Reliable Exclusion of Acute Coronary Syndrome Among Hospitalized Patients With Elevated Troponin

Background Elevated cardiac troponin I ( cTnI ) occurs in acute coronary syndrome ( ACS ) as well as various scenarios not associated with ACS . Hypothesis Simple clinical criteria can reliably exclude ACS among hospitalized patients with elevated cTnI. Methods Records for patients hospitalized from January to April 2011 with elevated cTnI (>0.29 ng/ dL ) and an available echocardiogram were retrospectively reviewed. Patients with ST ‐segment elevation myocardial infarction were excluded. Based on available clinical data, patients were classified as having ACS or elevation of cTnI unrelated to ACS (non‐ ACS ). Median follow‐up was 365 days. Results Of 265 records meeting inclusion criteria, 82 (31%) had ACS and 183 (69%) had non‐ ACS . In multivariable analysis, odds ratios for non‐ ACS were 7.6 (95% confidence interval [ CI ]: 3.8‐15.3) for peak cTnI <2 ng/ dL , 6.3 (95% CI : 3.1‐13.0) for absent wall‐motion abnormality, and 4.4 (95% CI : 2.2‐8.6) for no prior coronary artery disease history. The area under the receiver operating curve for a model using these 3 variables was 0.86, with a 98% negative predictive value for excluding ACS . Patients who met these 3 criteria had no ACS ‐related deaths over 1‐year follow‐up. Conclusions Hospitalized patients with peak Tn level <2 ng/ dL , no prior history of coronary artery disease, and no new echocardiographic wall‐motion abnormality appear to have a very low likelihood of ACS . Prospective validation of these results is needed to determine whether additional diagnostic testing could be safely avoided in hospitalized patients meeting these simple clinical criteria.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108093/1/clc22263.pd

Hepatic Sarcoidosis Presenting as Portal Hypertension and Liver Cirrhosis: Case Report and Review of the Literature

Systemic sarcoidosis is a disease of unknown etiology, with the liver being the third most commonly affected organ. Most cases of hepatic sarcoidosis are not clinically apparent, but a few can progress to liver cirrhosis, portal hypertension and ultimately liver failure. The diagnosis of hepatic sarcoidosis is difficult, considering that no single laboratory test or radiographic finding can definitively diagnose this systemic disease. Diagnosis of hepatic sarcoidosis relies heavily on histopathologic evaluation of two or more organs, a diagnostic modality that is invasive and may not be applicable to all patients. The treatment of hepatic sarcoidosis is challenging, with no large randomized controlled trials done to date. Physicians must be aware of the complications of hepatic sarcoidosis, and must include the same in the differential diagnosis of liver cirrhosis. We present a case of hepatic sarcoidosis complicated by portal hypertension and liver cirrhosis

Microencapsulation of rice bran oil using pea protein and maltodextrin mixtures as wall material

In this work, the encapsulation of rice bran oil extracted using supercritical CO2 has been studied. In the first stage, the emulsification process by high pressure homogenization was studied and optimized. The effect of the working pressure (60–150 MPa), the composition of the carrier (mixtures of pea protein isolate (PPI) and maltodextrin (MD), from 50 to 90% of PPI) and the carrier to oil ratio (2–4) on the emulsion droplet size (EDS) was studied. To minimize the EDS, moderate pressures (114 MPa), a carrier composed mainly by PPI (64%) and carrier to oil ratios around 3.2 were required. The emulsion obtained in the optimal conditions (EDS ¼ 189 3nm) was dried using different technologies (spray-drying, PGSS-drying and freeze drying). The supercritical CO2 based drying process (PGSS) provided spherical particles that resulted in the smallest average size (but broader distribution) and lower encapsulation efficiency (53 2%).Junta de Castilla y Leon and ERDF Project BU301P18)

Ranolazine as an Alternative Therapy to Flecainide for SCN5A V411M Long QT Syndrome Type 3 Patients

