Changes in the numeric descriptive scale for pain after sublingual nitroglycerin do not predict cardiac etiology of chest pain.

Study Objective: We determine whether the change in numeric descriptive scale for pain after sublingual nitroglycerin use can predict cardiac etiology of chest pain.

Methods: A prospective study of a convenience sample of patients who had chest pain, presented to the emergency department from May 24, 2001, to April 30, 2002, and received sublingual nitroglycerin during their evaluation was performed. The 11-point numeric descriptive scale for chest pain was recorded before and after the initial dose of sublingual nitroglycerin.

2004 American College of Cardiology/American Heart Association guidelines for the management of patients with ST-elevation myocardial infarction: implications for emergency department practice.

The American College of Cardiology and the American Heart Association last published evidence-based guidelines for the management of ST-segment elevation myocardial infarction (STEMI) in 1999. In mid-2004, in recognition of the evolution and improvement of many of the most basic tenets of clinical management of STEMI since that time, an updated edition of the STEMI guidelines has been published. These guidelines offer many evidence-based recommendations that are pertinent to the out-of-hospital and emergency department care of STEMI patients, including initial evaluation, risk stratification, stabilizing management, and the choice between pharmacologic and mechanical revascularization.

Influence of timing of troponin elevation on clinical outcomes and use of evidence-based therapies for patients with non-ST-segment elevation acute coronary syndromes.

Study Objective: Previous studies in clinical trial populations have demonstrated that patients presenting with positive troponin levels have a higher risk of mortality than patients with later positive troponin levels, but the influence of the timing of troponin elevation has not been previously characterized. We evaluate the impact of the timing of troponin elevation on clinical outcomes and adherence to the American College of Cardiology/American Heart Association acute care guidelines for patients with non-ST-segment elevation acute coronary syndromes.

Methods: We examined inhospital outcomes and use of acute (<24 hours) medications and invasive cardiac procedures in 23,184 high-risk patients with non-ST-segment elevation acute coronary syndromes (positive cardiac markers or ischemic ST-segment changes) during 2001 to 2002 from 396 US hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) Initiative.

Comparison of analog and digital preoperative planning in total hip and knee arthroplasties. A prospective study of 173 hips and 65 total knees.

Introduction: Digital correction of the magnification factor is expected to yield more accurate and reliable preoperative plans. We hypothesized that digital templating would be more accurate than manual templating for total hip and knee arthroplasties.

Patients And Methods: Firstly, we established the interobserver and intraobserver reliability of the templating procedure.

Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative.

Objectives: We hypothesized that significant disparities in gender exist in the management of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS).

Background: Gender-related differences in the diagnosis and treatment of ACS have important healthcare implications. No large-scale examination of these disparities has been completed since the publication of the revised American College of Cardiology/American Heart Association guidelines for management of patients with NSTE ACS.

Adjusted transfusion triggers improve transfusion practice in orthopaedic surgery.

Although blood transfusion has never been safer, there remains concern about adverse effects. We designed guidelines, the 6-8-10-Flexinorm, based on the conditions which are relevant to the decision to transfuse. To evaluate these new guidelines, we performed a case-control study in patients undergoing elective primary total hip replacement.

C-reactive protein and microalbuminuria are associated with atrial fibrillation.

Background: Atrial fibrillation (AF) is associated with an increased risk for cardiovascular disease. It is important to detect AF at an early stage and to search for new pathophysiological pathways to intervene. We hypothesized that microalbuminuria and C-reactive protein (CRP), a marker of generalized vascular damage and inflammation, respectively, are associated with AF.

Factors influencing the surgical process during shoulder joint replacement: time-action analysis of five different prostheses and three different approaches.

Background: To evaluate the per-operative process of shoulderjoint replacement, time-action analysis can be used.

Material/methods: Forty procedures performed by 7 surgeons with different experience using 5 different prostheses and 3 different surgical approaches were analyzed.

Results: The surgical procedures showed a large variation in, for example, duration, tasks of team members, and protocol used.

Effects of fosinopril and pravastatin on cardiovascular events in subjects with microalbuminuria.

Background: Microalbuminuria is associated with increased risk of cardiovascular events. We assessed whether therapeutic intervention aimed at lowering urinary albumin excretion would reduce cardiovascular events in microalbuminuric subjects (15 to 300 mg/24 hours).

