Propranolol in infantile haemangioma: simplifying pretreatment monitoring.

BACKGROUND: Infantile haemangiomas (IHs) are very common vascular tumours. Propranolol is at present the first-line treatment for problematic and complicated haemangioma. In accordance with a Swiss protocol, children are monitored for 2 days at the start of the treatment to detect possible side effects of this drug. Our study advocates a simplification of the pretreatment monitoring process. METHODS: All children with a problematic and complicated haemangioma treated with propranolol between September 2009 and September 2012 were included in the study. All patients were hospitalised under constant nurse supervision for 48 hours at the start of the treatment and subjected to cardiac and blood measurements. The dosage of propranolol was 1 mg/kg/day on the first day and 2 mg/kg/day from the second day. Demographic data, clinical features, treatment outcome and complications were analysed. RESULTS: Twenty-nine infants were included in our study. Of these, 86.2% responded immediately to the treatment. There were no severe adverse reactions. Six patients presented transient side effects such as bradycardia, hypotension after the first dose and hypoglycaemia later. No side effects occurred after the second dose. Treatment was never interrupted. CONCLUSION: Propranolol (a β-blocker) is a safe treatment for problematic IH. Side effects may occur after the first dose. A strict 48 hour monitoring in hospital is expensive and may be unnecessary as long as the contraindications for the drug are respected.

Caution on the storage of waters and aqueous solutions in plastic containers for hydrogen and oxygen stable isotope analysis

RATIONALE The choice of containers for storage of aqueous samples between their collection, transport and water hydrogen (2H) and oxygen (18O) stable isotope analysis is a topic of concern for a wide range of fields in environmental, geological, biomedical, food, and forensic sciences. The transport and separation of water molecules during water vapor or liquid uptake by sorption or solution and the diffusive transport of water molecules through organic polymer material by permeation or pervaporation may entail an isotopic fractionation. An experiment was conducted to evaluate the extent of such fractionation. METHODS Sixteen bottle-like containers of eleven different organic polymers, including low and high density polyethylene (LDPE and HDPE), polypropylene (PP), polycarbonate (PC), polyethylene terephthalate (PET), and perfluoroalkoxy-Teflon (PFA), of different wall thickness and size were completely filled with the same mineral water and stored for 659?days under the same conditions of temperature and humidity. Particular care was exercised to keep the bottles tightly closed and prevent loss of water vapor through the seals. RESULTS Changes of up to +5 parts per thousand for d2H values and +2.0 parts per thousand for d18O values were measured for water after more than 1?year of storage within a plastic container, with the magnitude of change depending mainly on the type of organic polymer, wall thickness, and container size. The most important variations were measured for the PET and PC bottles. Waters stored in glass bottles with Polyseal (TM) cone-lined PP screw caps and thick-walled HDPE or PFA containers with linerless screw caps having an integrally molded inner sealing ring preserved their original d2H and d18O values. The carbon, hydrogen, and oxygen stable isotope compositions of the organic polymeric materials were also determined. CONCLUSIONS The results of this study clearly show that for precise and accurate measurements of the water stable isotope composition in aqueous solutions, rigorous sampling and storage procedures are needed both for laboratory standards and for unknown samples. Copyright (c) 2012 John Wiley & Sons, Ltd.

Volatile transport during the crystallization of anatectic melts: Oxygen, boron and hydrogen stable isotope study on the metamorphic complex of Naxos, Greece

