Gender differences in hemostatic and inflammatory factors in patients with acute coronary syndromes: a pilot study

Many studies have shown gender differences in the progress of acute coronary syndromes (ACS). These differences include, amongst others, processes involved in hemostasis and inflammation, and in the present study we put forward the hypothesis that these are the primary cause of other differences. The study included 66 ACS patients (27 women and 39 men) aged 43 - 83 years, 23 with non-ST-elevation myocardial infarction (NSTEMI) and 43 with ST-elevation myocardial infarction (STEMI). Blood samples were taken on day 3 (NSTEMI) or day 5 (STEMI) after hospitalization, and fibrinogen, D-dimers, von Willebrand factor, C-reactive protein and interleukin-6 levels measured. Men, compared to women, had significantly higher levels of fibrinogen (STEMI: P = 0.028; NSTEMI: P = 0.008), C-reactive protein (STEMI: P <0.0001; NSTEMI: P = 0.004) and interleukin-6 with STEMI (P = 0.015), but a lower D-dimer concentration with NSTEMI (P = 0.042). In women fibrinogen concentration was significantly higher with STEMI compared to NSTEMI (P = 0.052). Significant correlations were found between hemostatic and proinflammatory factors, especially in men, regardless of ACS type. In addition, correlations between fibrinogen and D-dimers were found: negative for women (r = -0.67) ) and positive for men (r = +0.60), as was that between C-reactive protein and interleukin-6: women (r = -0.72); men (r = +0.56). Based on these findings, we conclude that acute coronary syndromes in men may be potentially related to inflammatory processes, as indicated by strong associations between elevated C-reactive protein, interleukin-6 and hyperfibrinogenemia, most clearly shown in STEMI. By contrast in women, factors possibly most important for the course of acute coronary syndrome are D-dimer concentrations and an increased turnover of fibrin with NSTEMI and hyperfibrinogenemia with STEMI.

Factors associated with treatment delays in pediatric refractory convulsive status epilepticus

OBJECTIVE

To identify factors associated with treatment delays in pediatric patients with convulsive refractory status epilepticus (rSE).

METHODS

This prospective, observational study was performed from June 2011 to March 2017 on pediatric patients (1 month to 21 years of age) with rSE. We evaluated potential factors associated with increased treatment delays in a Cox proportional hazards model.

RESULTS

We studied 219 patients (53% males) with a median (25th-75th percentiles [p₂₅-p₇₅]) age of 3.9 (1.2-9.5) years in whom rSE started out of hospital (141 [64.4%]) or in hospital (78 [35.6%]). The median (p₂₅-p₇₅) time from seizure onset to treatment was 16 (5-45) minutes to first benzodiazepine (BZD), 63 (33-146) minutes to first non-BZD antiepileptic drug (AED), and 170 (107-539) minutes to first continuous infusion. Factors associated with more delays to administration of the first BZD were intermittent rSE (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.14-2.09; p = 0.0467) and out-of-hospital rSE onset (HR 1.5, 95% CI 1.11-2.04; p = 0.0467). Factors associated with more delays to administration of the first non-BZD AED were intermittent rSE (HR 1.78, 95% CI 1.32-2.4; p = 0.001) and out-of-hospital rSE onset (HR 2.25, 95% CI 1.67-3.02; p < 0.0001). None of the studied factors were associated with a delayed administration of continuous infusion.

CONCLUSION

Intermittent rSE and out-of-hospital rSE onset are independently associated with longer delays to administration of the first BZD and the first non-BZD AED in pediatric rSE. These factors identify potential targets for intervention to reduce time to treatment.

Paediatric tuberculosis in Queensland, Australia: overrepresentation of cross-border and Indigenous children

SETTING

Queensland, Australia.

BACKGROUND

Understanding paediatric tuberculosis (TB) is important, as children with TB typically reflect recent community transmission. Children pose unique diagnostic challenges and are at risk of developing severe disseminated infection.

OBJECTIVE

To describe the epidemiology, presentation and outcomes of children with TB disease in Queensland.

DESIGN

This is a retrospective case series of children diagnosed with TB aged 0-16 years notified in 2005-2014. Data collected in the Queensland Notifiable Conditions System were extracted and analysed.

RESULTS

Of 127 children diagnosed with TB, 16 were Australian-born (including 12 Indigenous Queenslanders), 41 were overseas-born permanent and temporary residents and 70 were cross-border Papua New Guinea (PNG) children; 88 children had pulmonary disease (with/without other sites) and 39 had extra-pulmonary disease only, with lymph node TB the predominant extra-pulmonary site; 70.1% of children had laboratory confirmation; and 14 cross-border children had multidrug-resistant TB. Treatment outcomes among children residing in Australia were good (100% among Australian-born and 97.2% among permanent and temporary residents), but they were less favourable among PNG children diagnosed in the Torres Strait Protected Zone (76.6%).

