Gender-related differences in patients presenting with suspected acute coronary syndromes: clinical presentation, biomarkers and diagnosis

Objectives: Gender differences in patients presenting with suspected acute coronary syndromes (ACS) have not yet been fully characterized. The aim of this study was to assess gender-related disparities in clinical profiles, biomarkers and diagnoses of patients with suspected ACS. Methods: This single-centre, prospective cohort study included 377 consecutive patients presenting with suspected ACS to the emergency department. Suspected ACS was defined as a request for conventional troponin T (c-cTnT) measurements on clinical grounds. Results: Women were older than men (p = 0.004), and had a lower prevalence of known coronary artery and peripheral vascular disease (p < 0.05). c-cTnT was positive in 8% of female and in 14% of male patients (p = 0.16), TIMI risk score and cardiac biomarkers including c-cTnT, hs-cTnT, myoglobin, creatine kinase, N-terminal pro-brain natriuretic peptide, myeloid-related protein 8/14 and pregnancy-associated plasma protein A were lower in women (p < 0.05). Women were less frequently diagnosed with ACS (30 vs. 51%), and were not referred for urgent coronary angiography as often as men (p < 0.001). In multivariate analysis, female gender was associated with a lower referral for coronary angiography (HR 0.41, 95% CI 0.23-0.78, p = 0.006). Conclusions: In patients with suspected ACS, women presented with different biomarker profiles, and were less often diagnosed with ACS and referred to coronary angiography

Organics in comet 67P – a first comparative analysis of mass spectra from ROSINA–DFMS, COSAC and Ptolemy

The ESA Rosetta spacecraft followed comet 67P at a close distance for more than 2 yr. In addition, it deployed the lander Philae on to the surface of the comet. The (surface) composition of the comet is of great interest to understand the origin and evolution of comets. By combining measurements made on the comet itself and in the coma, we probe the nature of this surface material and compare it to remote sensing observations. We compare data from the double focusing mass spectrometer (DFMS) of the ROSINA experiment on ESA's Rosetta mission and previously published data from the two mass spectrometers COSAC (COmetary Sampling And Composition) and Ptolemy on the lander. The mass spectra of all three instruments show very similar patterns of mainly CHO-bearing molecules that sublimate at temperatures of 275 K. The DFMS data also show a great variety of CH-, CHN-, CHS-, CHO2- and CHNO-bearing saturated and unsaturated species. Methyl isocyanate, propanal and glycol aldehyde suggested by the earlier analysis of the measured COSAC spectrum could not be confirmed. The presence of polyoxymethylene in the Ptolemy spectrum was found to be unlikely. However, the signature of the aromatic compound toluene was identified in DFMS and Ptolemy data. Comparison with remote sensing instruments confirms the complex nature of the organics on the surface of 67P, which is much more diverse than anticipated

Origin and trends in NH4+ observed in the coma of 67P

The European Space Agency/Rosetta mission escorted comet 67P/Churyumov–Gerasimenko and witnessed the evolution of its coma from low activity (∼2.5–3.8 au) to rich ion-neutral chemistry (∼1.2–2.0 au). We present an analysis of the ion composition in the coma, focusing on the presence of protonated high proton affinity (HPA) species, in particular NH4+ ⁠. This ion is produced through the protonation of NH3 and is an indicator of the level of ion-neutral chemistry in the coma. We aim to assess the importance of this process compared with other NH4+ sources, such as the dissociation of ammonium salts embedded in dust grains. The analysis of NH4+ has been possible thanks to the high mass resolution of the Rosetta Orbiter Spectrometer for Ion and Neutral Analysis/Double Focusing Mass Spectrometer (ROSINA/DFMS). In this work, we examine the NH4+ data set alongside data from the Rosetta Plasma Consortium instruments, and against outputs from our in-house ionospheric model. We show that increased comet outgassing around perihelion yields more detections of NH4+ and other protonated HPA species, which results from more complex ion-neutral chemistry occurring in the coma. We also reveal a link between the low magnetic field strength associated with the diamagnetic cavity and higher NH4+ counts. This suggests that transport inside and outside the diamagnetic cavity is very different, which is consistent with 3D hybrid simulations of the coma: non-radial plasma dynamics outside the diamagnetic cavity is an important factor affecting the ion composition

