EMS blood collection from patients with acute chest pain reduces emergency department length of stay

BACKGROUND

Expediting the measurement of serum troponin by leveraging EMS blood collection could reduce the diagnostic time for patients with acute chest pain and help address Emergency Department (ED) overcrowding. However, this practice has not been examined among an ED chest pain patient population in the United States.

METHODS

A prospective observational cohort study of adults with non-traumatic chest pain without ST-segment elevation myocardial infarction was conducted in three EMS agencies between 12/2016-4/2018. During transport, paramedics obtained a patient blood sample that was sent directly to the hospital core lab for troponin measurement. On ED arrival HEART Pathway assessments were completed by ED providers as part of standard care. ED providers were blinded to troponin results from EMS blood samples. To evaluate the potential impact on length of stay (LOS), the time difference between EMS blood draw and first clinical ED draw was calculated. To determine the safety of using troponin measures from EMS blood samples, the diagnostic performance of the HEART Pathway for 30-day major adverse cardiac events (MACE: composite of cardiac death, myocardial infarction (MI), coronary revascularization) was determined using EMS troponin plus arrival ED troponin and EMS troponin plus a serial 3-h ED troponin.

RESULTS

The use of EMS blood samples for troponin measures among 401 patients presenting with acute chest pain resulted in a mean potential reduction in LOS of 72.5 ± SD 35.7 min. MACE at 30 days occurred in 21.0% (84/401), with 1 cardiac death, 78 MIs, and 5 revascularizations without MI. Use of the HEART Pathway with EMS and ED arrival troponin measures yielded a NPV of 98.0% (95% CI: 89.6-100). NPV improved to 100% (95% CI: 92.9-100) when using the EMS and 3-h ED troponin measures.

CONCLUSIONS

EMS blood collection used for core lab ED troponin measures could significantly reduce ED LOS and appears safe when integrated into the HEART Pathway.

Assessment of volatile compounds, neutral and polar lipid fatty acids of four beef muscles from USDA Choice and Select graded carcasses and their relationships with consumer palatability scores and intramuscular fat content

Fatty acids (FA) in neutral and polar lipids (NL and PL) and volatile compounds were determined in Gluteus medius (GM), Longissimus lumborum (LL), Serratus ventralis (SV), and Semimembranosus (SM) muscles from upper 2/3 USDA Choice and Select quality grades (QG). Concentrations of NL FA (mg/g) were influenced by intramuscular fat (IMF) content being greater in upper 2/3 Choice compared with Select. The SV contained greater concentrations of NL FA; meanwhile, the SM contained the lowest quantities of NL FA. Percentages (g/100g of total FA) of NL SFA and MUFA were increased in beef with greater IMF content. Concentrations and percentages of PL FA had muscle specific differences between QG. Volatile compounds were primarily affected by muscle. Increases in SFA and MUFA were related with consumer liking, regardless of lipid fraction. Overall the influence of QG on SFA and MUFA was muscle specific. Therefore, each muscle may require specific considerations when considering FA, volatile compounds, and ultimately consumer liking.

Sensory evaluation of tender beef strip loin steaks of varying marbling levels and quality treatments

The palatability of tender [Warner-Bratzler shear force values <33.34N (3.4kg)] beef strip loins of 10 different treatments [USDA Prime, High Choice (upper 1/3 Choice), Low Choice (lower 1/3 Choice), Select, Standard, Australian Wagyu, American Wagyu, Holstein Select, Holstein Top Choice (upper 2/3 Choice) and Grass-finished] was evaluated by consumers and a trained flavor panel. In general, tenderness, juiciness, flavor, and overall liking ratings as well as acceptability percentage for each trait, increased with increased fat levels. Moreover, overall liking was highly correlated (P<0.01) with flavor liking (r=0.96) as well as fat percentage (r=0.79). Beef flavor scores were positively associated (P<0.01) with fat-like (r=0.67) and umami (r=0.59) flavors. Fat level was the primary driver of beef flavor acceptability in all samples when no undesirable off-flavors were present.

