Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis.

Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI). Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain. Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016). Study Selection: Cohort studies involving adults presenting to the ED with possible acute coronary syndrome in whom an ECG and hs-cTnT measurements were obtained and AMI outcomes adjudicated during initial hospitalization. Data Extraction: Investigators of studies provided data on the number of low-risk patients (no new ischemia on ECG and hs-cTnT measurements <0.005 µg/L) and the number who had AMI during hospitalization (primary outcome) or a major adverse cardiac event (MACE) or death within 30 days (secondary outcomes), by risk classification (low or not low risk). Two independent epidemiologists rated risk of bias of studies. Data Synthesis: Of 9241 patients in 11 cohort studies, 2825 (30.6%) were classified as low risk. Fourteen (0.5%) low-risk patients had AMI. Sensitivity of the risk classification for AMI ranged from 87.5% to 100% in individual studies. Pooled estimated sensitivity was 98.7% (95% CI, 96.6% to 99.5%). Sensitivity for 30-day MACEs ranged from 87.9% to 100%; pooled sensitivity was 98.0% (CI, 94.7% to 99.3%). No low-risk patients died. Limitation: Few studies, variation in timing and methods of reference standard troponin tests, and heterogeneity of risk and prevalence of AMI across studies. Conclusion: A single hs-cTnT concentration below the limit of detection in combination with a nonischemic ECG may successfully rule out AMI in patients presenting to EDs with possible emergency acute coronary syndrome. Primary Funding Source: Emergency Care Foundation

Effects of temperature at constant air dew point on leaf carboxylation efficiency and CO 2 compensation point of different leaf types

The effect of temperature on photosynthesis at constant water-vapor pressure in the air was investigated using two sclerophyll species, Arbutus unedo and Quercus suber , and one mesophytic species, Spinacia oleracea . Photosynthesis and transpiration were measured over a range of temperatures, 20–39° C. The external concentration of CO 2 was varied from 340 μbar to near CO 2 compensation. The initial slope (carboxylation efficiency, CE) of the photosynthetic response to intercellular CO 2 concentration, the CO 2 compensation point (Γ), and the extrapolated rate of CO 2 released into CO 2 -free air ( R i ) were calculated. At an external CO 2 concentration of 320–340 μbar CO 2 , photosynthesis decreased with temperature in all species. The effect of temperature on Γ was similar in all species. While CE in S. oleracea changed little with temperature, CE decreased by 50% in Q. suber as temperature increased from 25 to 34° C. Arbutus unedo also exhibited a decrease in CE at higher temperatures but not as marked as Q. suber . The absolut value of R i increased with temperature in S. oleracea , while changing little or decreasing in the sclerophylls. Variations in Γ and R i of the sclerophyll species are not consistent with greater increase of respiration with temperature in the light in these species compared with S. oleracea .Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47470/1/425_2004_Article_BF00397389.pd

Heart Fatty Acid Binding Protein and cardiac troponin: Development of an optimal rule-out strategy for acute myocardial infarction

10.1186/s12873-016-0089-yBMC Emergency Medicine1613