Diagnosing Clostridioides difficile infections with molecular diagnostics: multicenter evaluation of revogene C. difficile assay

Clostridioides difficile infections are a significant threat to our healthcare system, and rapid and accurate diagnostics are crucial to implement the necessary infection prevention and control measurements. Nucleic acid amplification tests are such reliable diagnostic tools for the detection of toxigenic Clostridioides difficile strains directly from stool specimens. In this multicenter evaluation, we determined the performance of the revogene C. difficile assay. The analysis was conducted on prospective stool specimens collected from six different sites in Europe. The performance of the revogene C. difficile assay was compared to the different routine diagnostic methods and, for a subset of the specimens, against toxigenic culture. In total, 2621 valid stool specimens were tested, and the revogene C. difficile assay displayed a sensitivity/specificity of 97.1% [93.3-99.0] and 98.9% [98.5-99.3] for identification of Clostridioides difficile infection. Discrepancy analysis using additional methods improved this performance to 98.8% [95.8-99.9] and 99.6% [99.2-99.8], respectively. In comparison to toxigenic culture, the revogene C. difficile assay displayed a sensitivity/specificity of 93.0% [86.1-97.1] and 99.5% [98.7-99.9], respectively. These results indicate that the revogene C. difficile assay is a robust and reliable aid in the diagnosis of Clostridioides difficile infections.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.This study was supported by grants from GenePOC, now part of Meridian Biosciences.published version, accepted versio

The heterogeneous coma of comet 67P/Churyumov-Gerasimenko as seen by ROSINA: H <inf>2</inf> O, CO <inf>2</inf>, and CO from September 2014 to February 2016

Context. The ESA Rosetta mission has been investigating the environment of comet 67P/Churyumov-Gerasimenko (67P) since August 2014. Among the experiments on board the spacecraft, the ROSINA experiment (Rosetta Orbiter Spectrometer for Ion and Neutral Analysis) includes two mass spectrometers to analyse the composition of neutrals and ions and a COmet Pressure Sensor (COPS) to monitor the density and velocity of neutrals in the coma. Aims. We study heterogeneities in the coma during three periods starting in October 2014 (summer in the northern hemisphere) and ending in February 2016 (end of winter in the northern hemisphere). We provide a detailed description of the main volatiles dynamics (H2O, CO2, CO) and their abundance ratios. Methods. We analysed and compared the data of the Reflectron-Type Time-Of-Flight (RTOF) mass spectrometer with data from both the Double Focusing Mass Spectrometer (DFMS) and COPS during the comet escort phase. This comparison has demonstrated that the observations performed with each ROSINA sensor are indeed consistent. Furthermore, we used a Direct Simulation Monte Carlo (DSMC) model to compare modelled densitites with in situ detections. Results. Our analysis shows how the active regions of the main volatiles evolve with the seasons with a variability mostly driven by the illumination conditions; this is the case except for an unexpected dichotomy suggesting the presence of a dust layer containing water deposited in the northern hemisphere during previous perihelions hiding the presence of CO2. The influence of various parameters is investigated in detail: distance to the comet, heliocentric distance, longitude and latitude of sub-satellite point, local time, and phase angle

Pregnancy in MNGIE: a clinical and metabolic honeymoon.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an inherited disease caused by a deficiency in thymidine phosphorylase and characterized by elevated systemic deoxyribonucleotides and gastrointestinal (GI) and neurological manifestations. We report the clinical and biochemical manifestations that were evaluated in a single patient before, during, and after pregnancy, over a period of 7 years. GI symptoms significantly improved, and plasma deoxyribonucleotide concentrations decreased during pregnancy. Within days after delivery, the patient's digestive symptoms recurred, coinciding with a rapid increase in plasma deoxyribonucleotide concentrations. We hypothesize that the clinico-metabolic improvements could be attributed to the enzyme replacement action of the placental thymidine phosphorylase

