An invasive management strategy is associated with improved outcomes in high-risk acute coronary syndromes in patients with chronic kidney disease.

Introduction: Chronic kidney disease (CKD) is associated with poor outcomes after acute coronary syndromes, yet selection for invasive investigation and management is low.

Methods: Patients presenting with ST segment elevation myocardial infarction (STEMI) or intermediate- to high-risk non-ST segment elevation acute coronary syndrome (NSTEACS) (n=2597) were stratified into groups based on kidney function, defined as normal (glomerular filtration rate (GFR)≥60mL/min/1.73m(2) ), moderate CKD (GFR 30-59mL/min/1.

Reperfusion therapy in the acute management of ST-segment-elevation myocardial infarction in Australia: findings from the ACACIA registry.

Objective: To describe the contemporary management and outcomes of patients presenting with ST-segment-elevation myocardial infarction (STEMI) in Australia.

Design, Participants And Setting: Observational analysis of data for patients who presented with suspected STEMI and enrolled in the Australian Acute Coronary Syndrome Prospective Audit from 1 November 2005 to 31 July 2007.

Main Outcome Measures: Factors associated with use of reperfusion therapy and timely use of reperfusion therapy, and the effects of reperfusion on mortality.

Prediction of serum ionized calcium concentration by serum total calcium measurement in cats.

Feline serum samples (n = 434) were classified as hypercalcemic, normocalcemic, or hypocalcemic based on both total calcium (tCa) and ionized calcium (iCa) concentrations. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive diagnostic likelihood ratio (PDLR), and negative diagnostic likelihood ratio (NDLR) were calculated for prediction of hypercalcemia and hypocalcemia in all samples, in hypoalbuminemic cats, and in those with chronic renal failure (CRF) as compared with cats that had other conditions. Diagnostic discordance in prediction of iCa using tCa was 40%.

Least-Squares Support Vector Machine Approach to Viral Replication Origin Prediction.

Replication of their DNA genomes is a central step in the reproduction of many viruses. Procedures to find replication origins, which are initiation sites of the DNA replication process, are therefore of great importance for controlling the growth and spread of such viruses. Existing computational methods for viral replication origin prediction have mostly been tested within the family of herpesviruses.

Surgical management of diffuse polypoid cystitis using submucosal resection in a dog.

A 6-year-old, spayed female Labrador retriever was presented with clinical signs of stranguria, pollakiuria, and hematuria of 12 weeks' duration. A bacterial urinary tract infection, diffuse polypoid cystitis, and emphysematous cystitis were diagnosed. Antibiotic therapy combined with extensive resection of the mucosa and submucosa associated with polypoid lesions resulted in complete resolution of clinical signs and resolution of the remaining polypoid lesions.

Six-month survival benefits associated with clinical guideline recommendations in acute coronary syndromes.

Aims: The authors sought to define which guideline-advocated therapies are associated with the greatest benefit with respect to 6-month survival in patients hospitalised with an acute coronary syndrome (ACS).

Methods And Results: The authors conducted a nested case-control study of ACS patients within the Global Registry of Acute Coronary Events cohort between April 1999 and December 2007. The cases were ACS patients who survived to discharge but died within 6 months.

Cost effectiveness of a general practice chronic disease management plan for coronary heart disease in Australia.

Background: The cost effectiveness of a general practice-based program for managing coronary heart disease (CHD) patients in Australia remains uncertain. We have explored this through an economic model.

Methods: A secondary prevention program based on initial clinical assessment and 3 monthly review, optimising of pharmacotherapies and lifestyle modification, supported by a disease registry and financial incentives for quality of care and outcomes achieved was assessed in terms of incremental cost effectiveness ratio (ICER), in Australian dollars per disability adjusted life year (DALY) prevented.

Magnetic resonance imaging of clinically suspected Salter-Harris I fracture of the distal fibula.

Objectives: In skeletally immature children, isolated lateral ankle injuries without radiograph-visible fractures are often diagnosed with Salter-Harris I fractures of the distal fibula (SH1DF). However, recent magnetic resonance imaging (MRI) evidence in children suggests that sprains may be more common than previously thought. Thus, the main objective of this study was to determine the rate of MRI-confirmed SH1DF among cases where this diagnosis was made presumptively, based on clinical findings.

Antiplatelet therapy in percutaneous coronary intervention: recent advances in oral antiplatelet agents.

Purpose Of Review: Dual antiplatelet therapy with aspirin and clopidogrel, in conjunction with heparin, is the most common antithrombotic strategy in percutaneous coronary intervention (PCI) used to reduce peri-procedural ischaemic complications. However, there remains significant inter-individual variability in post-treatment platelet inhibition with this current established therapy. This review focuses on recent developments in oral antiplatelet agents used in PCI, which promise to overcome, at least in part, current shortfalls.

The role of antiplatelet therapy in the secondary prevention of coronary artery disease.

Purpose Of Review: In this study, we review the evidence for both long-standing and newer oral antiplatelet agents as secondary prevention in coronary artery disease, and give our opinion on where each agent's treatment role lies.

Recent Findings: Platelets play a pathological role in acute coronary syndromes and are therefore a major therapeutic target. The caveat to this is that their physiological haemostatic role means there must be a careful balance between preventing ischaemia and not promoting bleeding.

Alignment-free sequence comparison (I): statistics and power.

Large-scale comparison of the similarities between two biological sequences is a major issue in computational biology; a fast method, the D(2) statistic, relies on the comparison of the k-tuple content for both sequences. Although it has been known for some years that the D(2) statistic is not suitable for this task, as it tends to be dominated by single-sequence noise, to date no suitable adjustments have been proposed. In this article, we suggest two new variants of the D(2) word count statistic, which we call D(2)(S) and D(2)(*).

