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Comparison of referral rates and diagnosis of axial spondyloarthritis before and after an ankylosing spondylitis public awareness campaign White D, Badenhorst C Objectives To measure the effect of a national ankylosing spondylitis (AS) public awareness campaign on numbers of referrals for suspected AS and numbers of cases diagnosed with axial spondyloarthritis (SpA) in three New Zealand rheumatology services. Methods A television and newspaper advertising campaign was conducted by Arthritis New Zealand in 2011 to raise public awareness of AS. The reach of the campaign was measured using target audience rating point (TARP) analysis. A retrospective analysis was made of referrals received by the rheumatology services based in three centres in the three months before the campaign started and the three months after the campaign ended. Total number of referrals received, number of referrals for suspected AS, number of referrals resulting in a diagnosis of axial SpA, and age and gender of cases were recorded. Results Target audience rating point analysis indicated that the awareness campaign would have been viewed by 82% of young men between the ages of 18 and 40, and 88% of all people between the ages of 20 and 54. In the three months after the awareness campaign there was a significant increase (54 v 88, 63%, p = 0.0056) in referrals for suspected AS compared with the three months before the campaign. Referrals for other conditions remained constant over the same period. The number of referrals resulting in a diagnosis of axial SpA also increased (27 v 44, 63%, p = 0.0576). The mean ages of patients referred and of those diagnosed with axial SpA did not change before and after the campaign. The male:female ratio was 1:1 among referrals for suspected AS and 2:1 in referrals diagnosed with axial SpA, before and after the campaign. Conclusion The Arthritis New Zealand AS public awareness campaign was associated with a significant increase in referrals to rheumatology services for suspected AS and increase in the diagnosis of axial SpA at the first clinic visit. Impact of ethnicity on cardiac admission with thyrotoxicosis Tamatea JAU, Conaglen JV Elston MS Thyrotoxicosis is one of the most common endocrine disorders with a local incidence of 0.2%1. The majority of patients with thyrotoxicosis have either Graves disease (autoimmune thyrotoxicosis due to the presence of antibodies which stimulate the TSH receptor) or a toxic multinodular goitre (TMNG). Cardiac complications of thyrotoxicosis commonly include ischaemia, dysrhythmia and congestive heart failure (CHF)2. Mori are over-represented in cardiac admissions3, and an Australian group have raised the question of a relationship between Mori ethnicity and cardiac admissions3. However the relationship between thyrotoxicosis and cardiac admission has not been assessed in Aotearoa. We carried out a retrospective review of all patients admitted to Waikato Hospital with cardiac complications of thyrotoxicosis between January 2005 and August 2012. Mori were over-represented within the group (38%) when compared to DHB population (18%). Mori patients were 12 years younger (66yrs vs 54yrs; p=0.01), were more likely to be admitted with CHF (21.7% vs 57.1%; p=0.01) and had an association with higher T4 levels (p=0.022). References: Gibbons V, Conaglen JV, Lillis S, Naras V, & Lawrenson R. Epidemiology of thyroid disease in Hamilton (New Zealand) general practice. ANZ J Pub Health 2008;32:421-423. Curtis et al. Cardiovascular disease section. Hauora: Mori Standards of Health IV 2000-2005. Nigram P & Morton A. Are Mori women at increased risk of cardiac complications of Graves disease? NZMJ 2012;125:90-2 Impacts on couples of prostate cancer diagnosis & treatment Helen M Conaglen1, Charis Brown1, John V Conaglen1, Ross Lawrenson1,2. University of Auckland, Waikato Clinical School, Hamilton, New Zealand Waikato Hospital, Hamilton, New Zealand Background Carcinoma of the Prostate (CaP) is common with the diagnosis and treatment affecting not only the man but also his partner. Problems for couples with CaP have been outlined in clinical reports but seldom formally studied. Women have been reported to be as affected by some psychological problems as their CaP partner. Aim To investigate the psychosocial impact of CaP on couples. Method This cross-sectional study investigated psychological and sexual function in a sample of 54 heterosexual couples, 2-6 years following CaP diagnosis and treatment. Couples completed the HADS, a stress scale, DAS, SIS and the FSFI-SF or IIEF-SF; couples scores were correlated, and comparison made with population standards to understand the impact of CaP on couples. Results Most couples reported that chances of sexual problems were somewhat or very important in choosing a treatment option for their CaP. Psychological distress (HADS) was significant in 30% of the women and 15% of men in the study. Stress was at higher levels than in the normal population. Despite this most couples were well-adjusted with 87-90% reporting relationships as happy, very happy, extremely happy, or perfect. Women reported social intimacy levels comparable women presenting for marital therapy. 50% of women experienced sexual dysfunction and 21% were sexually dissatisfied. Of the men who completed IIEF-SF, 85% had erectile problems. Womens psychological stress/distress correlated with their partners sexual function scores. Conclusion The impact of CaP and its various treatments affects partners as much as the men with the diagnosis. Further studies of the impact of CaP on partners are required to develop suitable treatment options for the couple affected by this disease. Intestinal bacterial colonisation patterns in very low birth weight preterm infants Thirayan V, Mansell C, Nair A Background Preterm, very low birth weight (VLBW <1500 g) infants often remain hospitalised in neonatal intensive care units for prolonged periods and are exposed to a variety of factors including antibiotics and formula feeds which may affect the composition of the intestinal microbiota compared to their term born peers. Growth, development and gut related morbidity in VLBW infants might be partly related to an altered intestinal bacterial colonisation pattern. In full term breast-fed infants Bifidobacterium spp are numerically dominant, which is presumed to be beneficial, while Clostridium spp, Bacteroides spp and facultative anaerobes such as Enterobacteriaceae and enterococci are found in relatively lower numbers. Recent reports indicate that administering probiotics to VLBW babies can potentially alter their intestinal colonisation pattern to achieve similar patterns to breast-fed full term babies. This may in turn help reduce necrotising enterocolitis, infection and mortality rates in the short term and may have long term benefits in the form of better growth, feed tolerance and reduction in allergy in these babies. Type of Study Prospective observational study Objective To characterise the bacterial colonisation pattern in serially collected stool samples from VLBW infants within the first few weeks of life to help define the natural history of succession in these babies at Waikato Hospital, in the absence of probiotic therapy. Patients & Methods Serial stool specimens from VLBW babies were collected at approximately 1-week intervals postnatally for the study duration of 10 weeks. Pure cultures of aerobic and anaerobic isolates were identified by Matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF). Bacterial diversity was assessed by numbers of distinct species identified and numbers were quantitatively expressed in CFU/g for analysis. Data were analysed by week of infant age, relative to patient demographics, antibiotic exposure and feeding patterns. Results The average number of species per VLBW infant (n=11) increased from 2 to 9.7 between week 1 and 10 after delivery, respectively. The average number of species of skin organisms per infant decreased from 4 to 1.7; Enterobactericeae increased from 1.5 to 3.7; enteric streptococci from 1.5 to 3.7 and anaerobes increased from 0 to 2, only between week 2 and 10. 