Identifying patients for early discharge: performance of decision rules among patients with acute chest pain.

Background: The HEART score and North American Chest Pain Rule (NACPR) are decision rules designed to identify acute chest pain patients for early discharge without stress testing or cardiac imaging. This study compares the clinical utility of these decision rules combined with serial troponin determinations.

Methods And Results: A secondary analysis was conducted of 1005 participants in the Myeloperoxidase In the Diagnosis of Acute coronary syndromes Study (MIDAS).

Modafinil attenuates reinstatement of cocaine seeking: role for cystine-glutamate exchange and metabotropic glutamate receptors.

Modafinil may be useful for treating stimulant abuse, but the mechanisms by which it acts to do so are unknown. Indeed, a primary effect of modafinil is to inhibit dopamine transport, which typically promotes rather than inhibits motivated behavior. Therefore, we examined the role of nucleus accumbens extracellular glutamate and the group II metabotropic glutamate receptor (mGluR2/3) in modafinil effects.

Fos activation of selective afferents to ventral tegmental area during cue-induced reinstatement of cocaine seeking in rats.

Ventral tegmental area (VTA) dopamine neurons are crucial for appetitive responses to Pavlovian cues, including cue-induced reinstatement of drug seeking. However, it is unknown which VTA inputs help activate these neurons, transducing stimuli into salient cues that drive drug-seeking behavior. Here we examined 56 VTA afferents from forebrain and midbrain that are Fos activated during cue-induced reinstatement.

A rodent "self-report" measure of methamphetamine craving? Rat ultrasonic vocalizations during methamphetamine self-administration, extinction, and reinstatement.

Rats emit ultrasonic vocalizations (USVs) in a variety of contexts, and it is increasingly clear that USVs reflect more complex information than mere positive and negative affect states. We sought to examine USVs in a common model of addiction and relapse, the self-administration/reinstatement paradigm, in order to gain insight into subjective states experienced by rats during various types of methamphetamine seeking. We measured three subtypes of "50kHz" USVs [flats, trills, and non-trill frequency modulated (FM) USVs], as well as long and short duration "22kHz" USVs, during self-administration and extinction training, and during reinstatement elicited by cues, a methamphetamine prime, cues+prime, or the pharmacological stressor yohimbine.

Multiple roles for orexin/hypocretin in addiction.

Orexins/hypocretins are hypothalamic peptides involved in arousal and wakefulness, but also play a critical role in drug addiction and reward-related behaviors. Here, we review the roles played by orexins in a variety of animal models of drug addiction, emphasizing both commonalities and differences for orexin's involvement in seeking of the major classes of abused drugs, as well as food. One common theme that emerges is an involvement of orexins in drug seeking triggered by external stimuli (e.

Ultrasound guidance to approach the femoral nerve in the iliopsoas muscle: a preliminary study in the dog.

Objective: To describe the location of the femoral nerve within the iliopsoas muscle and determine the feasibility and potential complications of an ultrasound-guided block.

Study Design: Prospective experimental trial.

Animals: Sixteen adult dogs, median weight 14.

Interactions between VTA orexin and glutamate in cue-induced reinstatement of cocaine seeking in rats.

Rationale: Glutamate and orexin/hypocretin systems are involved in Pavlovian cue-triggered drug seeking.

Objectives: Here, we asked whether orexin and glutamate interact within ventral tegmental area (VTA) to promote reinstatement of extinguished cocaine seeking in a rat self-administration paradigm.

Methods/results: We first found that bilateral VTA microinjections of the orexin 1 receptor (OX1R) antagonist SB-334867 (SB) or a cocktail of the AMPA and NMDA glutamate receptor antagonists CNQX/AP-5 reduced reinstatement of cocaine seeking elicited by cues.

Vascular pedicle width on chest radiograph as a measure of volume overload: meta-analysis.

Introduction: Vascular pedicle width (VPW), a measurement obtained from a chest radiograph (CR), is thought to be an indicator of circulating blood volume. To date there are only a handful of studies that demonstrate a correlation between high VPW and volume overload, each utilizing different VPW values and CR techniques. Our objective was to determine a mean VPW measurement from erect and supine CRs and to determine whether VPW correlates with volume overload.

What and when to "want"? Amygdala-based focusing of incentive salience upon sugar and sex.

Rationale: Amygdala-related circuitry helps translate learned Pavlovian associations into appetitive and aversive motivation, especially upon subsequent encounters with cues.

Objectives: We asked whether μ-opioid stimulation via microinjections of the specific agonist D-Ala(2), N-MePhe(4), Gly-ol)-enkephalin (DAMGO) in central nucleus of amygdala (CeA), or the adjacent basolateral amygdala (BLA) would magnify sucrose or sex "wanting", guided by available cues.

Materials And Methods: CeA or BLA DAMGO enhancement of cue-triggered "wanting" was assessed using Pavlovian to instrumental transfer (PIT).

Provider-directed imaging stress testing reduces health care expenditures in lower-risk chest pain patients presenting to the emergency department.

Background: Among intermediate- to high-risk patients with chest pain, we have shown that a cardiac magnetic resonance (CMR) stress test strategy implemented in an observation unit (OU) reduces 1-year health care costs compared with inpatient care. In this study, we compare 2 OU strategies to determine among lower-risk patients if a mandatory CMR stress test strategy was more effective than a physicians' ability to select a stress test modality.

Methods And Results: On emergency department arrival and referral to the OU for management of low- to intermediate-risk chest pain, 120 individuals were randomly assigned to receive (1) a CMR stress imaging test (n=60) or (2) a provider-selected stress test (n=60: stress echo [62%], CMR [32%], cardiac catheterization [3%], nuclear [2%], and coronary CT [2%]).

Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for major adverse cardiac events?

Background: Patients with low-risk chest pain have high utilization of stress testing and cardiac imaging, but low rates of acute coronary syndrome (ACS). The objective of this study was to determine whether the HEART score could safely reduce objective cardiac testing in patients with low-risk chest pain.

Methods: A cohort of chest pain patients was identified from an emergency department-based observation unit registry.

Can we make the basilic vein larger? maneuvers to facilitate ultrasound guided peripheral intravenous access: a prospective cross-sectional study.

Background: Studies have shown that vein size is an important predictor of successful ultrasound-guided vascular access. The objective of this study is to evaluate maneuvers designed to increase basilic vein size, which could be used to facilitate ultrasound-guided peripheral intravenous access (USGPIV) in the Emergency Department (ED) setting.

Methods: This was a prospective non-randomized trial.

Bridging the gap: facilities and technologies for development of early stage therapeutic mAb candidates.

Therapeutic monoclonal antibodies (mAbs) currently dominate the biologics marketplace. Development of a new therapeutic mAb candidate is a complex, multistep process and early stages of development typically begin in an academic research environment. Recently, a number of facilities and initiatives have been launched to aid researchers along this difficult path and facilitate progression of the next mAb blockbuster.

Dedicated emergency department ultrasound rotation improves residents' ultrasound knowledge and interpretation skills.

Background: Graduates of Emergency Medicine (EM) residency training programs are expected to be proficient in ultrasound. However, best practices for teaching residents ultrasonography has yet to be determined.

Study Objectives: To determine if a dedicated Emergency Department (ED) ultrasound rotation objectively improves residents' EM ultrasound knowledge, interpretation accuracy, and clinical decision-making based on ultrasound findings.

The impact of emergency department overcrowding on resident education.

Background: Few studies have evaluated the effect of Emergency Department (ED) overcrowding on resident education.

Objectives: To determine the impact of ED overcrowding on Emergency Medicine (EM) resident education.

Materials And Methods: A prospective cross-sectional study was performed from March to May 2009.

Techniques for teaching electrocardiogram interpretation: self-directed learning is less effective than a workshop or lecture.

Context: Teaching 12-lead electrocardiogram (ECG) interpretation to students and residents is a challenge for medical educators. To date, few studies have compared the effectiveness of different techniques used for ECG teaching.

Objectives: This study aimed to determine if common teaching techniques, such as those involving workshops, lectures and self-directed learning (SDL), increase medical students' ability to correctly interpret ECGs.

Synthesis of 2-hydrazolyl-4-thiazolidinones based on multicomponent reactions and biological evaluation against Trypanosoma Cruzi.

A series of 18 novel 2-hydrazolyl-4-thiazolidinones-5-carboxylic acids, amides and 5,6-α,β-unsaturated esters were synthesized, and their in vitro activity on cruzipain and T. cruzi epimastigotes was determined. Some agents show activity at 37 μm concentration in the enzyme assay.

Alcohol affects the late differentiation of progenitor B cells.

Aims: Previous studies show that alcohol exposure can affect the differentiation of progenitor B cells. Before final commitment to a B lineage, progenitor B cells usually undergo several important stages. However, it is still unclear whether alcohol alters B cell differentiation at which stages.

Cue-reactors: individual differences in cue-induced craving after food or smoking abstinence.

Background: Pavlovian conditioning plays a critical role in both drug addiction and binge eating. Recent animal research suggests that certain individuals are highly sensitive to conditioned cues, whether they signal food or drugs. Are certain humans also more reactive to both food and drug cues?

Methods: We examined cue-induced craving for both cigarettes and food, in the same individuals (n = 15 adult smokers).

Intestinal angioedema misdiagnosed as recurrent episodes of gastroenteritis.

Emergency physicians (EP) frequently encounter angioedema involving the lips and tongue. However, angioedema from Angiotensin Converting Enzyme inhibitors or hereditary angioedema (HAE) can present with gastrointestinal symptoms due to bowel wall involvement. EPs should begin to consider this clinical entity as a potential cause for abdominal pain and associated gastrointestinal symptoms given the common use of medications that can precipitate angioedema.

Emergency Department Activation of Interventional Cardiology to Reduce Door-to-Balloon Time.

Background: Despite American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, many hospitals have door-to-balloon times in excess of 90 minutes. Emergency Department (ED) activation of interventional cardiology has been described as an important strategy to reduce door-to-balloon time. However, prior studies on ED activation have been in suburban hospitals with door-to-balloon times near the ACC/AHA targeted times.

Short- vs long-axis approach to ultrasound-guided peripheral intravenous access: a prospective randomized study.

Objective: The objective of the study was to determine if the short-axis approach and long-axis approach to ultrasound-guided peripheral intravenous access (USGPIV) differ in success rate, catheter insertion time, and number of needle sticks.

Methods: A convenience sample of emergency department patients aged 18 to 65 years with difficult IV access (2 or more failed landmark attempts) was prospectively randomized to short-axis or long-axis USGPIV. Time from skin puncture to catheter insertion (insertion time) and number of needle sticks were recorded.

Resuscitation with balanced electrolyte solution prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis.

Objective: The objective of the study was to determine if balanced electrolyte solution (BES) prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis (DKA).

Methods: This is a prospective, randomized, double-blind study. A convenience sample of DKA patients aged 18 to 65 years with serum bicarbonate less than or equal to 15 and anion gap greater than or equal to 16 was enrolled at "Louisiana State University Health Sciences Center-Shreveport" an capitalize Emergency Department over a 24-month period (2006-2008).