CONCLUSION

Queensland has unique challenges in TB control, with a high proportion of cross-border diagnoses and over-representation of Indigenous children. Vigilance is needed given the wide spectrum of clinical presentation, particularly in high-risk communities.

Incremental exercise test performance with and without a respiratory gas collection system

Objective. Despite their widespread use in exercise testing, few data are available on the effect of wearing respiratory gas collection (RGC) systems on exercise test performance. Industrial-type mask wear is thought to impair exercise performance through increased respiratory dead space, flow resistance and/or discomfort when compared with RGC facemasks, but whether performance decrements exist for RGC facemask wear versus non-wear is unclear. The objective of this study was to evaluate the difference in incremental exercise test performance with and without a RGC system. Incremental exercise test performance with and without a respiratory gas collection system  Design. Twenty moderately active males (age 21.0 ± 1.9 years; VO2peak 55.9 ± 3.0 ml∙kg-1∙min-1) performed two progressive treadmill tests to volitional exhaustion. In random order subjects ran with (MASK) or without (NO-MASK) a RGC facemask and flow sensor connected to a gas analyzer. Descriptive data (mean ± SD) were determined for all parameters. The Wilcoxon signed rank test for paired differences was used to assess mean differences between MASK and NO-MASK conditions. Results. Exercise time to exhaustion, peak treadmill speed, peak blood lactate concentration, peak heart rate and rating of perceived exertion (RPE) were not different (p>0.05) between MASK and NO-MASK conditions. Conclusions. Incremental exercise test performance is not adversely affected by RGC and analysis equipment, at least in short duration progressive treadmill exercise. Respiratory gas analysis during exercise testing for diagnostic, performance assessment or training prescription purposes would appear to be unaffected by RGC systems.

Thioether-Catalysed Tandem Synthesis of Furans and Cyclic Ethers or Lactones

Acyclic conjugated ynenediones tethered to an alcohol or carboxylic acid are converted into furanyl-substituted cyclic ethers or lactones in a single step by treatment with the tetrahydrothiophene. Modest levels of diastereocontrol can be achieved in some cases where the presence of a substituent on the tether results in the creation of a second stereogenic centre upon formation of the cyclic ether or lactone.

Development towards a fast ion loss detector for the reversed field pinch

A fast ion loss detector has been constructed and implemented on the Madison Symmetric Torus (MST) to investigate energetic ion losses and transport due to energetic particle and MHD instabilities. The detector discriminates particle orbits solely on pitch and consists of two thin-foil, particle collecting plates that are symmetric with respect to the device aperture. One plate collects fast ion signal, while the second aids in the minimization of background and noise effects. Initial measurements are reported along with suggestions for the next design phase of the detector.

The origin of incipient ferroelectricity in lead telluride

The interactions between electrons and lattice vibrations are fundamental to materials behaviour. In the case of group IV–VI, V and related materials, these interactions are strong, and the materials exist near electronic and structural phase transitions. The prototypical example is PbTe whose incipient ferroelectric behaviour has been recently associated with large phonon anharmonicity and thermoelectricity. Here we show that it is primarily electron-phonon coupling involving electron states near the band edges that leads to the ferroelectric instability in PbTe. Using a combination of nonequilibrium lattice dynamics measurements and first principles calculations, we find that photoexcitation reduces the Peierls-like electronic instability and reinforces the paraelectric state. This weakens the long-range forces along the cubic direction tied to resonant bonding and low lattice thermal conductivity. Our results demonstrate how free-electron-laser-based ultrafast X-ray scattering can be utilized to shed light on the microscopic mechanisms that determine materials properties.

Group IV–VI materials often exist in a state near an electronic or structural phase transition. Here, the authors use ultrafast X-ray scattering to show that coupling of band-edge electrons and phonons causes the ferroelectric instability observed in lead telluride.

Production of Highly Polarized Positrons Using Polarized Electrons at MeV Energies

The Polarized Electrons for Polarized Positrons experiment at the injector of the Continuous Electron Beam Accelerator Facility has demonstrated for the first time the efficient transfer of polarization from electrons to positrons produced by the polarized bremsstrahlung radiation induced by a polarized electron beam in a high-Z target. Positron polarization up to 82% have been measured for an initial electron beam momentum of 8.19  MeV/c, limited only by the electron beam polarization. This technique extends polarized positron capabilities from GeV to MeV electron beams, and opens access to polarized positron beam physics to a wide community.