243 species were identified across the first 10 weeks of life. Staphylococcus epidermidis (13%), Enterococcus faecalis (9%), Klebsiella oxytoca (9%) and Escherichia coli (6%) were the most frequently isolated species. Beneficial species, included Bifidobacterium breve (0.8%), dentium (0.8%) and longum (0.8%) and Lactobacillus paracasei (0.4%), were found only between week 4 and 8. Micrococcus luteus and Bacillus cereus were found only in week 1. The most frequently identified bacterial organisms in week 5 were S. epidermidis (12%), E. faecalis (11%), K. oxytoca (7%), S. aureus (5%), E. coli (5%),K. pneumonia (5%) and Citrobacter freundii (4%); and in week 10 were C. freundii (10%), E. coli (10%), K. oxytoca (10%), E. faecalis (10%) and Veillonella parvula (10%). Average CFU/ml/infant increased between week 1 and 10 from 2 X 106 to 3.6 X 1011. K. oxytoca was the most numerous species (94% of all cfu/ml). In week 5, the most numerous species was Klebsiella pneumonia (36%), B. breve (12%) , C. freundii (7%) and E. faecalis (7%); and in week 10, the most numerous species was K. oxytoca (86%) and S. aureus (11%). Beneficial organisms accounted for 0.3% of all growth across the study. Conclusions Breast-fed VLBW infants are colonised in succession. As the gut develops, skin and environmental organisms decrease and the numbers of Enterobactericeae, enteric streptococci and anaerobes increase. S. epidermidis was the most frequently isolated species and K. oxytoca was the most numerous. Lactobacillus and Bifidobacterium species were infrequently isolated. A follow up study, using the same methodology, is planned to assess the effect of introduction of probiotic therapy from March 2013 at the Waikato Neonatal Intensive Care Unit. Characteristics of men diagnosed with prostate cancer in New Zealand general practice Obertov\u00e1 Z, Hodgson F, Holmes M, Brown C, Lawrenson R Objective to identify new cases of prostate cancer in a cohort of men enrolled in general practices in the Midlands Cancer Network region. Methods The study population included 35,734 men aged 40+ years enrolled in 31 general practices in the Midland Cancer Network region. Computerised practice records, New Zealand Cancer Registry and local laboratory data were searched for new diagnoses of prostate cancer in men who had a prostate-specific antigen (PSA) test between 1 January and 31 December 2010. Biopsy information was obtained from local laboratories and cross-referenced with practice records. PSA level at referral, Gleason sum and clinical stage were noted when available. In addition, information about treatment following cancer diagnosis was obtained from the practice records. Results There were 172 men diagnosed with prostate cancer in 2010/2011 following a PSA test. Twenty nine men (17%) were diagnosed following screening. The majority of men (59%) were diagnosed with a Gleason sum of 6, while 67% had PSA level at referral lower than 10 ng/ml and 69% had a clinical stage of T1c or T2. More than one-quarter of the diagnosed men have been treated with a radical prostatectomy but a proportion are managed with watchful waiting or active surveillance. Conclusion Most men were diagnosed with low-risk prostate cancer. Only a small proportion of men were diagnosed following screening. The number of men with prostate cancer who are managed in general practice is steadily increasing, therefore it is necessary to establish guidelines that would help GPs to provide high-quality care for these men. SDHB malignant paragangliomas: management in pregnancy Wing L, Conaglen JV, Meyer Rochow GY, Elston MS Department of Endocrinology, Waikato Hospital Management of phaeochromocytoma/paraganglioma in pregnancy raises both diagnostic and therapeutic challenges. In the 1970s fetal and maternal mortality rates were as high as 50% for pregnancies complicated by phaeochromocytoma. Improved perinatal care for these patients has resulted in better survival for these high risk pregnancies although there still remains a significant maternal and fetal mortality of 2% and 10%, respectively. We present a local series of eight pregnancies in four women with functioning paragangliomas during pregnancy and discuss issues regarding diagnosis, management and outcome. Management of phaeochromocytoma during pregnancy presents a difficult balance between the critical need for adequate adrenergic blockade, while not compromising placental blood flow. Careful planning for delivery is necessary in order to minimise maternal and fetal risk. The optimal method of delivery is usually caesarean section as it is associated with lower maternal mortality. Invasive monitoring of the mother is required in order to monitor for haemodynamic instability. Stat5a and Stat5b in the regulation of sexually dimorphic growth Ryan G Paul1, Marianne S Elston1, Chris D McMahon2, John V Conaglen1. Waikato Clinical School, Department of Medicine, University of Auckland, Hamilton, New Zealand. AgResearch, Ruakura, New Zealand. Introduction Growth hormone (GH) regulates insulin-like growth factor one (IGF-1) production predominantly through the intracellular signallers Stat5a and Stat5b. Loss of Stat5b results in reduced production of liver IGF-1 and loss of sexually dimorphic growth in males. However, no study has observed the phenotype beyond twelve weeks, or looked at normalised muscle mass and fat mass. Methods The hindlimb muscles and abdominal fat of male and female Stat5b knockout mice and wild type mice were collected at 6, 12 and 24 weeks of age (n=16 per time and sex). Muscle mass was normalised to tibia length and abdominal fat mass was normalised to body mass. C2C12 myoblast cell lines were treated with viral Stat5b siRNA, Stat5a siRNA or a scrambled vector as a control, then differentiated and treated with 100ng/mL of GH for 24 hours. RNA and protein were harvested for quantitative PCR and Western blotting. Results Nose-to-tail length, tibia length and normalised hindlimb muscle mass were decreased to a greater extent in male (29.8%) than in female (11.5%) Stat5b knockout mice versus wild type mice at all ages (P <0.001). Both male and female Stat5b knockout mice had a greater abundance of abdominal fat than wild type mice at 24 weeks (P <0.05). Individual Stat5a and Stat5b knockdown both blocked the GH induced increase in IGF-1, IGF-1R and GHR mRNA. Additionally Stat5a knockdown blocked the increase in AR mRNA and decrease in myostatin mRNA . Stat5b knockdown reduced the abundance of mature myostatin protein. Conclusions We conclude that (1), sexual dimorphism persists in Stat5b-null mice, (2) both Stat5a and Stat5b have essential signalling roles in skeletal muscle wherein Stat5a regulates AR and myostatin mRNA, Stat5b regulates myostatin protein and both Stat5a and Stat5b independently, or a heterodimer between the two, regulate IGF-1, IGF-1R and GHR. Sugary drinks and the risk of gout: evidence for SLC2A9 gene interaction Batt C1, Phipps-Green AJ1, Black MA1, Cadzow M1, Merriman ME1, Topless R1, Gow P2, Harrison A1, Highton J1, Jones PB3, Stamp L1, Dalbeth N3 and Merriman TR1 University of Otago, Dunedin, NZ Department of Rheumatology, Middlemore Hospital, Auckland, NZ University of Auckland, Auckland, NZ. Objective To test for an association between consumption of drinks sweetened with sucrose (sugar-sweetened beverages, SSB) and prevalent gout among New Zealanders of European, Maori or Pacific descent. To test the hypothesis that