The prevalence of cocaine-associated chest pain in a London hospital

Objectives: To determine the prevalence of cocaine misuse in patients presenting to an Accident and Emergency department with chest pain. 4 of 12 FAEM abstracts www.emjonline.co

How does multiple trauma, traumatic brain injury (TBI) or spinal cord injury (SCI) affect male sexual functioning?

Sex is an important part of life for many people, therefore dealing with erectile problems, living with the effects of physical injury, changes in your appearance or side-effects of treatment can have an enormous impact on your sex life and relationships. Normal sexual behaviour and erectile function depends on a complex interaction between various body-systems, including the brain, nerves, blood-supply and hormones. All of these systems (alone or in combination) may be affected following multiple trauma, traumatic brain injury (TBI) or spinal cord injury (SCI). For men, trauma may result in problems with achieving or maintaining erections (commonly referred to as erectile dysfunction; ED), problems with ejaculation, or how they think/feel about sex - all of these problems may have an indirect, if not profound impact on long-term functional recovery and overall quality of life. Following multiple trauma, spinal injury, or TBI, it is not unusual for some men to go through a period of reduced sexual drive (reduced libido). Apart from physical effects of injury, the way the body responds sexually also depends on thoughts and feelings – thoughts and feelings about yourself and others may be influenced by changes in mood, motivation, personality and thought-processes. This may be complicated by depression, emotional trauma following the injury, medication, or changes in hormone levels. As some men grapple with the changes and implications associated with their injury, many may initially ignore the importance of sexual difficulties, as they remain focused on physical rehabilitation and recovery of mobility. Other men may be reluctant to acknowledge sexual difficulties, due to cultural or personal reasons. There are a wide range of treatments and interventions that may be helpful for the man and his partner, which is why assessment of sexual function should be routinely incorporated into rehabilitation and follow-up services for trauma-survivors. The information below describes common sexual problems after TBI, SCI or multiple trauma and ways to improve sexual functioning

Farm-gate nitrogen balances on intensive dairy farms in the south west of Ireland

peer-reviewedNitrogen management and farm-gate N balances were evaluated on 21 intensive dairy farms in the south west of Ireland for each of four years (2003 to 2006). The mean annual stocking density was equivalent to 202 kg/ha (s.d. 29.6) of N excreted by livestock on the farm. The mean annual farm-gate N surplus (imports – exports) declined between 2003 and 2006 (277 to 232 kg/ha, s.e. 6.8; P < 0.001) due to a decline in annual N imports (fertilizer, feed and imported manures; 335 to 288 kg/ha, s.e. 6.9; P < 0.001). Overall annual fertilizer N use on the farms decreased during the study period (266 to 223 kg/ha, s.e. 6.5; P < 0.001) mainly due to lower inputs for the first application in spring and for the production of first-cut silage. These decreases were partly offset by applying more slurry in spring for early grazing and for first-cut silage. The introduction of white clover resulted in lower N imports on four farms. Export of N from farms was unaffected by reductions in N imports. The mean efficiency of N use tended to increase over time (0.18 in 2003 to 0.20 in 2006). The large variation in quantities of fertilizer N applied on farms with similar stocking densities suggests potential for further improvements in the efficiency of N use. In terms of fertilizer N use, complying with S.I. No. 378 of 2006 did not require major changes in the N management practiceson 19 of the farms.This project was part-funded by the European Research and Development Fund under INTERREG IIIB: Green Dairy Project N° 100 and partly by the Dairy Levy. Financial support for post-graduate students involved in this study was provided by the Teagasc Walsh Fellowship Scheme

Maternal distress in late pregnancy alters obstetric outcomes and the expression of genes important for placental glucocorticoid signalling

The experience of maternal distress in pregnancy is often linked with poorer obstetric outcomes for women as well as adverse outcomes for offspring. Alterations in placental glucocorticoid signalling and subsequent increased fetal exposure to cortisol have been suggested to underlie this relationship. In the current study, 121 pregnant women completed the Perceived Stress Scale, State Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale in the third trimester of pregnancy. Placental samples were collected after delivery. Maternal history of psychiatric illness and miscarriage were significant predictors of poorer mental health in pregnancy. Higher anxiety was associated with an increase in women delivering via elective Caesarean Section, and an increase in bottle-feeding. Birth temperature was mildly reduced among infants of women with high levels of depressive symptomology. Babies of mothers who scored high in all stress (cumulative distress) measures had reduced 5-min Apgar scores. High cumulative distress reduced the expression of placental HSD11B2 mRNA and increased the expression of placental NR3C1 mRNA. These data support a role for prenatal distress as a risk factor for altered obstetric outcomes. The alterations in placental gene expression support a role for altered placental glucocorticoid signalling in the relationship between maternal prenatal distress and adverse outcomes

