Disparities in Out-of-Hospital Cardiac Arrest Treatment and Outcomes of Males and Females.

Background: Previous studies comparing the treatment of males and females during out-of-hospital cardiac arrests (OHCA) have been contradictory. Understanding differences in treatment and outcomes is important to assuring appropriate care to both sexes.Hypothesis: Females with OHCA receive fewer interventions and have lower rates of survival to hospital discharge when compared to males with OHCA.Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium (ROC) Cardiac Arrest Epistry 3 data collected from April 2011 to June 2015. We included all OHCA cases treated by emergency medical services (EMS) who had sex recorded. We analyzed 36 treatment and outcome variables. We calculated descriptive statistics and compared treatment and outcomes between males and females using chi-square and t-tests. We performed multivariate regressions adjusting for baseline characteristics.Results: Of 120,306 total subjects, 65,241 were included (23,924 female, 41,317 male). Females were 9.9% less likely to have OHCA in public, 10.9% less likely to have a shockable rhythm, and were a median of 5 years older. In the unadjusted analysis, females were defibrillated by EMS less often (OR 1.81, 95% CI [1.74, 1.88]), received epinephrine less often (OR 1.15, 95% CI [1.10, 1.19]), took an average of 67 seconds longer to achieve first return of spontaneous circulation (ROSC) (coefficient -66.75, 95% CI [-83.98, -49.52]), and had 2.2% lower survival to emergency department (ED) arrival (OR 1.09, 95% CI [1.06, 1.13]). After adjusting for age, bystander CPR, witness status, episode location, and initial rhythm, the odds of surviving to hospital discharge were higher in males (OR 1.12, 95% CI [1.05, 1.21]), and the odds of surviving to ED arrival favored females (OR 0.87, 95% CI [0.84-0.90]). Additionally, odds of receiving epinephrine (OR 1.22, 95% CI [1.16, 1.27]) and odds of receiving defibrillation (OR 1.36, 95% CI [1.29, 1.44]) were both higher in males, and time to achieve first ROSC was no longer associated with sex (p = 0.114, 95% CI [-3.32, 31.11]).Conclusions: After adjusting for case characteristics, females were less likely to receive some key treatments, including epinephrine and defibrillation. Females also had poorer survival to hospital discharge but had higher odds of surviving to ED arrival.

Probing High Permeability of Nuclear Pore Complexes by Scanning Electrochemical Microscopy: Ca2+ Effects on Transport Barriers.

The nuclear pore complex (NPC) solely mediates molecular transport between the nucleus and cytoplasm of a eukaryotic cell to play important biological and biomedical roles. However, it is not well-understood chemically how this biological nanopore selectively and efficiently transports various substances, including small molecules, proteins, and RNAs by using transport barriers that are rich in highly disordered repeats of hydrophobic phenylalanine and glycine intermingled with charged amino acids. Herein, we employ scanning electrochemical microscopy to image and measure the high permeability of NPCs to small redox molecules. The effective medium theory demonstrates that the measured permeability is controlled by diffusional translocation of probe molecules through water-filled nanopores without steric or electrostatic hindrance from hydrophobic or charged regions of transport barriers, respectively. However, the permeability of NPCs is reduced by a low millimolar concentration of Ca2+, which can interact with anionic regions of transport barriers to alter their spatial distributions within the nanopore. We employ atomic force microscopy to confirm that transport barriers of NPCs are dominantly recessed (∼80%) or entangled (∼20%) at the high Ca2+ level in contrast to authentic populations of entangled (∼50%), recessed (∼25%), and "plugged" (∼25%) conformations at a physiological Ca2+ level of submicromolar. We propose a model for synchronized Ca2+ effects on the conformation and permeability of NPCs, where transport barriers are viscosified to lower permeability. Significantly, this result supports a hypothesis that the functional structure of transport barriers is maintained not only by their hydrophobic regions, but also by charged regions.