Intravenous platelet blockade with cangrelor during PCI.

Background: Intravenous cangrelor, a rapid-acting, reversible adenosine diphosphate (ADP) receptor antagonist, might reduce ischemic events during percutaneous coronary intervention (PCI).

Methods: In this double-blind, placebo-controlled study, we randomly assigned 5362 patients who had not been treated with clopidogrel to receive either cangrelor or placebo at the time of PCI, followed by 600 mg of clopidogrel. The primary end point was a composite of death, myocardial infarction, or ischemia-driven revascularization at 48 hours.

Platelet inhibition with cangrelor in patients undergoing PCI.

Background: Cangrelor, a nonthienopyridine adenosine triphosphate analogue, is an intravenous blocker of the adenosine diphosphate receptor P2Y(12). This agent might have a role in the treatment of patients who require rapid, predictable, and profound but reversible platelet inhibition.

Methods: We performed a large-scale international trial comparing cangrelor with 600 mg of oral clopidogrel administered before percutaneous coronary intervention (PCI) in patients with acute coronary syndromes.

Treatment disparities and effect on late mortality in patients with diabetes presenting with acute myocardial infarction: observations from the ACACIA registry.

Objectives: To compare the use of evidence-based pharmacological and invasive treatments and 12-month mortality rates between patients with and without diabetes who present with acute myocardial infarction (MI), and to explore the relationship between these treatments and late clinical outcomes.

Design And Setting: Prospective, nationwide multicentre registry: the Acute Coronary Syndrome Prospective Audit (ACACIA).

Patients: Patients presenting to 24 metropolitan and 15 non-metropolitan hospitals with acute coronary syndrome (ACS) and a final discharge diagnosis of acute MI between November 2005 and July 2007.

Prognostic impact of types of atrial fibrillation in acute coronary syndromes.

Atrial fibrillation (AF) has been established as an independent predictor of long-term mortality after acute myocardial infarction. However, this is less well defined across the whole spectrum of acute coronary syndromes (ACSs). The Acute Coronary Syndrome Prospective Audit is a prospective multicenter registry with 12-month outcome data for 3,393 patients (755 with ST-segment elevation myocardial infarction, 1942 with high-risk non-ST-segment elevation ACS [NSTE-ACS], and 696 with intermediate-risk NSTE-ACS).

Surgical views: Surgical treatment of urethral sphincter mechanism incompetence in dogs.

Urinary incontinence--loss of voluntary control over the retention and expulsion of urine--is a common medical problem in small animal patients. Incontinence occur when pressure within the bladder exceeds urethral pressure. Incontinence may result from a variety of etiologies, including congenital anatomic abnormalities of the lower urinary and reproductive systems (ureter, bladder, bladder neck, urethra, vagina,vestibule) as well as neurologic, neoplastic, infectious, and inflammatory disease.

Treatment options for hyperphosphatemia in feline CKD: what's out there?

Practical Relevance: Phosphorus is retained in chronic kidney disease (CKD), promoting renal secondary hyperparathyroidism and eventually resulting in hyperphosphatemia. Most agree that phosphate retention is a major contributor to the progression of CKD in many species and it is well known that hyperphosphatemia is associated with a significant mortality risk in humans with end-stage renal disease.

Patient Group: Chronic kidney disease is a common ailment of geriatric cats.

Effects of cyclic flexure on endothelial permeability and apoptosis in arterial segments perfused ex vivo.

Certain arteries (e.g., coronary, femoral, etc.

Characterizing the transcriptional regulation of let-721, a Caenorhabditis elegans homolog of human electron flavoprotein dehydrogenase.

LET-721 is the Caenorhabditis elegans ortholog of electron-transferring flavoprotein dehydrogenase (ETFDH). We are studying this protein in C. elegans in order to establish a tractable model system for further exploration of ETFDH structure and function.

24-Hour observational ward management of diabetic patients presenting with hypoglycaemia: a prospective observational study.

Background: A 24 h observational ward was set up in the study hospital emergency department (ED) in September 2005 to manage a group of patients with specific conditions including hypoglycaemia that require only short focused inpatient care.

Aim: To evaluate the efficacy and safety of the management of hypoglycaemia in the observational ward via criteria of successful discharge of patients from the observational ward within 24 h and the recurrence of hypoglycaemia after discharge.

Methods: Hypoglycaemic patients admitted to the observational ward had their treatment and evaluation performed within 24 h.

Unperceived treatment gaps in acute coronary syndromes.

Background: Despite a strong evidence-base for several therapies recommended in the management of acute coronary syndromes (ACS), many patients do not receive these therapies. The barriers preventing translation of evidence into practice are incompletely understood. The aim of this study was to survey clinicians regarding barriers to implementing recommendations of recently published national clinical guidelines and to determine the extent to which these impact clinical practice.

Acute coronary syndromes: consensus recommendations for translating knowledge into action.

A systematic, integrated national approach is needed to implement 2006 Australian guidelines for management of acute coronary syndromes (ACS). Clinical outcomes can be improved by closing the current gaps between evidence and practice. In 2007, the National Heart Foundation of Australia, the Cardiac Society of Australia and New Zealand, and the Australasian College for Emergency Medicine held a national forum to identify current gaps in ACS management and priority strategies to improve outcomes.

Drug treatment and cost of cardiovascular disease in Australia.

Australia's Pharmaceutical Benefits Scheme supports the use of effective drugs for the prevention and control of cardiovascular risk factors. However, there are little data available describing per person costs of medication in primary prevention and secondary prevention in the community. We aim to understand annual expenditure on cardiovascular medicines according to the level and extent of cardiovascular disease, using participants enrolled in the Reduction of Atherothrombosis for Continued Health (REACH) registry.