Ethnic Differences and Trends in ST-Segment Elevation Myocardial Infarction Incidence and Mortality in a Multi-Ethnic Population

INTRODUCTION@#This study aimed to compare the incidence and mortality of ST-segment elevation myocardial infarction (STEMI) across the 3 main ethnic groups in Singapore, determine if there is any improvement in trends over the years and postulate the reasons underlying the ethnic disparity.@*MATERIALS AND METHODS@#This study consisted of 16,983 consecutive STEMI patients who sought treatment from all public hospitals in Singapore from 2007 to 2014.@*RESULTS@#Compared to the Chinese (58 per 100,000 population in 2014), higher STEMI incidence rate was consistently observed in the Malays (114 per 100,000 population) and Indians (126 per 100,000 population). While the incidence rate for the Chinese and Indians remained relatively stable over the years, the incidence rate for the Malays rose slightly. Relative to the Indians (30-day and 1-year all-cause mortality at 9% and 13%, respectively, in 2014), higher 30-day and 1-year all-cause mortality rates were observed in the Chinese (15% and 21%) and Malays (13% and 18%). Besides the Malays having higher adjusted 1-year all-cause mortality, all other ethnic disparities in 30-day and 1-year mortality risk were attenuated after adjusting for demographics, comorbidities and primary percutaneous coronary intervention.@*CONCLUSION@#It is important to continuously evaluate the effectiveness of existing programmes and practices as the aetiology of STEMI evolves with time, and to strike a balance between prevention and management efforts as well as between improving the outcome of "poorer" and "better" STEMI survivors with finite resources.

Outcomes of neoadjuvant chemoradiotherapy followed by total mesorectal excision surgery for locally advanced rectal cancer: a single-institution experience

<p><b>INTRODUCTION</b>Neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) surgery for locally advanced rectal cancer has been shown to improve local control and reduce toxicity, as compared to adjuvant CRT. We reported the outcomes of our patients with locally advanced rectal cancer treated at National University Hospital, Singapore.</p><p><b>METHODS</b>From April 2002 to December 2014, 117 patients with T3/4, N0/+, M0 rectal cancer received neoadjuvant CRT followed by TME surgery. The treatment regimen comprised a total radiotherapy dose of 50.4 Gy in 28 daily fractions delivered concurrently with 5-fluorouracil or capecitabine chemotherapy over 5.5 weeks. All patients were planned for TME surgery. Local control, disease-free survival, overall survival and treatment toxicities were analysed.</p><p><b>RESULTS</b>Median follow-up was 34 (range 2-122) months. 11.5% (13/113) of patients achieved a pathological complete response (pCR) and 72.6% (85/117) had either tumour or nodal downstaging following neoadjuvant CRT. 5.2% (5/96) of patients had Grade 3 acute toxicities (dermatitis and diarrhoea) and 3.1% (3/96) had Grade 3 late toxicities (fistula and stricture). There was no Grade 4 toxicity noted. The five-year local recurrence, disease-free survival and overall survival rates were 4.5%, 65.7% and 80.6%, respectively. Multivariate analysis showed that nodal positivity was a predictor of poor disease-free survival and poor overall survival. Tumour downstaging and pCR did not improve outcomes.</p><p><b>CONCLUSION</b>Our outcomes were comparable to internationally published data, and this treatment regimen remains the standard of care for locally advanced rectal cancer in our local population.</p>

Selection and Short-Term Outcomes of Living Kidney Donors in Singapore - An Analysis of the Donor Care Registry

<p><b>INTRODUCTION</b>Transplant rates in Singapore have been falling and there is limited information on baseline characteristics and clinical outcomes of living kidney donors nationally. This study aimed to determine the safety of living kidney donor transplant in Singapore by exploring the proportion of donors that meets international selection guidelines and describing short-term clinical outcomes.</p><p><b>MATERIALS AND METHODS</b>We analysed 472 donors who underwent nephrectomies from 1 January 2010 to 31 December 2014 from the Donor Care Registry. We described donor characteristics against 5 international guidelines and measured post-nephrectomy outcomes in 150 local donors for up to 24 months. A multivariate analysis was performed to determine the baseline variables associated with poorer outcomes.</p><p><b>RESULTS</b>There were more foreign than local donors, with differences in gender and hospital types. Selection was generally aligned with international recommendations although 3.0% (using the Chronic Kidney Disease Epidemiology [CKD-EPI] equation) to 8.5% (using radionuclide and creatinine clearance methods) of donors had inappropriate baseline estimated glomerular filtration rates (eGFR) forage. Post-procedure, many foreign donors were lost to follow-up. Over 24 months, eGFR decreased by 33.8% from baseline before recovering gradually to 29.6%. During this period, only 2 donors were admitted for renal or urological conditions and there were no cases of end-stage renal failure or deaths. A lower baseline eGFR (HR: 1.05; 95% Cl, 1.02 to 1.09) and older age (HR: 1.04; 95% Cl, 1.00 to 1.08) were associated with a post-nephrectomy eGFR of less than 60 mL/kg/1.73 m.</p><p><b>CONCLUSION</b>Kidney donation is safe in Singapore. Donor selection is in keeping with international guidelines and short-term outcomes are comparable to other cohorts.</p>

Effects of different time courses and depths of acute normovolemic hemodilution on injury to mucous membrane of small intestines in rabbits / 中华麻醉学杂志