Crystallization of anatectic melts in high-temperature metamorphic terrains releases volatile-rich magmas that can be transported into adjacent lithologies. This study addresses the variations in the oxygen, boron and hydrogen isotopic composition of aplite-pegmatite dikes that formed during the crystallization of anatectic melts in regional high-temperature metamorphism on the island of Naxos, Greece, and propagated upward into the overlying sequences of metamorphic schist. The transport distance of these dikes was increased through a significant horizontal component of travel that was imposed by contemporaneous low-angle extensional shearing. Laser fluorination oxygen isotope analyses of quartz, tourmaline, garnet, and biotite mineral separates from the aplite-pegmatite dikes show a progressive rise in delta(18)O values with increasing distance from the core. Oxygen isotope fractionations among quartz, tourmaline, and garnet show temperature variations from > 700degreesC down to similar to400degreesC. This range is considered to reflect isotopic fractionation beginning with crystallization at high temperatures in water-undersaturated conditions and then evolving through lower temperature crystallization and retrograde sub-solidus exchange. Two processes are examined for the cause of the progressive increase in delta(18)O values: (1) heterogeneous delta(18)O sources and (2) fluid-rock exchange between the aplite/pegmatite magmas and their host rock. Although the former process cannot be ruled out, there is as yet no evidence in the exposed sequences on Naxos for the presence of a suitable high delta(18)O magma source. In contrast, a tendency for the delta(18)O of quartz in the aplite/pegmatite dikes to approach that of the quartz in the metamorphic rock suggests that fluid-rock exchange with the host rock may potentially be an important process. Advection of fluid into the magma is examined based on Darcian fluid flow into an initially water-undersaturated buoyantly propagating aplitic dike magma. It is shown that such advective flow could only account for part of the O-18-enrichment, unless it were amplified by repeated injection of magma pulses, fluid recycling, and deformation-assisted post-crystallization exchange. The mechanism is, however, adequate to account for hydrogen isotope equilibration between dike and host rock. In contrast, variations in the delta(11)B values of tourmalines suggest that B-11/B-10 fractionation during crystallization and/or magma degassing was the major control of boron geochemistry rather than fluid-rock interaction and that the boron isotopic system was decoupled from that of oxygen. Copyright (C) 2003 Elsevier Ltd.

Basis set effects on the energy and hardness profiles of the hydrogen fluoride dimer

In earlier work, the present authors have shown that hardness profiles are less dependent on the level of calculation than energy profiles for potential energy surfaces (PESs) having pathological behaviors. At variance with energy profiles, hardness profiles always show the correct number of stationary points. This characteristic has been used to indicate the existence of spurious stationary points on the PESs. In the present work, we apply this methodology to the hydrogen fluoride dimer, a classical difficult case for the density functional theory methods

Indirect hydrogen monitoring by chemi-ionisation following an associative ionisation pathway after metastable helium atoms production by electron impact ionisation: Protonation and deuteration of carrier gas

Gas chromatography (GC) is an analytical tool very useful to investigate the composition of gaseous mixtures. However, hydrogen (H2) detection after a GC separation is only possible with a Thermal Conductivity Detector (TCD), a Helium Ionisation Detector (HID) or expensive Atomic Emission Detector (AED). Recently, indirect H2 detection by GC coupled to mass spectrometry (MS) was demonstrated but the mechanism of carrier gas protonation remained unclear. With electron impact as ionisation source of MS and helium (He) as GC carrier gas, H2 is not ionised according the expected Penning ionisation neither according to the Associative ionisation. Rearrangement ionisation (RI) was found to be the main channel for H2 and D2 ionisation under GC-MS conditions used in most of laboratories using GC-MS, leading to the formation of [He−H]+ and [He−D]+ ions.

The stable hydrogen and oxygen isotope variation of water stored in polyethylene terephthalate (PET) bottles

A set of bottled waters from a single natural spring distributed worldwide in polyethylene terephthalate (PET) bottles has been used to examine the effects of storage in plastic polymer material on the isotopic composition (delta(18)O and delta(2)H values) of the water. All samples analyzed were subjected to the same packaging procedure but experienced different conditions of temperature and humidity during storage. Water sorption and the diffusive transfer of water and water vapor through the wall of the PET bottle may cause isotopic exchange between water within the bottle and water vapor in air near the PET-water interface. Changes of about +4 parts per thousand for delta(2)H and +0.7 parts per thousand for delta(18)O have been measured for water after 253 days of storage within the PET bottle. The results of this study clearly indicate the need to use glass bottles for storing water samples for isotopic studies. It is imperative to transfer PET-bottled natural waters to glass bottles for their use as calibration material or potential international working standards. Copyright (C) 2008 John Wiley & Sons, Ltd.

Investigations on hydrogen isotope ratios of endogenous urinary steroids: reference-population-based thresholds and proof-of-concept.

