Issues
Volume 209 Issue 3
News
News briefs
The antioxidant benefits of sleep Researchers from Columbia University in New York have found that short-sleeping fruit fly mutants shared the feature of sensitivity to acute oxidative stress, and concluded that sleep facilitates antioxidant processes. In a study published in PLoS Biology, the researchers reasoned that if sleep were required for a core function of health, animals that sleep significantly less than usual should share a defect in that core function. They examined a diverse group of short-sleeping Drosophila mutants and found that they indeed shared a common defect: they were all sensitive to acute oxidative stress. Oxidative stress results from excessive levels of free radicals that can damage cells and lead to organ dysfunction. Toxic free radicals, or reactive oxygen species, can accumulate in cells because of normal metabolism and environmental damage. If the function of sleep is to defend against oxidative stress, increasing sleep should increase resistance to oxidative stress. The effects of experimental pharmacological and genetic manipulations support this hypothesis. Finally, the authors proposed that, conversely, oxidative stress might regulate sleep. Consistent with this hypothesis, they found that reducing oxidative stress in the brain by overexpressing antioxidant genes reduced the amount of sleep. Taken together, these results point to a bidirectional relationship between sleep and oxidative stress; that is, sleep is important for defending the body against oxidative stress, and oxidative stress helps induce sleep. This work is relevant to human health because sleep disorders are associated with many diseases that are also associated with oxidative stress, such as Alzheimer, Parkinson and Huntington diseases. Sleep loss could make individuals more sensitive to oxidative stress and subsequent disease; conversely, pathological disruption of the antioxidant response could also lead to loss of sleep and associated disease pathologies. http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2005206 Iceman’s last meal was a fatty binge Italian researchers have conducted the first in depth analysis of the stomach contents of the Iceman, a 5300-year-old human body discovered in 1991 in the eastern Italian Alps, the oldest naturally preserved ice mummy. Their findings indicate that the Iceman’s last meal was heavy in fat. Applying a complementary -omics approach combined with microscopy, they reconstructed the Iceman’s last meal. Writing in Current Biology, the researchers showed that he had a “remarkably high proportion of fat” in his diet, supplemented by wild meat from ibex and red deer, cereals, and traces of toxic bracken. The analysis was only recently undertaken because scientists were initially unable to identify the Iceman’s stomach, as it had moved up during the mummification process. In 2009, his stomach was identified during a re-investigation of computed tomography scans. Compared with previously analysed lower intestine samples, the stomach material was extraordinarily well preserved, and contained large amounts of unique biomolecules, such as lipids, that opened new methodological opportunities for investigating questions about the Iceman’s diet. The investigators combined classic microscopic and modern molecular approaches to determine the exact composition of his diet. The broad-spectrum approach allowed them to make inferences based on ancient DNA, proteins, metabolites, and lipids. The analysis identified ibex adipose tissue as the most likely fat source; in fact, about half of the stomach contents were adipose fat. While the high fat diet was unexpected, the researchers wrote that it made sense, given the extreme alpine environment in which the Iceman lived. The analysis indicated that the wild meat was eaten fresh or perhaps dried. While the presence of toxic bracken particles is more difficult to explain, the researchers suggest the Iceman may have had intestinal problems related to parasites found in his gut and took the bracken as a medicine. On the other hand, he may have used the fern leaves to wrap food and then unintentionally ingested toxic spores. The analysis also revealed traces of the original gut bacterial community present in the Iceman’s intestine. The researchers plan to conduct further studies to reconstruct the ancient gut microbiomes of the Iceman and other mummified human remains. https://www.cell.com/current-biology/fulltext/S0960-9822(18)30703-6
Cate Swannell
Perspectives
Public reporting of percutaneous coronary interventions
American experience suggests that public reporting of percutaneous coronary interventions is not associated with improved patient outcomes and is instead associated with possible patient harm through risk aversion
David Enze Wang · Rishi K Wadhera · Deepak L Bhatt
Rendering visible the previously invisible in health care: the ageing LGBTI communities
Recent legislative and policy measures aim to raise awareness of the needs of older LGBTI people
Carmelle Peisah · Kim Burns · Samantha Edmonds · Henry Brodaty
Potential implications of the new American hypertension guidelines in Australia
If the American hypertension guidelines were to be adopted, many of the newly diagnosed people with hypertension would be younger and would fall outside the age range for absolute risk assessment by the Australian standard
Garry LR Jennings · Bronwyn A Kingwell · Erin Hoare
New enhanced influenza vaccines for older Australians: what promise do they hold?
Even modest improvements in influenza vaccine effectiveness are predicted to have an impact on preventing severe disease in older people
Sarah L Sheridan · Cyra Patel · Kristine Macartney · Allen C Cheng
Medical education
Brugada syndrome and undifferentiated syncope: use of an implantable loop recorder to document causation
Implantable loop recorders allow for continuous cardiac rhythm monitoring in patients with undifferentiated syncope
Garry Hamilton · David O'Donnell · Hui-Chen Han
Editorials
Why are women with ST-elevation myocardial infarction treated differently to men?
