% were current smokers, 65.3% of ATSI patients vs 42.3% were hypertensive, and 64.2% of ATSI patients vs 50.4% had a family history of premature coronary artery disease. This demonstrates significantly higher incidence of cardiac risk factors in ATSI patients (combined risk factors P = 0.00086).  

When comparing coronary artery disease, as demonstrated by coronary angiography, the ATSI group had significantly more abnormal coronary angiograms - 74.5% compared to the non-indigenous group 42.3% (P = 0.000006). There was not a statistically significant difference between the severity of coronary artery disease between the two populations who had coronary disease, however, the ATSI population demonstrated a higher incidence of triple vessel disease. ATSI patients were more likely to have repeat coronary angiography 11% vs 4%.

In the four-year follow up period, 18.5% of the ATSI population had at least one major adverse cardiac event (MACE), whereas in the non-indigenous group 7.0% had at least one MACE. 

There was not a statistically significant difference between all cause mortality between the two populations.

Conclusion

 

We have shown that Aboriginal and Torres Strait Islanders Australians are more likely to have coronary angiography at a younger age. That Aboriginal and Torres Strait Islanders Australians have a significantly higher incidence of cardiac risk factors, higher incidence of coronary artery disease, and more major cardiac events after undergoing coronary angiography compared to non-indigenous patients. The all cause mortality in this young population was not significantly different.

Hyperbaric oxygen for neurologic indications--action plan for multicenter trials in: stroke, traumatic brain injury, radiation encephalopathy & status migrainosus

The 2008 Toronto Hyperbaric Medicine Symposium was convened to discuss research into neurologic indications for hyperbaric oxygen therapy (HBO2T). Four topics were particularly addressed: acute ischemic stroke; acute traumatic brain injury; brain radiation necrosis; and status migrainosus. Four multicenter trials were designed and proposed to evaluate the efficacy of HBO2T for these indications and are presented here in addition to brief reviews of the rationale behind each.

Erythropoietin in thyroid cancer

Erythropoietin (Epo) and the epo-receptor (EpoR) have been implicated in tumor growth, invasion and metastasis. We previously demonstrated Epo and EpoR expression in a small group of archived papillary thyroid cancers (PTC), but were unable to examine functional integrity using formalin-fixed tissues. In the present study, we examined the in vitro expression, induction and function of Epo and EpoR in papillary (NPA), follicular (WRO) and anaplastic (ARO-81) thyroid cancer cells. We found that all three cell lines expressed Epo and EpoR mRNA and that the hypoxia-mimetic cobalt induced Epo expression in all cell lines. None of the growth factors we examined (thyrotropin, vascular endothelial growth factor, IGF-I, or human Epo) altered Epo or EpoR gene expression. Importantly, however, administration of Epo to NPA but not WRO cells resulted in significant alterations in the expression of several mitogenic genes including cyclooxygenase-2 (COX-2), beta-casein (CSN2), wild type p53-induced gene-1 (WIG1) and cathepsin D (CTSD). Epo treated ARO-81 cells only had an increase in CSN2 expression. We conclude that Epo and EpoR are expressed by thyroid cancers and that stimulation of the Epo/EpoR signal pathway results in changes that could impact on the clinical behavior of thyroid cancers.

Immature human dendritic cells express asialoglycoprotein receptor isoforms for efficient receptor-mediated endocytosis

In a search for genes expressed by dendritic cells (DC), we have cloned cDNAs encoding different forms of an asialoglycoprotein receptor (ASGPR). The DC-ASGPR represents long and short isoforms of human macrophage lectin, a Ca(2+)-dependent type II transmembrane lectin displaying considerable homology with the H1 and H2 subunits of the hepatic ASGPR. Immunoprecipitation from DC using an anti-DC-ASGPR mAb yielded a major 40-kDa protein with an isoelectric point of 8.2. DC-ASGPR mRNA was observed predominantly in immune tissues. Both isoforms were detected in DC and granulocytes, but not in T, B, or NK cells, or monocytes. DC-ASGPR species were restricted to the CD14-derived DC obtained from CD34(+) progenitors, while absent from the CD1a-derived subset. Accordingly, both monocyte-derived DC and tonsillar interstitial-type DC expressed DC-ASGPR protein, while Langerhans-type cells did not. Furthermore, DC-ASGPR is a feature of immaturity, as expression was lost upon CD40 activation. In agreement with the presence of tyrosine-based and dileucine motifs in the intracytoplasmic domain, mAb against DC-ASGPR was rapidly internalized by DC at 37 degrees C. Finally, intracellular DC-ASGPR was localized to early endosomes, suggesting that the receptor recycles to the cell surface following internalization of ligand. Our findings identify DC-ASGPR/human macrophage lectin as a feature of immature DC, and as another lectin important for the specialized Ag-capture function of DC.

Self-organized patterning of an insulator-on-metal system by surface faceting and selective growth: NaCl/Cu(211)

We report experimental results on an insulator-on-metal system which is inherently unstable against lateral pattern formation on the nanometer scale. NaCl deposition on Cu(211) at substrate temperatures >300 K leads to faceting into (311) and (111) facets and selective NaCl growth on (311) facets only, thereby creating alternating stripes of bare Cu and NaCl-covered areas. The mesoscopic restructuring process is brought about by (1) the tendency to form (100)-terminated NaCl layers, (2) epitaxial matching between NaCl(100) and Cu(311), and (3) sufficient mobility of the Cu substrate surface.

Leukocystatin, a new Class II cystatin expressed selectively by hematopoietic cells

We describe a new cystatin in both mice and humans, which we termed leukocystatin. This protein has all the features of a Class II secreted inhibitory cystatin but contains lysine residues in the normally hydrophobic binding regions. As determined by cDNA library Southern blots, this cystatin is expressed selectively in hematopoietic cells, although fine details of the distribution among these cell types differ between the human and mouse mRNAs. In addition, we have determined the genomic organization of mouse leukocystatin, and we found that in contrast to most cystatins, the leukocystatin gene contains three introns. The recombinant proteins corresponding to these cystatins were expressed in Escherichia coli as N-terminal glutathione S-transferase or FLAGTM fusions, and studies showed that they inhibited papain and cathepsin L but with affinities lower than other cystatins. The unique features of leukocystatin suggests that this cystatin plays a role in immune regulation through inhibition of a unique target in the hematopoietic system.

Characterization of a novel CC chemokine, HCC-4, whose expression is increased by interleukin-10

We have identified and characterized a human beta (CC) chemokine, designated HCC-4, that is most closely related to HCC-1 and which demonstrates chemotactic activity for monocytes. Northern analysis of multiple tissue blots and of activated monocytes mRNA shows expression of a 500-bp mRNA. A 1,500-bp mRNA was highly expressed in monocytes activated 12 hours in the presence of interleukin-10 (IL-10) but was absent in monocytes activated for only 1 hour regardless of the presence or absence of IL-10. The upregulation of expression in the presence of IL-10 is in contrast to the downregulatory effects of IL-10 on expression of most other chemokines. Recombinant HCC-4 demonstrated chemotactic activity for human monocytes and THP-1 monocyte cells but not for resting lymphocytes or neutrophils. HCC-4 also induced a Ca2+ flux in THP-1 cells that was desensitized by prior exposure to RANTES. Taken together, these data indicate that HCC-4 is a novel chemokine whose expression is uniquely upregulated by IL-10.