Diagnosis of recent and relapsed cases of human brucellosis by PCR assay

BACKGROUND: Brucellosis affects human populations in many developing countries including the Middle East, and Latin America where it is still endemic. It has been prevalent in Jordan for years, where 7842 cases of human brucellosis were registered at the Ministry of Health during 10 year-period. This study was initiated by the recent increase in the number of human cases diagnosed in a rural area in the Northern Jordan to help assess the status of the disease in that area. For this purpose blood specimens from brucellosis suspected cases were tested by serology, culture and PCR. METHODS: Peripheral blood specimens from 50 healthy control subjects and 165 seropositive patients having compatible signs and symptoms that were clinically diagnosed to have brucellosis were tested by blood culture, and by PCR. The PCR assay used genus-specific primers from the conserved region of the 16S rRNA sequence, which showed high specificity for the Brucella spp. RESULTS: Diagnosis of Brucella was established by PCR in 120 cases (72.7%). All of them were seropositive and 20 were positive by culture. Forty-eight of 58 (82.8%) of the relapsed cases two months after completing the treatment with an increase in the previous serological titers were positive by PCR. The assay has 85.7% positive predicative value, 100% sensitivity and specificity since it correctly identified all cases that were positive by blood cultures, 95.8% by serology and none of the control group was positive. CONCLUSIONS: Results showed that PCR assay can be applied with serology for the diagnosis of brucellosis suspected cases and relapses regardless of the duration or type of the disease without relying on the blood cultures, especially in chronic cases

Rosina - Rosetta Orbiter Spectrometer for Ion and Neutral Analysis

The Rosetta Orbiter Spectrometer for Ion and Neutral Analysis (ROSINA) will answer important questions posed by the mission's main objectives. After Giotto, this will be the first time the volatile part of a comet will be analyzed in situ. This is a very important investigation, as comets, in contrast to meteorites, have maintained most of the volatiles of the solar nebula. To accomplish the very demanding objectives through all the different phases of the comet's activity, ROSINA has unprecedented capabilities including very wide mass range (1 to >300 amu), very high mass resolution (m/Δ m > 3000, i.e. the ability to resolve CO from N2 and 13C from 12CH), very wide dynamic range and high sensitivity, as well as the ability to determine cometary gas velocities, and temperature. ROSINA consists of two mass spectrometers for neutrals and primary ions with complementary capabilities and a pressure sensor. To ensure that absolute gas densities can be determined, each mass spectrometer carries a reservoir of a calibrated gas mixture allowing in-flight calibration. Furthermore, identical flight-spares of all three sensors will serve for detailed analysis of all relevant parameters, in particular the sensitivities for complex organic molecules and their fragmentation patterns in our electron bombardment ion source

Evolution of water production of 67P/Churyumov-Gerasimenko: An empirical model and a multi-instrument study

We examine the evolution of the water production of comet 67P/Churyumov–Gerasimenko during the Rosetta mission (2014 June–2016 May) based on in situ and remote sensing measurements made by Rosetta instruments, Earth-based telescopes and through the development of an empirical coma model. The derivation of the empirical model is described and the model is then applied to detrend spacecraft position effects from the Rosetta Orbiter Spectrometer for Ion and Neutral Analysis (ROSINA) data. The inter-comparison of the instrument data sets shows a high level of consistency and provides insights into the water and dust production. We examine different phases of the orbit, including the early mission (beyond 3.5 au) where the ROSINA water production does not show the expected increase with decreasing heliocentric distance. A second important phase is the period around the inbound equinox, where the peak water production makes a dramatic transition from northern to southern latitudes. During this transition, the water distribution is complex, but is driven by rotation and active areas in the north and south. Finally, we consider the perihelion period, where there may be evidence of time dependence in the water production rate. The peak water production, as measured by ROSINA, occurs 18–22 d after perihelion at 3.5 ± 0.5 × 1028 water molecules s-1. We show that the water production is highly correlated with ground-based dust measurements, possibly indicating that several dust parameters are constant during the observed period. Using estimates of the dust/gas ratio, we use our measured water production rate to calculate a uniform surface loss of 2–4 m during the current perihelion passage