Carbon isotope ratio (CIR) analysis has been routinely and successfully used in sports drug testing for many years to uncover the misuse of endogenous steroids. One limitation of the method is the availability of steroid preparations exhibiting CIRs equal to endogenous steroids. To overcome this problem, hydrogen isotope ratios (HIR) of endogenous urinary steroids were investigated as a potential complement; results obtained from a reference population of 67 individuals are presented herein. An established sample preparation method was modified and improved to enable separate measurements of each analyte of interest where possible. From the fraction of glucuronidated steroids; pregnanediol, 16-androstenol, 11-ketoetiocholanolone, androsterone (A), etiocholanolone (E), dehydroepiandrosterone (D), 5α- and 5β-androstanediol, testosterone and epitestosterone were included. In addition, sulfate conjugates of A, E, D, epiandrosterone and 17α- and 17β-androstenediol were considered and analyzed after acidic solvolysis. The obtained results enabled the calculation of the first reference-population-based thresholds for HIR of urinary steroids that can readily be applied to routine doping control samples. Proof-of-concept was accomplished by investigating urine specimens collected after a single oral application of testosterone-undecanoate. The HIR of most testosterone metabolites were found to be significantly influenced by the exogenous steroid beyond the established threshold values. Additionally, one regular doping control sample with an extraordinary testosterone/epitestosterone ratio of 100 without suspicious CIR was subjected to the complementary methodology of HIR analysis. The HIR data eventually provided evidence for the exogenous origin of urinary testosterone metabolites. Despite further investigations on HIR being advisable to corroborate the presented reference-population-based thresholds, the developed method proved to be a new tool supporting modern sports drug testing procedures.

Hydrogen sulfide measurement by headspace-gas chromatography-mass spectrometry (HS-GC-MS): application to gaseous samples and gas dissolved in muscle.

The aim of our study was to present a new headspace-gas chromatography-mass spectrometry (HS-GC-MS) method applicable to the routine determination of hydrogen sulfide (H(2)S) concentrations in biological and gaseous samples. The primary analytical drawback of the GC/MS methods for H(2)S measurement discussed in the literature was the absence of a specific H(2)S internal standard required to perform quantification. Although a deuterated hydrogen sulfide (D(2)S) standard is currently available, this standard is not often used because this standard is expensive and is only available in the gas phase. As an alternative approach, D(2)S can be generated in situ by reacting deuterated chloride with sodium sulfide; however, this technique can lead to low recovery yield and potential isotopic fractionation. Therefore, N(2)O was chosen for use as an internal standard. This method allows precise measurements of H(2)S concentrations in biological and gaseous samples. Therefore, a full validation using accuracy profile based on the β-expectation tolerance interval is presented. Finally, this method was applied to quantify H(2)S in an actual case of H(2)S fatal intoxication.

Hydrogen-induced changes in the breakdown voltage of InP HEMTs

In this work, electrical measurements show that the breakdown voltage,BVDG, of InP HEMTs increases following exposure to H2. This BVDG shift is nonrecoverable. The increase in BVDG is found to be due to a decrease in the carrier concentration in the extrinsic portion of the device.We provide evidence that H2 reacts with the exposed InAlAs surface in the extrinsic region next to the gate, changing the underlying carrier concentration. Hall measurements of capped and uncapped HEMT samples show that the decrease in sheet carrier concentration can be attributed to a modification of the exposed InAlAs surface. Consistent with this, XPS experiments on uncapped heterostructures give evidence of As loss from the InAlAs surface upon exposure to hydrogen.

Nonrelativistic bound states at finite temperature. II. Muonic hydrogen

We illustrate how to apply modern effective field-theory techniques and dimensional regularization to factorize the various scales, which appear in QED bound states at finite temperature. We focus here on the muonic hydrogen atom. Vacuum polarization effects make the physics of this atom at finite temperature very close to that of heavy quarkonium states. We comment on the implications of our results for these states in the quark gluon plasma. In particular, we estimate the effects of a finite-charm quark mass in the dissociation temperature of bottomonium.

Calorimetry of hydrogen desorption from a-Si nanoparticles

The process of hydrogen desorption from amorphous silicon (a-Si) nanoparticles grown by plasma-enhanced chemical vapor deposition (PECVD) has been analyzed by differential scanning calorimetry (DSC), mass spectrometry, and infrared spectroscopy, with the aim of quantifying the energy exchanged. Two exothermic peaks centered at 330 and 410 C have been detected with energies per H atom of about 50 meV. This value has been compared with the results of theoretical calculations and is found to agree with the dissociation energy of Si-H groups of about 3.25 eV per H atom, provided that the formation energy per dangling bond in a-Si is about 1.15 eV. It is shown that this result is valid for a-Si:H films, too.