STEMI and coronary artery disease are major but underappreciated killers of Australian women
Andrew I MacIsaac · Gemma Figtree
The epidemiology and costs of implantable cardioverter–defibrillator therapy in Australia
The benefit of few medical interventions are as dramatic as the lifesaving effect of an ICD
Jitendra Vohra · Haris M Haqqani
Research
Differences in management and outcomes for men and women with ST-elevation myocardial infarction
Women with STEMI are less likely to receive invasive management, revascularisation, or preventive medication at discharge
Ehsan Khan · David Brieger · John Amerena · John J Atherton · Derek P Chew · Ahmad Farshid · Marcus Ilton · Craig P Juergens · Nadarajah Kangaharan · Rohan Rajaratnam · Amy Sweeny · Darren L Walters · Clara K Chow
Implantable cardioverter–defibrillator therapy in Australia, 2002–2015
ICD procedures are becoming more frequent in Australia, particularly in people aged 70 or more
Bianca Blanch · Luise P Lago · Raymond Sy · Phillip J Harris · Christopher Semsarian · Jodie Ingles
Research letter
Delays in primary percutaneous coronary treatment for patients with ST-elevation myocardial infarction
More effort is needed to improve time to reperfusion for patients with STEMI
Diem T Dinh · Yishen Wang · Angela L Brennan · Stephen J Duffy · Dion Stub · Christopher M Reid · Jeffrey Lefkovits
Position statement summary
Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents
These are the first guidelines to be developed for TGD children and adolescents in Australia
Michelle M Telfer · Michelle A Tollit · Carmen C Pace · Ken C Pang
Narrative review
Transcatheter aortic valve implantation: a new standard of care
The introduction of TAVI has revolutionised the management of aortic valve disease in Australia
Adam J Nelson · Nicholas J Montarello · Claudia S Cosgrove · Ross L Roberts-Thomson · Sinny Delacroix · Ramesh G Chokka · Joseph K Montarello · Stephen G Worthley
Letters
Traumatic cricket-related fatalities in Australia: a historical review of media reports
To the Editor:I read with interest the article by Brukner and colleagues1 on traumatic cricket-related fatalities in Australia, which describes two autopsy-confirmed deaths due to subarachnoid haemorrhage following vertebral artery dissection, with a further 11 deaths suspected to be secondary to this condition. Two recent articles described a total of 230 cases of carotid or vertebral artery dissection temporally related to 45 different sports or recreational activities.2,3 The majority of episodes of arterial dissection were related to non-contact sports, including jogging, walking, swimming, golf, basketball, tennis and scuba diving. The mean age of patients was 35 years. The mechanism of non-traumatic dissection is thought to relate to shearing stress on the arterial wall with sudden neck rotation. Thus arterial dissection in golfers affected the right side in 11 of 14 patients (79%), and involved the posterior circulation in 12 of 14 patients (86%).4 Controversy regarding the association between neck manipulation and arterial dissection persists, although a retrospective case–control study found an odds ratio of 12.8 for prior neck manual therapy in individuals aged 55 years or less presenting with craniocervical arterial dissection.5 Arterial dissection may also occur spontaneously, the risk being increased in the setting of systemic lupus erythematosus, other connective tissue disorders, migraine and in the postpartum period. It is important that health professionals recognise that arterial dissection may occur spontaneously or as a result of non-contact sports and activities, and that persons of any age presenting with symptoms suggestive of anterior or posterior circulation ischaemia require urgent review and neuroimaging.
Adam Morton
Tackling the worsening epidemic of Buruli ulcer in Australia in an information void: time for an urgent scientific response
To the Editor:A recent article by O’Brien and colleagues1 highlights the worsening epidemic of Buruli ulcer in Australia. The steep rise in both the incidence and severity of the disease is associated with estimated health care costs of over $2.5 million per year in Victoria.1 The increase in Buruli ulcer cases in Australia parallels the increase in non-tuberculous mycobacterial (NTM) infections, especially lymphadenitis and Buruli ulcer, reported worldwide. Although this rise might be partly attributable to improved awareness and diagnostic methods, it might also be related to the discontinuation of universal bacillus Calmette–Guérin (BCG) vaccination in settings where the rate of tuberculosis has declined. Routine vaccination with BCG through the school program was discontinued in Victoria in the mid-1980s. The live-attenuated strain of Mycobacterium bovis contained in BCG vaccine shares epitopes with NTM, which makes cross-protection plausible. Our recently published meta-analysis indicates that BCG vaccination has a protective effect against NTM.2 In particular, two randomised controlled trials provide strong evidence for protection against Mycobacterium ulcerans.3,4 However, immunity might only be short lived, as the highest protection was observed in the first year after vaccination. Nevertheless, studies also report that compared with BCG-naive individuals, those who have received the BCG vaccine have smaller skin lesions,4 a shorter duration to healing5 and protection against severe forms of Buruli ulcer with multiple skin lesions.6 Buruli ulcer is a serious condition, which, despite prolonged antibiotic treatment and surgical intervention, can lead to complications such as osteomyelitis and other crippling sequelae. In light of the worsening epidemic, the protective effect of BCG vaccination should not be overlooked.
Petra Zimmermann · Adam Finn · Nigel Curtis
Careers
Navigating VUS Land
Dr Jodie Ingles is a cardiac genetic counsellor, navigating the winding pathways of the genetics of sudden cardiac death, and delivering help to affected families
Cate Swannell
Calendar of conferences in Australia and New Zealand
This calendar will be updated each month. If you have an event you would like to add, please include relevant details in an email to cswannell@mja.com.au
Cate Swannell
News briefs
Cate Swannell
Screening for spinal muscular atrophy
Hugo Sampaio · Bridget Wilcken · Michelle Farrar
A shift in scholarly publishing practices and the growing menace of predatory journals
Peter L Munk · Tyler M Coupal · Wilfred CG Peh
Network meta-analysis in health care decision making
Bram Rochwerg · Romina Brignardello-Petersen · Gordon Guyatt
News briefs
Cate Swannell
Preparation for general practice vocational training: time for a rethink
Susan M Wearne · Parker J Magin · Neil A Spike
Care of patients with chronic disease: achievements in Australia over the past decade
Mark F Harris · Ben Harris-Roxas · Andrew W Knight