A new animal model of postsurgical bowel inflammation and fibrosis: the effect of commensal microflora

OBJECTIVE

Ileocaecal resection (ICR) is common in Crohn's disease. Inflammation and fibrosis frequently recur at the site of anastomosis or in the small intestine (SI). No animal models of postsurgical inflammation and fibrosis exist. A model of ICR was developed in interleukin 10 (IL10) null and wild-type (WT) mice to test the hypothesis that ICR promotes postsurgical inflammation and fibrosis in the SI or anastomosis of genetically susceptible IL10 null, but not WT or germ-free (GF)-IL10 null mice.

METHODS

GF-IL10 null mice were conventionalised (CONV) and 3 weeks later randomised to ICR, transection (T) or no treatment (NoTx). Age-matched conventionally raised (CONV) WT and GF-IL10 null mice received ICR, T or NoTx. Animals were killed 28 days later. Histological scoring, real-time PCR for tumour necrosis factor alpha and collagen, and immunostaining for CD3(+) T cells assessed inflammation and fibrosis.

RESULTS

After ICR, CONV-IL10 null, but not CONV-WT mice, developed significant inflammation and fibrosis in the SI and inflammation in anastomosis compared with NoTx or T controls. Fibrosis occurred in the anastomosis of both CONV-IL10 null and CONV-WT mice following ICR. GF-IL10 null mice developed little or no inflammation or fibrosis in the SI or anastomosis after ICR.

CONCLUSIONS

ICR in CONV-IL10 null mice provides a new animal model of postsurgical inflammation and fibrosis in the SI and anastomosis. Absence of inflammation and fibrosis in the SI of CONV-WT and GF-IL10 null mice following ICR indicates that postsurgical small bowel disease occurs only in genetically susceptible IL10 null mice and is bacteria dependent.

The crystal structure of diethylene tetraxanthogen, the oxidation product of the diethylene dixanthate ion

The structure of the oxidation product of the diethylene dixanthate anion, diethylene tetraxanthogen (Cl12H1606S8), has been determined by single crystal X-ray diffraction methods. The crystals are tetragonal of space group Z41/acd with a 15.798(1), c 17.755(1) �, containing eight molecules per unit cell. The structure was solved using conventional Patterson and Fourier methods and refined by a full-matrix least-squares method to R 0.055 for the 817 independent statistically significant reflections collected by counter methods. The crystals are composed of discrete molecules held together by van der Waals forces. Each molecule, situated about a site of symmetry 222, has the novel 22-membered ring structure involving disulphide bonds of length 2.035(2) �. The planarity of the dithiocarbonate moiety and the relatively short carbon-to-oxygen and carbon-to-sulphur bond lengths correlate with extensive π-electron delocalization over the group.

The oxidation of potassium dixanthates to tetraxanthogens

Alkyl monoxanthates are used extensively in sulphide ore flotation and there is an abundant literature1 dealing with their chemistry and physical properties. Very little seems to be known of dixanthates. The insertion of CS2 into the potassium salts of ethylene glycol, diethylene glyool, and triethylene glycol was reported by Shupe.Woods has shown recently that oxidation of the ethyl xanthate ion to dixantho-gen plays a major role in ore flotation processes when ethylxanthate is used as a collector. The ease or otherwise of this oxidation and the nature of the oxidation product is likely, therefore, to have a marked influence on the efficiency of the process. A study of the oxidation of dixanthates is the purpose of the present work.

C-O, C-S, and M-S vibration frequencies of metal xanthates

Changes of coordination from four to five or six in the xanthates of nickel, lead, zinc, and cadmium result in a shift towards lower energy of the M-S vibration, a small shift to higher energy of the C-S vibration, and an unexpected large shift to lower frequency of the C-O vibration.