It's Probably Just Heart Burn! A Case of Pregnancy-Associated Spontaneous Coronary Artery Dissection.

Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) poses a rare yet critical concern among postpartum individuals, increasingly recognized as a significant trigger for acute myocardial infarction. Timely identification, accurate diagnosis, and prompt treatment are paramount for clinicians confronted with this condition. Patients with P-SCAD commonly manifest signs and symptoms akin to acute coronary syndrome but have different etiology and treatment.

Standardizing Child Passenger Safety Screening in the Emergency Department: A Quality Improvement Study.

Background: Motor vehicle collisions remain a leading cause of death and injury in children in the United States. Our Level I trauma center found that 53% of children ages 1-19 years are improperly restrained or unrestrained. Our center employs a Pediatric Injury Prevention Coalition with nationally certified child passenger safety technicians who are active in the community yet remain underutilized in the clinical setting.

Discharge optimization tool to decrease length of stay and improve satisfaction related to advanced practice provider communication.

Background: Prolonged length of stay (LOS) due to delayed hospital discharge is associated with increased patient morbidity and mortality and other poor outcomes. The length of stay (LOS) in patients undergoing elective, isolated coronary artery bypass grafting (CABG) at an urban, level 1 trauma center is 8.73 days, compared to the 7.

Giant Tricuspid Valve Fibroelastoma Incidentally Diagnosed During Routine Stress Testing.

Papillary fibroelastomas (PFEs) are the most common valvular tumor, typically occurring on left-sided valves. We describe the evaluation and treatment of a giant tricuspid PFE in a healthy 43-year-old police officer who was referred for evaluation of frequent premature ventricular contractions during job-related treadmill stress testing. ().

Atrial fibrillation clinical decision aid for emergency medicine providers: An initiative to improve quality healthcare outcomes in adults with new-onset atrial fibrillation.

Background: Atrial fibrillation (AF) affects 6 million Americans with an annual cost of $6 billion and a 30-day readmission rate of 15%.

Methods: We conducted a quality improvement project using pretest-posttest analysis to determine the effects of an AF clinical decision aid for Emergency Medicine providers on quality measures for patients with new-onset AF at a tertiary care facility. Outcomes included readmission rates, documentation of thromboembolic risk (CHADS-VASc), bleeding risk (HAS-BLED), incidence of anticoagulation (AC) patient education, and prescription of AC.

Regional review of patients with psoriatic arthritis in secondary care in the West Midlands: prevalence, disease activity and eligibility for anti-tumour necrosis factor therapy.

Objectives: Tumour necrosis factor alpha-blockers (TNF-alpha) are licensed for the treatment of psoriatic arthritis (PsA) and their use has been approved by the National Institute for Health and Clinical Excellence (NICE) for use in the United Kingdom under a set of defined clinical criteria.

Methods: In this out-patient study we evaluated PsA in rheumatology secondary care clinics in units across the West Midlands over a 2-week period, assessing prevalence, disease activity and eligibility for anti TNF-alpha treatment as defined by the NICE criteria.

Results: Of the 1718 forms returned from the 2000 sent (86% response rate), 175 patients had PsA (10.

Metal ion dependency of microfibrils supports a rod-like conformation for fibrillin-1 calcium-binding epidermal growth factor-like domains.

The effects of the removal and replacement of divalent cations on the ultrastructure of 10 to 12 nm fibrillin-1-containing microfibrils have been studied, in order to investigate the conformation of fibrillin-1 calcium-binding epidermal growth factor-like (cbEGF-like) domains within the microfibril. The NMR structure of a covalently linked pair of cbEGF-like domains from fibrillin-1 recently identified a rigid rod-like conformation for the domain pair stabilised by interdomain calcium binding. This suggested that tandem arrays of fibrillin-1 cbEGF-like domains may adopt an extended conformation within a microfibril.

Solution structure of a pair of calcium-binding epidermal growth factor-like domains: implications for the Marfan syndrome and other genetic disorders.

The nuclear magnetic resonance structure of a covalently linked pair of calcium-binding (cb) epidermal growth factor-like (EGF) domains from human fibrillin-1, the protein defective in the Marfan syndrome, is described. The two domains are in a rigid, rod-like arrangement, stabilized by interdomain calcium binding and hydrophobic interactions. We propose a model for the arrangement of fibrillin monomers in microfibrils that reconciles structural and antibody binding data, and we describe a set of disease-causing mutations that provide the first clues to the specificity of cbEFG interactions.

Calcium binding properties of an epidermal growth factor-like domain pair from human fibrillin-1.

Ca2+ binding epidermal growth factor-like (EGF-like) domains are found in a large number of extracellular proteins with diverse functions, including those involved in blood coagulation, determination of cell fate, cell adhesion and connective tissue architecture. Their importance is emphasised by the identification of mutations in these domains in patients with haemophilia B (defective in coagulation factor IX) and the Marfan syndrome (defective in the connective tissue protein fibrillin-1). The X-ray crystal structure of a single Ca2+ binding EGF-like domain from human coagulation factor IX has recently been solved.

The in vitro formation of sulfates and glucuronides of estrogens by adult and fetal ovine tissues.

Incubation of nanomolar concentrations of [3H]estrone with ovine liver slices from adult and fetal animals demonstrated, in particular, the production of estrogen sulfates together with smaller amounts of glucuronides, even although microsomal estrogen glucuronyltransferase (GT) and sulfatase activities were high, especially in adult tissue. [3H]Estriol was conjugated almost exclusively as sulfate under the same experimental conditions. Slices of maternal and fetal kidney medulla were also strikingly active in promoting estrogen sulfate production as were slices of fetal kidney cortex.

Development and characteristics of an oestrogen sulphotransferase in placenta and uterus of the pregnant mouse. Comparison between mouse and rat.

The mouse placenta possesses a soluble oestrogen sulphotransferase activity which increases markedly from at least 12 days of gestation until term. At about 16 days of gestation, a similar activity is found in the uterus. This activity also increases until term and disappears rapidly post partum.

Estrone sulfatase activity in guinea pig tissues.

Estrone sulfatase activity is widespread in guinea pig tissues. Whole homogenates of adult testis, uterus, lung, adrenal, amnion, ovary, chorion, small intestine, placenta, spleen, kidney and liver exhibit approximately descending order of specific activity. Certain properties, including pH requirement, lack of inhibition by inorganic sulfate and magnitude of estimated Km values, are similar to that for arylsulfatase C of rat liver.

Glutathione-insulin transhydrogenase activity in pregnant mouse mammary gland: hormonal influences studied in tissue culture.

Glutathione-insulin trandhydrogenase (GIT) activity has been shown to be stimulated in culture of explants of pregnant mouse mammary gland by a mixture of insulin, cortisol, and prolactin. Since this hormone mixture stimulates lactogenesis in vitro it is possible that the increase in GIT activity is functionally related to one of the processes of milk secretion or ejection. Oxytocin is degraded by GIT and the interaction of this hormone with its mammary gland receptors may be influenced by the change in enzyme activity.