genetic variants in the urate transporter gene SLC2A9 interact with SSB consumption to predict the risk of gout. Methods Participants were recruited from the community in Auckland, Waikato, Bay of Plenty, Wellington region, Christchurch and Dunedin. There were 1634 New Zealand (NZ) European Caucasian, Mori and Pacific Island people and 7075 European Caucasians from the Atherosclerosis Risk in Communities (ARIC) study. NZ samples were genotyped for rs11942223 and ARIC for rs6449173. Effect estimates were multivariate adjusted. Participants self-reported their daily consumption of SSB among other dietary information, and also recorded the occurrence of acute gouty arthritis. Results A gradient of gout risk was observed with increasing SSB consumption. Compared with zero intake, the odds ratios for 4 drinks/day were: 6.89 (P=0.045) for European Caucasian, 5.19 (P=0.010) for Maori and 2.84 (P=0.043) for Pacific Island people. In those carrying the gout protective allele SLC2A9 , there was a 15% increase in risk with each additional daily serving of SSB(P=0.078), compared to a 12% increase in non-carriers (P=0.002). The interaction term was significant in pooled (PInteraction=0.01) but not meta-analyzed (PInteraction=0.99) data. In ARIC, with each extra daily serving, a greater increase in serum urate protective allele carriers (0.005 (P=8.7x10-5) compared to 0.002 (P=0.016) mmol/L) supported the gout data (PInteraction=0.062). Conclusion We found evidence of an environment-gene interaction between consumption of SSB and SLC2A9 in determining the risk of gout, suggesting that sucrose negates the protective effect of this allele. The data supports people with gout limiting consumption of sugary drinks. The impact of waiting time for elective surgery on the growth of periocular basal cell carcinomas Sheck LHN1, Tan E2, Lin FPY3, Mortimer NJ2, Salmon PJ2, Ng SGJ1 Eye Department, Waikato Hospital, Hamilton, New Zealand Skin Cancer Institute, Dermatologic Surgical Unit, Tauranga, New Zealand Department of Medicine, Waikato Hospital, Hamilton, New Zealand, and Centre for Health Informatics, University of New South Wales, Sydney, Australia Aim To investigate the growth of periocular basal cell carcinomas (pBCC) while awaiting excision. Methods A prospective cohort study of patients with pBCC during a 24 month period at a public hospital and a private clinic. All patients underwent tumour excision by Mohs micrographic surgery and reconstruction. Demographic data, clinical photographs, tumour size at initial visit and at time of excision, histological subtype, resulting defect size, and reconstruction technique were recorded. Results 112 consecutive patients were recruited. The mean age was 73 years, with 54% male. 63% of all patients were treated in the public hospital. There was a significant difference in waiting time for surgery between public and private patients (median 143.5 days public, 62 days private, p<0.005). In all patients, there was a significant difference in tumour size between their initial assessments and at the time of excision. (37.7mm2 at the initial assessment versus 51.8 mm2 at time of excision, p<0.001), but there was no statistically significant difference between the public and private patients. The median growth rate of the pBCC was 2.92mm2 per 30 days, and the risk factors for a faster growth rate were male sex (OR 2.99, p=0.018) and recurrent tumours (OR 3.56, p=0.037). The effect of histological subtype of the pBCC and the technique used for lid reconstruction were analysed. Conclusions In this group of patients, there was a significant increase in the size of pBCC while awaiting treatment. Due to more rapid growth rates, delays in surgery should particularly be avoided in men with pBCC & recurrent pBCC. Bleeding risk in elderly STEMI patients post thrombolysis with Ticagrelor Lee M, Pera V, Nuriman A, Devlin G Aims Randomised controlled trials showed a significant mortality benefit with Ticagrelor over Clopidogrel following an Acute Coronary Syndrome (ACS), but due to concerns with increased bleeding, ST Elevation Myocardial Infarctions (STEMI) receiving thrombolysis were excluded. We report our experience with the use of Ticagrelor and Clopidogrel in thrombolysed STEMI patients at Waikato Hospital, New Zealand. Methods We retrospectively audited 97 patients post thrombolysis with STEMIs from 1st January to the 31st of October 2012. Patients who had anti-platelet therapy withheld while awaiting surgical revascularisation were excluded. Results There were no significant baseline differences between Clopidogrel (n=49) and Ticagrelor (n=48) groups. Bleeding complications occurred exclusively in the Ticagrelor treated group but this was not significant. In a subgroup analysis of elderly patients aged >80 years (Clopidogrel n=7, Ticagrelor n=4), we found a statistically increased number of bleeds for patients on Ticagrelor (p=0.047). Conclusions Real world experiences with Ticagrelor show safety in younger patients but caution is recommended in thrombolysed elderly patients due to an increased risk of bleeding compared to Clopidogrel.

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Comparison of referral rates and diagnosis of axial spondyloarthritis before and after an ankylosing spondylitis public awareness campaign White D, Badenhorst C Objectives To measure the effect of a national ankylosing spondylitis (AS) public awareness campaign on numbers of referrals for suspected AS and numbers of cases diagnosed with axial spondyloarthritis (SpA) in three New Zealand rheumatology services. Methods A television and newspaper advertising campaign was conducted by Arthritis New Zealand in 2011 to raise public awareness of AS. The reach of the campaign was measured using target audience rating point (TARP) analysis. A retrospective analysis was made of referrals received by the rheumatology services based in three centres in the three months before the campaign started and the three months after the campaign ended. Total number of referrals received, number of referrals for suspected AS, number of referrals resulting in a diagnosis of axial SpA, and age and gender of cases were recorded. Results Target audience rating point analysis indicated that the awareness campaign would have been viewed by 82% of young men between the ages of 18 and 40, and 88% of all people between the ages of 20 and 54. In the three months after the awareness campaign there was a significant increase (54 v 88, 63%, p = 0.0056) in referrals for suspected AS compared with the three months before the campaign. Referrals for other conditions remained constant over the same period. The number of referrals resulting in a diagnosis of axial SpA also increased (27 v 44, 63%, p = 0.0576). The mean ages of patients referred and of those diagnosed with axial SpA did not change before and after the campaign. The male:female ratio was 1:1 among referrals for suspected AS and 2:1 in referrals diagnosed with axial SpA, before and after the campaign. Conclusion The Arthritis New Zealand AS public awareness campaign was associated with a significant increase in referrals to rheumatology services for suspected AS and increase in the diagnosis of axial SpA at the first clinic visit. Impact of ethnicity on cardiac admission with thyrotoxicosis Tamatea JAU, Conaglen JV Elston MS Thyrotoxicosis is one of the most common endocrine disorders with a local incidence of 0.2%1. The majority of patients with thyrotoxicosis have either Graves disease (autoimmune thyrotoxicosis due to the presence of antibodies which stimulate the TSH receptor) or a toxic multinodular goitre (TMNG). Cardiac complications of thyrotoxicosis commonly include ischaemia, dysrhythmia and congestive heart failure (CHF)2. Mori are over-represented in cardiac admissions3, and an