Syncope: Assessment of risk and an approach to evaluation in the emergency department and urgent care clinic

Syncope is among the most frequent forms of transient loss of consciousness (TLOC), and is characterized by a relatively brief and self-limited loss of consciousness that by definition is triggered by transient cerebral hypoperfusion. Most often, syncope is caused by a temporary drop of systemic arterial pressure below that required to maintain cerebral function, but brief enough not to cause permanent structural brain injury. Currently, approximately one-third of syncope/collapse patients seen in the emergency department (ED) or urgent care clinic are admitted to hospital for evaluation. The primary objective of developing syncope/TLOC risk stratification schemes is to provide guidance regarding the immediate prognostic risk of syncope patients presenting to the ED or clinic; thereafter, based on that risk assessment physicians may be better equipped to determine which patients can be safely evaluated as outpatients, and which require hospital care. In general, the need for hospitalization is determined by several key issues: i) the patient''s immediate (usually considered 1 week to 1 month) mortality risk and risk for physical injury (e.g., falls risk), ii) the patient''s ability to care for him/herself, and iii) whether certain treatments inherently require in-hospital initiation (e.g., pacemaker implantation). However, at present no single risk assessment protocol appears to be satisfactory for universal application, and development of a consensus recommendation is an essential next step.     

Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis

ImportanceSudden cardiac death is a leading cause of mortality in psychiatric patients. Long QT (LQT) is common in this population and predisposes to Torsades-de-Pointes (TdP) and subsequent mortality.ObjectiveTo estimate the cost-effectiveness of electrocardiographic screening to detect LQT in psychiatric inpatients.ResultsIn the base-case scenario, the numbers of patients needed to screen were 1128 and 2817 to avoid one TdP and one death, respectively. The ICER of systematic ECG screening was $8644 (95%CI, 3144-82 498) per QALY. The probability of cost-effectiveness was 96% at a willingness-to-pay of $50 000 for one QALY. In sensitivity analyses, results were sensitive to the case-fatality of TdP episodes and to the TdP reduction following the diagnosis of LQT.

Conclusion and Relevance

In psychiatric hospitals, performing systematic ECG screening at admission help reduce the number of sudden cardiac deaths in a cost-effective fashion.     

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Netherlands Heart Journal -     

Gamma-ray attenuation properties of some NLO materials: potential use in dosimetry

Mass attenuation coefficients ($$\mu _{\text {m}}$$) for some nonlinear optical materials such as potassium dihydrogen phosphate, ammonium dihydrogen phosphate, zinc tris-thiourea sulphate, and zinc thiourea chloride were measured using a $$2\times 2$$ NaI(Tl) scintillation detector at gamma energies of 122 keV, 356 keV, 511 keV, 662 keV, 840 keV, 1170 keV, 1270 keV, and 1330 keV. In addition, GEANT4 simulations were carried out to mimic the experiment at these energies. As a result, good agreement between the experimental and GEANT4 results was observed. The measured $$\mu _{\text {m}}$$ values were used to compute effective atomic numbers ($$Z_{\text {eff}}$$) for the selected materials. It was found that the $$Z_{\text {eff}}$$ values were in the range typical for dosimetric materials.     

Infrastructure for the life sciences: design and implementation of the UniProt website

Background  

The UniProt consortium was formed in 2002 by groups from the Swiss Institute of Bioinformatics (SIB), the European Bioinformatics Institute (EBI) and the Protein Information Resource (PIR) at Georgetown University, and soon afterwards the website was set up as a central entry point to UniProt resources. Requests to this address were redirected to one of the three organisations' websites. While these sites shared a set of static pages with general information about UniProt, their pages for searching and viewing data were different. To provide users with a consistent view and to cut the cost of maintaining three separate sites, the consortium decided to develop a common website for UniProt. Following several years of intense development and a year of public beta testing, the domain was switched to the newly developed site described in this paper in July 2008.     

In-depth review: is hepcidin a marker for the heart and the kidney?

Iron is an essential trace element involved in oxidation–reduction reactions, oxygen transport and storage, and energy metabolism. Iron in excess can be toxic for cells, since iron produces reactive oxygen species and is important for survival of pathogenic microbes. There is a fine-tuning in the regulation of serum iron levels, determined by intestinal absorption, macrophage iron recycling, and mobilization of hepatocyte stores versus iron utilization, primarily by erythroid cells in the bone marrow. Hepcidin is the major regulatory hormone of systemic iron homeostasis and is upregulated during inflammation. Hepcidin metabolism is altered in chronic kidney disease. Ferroportin is an iron export protein and mediates iron release into the circulation from duodenal enterocytes, splenic reticuloendothelial macrophages, and hepatocytes. Systemic iron homeostasis is controlled by the hepcidin–ferroportin axis at the sites of iron entry into the circulation. Hepcidin binds to ferroportin, induces its internalization and intracellular degradation, and thus inhibits iron absorption from enterocytes, and iron release from macrophages and hepatocytes. Recent data suggest that hepcidin, by slowing or preventing the mobilization of iron from macrophages, may promote atherosclerosis and may be associated with increased cardiovascular disease risk. This article reviews the current data regarding the molecular and cellular pathways of systemic and autocrine hepcidin production and seeks the answer to the question whether changes in hepcidin translate into clinical outcomes of all-cause and cardiovascular mortality, and cardiovascular and renal end-points.