Extinctions and Correlations for Uniformly Discrete Point Processes with Pure Point Dynamical Spectra

The paper investigates how correlations can completely specify a uniformly discrete point process. The setting is that of uniformly discrete point sets in real space for which the corresponding dynamical hull is ergodic. The first result is that all of the essential physical information in such a system is derivable from its $n$-point correlations, $n= 2, 3, >...$. If the system is pure point diffractive an upper bound on the number of correlations required can be derived from the cycle structure of a graph formed from the dynamical and Bragg spectra. In particular, if the diffraction has no extinctions, then the 2 and 3 point correlations contain all the relevant information.Comment: 16 page

Elevated levels of inflammatory cytokines predict survival in idiopathic and familial pulmonary arterial hypertension

BACKGROUND: Inflammation is a feature of pulmonary arterial hypertension (PAH), and increased circulating levels of cytokines are reported in patients with PAH. However, to date, no information exists on the significance of elevated cytokines or their potential as biomarkers. We sought to determine the levels of a range of cytokines in PAH and to examine their impact on survival and relationship to hemodynamic indexes. METHODS AND RESULTS: We measured levels of serum cytokines (tumor necrosis factor-alpha, interferon-gamma and interleukin-1beta, -2, -4, -5, -6, -8, -10, -12p70, and -13) using ELISAs in idiopathic and heritable PAH patients (n=60). Concurrent clinical data included hemodynamics, 6-minute walk distance, and survival time from sampling to death or transplantation. Healthy volunteers served as control subjects (n=21). PAH patients had significantly higher levels of interleukin-1beta, -2, -4, -6, -8, -10, and -12p70 and tumor necrosis factor-alpha compared with healthy control subjects. Kaplan-Meier analysis showed that levels of interleukin-6, 8, 10, and 12p70 predicted survival in patients. For example, 5-year survival with interleukin-6 levels of >9 pg/mL was 30% compared with 63% for patients with levels < or = 9 pg/mL (P=0.008). In this PAH cohort, cytokine levels were superior to traditional markers of prognosis such as 6-minute walk distance and hemodynamics. CONCLUSIONS: This study illustrates dysregulation of a broad range of inflammatory mediators in idiopathic and familial PAH and demonstrates that cytokine levels have a previously unrecognized impact on patient survival. They may prove to be useful biomarkers and provide insight into the contribution of inflammation in PAH

An ITPR1 gene deletion causes SCA15 and 16; a genetic, clinical and radiological description

Spinocerebellar ataxia (SCA) 15/16 is an autosomal dominantly inherited, almost pure cerebellar ataxia, which shows slow or no progression. (It has been designated variably SCA15 and SCA 16; we refer to it here as SCA15/16 to avoid confusion). Deletions in the inositol 1, 4, 5-triphosphate receptor 1 (ITPR1) on chromosome 3 have been shown to cause SCA15/16 in six families worldwide to date, with one further Japanese family identified as having an ITPR1 point mutation. We present a previously unreported SCA15/16 kindred. We describe the clinical phenotype of the family in detail; affected subjects display a remarkably slow, almost pure cerebellar syndrome. We also present genetic analyses for all subjects and longitudinal MRI data for one affected subject. Genetic analysis shows a deletion of 346,487bp in ITPR1 (the second largest ITPR1 deletion reported to date), suggesting SCA15 is due to a loss of ITPR1 function, and western blotting of lymphoblastoid cell line protein confirms reduced ITPR1 protein levels. Serial MRIs show progressive midline cerebellar atrophy with mild inferior parietal and temporal cortical volume loss in the absence of clinical disease progression. We believe that genetic testing for SCA15/16 should become a routine DNA screen available in all Neurogenetics clinics, which is likely to lead to an increased rate of the diagnosis. Familiarity with the phenotype is therefore important for all neurologists