Australian group have raised the question of a relationship between Mori ethnicity and cardiac admissions3. However the relationship between thyrotoxicosis and cardiac admission has not been assessed in Aotearoa. We carried out a retrospective review of all patients admitted to Waikato Hospital with cardiac complications of thyrotoxicosis between January 2005 and August 2012. Mori were over-represented within the group (38%) when compared to DHB population (18%). Mori patients were 12 years younger (66yrs vs 54yrs; p=0.01), were more likely to be admitted with CHF (21.7% vs 57.1%; p=0.01) and had an association with higher T4 levels (p=0.022). References: Gibbons V, Conaglen JV, Lillis S, Naras V, & Lawrenson R. Epidemiology of thyroid disease in Hamilton (New Zealand) general practice. ANZ J Pub Health 2008;32:421-423. Curtis et al. Cardiovascular disease section. Hauora: Mori Standards of Health IV 2000-2005. Nigram P & Morton A. Are Mori women at increased risk of cardiac complications of Graves disease? NZMJ 2012;125:90-2 Impacts on couples of prostate cancer diagnosis & treatment Helen M Conaglen1, Charis Brown1, John V Conaglen1, Ross Lawrenson1,2. University of Auckland, Waikato Clinical School, Hamilton, New Zealand Waikato Hospital, Hamilton, New Zealand Background Carcinoma of the Prostate (CaP) is common with the diagnosis and treatment affecting not only the man but also his partner. Problems for couples with CaP have been outlined in clinical reports but seldom formally studied. Women have been reported to be as affected by some psychological problems as their CaP partner. Aim To investigate the psychosocial impact of CaP on couples. Method This cross-sectional study investigated psychological and sexual function in a sample of 54 heterosexual couples, 2-6 years following CaP diagnosis and treatment. Couples completed the HADS, a stress scale, DAS, SIS and the FSFI-SF or IIEF-SF; couples scores were correlated, and comparison made with population standards to understand the impact of CaP on couples. Results Most couples reported that chances of sexual problems were somewhat or very important in choosing a treatment option for their CaP. Psychological distress (HADS) was significant in 30% of the women and 15% of men in the study. Stress was at higher levels than in the normal population. Despite this most couples were well-adjusted with 87-90% reporting relationships as happy, very happy, extremely happy, or perfect. Women reported social intimacy levels comparable women presenting for marital therapy. 50% of women experienced sexual dysfunction and 21% were sexually dissatisfied. Of the men who completed IIEF-SF, 85% had erectile problems. Womens psychological stress/distress correlated with their partners sexual function scores. Conclusion The impact of CaP and its various treatments affects partners as much as the men with the diagnosis. Further studies of the impact of CaP on partners are required to develop suitable treatment options for the couple affected by this disease. Intestinal bacterial colonisation patterns in very low birth weight preterm infants Thirayan V, Mansell C, Nair A Background Preterm, very low birth weight (VLBW <1500 g) infants often remain hospitalised in neonatal intensive care units for prolonged periods and are exposed to a variety of factors including antibiotics and formula feeds which may affect the composition of the intestinal microbiota compared to their term born peers. Growth, development and gut related morbidity in VLBW infants might be partly related to an altered intestinal bacterial colonisation pattern. In full term breast-fed infants Bifidobacterium spp are numerically dominant, which is presumed to be beneficial, while Clostridium spp, Bacteroides spp and facultative anaerobes such as Enterobacteriaceae and enterococci are found in relatively lower numbers. Recent reports indicate that administering probiotics to VLBW babies can potentially alter their intestinal colonisation pattern to achieve similar patterns to breast-fed full term babies. This may in turn help reduce necrotising enterocolitis, infection and mortality rates in the short term and may have long term benefits in the form of better growth, feed tolerance and reduction in allergy in these babies. Type of Study Prospective observational study Objective To characterise the bacterial colonisation pattern in serially collected stool samples from VLBW infants within the first few weeks of life to help define the natural history of succession in these babies at Waikato Hospital, in the absence of probiotic therapy. Patients & Methods Serial stool specimens from VLBW babies were collected at approximately 1-week intervals postnatally for the study duration of 10 weeks. Pure cultures of aerobic and anaerobic isolates were identified by Matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF). Bacterial diversity was assessed by numbers of distinct species identified and numbers were quantitatively expressed in CFU/g for analysis. Data were analysed by week of infant age, relative to patient demographics, antibiotic exposure and feeding patterns. Results The average number of species per VLBW infant (n=11) increased from 2 to 9.7 between week 1 and 10 after delivery, respectively. The average number of species of skin organisms per infant decreased from 4 to 1.7; Enterobactericeae increased from 1.5 to 3.7; enteric streptococci from 1.5 to 3.7 and anaerobes increased from 0 to 2, only between week 2 and 10. 243 species were identified across the first 10 weeks of life. Staphylococcus epidermidis (13%), Enterococcus faecalis (9%), Klebsiella oxytoca (9%) and Escherichia coli (6%) were the most frequently isolated species. Beneficial species, included Bifidobacterium breve (0.8%), dentium (0.8%) and longum (0.8%) and Lactobacillus paracasei (0.4%), were found only between week 4 and 8. Micrococcus luteus and Bacillus cereus were found only in week 1. The most frequently identified bacterial organisms in week 5 were S. epidermidis (12%), E. faecalis (11%), K. oxytoca (7%), S. aureus (5%), E. coli (5%),K. pneumonia (5%) and Citrobacter freundii (4%); and in week 10 were C. freundii (10%), E. coli (10%), K. oxytoca (10%), E. faecalis (10%) and Veillonella parvula (10%). Average CFU/ml/infant increased between week 1 and 10 from 2 X 106 to 3.6 X 1011. K. oxytoca was the most numerous species (94% of all cfu/ml). In week 5, the most numerous species was Klebsiella pneumonia (36%), B. breve (12%) , C. freundii (7%) and E. faecalis (7%); and in week 10, the most numerous species was K. oxytoca (86%) and S. aureus (11%). Beneficial organisms accounted for 0.3% of all growth across the study. Conclusions Breast-fed VLBW infants are colonised in succession. As the gut develops, skin and environmental organisms decrease and the numbers of Enterobactericeae, enteric streptococci and anaerobes increase. S. epidermidis was the most frequently isolated species and K. oxytoca was the most numerous. Lactobacillus and Bifidobacterium species were infrequently isolated. A follow up study, using the same methodology, is planned to assess the effect of introduction of probiotic therapy from March 2013 at the Waikato Neonatal Intensive Care Unit. Characteristics of men diagnosed with prostate cancer in New Zealand general practice Obertov\u00e1 Z, Hodgson F, Holmes M, Brown C, Lawrenson R Objective to identify new cases of prostate cancer in a cohort of men enrolled in general practices in the Midlands Cancer Network region. Methods The study population included 35,734 men aged 40+ years enrolled in 31 general practices in the Midland Cancer Network region. Computerised practice records, New Zealand Cancer Registry and local laboratory data were searched for new diagnoses of prostate cancer in men who had a prostate-specific