     

Multiple myeloma and occupation: A pooled analysis by the International Multiple Myeloma Consortium

Objective: We investigated occupational risk of multiple myeloma (MM) in a pooled analysis of five international case–control studies. Methods: We calculated the odds ratio and its 95% confidence interval for selected occupations with unconditional regression analysis in 1959 MM cases and 6192 controls, by pooling study-specific risks using random-effects meta-analysis. Exposure to organic solvents was assessed with a job-exposure matrix (JEM). Results: Gardeners and nursery workers combined, most likely exposed to pesticides, showed a 50% increase in risk (OR = 1.50, 95% CI 0.9–2.3), while other farming jobs did not. Metal processors (OR = 1.55, 95% CI 0.9–2.3), female cleaners (OR = 1.32, 95% CI 1.0–1.8), and high level exposure to organic solvents (OR = 1.38, 95% CI 0.96–1.8) also showed moderately increased risks. Conclusions: Additional case–control studies of MM aetiology are warranted to further investigate the nature of the repeatedly reported increase in MM risk in several occupational groups.     

Adequate magnesium nutrition mitigates adverse effects of heat stress on maize and wheat

Aims

Heat stress is a growing concern in crop production because of global warming. In many cropping systems heat stress often occurs simultaneously with other environmental stress factors such as mineral nutrient deficiencies. This study aimed to investigate the role of adequate magnesium (Mg) nutrition in mitigating the detrimental effects of heat stress on wheat (Triticum aestivum) and maize (Zea mays).

Methods

Wheat and maize plants were grown in solution culture with low or adequate Mg supply at 25/22 °C (light/dark). Half of the plants were, then, exposed to heat stress at 35/28 °C (light/dark). Development of leaf chlorosis and changes in root and shoot growth, chlorophyll and Mg concentrations as well as the activities of major antioxidative enzymes were quantified in the experimental plants. Additionally, maize plants were analyzed for the specific weights (e.g., dry or fresh weight per a given leaf surface area) and soluble carbohydrate concentrations of sink and source leaves.

Results

Visual leaf symptoms of Mg deficiency were aggravated in wheat and maize when exposed to heat stress. In both species, root growth was more sensitive to Mg deficiency than shoot growth, and the shoot-to-root ratios peaked when heat stress was combined with Mg deficiency. Magnesium deficiency markedly reduced soluble carbohydrate concentrations in young leaf; but resulted in substantial increase in source leaves. Magnesium deficiency also increased activities of antioxidative enzymes, especially when combined with heat stress. The highest activities of superoxide dismutase (up to 80 % above the control), glutathione reductase (up to 250 % above the control) and ascorbate peroxidase (up to 300 % above the control) were measured when Mg-deficient plants were subjected to heat, indicating stimulated formation of reactive oxygen species (ROS) in Mg deficient leaves under heat stress.

Conclusions

Magnesium deficiency increases susceptibility of wheat and maize plants to heat stress, probably by increasing oxidative cellular damage caused by ROS. Ensuring a sufficiently high Mg supply for crop plants through Mg fertilization is a critical factor for minimizing heat-related losses in crop production.     

Species composition, seasonal dynamics and numerical responses of arthropod predators in organic strawberry fields

The species composition and relative abundance of predatory arthropod fauna were studied in organic strawberry fields in northwestern Turkey using sweep net sampling and pitfall trapping (activity density). Arachnida constituted 13.1 and 11.5% of the sweep net and pitfall trap catches, respectively. Among the predatory insects, the most abundant groups were Heteroptera (26.7%), Diptera (25.9%), Coleoptera (16.9%) and Orthoptera (10.8%) in sweep net samples. Coleoptera (84.2%) dominated the pitfall trap catches. Many aphid specific and polyphagous predators reached peak abundance during June and July. Pearson's two-tailed correlations showed a significant and positive relationship between syrphid, coccinellid or chrysopid predator numbers and strawberry aphid density. Aphid density was not significantly correlated with carabid or with nabid abundance. Examination of spatial distribution patterns of all predatory arthropod groups using Taylor's Power Law indicated that most arthropod predators, except carabids, exhibited aggregated dispersion patterns. Coccinellids changed their spatial patterns from a uniform to an aggregated distribution through the season. There was also a significant linear correlation between Anterastes sp. abundance (larvae+adults) and Isophya rectipennis+Poecilimon ricteri (larvae+adults) density at both locations. We observed, for the first time, Anterastes preying on Isophya and Poecilimon species. The seasonal abundance of the major predatory groups were described, and their potential importance in controlling strawberry aphid and other pests is discussed.