Hydrogen isotope fractionations between amphiboles, micas, and fluids in alkaline igneous intrusions

RÉSUMÉ DE LA THÈSE Les teneurs des amphiboles en éléments majeurs et en isotopes stables ont été analysées dans plusieurs complexes ignés alcalins et hyperalcalins, dans le but de déterminer l'importance des variations de composition des minéraux pour le fractionnement isotopique de l'hydrogène dans un système naturel minéral-magma-fluide. Cette étude se concentre principalement sur les syénites néphéliniques de complexes intrusifs alcalins bien connus mais à chimie variable, dont les amphiboles, ainsi que d'autres silicates hydratés tels que micas et eudialytes, lorsque cela était possible, ont été séparés. L'intérêt principal s'est porté sur le complexe alcalin d'Ilímaussaq de la Province du Gardar, au Sud du Groenland. Dans une optique de comparaison, nous avons collecté et analysé d'autres échantillons provenant du complexe de Tugtutôq (Sud Groenland), des complexes de Khibina et Lovozero (Péninsule de Kola, Russie), du Mont St-Hilaire et du Mont Royal (Canada) et de 6 autres du nord-ouest de la Namibie (Cape Cross, Okenyenya, Messum, Etaneno, Kalkfeld,et Okorusu). Les compositions isotopiques de l'hydrogène des amphiboles des ces différentes zones présentent de grandes variations (-227 à -700/00), ce qui est atypique pour des magmas d'origine mantellique. Les valeurs comprises entre -80 et -400/00 indiquent une provenance du manteau. Ces larges variations de compositions ainsi que l'extrême appauvrissement en isotope lourd de l'hydrogène (D), en comparaison avec d'autres roches ignées, semblent être propres.aux roches alcalines et hyperalcalines de ce type, ce qui indiquerait un processus commun. Les différents complexes alcalins choisis présentent un large intervalle de composition chimique des amphiboles. La caractérisation des amphiboles par microscopie électronique et par spectroscopie Mössbauer contribuent à observer le contrôle du Fe sur le fractionnement des isotopes de l'hydrogène. En effet, cela a mis en évidence un contrôle du Fe sur le fractionnement et même, dans le cas du complexe hyperalcalin d'Ilímaussaq, une relation entre le rapport Fei3+/FeT et les variations du rapport D/H. Les complexes étudiés diffèrent de par leur index agpaïtique (Na+K/Al) et également de par leur contenu en fer. Les plus hautes valeurs en Fe (27-35 wt%) et en éléments alcalins dans les amphiboles, ainsi que les teneurs de D/H les plus basses et leur grande variation, sont celles du complexe d'Ilímaussaq. Les amphiboles de la Péninsule de Kola et du Canada sont similaires, mais toutefois moins appauvries en D. En ce qui concerne les amphiboles des complexes du NO de la Namibie, elles présentent des compositions isotopiques de l'hydrogène magmatiques normales (-73 à -100 0/00), contiennent moins de Fe (15-17 wt%) et sont fortement enrichies en Ca et moins en Na. Dans ce cas, l'alcalinité est moins importante en comparaison des autres complexes étudiés. En dehors des teneurs en éléments alcalins des amphiboles, l'alcalinité des fluides s'avère également un facteur important, ce qui est cohérent avec certaines suggestions à partir de systèmes expérimentaux. Afin de mieux contraindre ce facteur, des expériences d'échanges hydrothermaux entre les amphiboles et les fluides de salinité différente ont été effectuées en simulant des conditions naturelles. L'approximation d'amphiboles naturelles de complexes ignés alcalins, couplée aux expériences d'échange, aide à préciser les facteurs contrôlant le fractionnement des isotopes de l'hydrogène dans les roches alcalines. Les valeurs extrêmement basses de 3D des amphiboles de ces complexes alcalins peuvent être dues à une combinaison de différents facteurs, telles qu'une haute alcalinité, une haute teneur en Fe et une faible profondeur d'intrusion. Les grandes variations ainsi que les faibles valeurs de SD des amphiboles étudiées peuvent résulter d'un processus magmatique interne et il est peu probable que de l'eau météorique soit impliquée et/ou que le dégazage magmatique ait joué un rôle. THESIS ABSTRACT Major element and stable isotope compositions of amphiboles were analyzed from a number of alkaline and peralkaline igneous complexes in order to determine the importance of compositional variations in minerals to hydrogen isotope fractionations in natural mineral-melt-fluid systems. The thesis mainly focuses on nepheline syenites of well-studied, but chemically variable alkaline intrusive rocks, from which amphiboles and, if possible, other hydrous silicates such as micas and eudialytes were separated. The system of primary interest was the alkaline Ilímaussaq Complex of the Gardar Province of South Greenland. For the purpose of comparison additional samples were collected and examined from the Tugtutôq Complex (South Greenland), the Khibina and Lovozero Complexes (Kola Peninsular, Russia), Mount St-Hilaire and Mount Royal (Canada) and six further complexes from NW Namibia (Cape Cross, Okenyenya, Messum, Etaneno, Kalkfeld, and Okorusu). The hydrogen isotope compositions of amphiboles from the localities studied differ greatly, which is atypical for amphiboles from mantle, range between - 227 and - 700/00 (latter compatible with a simple mantle origin). As this wide range in compositions and the extreme depletion in the heavy hydrogen isotope (D) content relative to other igneous rocks appear to be unique to alkaline to peralkaline rocks of this type, a common process is indicated. The different alkaline complexes chosen cover a wide range of amphibole chemical compositions. Detailed chemical characterization of amphiboles by electron microprobe and Mössbauer spectroscopy analyses helped to constrain the control of Fe on the H-isotope fractionations. Complete characterization of the chemical compositions of the amphiboles support Fe-control on fractionations and at least for the peralkaline Ilímaussaq complex a relationship between Fe3+/FeT