antigen (PSA) test between 1 January and 31 December 2010. Biopsy information was obtained from local laboratories and cross-referenced with practice records. PSA level at referral, Gleason sum and clinical stage were noted when available. In addition, information about treatment following cancer diagnosis was obtained from the practice records. Results There were 172 men diagnosed with prostate cancer in 2010/2011 following a PSA test. Twenty nine men (17%) were diagnosed following screening. The majority of men (59%) were diagnosed with a Gleason sum of 6, while 67% had PSA level at referral lower than 10 ng/ml and 69% had a clinical stage of T1c or T2. More than one-quarter of the diagnosed men have been treated with a radical prostatectomy but a proportion are managed with watchful waiting or active surveillance. Conclusion Most men were diagnosed with low-risk prostate cancer. Only a small proportion of men were diagnosed following screening. The number of men with prostate cancer who are managed in general practice is steadily increasing, therefore it is necessary to establish guidelines that would help GPs to provide high-quality care for these men. SDHB malignant paragangliomas: management in pregnancy Wing L, Conaglen JV, Meyer Rochow GY, Elston MS Department of Endocrinology, Waikato Hospital Management of phaeochromocytoma/paraganglioma in pregnancy raises both diagnostic and therapeutic challenges. In the 1970s fetal and maternal mortality rates were as high as 50% for pregnancies complicated by phaeochromocytoma. Improved perinatal care for these patients has resulted in better survival for these high risk pregnancies although there still remains a significant maternal and fetal mortality of 2% and 10%, respectively. We present a local series of eight pregnancies in four women with functioning paragangliomas during pregnancy and discuss issues regarding diagnosis, management and outcome. Management of phaeochromocytoma during pregnancy presents a difficult balance between the critical need for adequate adrenergic blockade, while not compromising placental blood flow. Careful planning for delivery is necessary in order to minimise maternal and fetal risk. The optimal method of delivery is usually caesarean section as it is associated with lower maternal mortality. Invasive monitoring of the mother is required in order to monitor for haemodynamic instability. Stat5a and Stat5b in the regulation of sexually dimorphic growth Ryan G Paul1, Marianne S Elston1, Chris D McMahon2, John V Conaglen1. Waikato Clinical School, Department of Medicine, University of Auckland, Hamilton, New Zealand. AgResearch, Ruakura, New Zealand. Introduction Growth hormone (GH) regulates insulin-like growth factor one (IGF-1) production predominantly through the intracellular signallers Stat5a and Stat5b. Loss of Stat5b results in reduced production of liver IGF-1 and loss of sexually dimorphic growth in males. However, no study has observed the phenotype beyond twelve weeks, or looked at normalised muscle mass and fat mass. Methods The hindlimb muscles and abdominal fat of male and female Stat5b knockout mice and wild type mice were collected at 6, 12 and 24 weeks of age (n=16 per time and sex). Muscle mass was normalised to tibia length and abdominal fat mass was normalised to body mass. C2C12 myoblast cell lines were treated with viral Stat5b siRNA, Stat5a siRNA or a scrambled vector as a control, then differentiated and treated with 100ng/mL of GH for 24 hours. RNA and protein were harvested for quantitative PCR and Western blotting. Results Nose-to-tail length, tibia length and normalised hindlimb muscle mass were decreased to a greater extent in male (29.8%) than in female (11.5%) Stat5b knockout mice versus wild type mice at all ages (P <0.001). Both male and female Stat5b knockout mice had a greater abundance of abdominal fat than wild type mice at 24 weeks (P <0.05). Individual Stat5a and Stat5b knockdown both blocked the GH induced increase in IGF-1, IGF-1R and GHR mRNA. Additionally Stat5a knockdown blocked the increase in AR mRNA and decrease in myostatin mRNA . Stat5b knockdown reduced the abundance of mature myostatin protein. Conclusions We conclude that (1), sexual dimorphism persists in Stat5b-null mice, (2) both Stat5a and Stat5b have essential signalling roles in skeletal muscle wherein Stat5a regulates AR and myostatin mRNA, Stat5b regulates myostatin protein and both Stat5a and Stat5b independently, or a heterodimer between the two, regulate IGF-1, IGF-1R and GHR. Sugary drinks and the risk of gout: evidence for SLC2A9 gene interaction Batt C1, Phipps-Green AJ1, Black MA1, Cadzow M1, Merriman ME1, Topless R1, Gow P2, Harrison A1, Highton J1, Jones PB3, Stamp L1, Dalbeth N3 and Merriman TR1 University of Otago, Dunedin, NZ Department of Rheumatology, Middlemore Hospital, Auckland, NZ University of Auckland, Auckland, NZ. Objective To test for an association between consumption of drinks sweetened with sucrose (sugar-sweetened beverages, SSB) and prevalent gout among New Zealanders of European, Maori or Pacific descent. To test the hypothesis that genetic variants in the urate transporter gene SLC2A9 interact with SSB consumption to predict the risk of gout. Methods Participants were recruited from the community in Auckland, Waikato, Bay of Plenty, Wellington region, Christchurch and Dunedin. There were 1634 New Zealand (NZ) European Caucasian, Mori and Pacific Island people and 7075 European Caucasians from the Atherosclerosis Risk in Communities (ARIC) study. NZ samples were genotyped for rs11942223 and ARIC for rs6449173. Effect estimates were multivariate adjusted. Participants self-reported their daily consumption of SSB among other dietary information, and also recorded the occurrence of acute gouty arthritis. Results A gradient of gout risk was observed with increasing SSB consumption. Compared with zero intake, the odds ratios for 4 drinks/day were: 6.89 (P=0.045) for European Caucasian, 5.19 (P=0.010) for Maori and 2.84 (P=0.043) for Pacific Island people. In those carrying the gout protective allele SLC2A9 , there was a 15% increase in risk with each additional daily serving of SSB(P=0.078), compared to a 12% increase in non-carriers (P=0.002). The interaction term was significant in pooled (PInteraction=0.01) but not meta-analyzed (PInteraction=0.99) data. In ARIC, with each extra daily serving, a greater increase in serum urate protective allele carriers (0.005 (P=8.7x10-5) compared to 0.002 (P=0.016) mmol/L) supported the gout data (PInteraction=0.062). Conclusion We found evidence of an environment-gene interaction between consumption of SSB and SLC2A9 in determining the risk of gout, suggesting that sucrose negates the protective effect of this allele. The data supports people with gout limiting consumption of sugary drinks. The impact of waiting time for elective surgery on the growth of periocular basal cell carcinomas Sheck LHN1, Tan E2, Lin FPY3, Mortimer NJ2, Salmon PJ2, Ng SGJ1 Eye Department, Waikato Hospital, Hamilton, New Zealand Skin Cancer Institute, Dermatologic Surgical Unit, Tauranga, New Zealand Department of Medicine, Waikato Hospital, Hamilton, New Zealand, and Centre for Health Informatics, University of New South Wales, Sydney, Australia Aim To investigate the growth of periocular basal cell carcinomas (pBCC) while awaiting excision. Methods A prospective cohort study of patients with pBCC during a 24 month period at a public hospital and a private clinic. All patients underwent tumour excision by Mohs micrographic surgery and reconstruction. Demographic data, clinical photographs, tumour size at initial visit and at time of excision, histological subtype, resulting defect size, and reconstruction technique were recorded. Results 112 consecutive patients were recruited. The mean