Methods And Results: From the Prevention of Renal and Vascular Endstage Disease (PREVEND) cohort (n=8592), 1439 subjects fulfilled the inclusion criteria of the PREVEND Intervention Trial (PREVEND IT).

Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years.

Seventy-seven patients with idiopathic frozen shoulder syndrome were included in a prospective study to compare the effect of intensive physical rehabilitation treatment, including passive stretching and manual mobilization (stretching group) versus supportive therapy and exercises within the pain limits (supervised neglect group). There were no significant differences in age, sex, time elapsed since onset, and disease severity at inclusion. All patients were followed up for 24 months after the start of treatment.

Chromatic shifts in the fluorescence emitted by murine thymocytes stained with Hoechst 33342.

Background: Many methods in flow cytometry rely on staining DNA with a fluorescent dye to gauge DNA content. From the relative intensity of the fluorescence signature, one can then infer position in cell cycle, amount of DNA (i.e.

Electrocardiographic manifestations: electrolyte abnormalities.

Because myocyte depolarization and repolarization depend on intra- and extracellular shifts in ion gradients, abnormal serum electrolyte levels can have profound effects on cardiac conduction and the electrocardiogram (EKG). Changes in extracellular potassium, calcium, and magnesium levels can change myocyte membrane potential gradients and alter the cardiac action potential. These changes can result in incidental findings on the 12-lead EKG or precipitate potentially life-threatening dysrhythmias.

The Groningen Orthopedic Exit Strategy (GOES): a home-based support program for total hip and knee arthroplasty patients after shortened hospital stay.

The number of total hip and knee arthroplasty patients in The Netherlands will increase progressively in the coming decades. A reaction to this trend is a shortening of hospital stays. This however should not result in uncertainty, lack of information and unnecessary medical consumption by patients at home.

Syntheses of syn and anti doublebent [5]phenylene.

[structure: see text] The parent and dipropyl-substituted anti (1a,b) and syn doublebent (2a,b) [5]phenylenes have been assembled by CpCo-catalyzed double cyclization of regiospecifically constructed appropriate hexaynes. (1)H NMR, NICS, and an X-ray structural analysis of 1a reflect the aromatizing effect of double angular fusion on the central ring of the linear [3]phenylene substructure.

Derivation and validation of a risk stratification model to identify coronary artery disease in women who present to the emergency department with potential acute coronary syndromes.

Objectives: To derive and validate a model to identify women who would benefit from further evaluation of chest pain after an initial negative emergency department (ED) evaluation for acute coronary syndrome (ACS).

Methods: The derivation and validation cohorts were comprised of women who presented to the ED with chest pain at two university hospitals. Patients were excluded if the initial electrocardiogram (ECG) or cardiac markers were consistent with ACS.

Right precordial and posterior electrocardiographic leads do not increase detection of ischemia in low-risk patients presenting with chest pain.

Background: A number of innovative approaches have been investigated for their value in the early detection of acute ischemia or infarction in patients presenting to the emergency department (ED) with chest pain suggestive of a cardiac origin. Prior investigations have demonstrated the utility of adding right precordial and posterior chest leads to the standard 12-lead electrocardiogram (ECG) for identifying right ventricular and posterior wall infarctions in the ED.

Hypothesis: To assess the utility of additional ECG leads in low-risk patients presenting to the ED with symptoms suggestive of acute coronary syndromes who are managed in a chest pain evaluation unit (CPEU).

Insurance status and the treatment of myocardial infarction at academic centers.

Unlabelled: Numerous studies have documented treatment disparities in patients with acute coronary syndromes based on race and gender. Other causes for treatment disparities may exist.

Objectives: To determine if insurance status affects quality of care in patients with acute myocardial infarction (AMI) presenting to academic health centers.

Vascular endothelial growth factor: the link between cardiovascular risk factors and microalbuminuria?

Background: Microalbuminuria, i.e. slightly elevated urinary albumin excretion, is associated with increased cardiovascular risk factors and cardiovascular morbidity in the general population.

Bioimpedance-derived differences in cardiac physiology during exercise stress testing in low-risk chest pain patients.

Background: Little has been written about the utility of thoracic electrical bioimpedance (TEB)-derived cardiac physiologic variables in evaluating patients with low-risk chest pain syndromes. Noninvasive bioimpedance can monitor cardiac physiology while a patient is performing an exercise stress test. In addition, the demographics of patients with chest pain, the incidence of coronary artery disease (CAD), and the methods used for evaluation have well-documented sex differences.