Socioeconomic inequalities in coronary heart disease risk in older age: contribution of established and novel coronary risk factors

Background:Evidence on socioeconomic inequalities in coronary heart disease (CHD) and their pathways in the elderly is limited. Little is also known about the contributions that novel coronary risk factors (particularly inflammatory/hemostatic markers) make to socioeconomic inequalities in CHD. Objectives:To examine the extent of socioeconomic inequalities in CHD in older age, and the contributions (relative and absolute) of established and novel coronary risk factors. Methods:A population-based cohort of 3761 British men aged 60–79 years was followed up for 6.5 years for CHD mortality and incidence (fatal and non-fatal). Social class was based on longest-held occupation recorded at 40–59 years. Results:There was a graded relationship between social class and CHD incidence. The hazard ratio for CHD incidence comparing social class V (unskilled workers) with social class I (professionals) was 2.70 [95% confidence interval (CI) 1.37–5.35; P-value for trend = 0.008]. This was reduced to 2.14 (95% CI 1.06–4.33; P-value for trend = 0.11) after adjustment for behavioral factors (cigarette smoking, physical activity, body mass index, and alcohol consumption), which explained 38% of the relative risk gradient (41% of absolute risk). Additional adjustment for inflammatory markers (C-reactive protein, interleukin-6, and von Willebrand factor) explained 55% of the relative risk gradient (59% of absolute risk). Blood pressure and lipids made little difference to these estimates; results were similar for CHD mortality. Conclusions:Socioeconomic inequalities in CHD persist in the elderly and are at least partly explained by behavioral risk factors; novel (inflammatory) coronary risk markers made some further contribution. Reducing inequalities in behavioral factors (especially cigarette smoking) could reduce these social inequalities by at least one-third

Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients

Background: During the last decade, radiotherapy using MR Linac has gone from research to clinical implementation for different cancer locations. For head and neck cancer (HNC), target delineation based only on MR images is not yet standard, and the utilisation of MRI instead of PET/CT in radiotherapy planning is not well established. We aimed to analyse the inter-observer variation (IOV) in delineating GTV (gross tumour volume) on MR images only for patients with HNC. Material/methods: 32 HNC patients from two independent departments were included. Four clinical oncologists from Denmark and four radiation oncologists from Australia had independently contoured primary tumour GTVs (GTV-T) and nodal GTVs (GTV-N) on T2-weighted MR images obtained at the time of treatment planning. Observers were provided with sets of images, delineation guidelines and patient synopsis. Simultaneous truth and performance level estimation (STAPLE) reference volumes were generated for each structure using all observer contours. The IOV was assessed using the DICE Similarity Coefficient (DSC) and mean absolute surface distance (MASD). Results: 32 GTV-Ts and 68 GTV-Ns were contoured per observer. The median MASD for GTV-Ts and GTV-Ns across all patients was 0.17 cm (range 0.08–0.39 cm) and 0.07 cm (range 0.04–0.33 cm), respectively. Median DSC relative to a STAPLE volume for GTV-Ts and GTV-Ns across all patients were 0.73 and 0.76, respectively. A significant correlation was seen between median DSCs and median volumes of GTV-Ts (Spearman correlation coefficient 0.76, p < 0.001) and of GTV-Ns (Spearman correlation coefficient 0.55, p < 0.001). Conclusion: Contouring GTVs in patients with HNC on MRI showed that the median IOV for GTV-T and GTV-N was below 2 mm, based on observes from two separate radiation departments. However, there are still specific regions in tumours that are difficult to resolve as either malignant tissue or oedema that potentially could be improved by further training in MR-only delineation

Living in rural New England amplifies the risk of depression in patients with HIV