age was 73 years, with 54% male. 63% of all patients were treated in the public hospital. There was a significant difference in waiting time for surgery between public and private patients (median 143.5 days public, 62 days private, p<0.005). In all patients, there was a significant difference in tumour size between their initial assessments and at the time of excision. (37.7mm2 at the initial assessment versus 51.8 mm2 at time of excision, p<0.001), but there was no statistically significant difference between the public and private patients. The median growth rate of the pBCC was 2.92mm2 per 30 days, and the risk factors for a faster growth rate were male sex (OR 2.99, p=0.018) and recurrent tumours (OR 3.56, p=0.037). The effect of histological subtype of the pBCC and the technique used for lid reconstruction were analysed. Conclusions In this group of patients, there was a significant increase in the size of pBCC while awaiting treatment. Due to more rapid growth rates, delays in surgery should particularly be avoided in men with pBCC & recurrent pBCC. Bleeding risk in elderly STEMI patients post thrombolysis with Ticagrelor Lee M, Pera V, Nuriman A, Devlin G Aims Randomised controlled trials showed a significant mortality benefit with Ticagrelor over Clopidogrel following an Acute Coronary Syndrome (ACS), but due to concerns with increased bleeding, ST Elevation Myocardial Infarctions (STEMI) receiving thrombolysis were excluded. We report our experience with the use of Ticagrelor and Clopidogrel in thrombolysed STEMI patients at Waikato Hospital, New Zealand. Methods We retrospectively audited 97 patients post thrombolysis with STEMIs from 1st January to the 31st of October 2012. Patients who had anti-platelet therapy withheld while awaiting surgical revascularisation were excluded. Results There were no significant baseline differences between Clopidogrel (n=49) and Ticagrelor (n=48) groups. Bleeding complications occurred exclusively in the Ticagrelor treated group but this was not significant. In a subgroup analysis of elderly patients aged >80 years (Clopidogrel n=7, Ticagrelor n=4), we found a statistically increased number of bleeds for patients on Ticagrelor (p=0.047). Conclusions Real world experiences with Ticagrelor show safety in younger patients but caution is recommended in thrombolysed elderly patients due to an increased risk of bleeding compared to Clopidogrel.

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Comparison of referral rates and diagnosis of axial spondyloarthritis before and after an ankylosing spondylitis public awareness campaign White D, Badenhorst C Objectives To measure the effect of a national ankylosing spondylitis (AS) public awareness campaign on numbers of referrals for suspected AS and numbers of cases diagnosed with axial spondyloarthritis (SpA) in three New Zealand rheumatology services. Methods A television and newspaper advertising campaign was conducted by Arthritis New Zealand in 2011 to raise public awareness of AS. The reach of the campaign was measured using target audience rating point (TARP) analysis. A retrospective analysis was made of referrals received by the rheumatology services based in three centres in the three months before the campaign started and the three months after the campaign ended. Total number of referrals received, number of referrals for suspected AS, number of referrals resulting in a diagnosis of axial SpA, and age and gender of cases were recorded. Results Target audience rating point analysis indicated that the awareness campaign would have been viewed by 82% of young men between the ages of 18 and 40, and 88% of all people between the ages of 20 and 54. In the three months after the awareness campaign there was a significant increase (54 v 88, 63%, p = 0.0056) in referrals for suspected AS compared with the three months before the campaign. Referrals for other conditions remained constant over the same period. The number of referrals resulting in a diagnosis of axial SpA also increased (27 v 44, 63%, p = 0.0576). The mean ages of patients referred and of those diagnosed with axial SpA did not change before and after the campaign. The male:female ratio was 1:1 among referrals for suspected AS and 2:1 in referrals diagnosed with axial SpA, before and after the campaign. Conclusion The Arthritis New Zealand AS public awareness campaign was associated with a significant increase in referrals to rheumatology services for suspected AS and increase in the diagnosis of axial SpA at the first clinic visit. Impact of ethnicity on cardiac admission with thyrotoxicosis Tamatea JAU, Conaglen JV Elston MS Thyrotoxicosis is one of the most common endocrine disorders with a local incidence of 0.2%1. The majority of patients with thyrotoxicosis have either Graves disease (autoimmune thyrotoxicosis due to the presence of antibodies which stimulate the TSH receptor) or a toxic multinodular goitre (TMNG). Cardiac complications of thyrotoxicosis commonly include ischaemia, dysrhythmia and congestive heart failure (CHF)2. Mori are over-represented in cardiac admissions3, and an Australian group have raised the question of a relationship between Mori ethnicity and cardiac admissions3. However the relationship between thyrotoxicosis and cardiac admission has not been assessed in Aotearoa. We carried out a retrospective review of all patients admitted to Waikato Hospital with cardiac complications of thyrotoxicosis between January 2005 and August 2012. Mori were over-represented within the group (38%) when compared to DHB population (18%). Mori patients were 12 years younger (66yrs vs 54yrs; p=0.01), were more likely to be admitted with CHF (21.7% vs 57.1%; p=0.01) and had an association with higher T4 levels (p=0.022). References: Gibbons V, Conaglen JV, Lillis S, Naras V, & Lawrenson R. Epidemiology of thyroid disease in Hamilton (New Zealand) general practice. ANZ J Pub Health 2008;32:421-423. Curtis et al. Cardiovascular disease section. Hauora: Mori Standards of Health IV 2000-2005. Nigram P & Morton A. Are Mori women at increased risk of cardiac complications of Graves disease? NZMJ 2012;125:90-2 Impacts on couples of prostate cancer diagnosis & treatment Helen M Conaglen1, Charis Brown1, John V Conaglen1, Ross Lawrenson1,2. University of Auckland, Waikato Clinical School, Hamilton, New Zealand Waikato Hospital, Hamilton, New Zealand Background Carcinoma of the Prostate (CaP) is common with the diagnosis and treatment affecting not only the man but also his partner. Problems for couples with CaP have been outlined in clinical reports but seldom formally studied. Women have been reported to be as affected by some psychological problems as their CaP partner. Aim To investigate the psychosocial impact of CaP on couples. Method This cross-sectional study investigated psychological and sexual function in a sample of 54 heterosexual couples, 2-6 years following CaP diagnosis and treatment. Couples completed the HADS, a stress scale, DAS, SIS and the FSFI-SF or IIEF-SF; couples scores were correlated, and comparison made with population standards to understand the impact of CaP on couples. Results Most couples reported that chances of sexual problems were somewhat or very important in choosing a treatment option for their CaP. Psychological distress (HADS) was significant in 30% of the women and 15% of men in the study. Stress was at higher levels than in the normal population. Despite this most couples were well-adjusted with 87-90% reporting relationships as happy, very happy, extremely happy, or perfect. Women reported social intimacy levels comparable women presenting for marital therapy. 