Objective To evaluate the effects of different time courses and depths of acute normovolemic hemodilution (ANH) with hematocrit (Hct) on injury to the mucous membrane of small intestines in rabbits.Methods Thirty-two adult rabbits,weighing 2.0-2.5 kg,were randomly divided into 4 groups (n=8 each) using a random number table:control group (group C),Hct 18％ group (H1 group),Hct 15％ group (H2 group) and Hct 12％ group (H3 group).The animals were anesthetized with iv 20％ urethane 4 ml/kg,tracheostomized and mechanically ventilated.Blood samples were taken from the left femoral artery.Blood withdrawn from the femoral artery =2 ×body weight× body fluid per kilogram × (initial Hct-target Hct) ÷ (initial Hct+target Hct),and was simultaneously replaced with the equal volume of 6％ hydroxyethyl starch 130/0.4 infused over 30 min via the left femoral vein until the target Hct was achieved in H1,H2 and H3 groups.At 30 min of stabilization after puncture (T0) and 2,4 and 8 h after ANH (T1-3),blood samples were obtained from the superior mesenteric artery and vein for blood gas analysis and for determination of plasma concentrations of tumor necrosis factor-α (TNF-α) in the superior mesenteric vein.Oxygen extraction rate (ERO2) was calculated.Small intestinal mucosal tissues were obtained at T3 to observe the pathological changes with light microscope.Results Compared with those at T0,the plasma concentrations of TNF-α at T3 and ERO2 at T1-3 were significantly increased in H1 group,and the plasma concentrations of TNF-α at T3 and ERO2 at T1-3 were increased in H2 and H3 groups.The injury to the mucous membrane of small intestine was mild in group H1,and was severe in H2 and H3 groups.Conclusion ANH performed with 6％ hydroxyethyl starch causes injury to the mucous membrane of small intestine when Hct is 18％ and the time course ≥ 8 h,and when Hct ≤ 15％ and the time course ≥ 2 h in the rabbits.

Effect of different degrees of acute normovolemic hemodilution on mucous membrane of small intestine in rabbits / 中华麻醉学杂志

Objective To investigate the effect of different degrees of acute normovolemic hemodilution (ANH) with 6% HES 200/0.5 on mucous membrane of small intestine in rabbits. Methods Thirty-two adult rabbits weighing 2.0-2.5 kg were randomly divided into 4 groups ( n = 8 each): Ⅰ control group underwent no ANH, and Ⅱ, Ⅲ, Ⅳ group underwent ANH with hematocrit (Hct) reduced to 24%, 18% and 12% respectively (group H1-3 ). The animals were anesthetized with 20% urethane 4 ml/kg, thracheostomized and mechanically ventilated (VT = 8 ml/kg, RR = 50 bpm). The body temperature was maintained at 36.5-37.6 ℃. Left carotid artery was cannulated for MAP monitoring and blood sampling. Right jugular vein was cannulated for CVP monitoring. Blood withdrawn from femoral artery was simultaneously replaced by iv infusion of equal volume of HES (200/0.5) until the target Hct was achieved. Blood samples were obtained from superior mesenteric vein (SMV)for determination of plasma concentrations of TNF-α before ANH(T0) and at 8 h after ANH (T1). Small intestinal mucosal tissues were obtained at T1 to observe the pathological changes by electron microscopy. Results Compared with those at T0, plasma concentrations of TNF-a in SMV were significantly increased at T1 in group H2 and H3 ( P ＜ 0.01 ), but no significant change was found in group H1 ( P ＞ 0.05). Compared with group C, plasma concentrations of TNF-α in SMV were significantly increased in group H2 and H3 ( P ＜ 0.01 ), but no significant change was found in group H1 ( P ＞ 0.05). No injury was found in mucous membrane of small intestine in group H1 . The injury to mucous membrane of small intestine was mild in group H2 and severe in group H3 . Conclusion ANH with 6% HES 200/0.5 does not affect mucous membrane of small intestine when Hct is reduced to 24% The injury to mucous membrane of small intestine occurs when Hct is reduced to≤ 18%.

Effect of Zuoguiyin on expression of ovarian VEGF and SPARC in rats during peri-menopausal period / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the effect of one kind of regulating-qi and Nourishing-yin Chinese herbs Zuoguiyin on the expression of rats ovarian vascular endothelial growth factor (VEGF) and secreted protein acidic rich in cysteine (SPARC) during the period of peri-menopause.</p><p><b>METHOD</b>The animal models of perimenopause rats were established by natural aging. Perimenopause rats were treated by intragastric administration (ig) with low (13.78 g x kg(-1)), middle (20.67 g x kg(-1)) and high (31 g x kg(-1)) dose of Zuoguiyin for 8 weeks. Expression of VEGF and SPARC mRNA were detected by RT-PCR. Immunohistochemistry was used to evaluate expression levels of VEGF protein.</p><p><b>RESULT</b>Compared with that in the control group, ovarian expression levels of VEGF mRNA and its protein in rats during peri-menopause increased significantly (P < 0.01). Middle and high dose of Zuoguiyin could both down-regulate the expression of VEGF in ovaries of praesenilis rats, and the difference has statistical significance (P < 0.01). Expression levels of SPARC mRNA in rat ovaries during peri-menopausal period decreased obviously compared to that in the control group (P < 0.01). Middle and high dose of Zuoguiyin could greatly promote ovarian SPARC mRNA expression of praesenilis rats (P < 0.01).</p><p><b>CONCLUSION</b>The abnormal changes of VEGF and SPARC may play an important role in the aging process of ovary. Zuoguiyin, one kind of regulating-qi and Nourishing-yin Chinese herbs, can improve ovarian vascular formation through down-regulating the expression of VEGF meanwhile up-regulating the expression of SPARC. And it may delay aging by this way.</p>