[EN] The prolongation of the QT interval represents the main feature of the long QT syndrome (LQTS), a life-threatening genetic disease. The heterozygous SCN5A V411M mutation of the human sodium channel leads to a LQTS type 3 with severe proarrhythmic effects due to an increase in the late component of the sodium current (INaL). The two sodium blockers flecainide and ranolazine are equally recommended by the current 2015 ESC guidelines to treat patients with LQTS type 3 and persistently prolonged QT intervals. However, awareness of pro-arrhythmic effects of flecainide in LQTS type 3 patients arose upon the study of the SCN5A E1784K mutation. Regarding SCN5A V411M individuals, flecainide showed good results albeit in a reduced number of patients and no evidence supporting the use of ranolazine has ever been released. Therefore, we ought to compare the effect of ranolazine and flecainide in a SCN5A V411M model using an in-silico modeling and simulation approach. We collected clinical data of four patients. Then, we fitted four Markovian models of the human sodium current (INa) to experimental and clinical data. Two of them correspond to the wild type and the heterozygous SCN5A V411M scenarios, and the other two mimic the effects of flecainide and ranolazine on INa. Next, we inserted them into three isolated cell action potential (AP) models for endocardial, midmyocardial and epicardial cells and in a one-dimensional tissue model. The SCN5A V411M mutation produced a 15.9% APD90 prolongation in the isolated endocardial cell model, which corresponded to a 14.3% of the QT interval prolongation in a one-dimensional strand model, in keeping with clinical observations. Although with different underlying mechanisms, flecainide and ranolazine partially countered this prolongation at the isolated endocardial model by reducing the APD90 by 8.7 and 4.3%, and the QT interval by 7.2 and 3.2%, respectively. While flecainide specifically targeted the mutation-induced increase in peak INaL, ranolazine reduced it during the entire AP. Our simulations also suggest that ranolazine could prevent early afterdepolarizations triggered by the SCN5A V411M mutation during bradycardia, as flecainide. We conclude that ranolazine could be used to treat SCN5A V411M patients, specifically when flecainide is contraindicated.This work was partially supported by Fondo Europeo de Desarrollo Regional (FEDER, "Union Europea, Una forma de hacer Europa") with the Ministerio de Economia y Competitividad (DPI2015-69125-R), Direccion General de Politica Cientifica de la Generalitat Valenciana (PROMETEO/2020/043) and Instituto de Salud Carlos III (La Fe Biobank PT17/0015/0043), as well as by Vicerrectorado de Investigacion, Innovacion y Transferencia de la Universitat Politecnica de Valencia with Ayuda a Primeros Proyectos de Investigacion (PAID-06-18), and by Memorial Nacho Barbera.Cano, J.; Zorio, E.; Mazzanti, A.; Arnau, MÁ.; Trenor Gomis, BA.; Priori, SG.; Saiz Rodríguez, FJ.... (2020). Ranolazine as an Alternative Therapy to Flecainide for SCN5A V411M Long QT Syndrome Type 3 Patients. 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About Art

In his article, About Art, Baruch Blich investigates why is art -- and especially modern art -- so difficult to understand? Why do art objects raise questions as to their status? Why scrutinizing art involves semiotics, philosophy of language, linguistics, epistemology, ontology, and even metaphysics? Why art is interpreted by psychoanalysis as well as by behaviorism and psychology of perception? What anthropology and sociology have to do with art and why do we witness art debated in the courtroom concerning copyright issues? In short -- what makes art a crossroad for many and sometimes conflicting disciplines? Is there something in art which compels us to tune our commonsense reactions differently? The answer to these queries, and many others, can be squeezed into one word -- aboutness : art\u27s reference to reality is constituted on conventions far out from the commonly accepted rules of thumb. The purpose of the paper is, therefore, to shed light on the use of mimesis, representation, depiction, and by the same token explicate why their use in the context of art bear special and unique meanings