50% of women experienced sexual dysfunction and 21% were sexually dissatisfied. Of the men who completed IIEF-SF, 85% had erectile problems. Womens psychological stress/distress correlated with their partners sexual function scores. Conclusion The impact of CaP and its various treatments affects partners as much as the men with the diagnosis. Further studies of the impact of CaP on partners are required to develop suitable treatment options for the couple affected by this disease. Intestinal bacterial colonisation patterns in very low birth weight preterm infants Thirayan V, Mansell C, Nair A Background Preterm, very low birth weight (VLBW <1500 g) infants often remain hospitalised in neonatal intensive care units for prolonged periods and are exposed to a variety of factors including antibiotics and formula feeds which may affect the composition of the intestinal microbiota compared to their term born peers. Growth, development and gut related morbidity in VLBW infants might be partly related to an altered intestinal bacterial colonisation pattern. In full term breast-fed infants Bifidobacterium spp are numerically dominant, which is presumed to be beneficial, while Clostridium spp, Bacteroides spp and facultative anaerobes such as Enterobacteriaceae and enterococci are found in relatively lower numbers. Recent reports indicate that administering probiotics to VLBW babies can potentially alter their intestinal colonisation pattern to achieve similar patterns to breast-fed full term babies. This may in turn help reduce necrotising enterocolitis, infection and mortality rates in the short term and may have long term benefits in the form of better growth, feed tolerance and reduction in allergy in these babies. Type of Study Prospective observational study Objective To characterise the bacterial colonisation pattern in serially collected stool samples from VLBW infants within the first few weeks of life to help define the natural history of succession in these babies at Waikato Hospital, in the absence of probiotic therapy. Patients & Methods Serial stool specimens from VLBW babies were collected at approximately 1-week intervals postnatally for the study duration of 10 weeks. Pure cultures of aerobic and anaerobic isolates were identified by Matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF). Bacterial diversity was assessed by numbers of distinct species identified and numbers were quantitatively expressed in CFU/g for analysis. Data were analysed by week of infant age, relative to patient demographics, antibiotic exposure and feeding patterns. Results The average number of species per VLBW infant (n=11) increased from 2 to 9.7 between week 1 and 10 after delivery, respectively. The average number of species of skin organisms per infant decreased from 4 to 1.7; Enterobactericeae increased from 1.5 to 3.7; enteric streptococci from 1.5 to 3.7 and anaerobes increased from 0 to 2, only between week 2 and 10. 243 species were identified across the first 10 weeks of life. Staphylococcus epidermidis (13%), Enterococcus faecalis (9%), Klebsiella oxytoca (9%) and Escherichia coli (6%) were the most frequently isolated species. Beneficial species, included Bifidobacterium breve (0.8%), dentium (0.8%) and longum (0.8%) and Lactobacillus paracasei (0.4%), were found only between week 4 and 8. Micrococcus luteus and Bacillus cereus were found only in week 1. The most frequently identified bacterial organisms in week 5 were S. epidermidis (12%), E. faecalis (11%), K. oxytoca (7%), S. aureus (5%), E. coli (5%),K. pneumonia (5%) and Citrobacter freundii (4%); and in week 10 were C. freundii (10%), E. coli (10%), K. oxytoca (10%), E. faecalis (10%) and Veillonella parvula (10%). Average CFU/ml/infant increased between week 1 and 10 from 2 X 106 to 3.6 X 1011. K. oxytoca was the most numerous species (94% of all cfu/ml). In week 5, the most numerous species was Klebsiella pneumonia (36%), B. breve (12%) , C. freundii (7%) and E. faecalis (7%); and in week 10, the most numerous species was K. oxytoca (86%) and S. aureus (11%). Beneficial organisms accounted for 0.3% of all growth across the study. Conclusions Breast-fed VLBW infants are colonised in succession. As the gut develops, skin and environmental organisms decrease and the numbers of Enterobactericeae, enteric streptococci and anaerobes increase. S. epidermidis was the most frequently isolated species and K. oxytoca was the most numerous. Lactobacillus and Bifidobacterium species were infrequently isolated. A follow up study, using the same methodology, is planned to assess the effect of introduction of probiotic therapy from March 2013 at the Waikato Neonatal Intensive Care Unit. Characteristics of men diagnosed with prostate cancer in New Zealand general practice Obertov\u00e1 Z, Hodgson F, Holmes M, Brown C, Lawrenson R Objective to identify new cases of prostate cancer in a cohort of men enrolled in general practices in the Midlands Cancer Network region. Methods The study population included 35,734 men aged 40+ years enrolled in 31 general practices in the Midland Cancer Network region. Computerised practice records, New Zealand Cancer Registry and local laboratory data were searched for new diagnoses of prostate cancer in men who had a prostate-specific antigen (PSA) test between 1 January and 31 December 2010. Biopsy information was obtained from local laboratories and cross-referenced with practice records. PSA level at referral, Gleason sum and clinical stage were noted when available. In addition, information about treatment following cancer diagnosis was obtained from the practice records. Results There were 172 men diagnosed with prostate cancer in 2010/2011 following a PSA test. Twenty nine men (17%) were diagnosed following screening. The majority of men (59%) were diagnosed with a Gleason sum of 6, while 67% had PSA level at referral lower than 10 ng/ml and 69% had a clinical stage of T1c or T2. More than one-quarter of the diagnosed men have been treated with a radical prostatectomy but a proportion are managed with watchful waiting or active surveillance. Conclusion Most men were diagnosed with low-risk prostate cancer. Only a small proportion of men were diagnosed following screening. The number of men with prostate cancer who are managed in general practice is steadily increasing, therefore it is necessary to establish guidelines that would help GPs to provide high-quality care for these men. SDHB malignant paragangliomas: management in pregnancy Wing L, Conaglen JV, Meyer Rochow GY, Elston MS Department of Endocrinology, Waikato Hospital Management of phaeochromocytoma/paraganglioma in pregnancy raises both diagnostic and therapeutic challenges. In the 1970s fetal and maternal mortality rates were as high as 50% for pregnancies complicated by phaeochromocytoma. Improved perinatal care for these patients has resulted in better survival for these high risk pregnancies although there still remains a significant maternal and fetal mortality of 2% and 10%, respectively. We present a local series of eight pregnancies in four women with functioning paragangliomas during pregnancy and discuss issues regarding diagnosis, management and outcome. Management of phaeochromocytoma during pregnancy presents a difficult balance between the critical need for adequate adrenergic blockade, while not compromising placental blood flow. Careful planning for delivery is necessary in order to minimise maternal and fetal risk. The optimal method of delivery is usually caesarean section as it is associated with lower maternal mortality. Invasive monitoring of the mother is required in order to monitor for haemodynamic instability. Stat5a and Stat5b in the regulation of sexually dimorphic growth Ryan G Paul1, Marianne S Elston1, Chris D McMahon2, John V Conaglen1. Waikato Clinical School, Department of Medicine, University of Auckland, Hamilton, New Zealand. AgResearch, Ruakura, New Zealand. Introduction Growth hormone (GH) regulates