ABSTRACT
OBJECTIVES: To investigate sex-based differences in clinical features, causative pathogens, outcome and treatment of adult community-acquired meningitis. METHODS: From January 2006 to July 2014, we prospectively investigated sex-based differences in clinical features, causative pathogens, outcome and treatment of adult community-acquired meningitis in a nationwide cohort study in the Netherlands. Sex was analysed along with known predictors of unfavourable outcome using logistic regression. RESULTS: We evaluated 1412 episodes of meningitis, 707 (50%) in men. Men more often presented with a history of remote head injury (41/667 (6%) versus 14/658 (2%) women, p 0.0002) or alcoholism (61/652 (9%) versus 21/660 (3%) women, p <0.0001). Neck stiffness was less common in men (453/651 (70%) versus 524/671 (78%) women, p 0.0004). Despite greater illness severity, women were less likely to receive treatment in an intensive care unit (odds ratio (OR) 0.72, 95% CI 0.58-0.89, p 0.003) or mechanical ventilation (OR 0.67, 95% CI 0.54-0.85, p 0.001). Women exhibited higher serum inflammatory parameters than men (median C-reactive protein 211 versus 171, p 0.0001; median erythrocyte sedimentation rate 48 versus 33, p <0.0001). Corticosteroids improved prognosis in both sexes, but absolute risk reduction was higher in women (20% versus 15%, p 0.001), although we found no significant interaction between sex and dexamethasone (p 0.38). In the multivariable analysis, male sex was an independent predictor of unfavourable outcome (OR 1.34, 95% CI 1.03-1.75, p 0.03) and death (OR 1.47, 95% CI 1.04-2.07, p 0.03). CONCLUSIONS: Our findings show sex-based differences in adults with community-acquired bacterial meningitis. Male sex is an independent risk factor for adverse outcome. It is possible that sex-based differences in immune reaction could determine a distinct response to corticosteroids.
Subject(s)
Community-Acquired Infections/epidemiology , Meningitis, Bacterial/epidemiology , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Biomarkers , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Comorbidity , Female , Humans , Male , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/microbiology , Middle Aged , Netherlands/epidemiology , Odds Ratio , Prospective Studies , Severity of Illness Index , Sex Factors , Treatment Outcome , Young AdultABSTRACT
OBJECTIVES: To characterize cognitive impairment in primary progressive multiple sclerosis (PPMS) and to correlate the pattern of cognitive deficits with brain magnetic resonance imaging (MRI) volumetric data. MATERIALS AND METHODS: In a multicenter cross-sectional study, we recruited consecutive patients with PPMS as well as age, sex, and education level-matched healthy controls (HC). All participants underwent neuropsychological (NP) assessment, and brain MRI was performed in patients with PPMS for analysis of lesion load, subcortical GM volumes, and regional cortical volumes. RESULTS: We recruited 55 patients with PPMS and 36 HC. Thirty-six patients were included in the MRI analysis. Patients with PPMS performed significantly worse than HC in all NP tests. Subcortical GM volume was significantly correlated with all NP tests, except for Stroop Test, with the largest effect for the thalamus (r=-.516 [BVMT-R DR, P=.016 FDR-corrected] to r=.664 [SDMT, P<.001 FDR-corrected]). In the stepwise linear regression model, thalamic volume was the only predictor of performance in all NP tests. CONCLUSION: Cognitive impairment is common in PPMS and affects all evaluated cognitive domains. Subcortical GM volume, particularly of the thalamus, is a strong predictor of cognitive performance, suggesting it has a central role in the pathophysiology of PPMS-related cognitive dysfunction.
Subject(s)
Cognitive Dysfunction/diagnostic imaging , Cognitive Dysfunction/psychology , Magnetic Resonance Imaging , Multiple Sclerosis, Chronic Progressive/diagnostic imaging , Multiple Sclerosis, Chronic Progressive/psychology , Adult , Cognitive Dysfunction/epidemiology , Cross-Sectional Studies , Female , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Multiple Sclerosis, Chronic Progressive/epidemiology , Neuropsychological Tests , Thalamus/diagnostic imagingABSTRACT
Equilibrium Langevin dynamics of one-dimensional Lennard-Jones chains is studied. It is shown that depending on the noise strength, the friction constant and the number of particles, chains can synchronize, break, or remain desynchronized. Generally the synchronization time and the maximal Lyapunov exponent are found to depend on the number of particles and the ratio of noise strength to friction constant.
ABSTRACT
The construction of conventional sewerage systems in small communities, with pipes laid on a uniform slope and manholes regularly spaced, is sometimes not economically feasible, because of the high costs of sewer installation. Under those circumstances, the small diameter gravity sewers (SDGS) have often proven to be substantially less costly than conventional sewers. Typically, in SDGS systems the wastewater from one or more households is discharged into an interceptor tank (or a single compartment septic tank). The settled effluent is discharged afterwards into small diameter sewers operating under gravity. In this paper, special emphasis is given to the analysis of self-cleansing conditions and to the analysis of risks of sulphide generation and occurrence of septic conditions in SDGS systems. For the evaluation of the self-cleansing conditions, the critical velocity and the critical shear stress were computed according to the Shields equation. The forecasting of dissolved oxygen concentrations and sulphide build-up along the lines, for different flow conditions, was done running an established wastewater quality model.