<p>Abstract</p> <p>Background</p> <p>The importance of depression as a complication of HIV infection is increasingly understood, and people living in rural areas are at increased risk for depression. However, it is not known whether living in rural areas amplifies the risk of depression in patients with HIV.</p> <p>Methods</p> <p>We compared the prevalence of depression between rural and metropolitan HIV patients seen at the Dartmouth-Hitchcock HIV Program in a retrospective cohort study. Using the validated Rural-Urban Commuting Area Score, we categorized patients as living in small town/rural areas, micropolitan or metropolitan towns. Then, using a multivariate logistic regression model to adjust for demographic factors that differed between rural and metropolitan patients, we estimated the impact of living in rural areas on the odds of depression.</p> <p>Results</p> <p>Among 646 patients with HIV (185 small town/rural, 145 micropolitan, 316 metropolitan), rural patients were older, white, male, and men who have sex with men (ANOVA, F-statistic < 0.05). The prevalence of depression was highest in rural patients (59.5 vs. 51.7 vs. 41.2%, F statistic < 0.001), particularly rural patients on antiretroviral therapy (72.4 vs. 53.5 vs. 38.2%, F-statistic < 0.001. A multivariate logistic regression model showed that the odds of depression in rural patients with HIV were 1.34 (P < 0.001).</p> <p>Conclusion</p> <p>HIV-infected patients living in rural areas, particularly those on antiretroviral therapy, are highly vulnerable to depression.</p

An Integrated-Photonics Optical-Frequency Synthesizer

Integrated-photonics microchips now enable a range of advanced functionalities for high-coherence applications such as data transmission, highly optimized physical sensors, and harnessing quantum states, but with cost, efficiency, and portability much beyond tabletop experiments. Through high-volume semiconductor processing built around advanced materials there exists an opportunity for integrated devices to impact applications cutting across disciplines of basic science and technology. Here we show how to synthesize the absolute frequency of a lightwave signal, using integrated photonics to implement lasers, system interconnects, and nonlinear frequency comb generation. The laser frequency output of our synthesizer is programmed by a microwave clock across 4 THz near 1550 nm with 1 Hz resolution and traceability to the SI second. This is accomplished with a heterogeneously integrated III/V-Si tunable laser, which is guided by dual dissipative-Kerr-soliton frequency combs fabricated on silicon chips. Through out-of-loop measurements of the phase-coherent, microwave-to-optical link, we verify that the fractional-frequency instability of the integrated photonics synthesizer matches the $7.0*10^{-13}$ reference-clock instability for a 1 second acquisition, and constrain any synthesis error to $7.7*10^{-15}$ while stepping the synthesizer across the telecommunication C band. Any application of an optical frequency source would be enabled by the precision optical synthesis presented here. Building on the ubiquitous capability in the microwave domain, our results demonstrate a first path to synthesis with integrated photonics, leveraging low-cost, low-power, and compact features that will be critical for its widespread use.Comment: 10 pages, 6 figure