insulin-like growth factor one (IGF-1) production predominantly through the intracellular signallers Stat5a and Stat5b. Loss of Stat5b results in reduced production of liver IGF-1 and loss of sexually dimorphic growth in males. However, no study has observed the phenotype beyond twelve weeks, or looked at normalised muscle mass and fat mass. Methods The hindlimb muscles and abdominal fat of male and female Stat5b knockout mice and wild type mice were collected at 6, 12 and 24 weeks of age (n=16 per time and sex). Muscle mass was normalised to tibia length and abdominal fat mass was normalised to body mass. C2C12 myoblast cell lines were treated with viral Stat5b siRNA, Stat5a siRNA or a scrambled vector as a control, then differentiated and treated with 100ng/mL of GH for 24 hours. RNA and protein were harvested for quantitative PCR and Western blotting. Results Nose-to-tail length, tibia length and normalised hindlimb muscle mass were decreased to a greater extent in male (29.8%) than in female (11.5%) Stat5b knockout mice versus wild type mice at all ages (P <0.001). Both male and female Stat5b knockout mice had a greater abundance of abdominal fat than wild type mice at 24 weeks (P <0.05). Individual Stat5a and Stat5b knockdown both blocked the GH induced increase in IGF-1, IGF-1R and GHR mRNA. Additionally Stat5a knockdown blocked the increase in AR mRNA and decrease in myostatin mRNA . Stat5b knockdown reduced the abundance of mature myostatin protein. Conclusions We conclude that (1), sexual dimorphism persists in Stat5b-null mice, (2) both Stat5a and Stat5b have essential signalling roles in skeletal muscle wherein Stat5a regulates AR and myostatin mRNA, Stat5b regulates myostatin protein and both Stat5a and Stat5b independently, or a heterodimer between the two, regulate IGF-1, IGF-1R and GHR. Sugary drinks and the risk of gout: evidence for SLC2A9 gene interaction Batt C1, Phipps-Green AJ1, Black MA1, Cadzow M1, Merriman ME1, Topless R1, Gow P2, Harrison A1, Highton J1, Jones PB3, Stamp L1, Dalbeth N3 and Merriman TR1 University of Otago, Dunedin, NZ Department of Rheumatology, Middlemore Hospital, Auckland, NZ University of Auckland, Auckland, NZ. Objective To test for an association between consumption of drinks sweetened with sucrose (sugar-sweetened beverages, SSB) and prevalent gout among New Zealanders of European, Maori or Pacific descent. To test the hypothesis that genetic variants in the urate transporter gene SLC2A9 interact with SSB consumption to predict the risk of gout. Methods Participants were recruited from the community in Auckland, Waikato, Bay of Plenty, Wellington region, Christchurch and Dunedin. There were 1634 New Zealand (NZ) European Caucasian, Mori and Pacific Island people and 7075 European Caucasians from the Atherosclerosis Risk in Communities (ARIC) study. NZ samples were genotyped for rs11942223 and ARIC for rs6449173. Effect estimates were multivariate adjusted. Participants self-reported their daily consumption of SSB among other dietary information, and also recorded the occurrence of acute gouty arthritis. Results A gradient of gout risk was observed with increasing SSB consumption. Compared with zero intake, the odds ratios for 4 drinks/day were: 6.89 (P=0.045) for European Caucasian, 5.19 (P=0.010) for Maori and 2.84 (P=0.043) for Pacific Island people. In those carrying the gout protective allele SLC2A9 , there was a 15% increase in risk with each additional daily serving of SSB(P=0.078), compared to a 12% increase in non-carriers (P=0.002). The interaction term was significant in pooled (PInteraction=0.01) but not meta-analyzed (PInteraction=0.99) data. In ARIC, with each extra daily serving, a greater increase in serum urate protective allele carriers (0.005 (P=8.7x10-5) compared to 0.002 (P=0.016) mmol/L) supported the gout data (PInteraction=0.062). Conclusion We found evidence of an environment-gene interaction between consumption of SSB and SLC2A9 in determining the risk of gout, suggesting that sucrose negates the protective effect of this allele. The data supports people with gout limiting consumption of sugary drinks. The impact of waiting time for elective surgery on the growth of periocular basal cell carcinomas Sheck LHN1, Tan E2, Lin FPY3, Mortimer NJ2, Salmon PJ2, Ng SGJ1 Eye Department, Waikato Hospital, Hamilton, New Zealand Skin Cancer Institute, Dermatologic Surgical Unit, Tauranga, New Zealand Department of Medicine, Waikato Hospital, Hamilton, New Zealand, and Centre for Health Informatics, University of New South Wales, Sydney, Australia Aim To investigate the growth of periocular basal cell carcinomas (pBCC) while awaiting excision. Methods A prospective cohort study of patients with pBCC during a 24 month period at a public hospital and a private clinic. All patients underwent tumour excision by Mohs micrographic surgery and reconstruction. Demographic data, clinical photographs, tumour size at initial visit and at time of excision, histological subtype, resulting defect size, and reconstruction technique were recorded. Results 112 consecutive patients were recruited. The mean age was 73 years, with 54% male. 63% of all patients were treated in the public hospital. There was a significant difference in waiting time for surgery between public and private patients (median 143.5 days public, 62 days private, p<0.005). In all patients, there was a significant difference in tumour size between their initial assessments and at the time of excision. (37.7mm2 at the initial assessment versus 51.8 mm2 at time of excision, p<0.001), but there was no statistically significant difference between the public and private patients. The median growth rate of the pBCC was 2.92mm2 per 30 days, and the risk factors for a faster growth rate were male sex (OR 2.99, p=0.018) and recurrent tumours (OR 3.56, p=0.037). The effect of histological subtype of the pBCC and the technique used for lid reconstruction were analysed. Conclusions In this group of patients, there was a significant increase in the size of pBCC while awaiting treatment. Due to more rapid growth rates, delays in surgery should particularly be avoided in men with pBCC & recurrent pBCC. Bleeding risk in elderly STEMI patients post thrombolysis with Ticagrelor Lee M, Pera V, Nuriman A, Devlin G Aims Randomised controlled trials showed a significant mortality benefit with Ticagrelor over Clopidogrel following an Acute Coronary Syndrome (ACS), but due to concerns with increased bleeding, ST Elevation Myocardial Infarctions (STEMI) receiving thrombolysis were excluded. We report our experience with the use of Ticagrelor and Clopidogrel in thrombolysed STEMI patients at Waikato Hospital, New Zealand. Methods We retrospectively audited 97 patients post thrombolysis with STEMIs from 1st January to the 31st of October 2012. Patients who had anti-platelet therapy withheld while awaiting surgical revascularisation were excluded. Results There were no significant baseline differences between Clopidogrel (n=49) and Ticagrelor (n=48) groups. Bleeding complications occurred exclusively in the Ticagrelor treated group but this was not significant. In a subgroup analysis of elderly patients aged >80 years (Clopidogrel n=7, Ticagrelor n=4), we found a statistically increased number of bleeds for patients on Ticagrelor (p=0.047). Conclusions Real world experiences with Ticagrelor show safety in younger patients but caution is recommended in thrombolysed elderly patients due to an increased risk of bleeding compared to Clopidogrel.

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Method

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Conclusion

Author Information

Acknowledgements

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Competing Interests

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