ratios and variations in D/H. The studied complexes differ in their agpaitic index (Na+K/Al) and also in their Fe-content. The most iron (27-35 wt. %) and alkaline element rich amphiboles, with the lowermost D/H ratio, as well with very wide range, are the ones from Ilímaussaq complex. Similar, but less D depleted amphiboles are from the Kola Peninsula and the Canadian localities. The complexes described from NW Namibia have amphiboles with normal magmatic hydrogen isotope composition (-730/00 to -1000/00), and have less Fe-content (15-17 wt. %), and are more Ca-and less Na-rich. In this case alkalinity is not that important in comparison to the other studied complexes. Beside the alkaline element contents in the amphiboles, the alkalinity of the fluids has been found to be an important factor, in conjunction with earlier suggestions from experimental systems. To further constrain this factor, hydrothermal exchange experiments between amphiboles and fluids of different salinity simulating natural conditions were performed. The approach of examining natural amphiboles from alkaline igneous complexes in parallel to performing exchange experiments - helped to further constrain the factors controlling the H-isotope fractionations in alkaline rocks. The observed changes between the hydrogen and oxygen isotope compositions of amphiboles and fluids before and after the experiments suggest that another phase was produced during the experiments, which influenced the final hydrogen isotope composition of the system. This presumably hydrous phase has also influenced the Fe3 +/Fe2+ ratio of the amphiboles, which became more oxidized. The extremely low SD values of amphiboles in these alkaline complexes may be due to a combination of different factors such as high alkalinity, high Fe-content, and shallow intrusion depths. This wide range and the low SD values of the amphiboles studied might be a result of internal, magmatic processes and it is unlikely that meteoric water was involved and/or magmatic degassing played an important role. RÉSUMÉ DE LA THÈSE (pour le grand public) Fractionnement isotopique de l'hydrogène entre amphiboles, micas et fluides dans des intrusions alcalines Zsófia Wáczek Directeur de thèse, Prof. Torsten W. Vennemann Institut de Minéralogie et Géochimie, Université de Lausanne Les roches alcalines et celles qui leurs sont associées sont des sources importantes de nombreux minéraux et minerais, tels l'apatite, le niobium, le diamant et autres pierres précieuses. Cette étude se concentre sur des complexes alcalins localisés dans le sud du Groenland, au Canada, dans la péninsule de Kola en Russie et au nord-ouest de la Namibie. Ces complexes sont composés de roches ayant cristallisé à partir de magmas et de fluides très enrichis en alcalins. Cet enrichissement permet la précipitation de minéraux inhabituels riches en potassium et/ou sodium, telles les amphiboles sodiques, également enrichies en fer. Les amphiboles étudiées ont des compositions calciques, sodi-calciques et sodiques, qui reflètent leurs différents environnements de formation. Des études précédentes ont révélé une large gamme de rapports isotopiques de l'hydrogène dans les amphiboles de roches hyperalcalines, dont certains extrêmement bas. Cette variation importante est très intrigante, sachant que des valeurs entre -40 et -800/00 correspondent à des silicates ignés hydratés et non altérés, alors que des valeurs descendant jusqu'a -1500/00 nécessiteraient une altération par de l'eau météorique et/ou une contamination par les roches environnantes ou des sédiments riches en matière organique. Dans lé cas précis du complexe d'Ilímaussaq (sud du Groenland), aucune de ces explications n'a pu être démontrée et des valeurs encore plus faibles ont été trouvées. Le complexe d'Ilímaussaq présente des valeurs de rapport isotopique de l'hydrogène entre -227 et -500/00 dans les amphiboles. Une origine mantellique permet d'expliquer les valeurs élevées, mais d'autres processus doivent entrer en jeu pour engendrer les valeurs les plus négatives. C'est à l'identification de ces processus que nous nous sommes attachés dans ce travail. Les grandes variations observées dans les teneurs en fer et dans le rapport Fe3+/FeT des roches et des minéraux de ces complexes sont corrélées avec d'autres paramètres chimiques, tels que la composition isotopique de l'hydrogène dans les amphiboles. Nous avons dès lors abordé les questions suivantes: quelle est la relation entre la teneur en fer des amphiboles et leur composition isotopique? Que nous apprennent les changements de la teneur en fer et les changements dans le rapport Fe3+/FeT sur les processus pétrologiques dans ces roches? Pour répondre à ces questions, nous avons analysé les compositions isotopiques de l'oxygène et de l'hydrogène dans les amphiboles et d'autres silicates hydratés. La composition chimique et le rapport Fe3+/FeT des amphiboles ont également été déterminés. Des expériences hydrothermales simulant des conditions naturelles ont été entreprises afin de mieux comprendre les processus de fractionnement isotopiques dans ces systèmes très alcalins. Nos conclusions sont les suivantes: (1) Les valeurs extrêmement faibles ainsi que les larges variations des rapports isotopiques de l'hydrogène des amphiboles de ces complexes alcalins sont dues à une combinaison de facteurs tels que la forte alcalinité, la haute teneur en fer et la profondeur très faible de l'intrusion. (2) Ces valeurs sont probablement le résultat de processus magmatiques internes. (3) Il est peu probable que les eaux météoriques et/ou le dégazage magmatique aient joué un rôle lors de la formation de ces amphiboles. (4) Certaines corrélations, en accord avec les études précédentes, ont pu être trouvées au niveau des concentrations en fer. (5) Dans le cas du complexe d'Ilímaussaq exclusivement, une relation a été trouvée entre le rapport Fe3+/FeT et la composition isotopique de l'hydrogène des amphiboles.