バレイショ近縁種における種の分化 XIII. S.acaule X S.demissumより得た7倍雑種の染色体行動と両親ゲノムの類縁関係

中央アンデス産Acaulia群4倍種S. acaule (acl, 2n=48)とメキシコ産Demissa群6倍種S. demissum (dms, 2n=72)のゲノムの類縁関係を明らかにするために, 前者を母本として得た7倍雑種(2n=84)の還元分裂における染色体行動と稔性を調べた。以下その結果を要約する。両種間の交雑は極めて困難で, aclを母とした時のみ受粉花数当り0.02の低率で雑種が得られたにすぎない。得られた雑種は, 両親との形態的比較から, aclの非還元性卵とdmsの還元性花粉の受精に起因するものと推定された。この雑種の第1中期における染色体対合行動は甚だしく多様であったが, その対合型のモードは(12)_+(20)_+8_I, その平均対合頻度は(0.18)_V+(1.11)_+(11.73)_+(18.11)_+(7.26)_Iで, 著しく高頻度の3価形成を示す点が特徴的であった。このような対合行動はその後の染色体行動にも反映し, 第1後期では観察細胞のすべてに平均4.8の遅滞染色体がみられ, 第2中期では94%の細胞が分散染色体を示し, 数的平衡核板頻度は0.6%にすぎなかった。稔性は極めて低く, 調査花粉粒数の27%が一見正常であったが, 自殖及び戻交配のいずれにおいても全く種子を生じなかった。上記の観察結果, 特に高頻度で出現した3価染色体の成因を考察して次の知見を得た。すでにaclはAAA^aA^a, dmsはA^dA^dC_1C_1C_2C_2のゲノム型をもつことが知られているので, 当雑種のゲノム型はAAA^aA^aA^dC_1C_2となる。A^dゲノムは若干の構造的差異はもつもののAゲノム群に属することも知られている。したがって, 当雑種にみられる3価形成は, 主に, aclからのAAとdmsからのA^dの3ゲノム間の染色体対合に由来すると推論でき, 両種はこれらのゲノムの相同性によって相互に関係づけられているものと考えられる。 / Meiotic behavior and fertility were studied in a heptaploid F_1 hybrid (2n=84) obtained from crossing S. acaule (acl, 2n=48) with S. demissum (dms, 2n=72), with the aim of assessing a genomic relationship between the parent species. Crossability between the two species was very low, the number of hybrid plants per pollination being only 0.02. Morphological evidence indicated that the hybrid arose through the union of an unreduced egg of acl and a reduced pollen grain of dms. The hybrid had the mean pairing frequency of (0.18)_V+(1.11)_+(11.73)_+(18.11)_+(7.26)_I per cell at metaphase I, with (12)_+(20)_+8_I as the modal configuration. Its subsequent behaviors were extremely irregular, showing several laggards in all the cells and chromatid bridges in occasional cells at anaphase I and also scattered chromosomes in 94% of the cells at metaphase II. The hybrid gave only 27% stainable pollen and no seed either on selfing or on backcrossing with both parents. The pattern of chromosome pairing found in the hybrid was interpreted in terms of genomic relationship between both parent species. From this, it was suggested that one (A) of the two genomes (designated AA^a) which acl possess in its gametes seems to be closely similar to, but not identical with, one (A^d) of the three genomes (A^dC_1C_2) which dms possess in its gemetes

No Evidence for Genome-Wide Interactions on Plasma Fibrinogen by Smoking, Alcohol Consumption and Body Mass Index : Results from Meta-Analyses of 80,607 Subjects

Peer reviewe

Rat-bite fever as a cause of septic arthritis: a diagnostic dilemma.

Rat-bite fever results from an infection with the organism Streptobacillus moniliformis. Symptomatic patients often present with fever, malaise, cough, maculopapular rash, and occasional arthritis, and usually have a history of rodent exposure. This report describes a patient with rat-bite fever resulting in suppurative arthritis. The patient's diagnosis was made by culture of S moniliformis from his left wrist. The diagnosis was delayed, however, owing to the lack of an exposure history, atypical clinical presentation, and the unusual microbiologic characteristics shown by this organism

Clinical differences between pulmonary and extrapulmonary tuberculosis: a 5-year retrospective study.

This article describes the clinical, epidemiologic, laboratory, and treatment characteristics of pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) in Eastern North Carolina, a primarily rural area. The database was obtained for 1988-1992 from the University Medical Center of Eastern North Carolina-Pitt County and East Carolina University School of Medicine (the tertiary care referral center for this region). One hundred thirty-eight culture-positive patients were enrolled in the study; 56% were PTB and 44% were EPTB. African-American males constituted 59% of the population. Sixty-nine percent of the patient base were uninsured. There was a bimodal age distribution of < 40 and > 60 years of age. Factors associated with PTB (reported as odds ratios) were white males (2.5), diabetes mellitus (5.4), and cancer (5.1). Factors associated with EPTB (reported as odds ratios) were African-American females, positive human immunodeficiency virus (HIV) serology (8.7), low hematocrit (32.6), and elevated alkaline phosphatase (199). This study emphasizes that in the latest resurgence of tuberculosis, impoverished rural areas, which have been ignored in earlier and present control efforts, are important reservoirs of disease