Pretreatment with statins improves early outcome in patients with first-ever ischaemic stroke: a pleiotropic effect of statins or a beneficial effect of hypercholesterolemia?

Background: Data from different studies suggest a favourable association between pretreatment with statins or hypercholesterolemia and outcome after ischaemic stroke. We examined whether there were differences in in-hospital mortality according to the presence or absence of statin therapy in a large population of first-ever ischaemic stroke patients and assessed the influence of statins upon early death and spontaneous neurological recovery. Methods: In 2,082 consecutive patients with first-ever ischaemic stroke collected from a prospective hospital-based stroke registry during a period of 19 years (1986-2004), statin use or hypercholesterolemia before stroke was documented in 381 patients. On the other hand, favourable outcome defined as grades 0-2 in the modified Rankin scale was recorded in 382 patients. Results: Early outcome was better in the presence of statin therapy or hypercholesterolemia (cholesterol levels were not measured) with significant differences between the groups with and without pretreatment with statins in in-hospital mortality (6% vs 13.3%, P = 0.001) and symptom-free (22% vs 17.5%, P = 0.025) and severe functional limitation (6.6% vs 11.5%, P = 0.002) at hospital discharge, as well as lower rates of infectious respiratory complications during hospitalization. In the logistic regression model, statin therapy was the only variable inversely associated with in-hospital death (odds ratio 0.57) and directly associated with favourable outcome (odds ratio 1.32).