Identifying low-risk chest pain in the emergency department without troponin testing: a validation study of the HE-MACS and HEAR risk scores.

INTRODUCTION: Patients presenting to EDs with chest pain of possible cardiac origin represent a substantial and challenging cohort to risk stratify. Scores such as HE-MACS (History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid) and HEAR (History, ECG, Age, Risk factors) have been developed to stratify risk without the need for troponin testing. Validation of these scores remains limited. METHODS: We performed a post hoc analysis of the Limit of Detection and ECG discharge strategy randomised-controlled trial dataset (n=629; June 2018 to March 2019; 8 UK hospitals) to calculate HEAR and HE-MACS scores. A <4% risk of major adverse cardiac events (MACE) at 30 days using HE-MACS and a score of <2 calculated using HEAR defined 'very low risk' patients suitable for discharge. The primary outcome of MACE at 30 days was used to assess diagnostic accuracy. RESULTS: MACE within 30 days occurred in 42/629 (7%) of the cohort. HE-MACS and HEAR scores identified 85/629 and 181/629 patients as 'very low risk', with MACE occurring in 0/85 and 1/181 patients, respectively. The sensitivities of each score for ruling out MACE were 100% (95% CI: 91.6% to 100%) for HE-MACS and 97.6% (95% CI: 87.7% to 99.9%) for HEAR. Presenting symptoms within these scores were poorly predictive, with only diaphoresis reaching statistical significance (OR: 4.99 (2.33 to 10.67)). Conventional cardiovascular risk factors and clinician suspicion were related to the presence of MACE at 30 days. CONCLUSION: HEAR and HE-MACS show potential as rule out tools for acute myocardial infarction without the need for troponin testing. However, prospective studies are required to further validate these scores.

How to Start Up a National Wildlife Health Surveillance Programme.

Whilst multiple countries in Europe have wildlife health surveillance (WHS) programmes, they vary in scope. In many countries, coordinated general surveillance at a national scale is not conducted and the knowledge of wildlife health status in Europe remains limited. Learning lessons from countries with established systems may help others to effectively implement WHS schemes. In order to facilitate information exchange, the WHS Network of the European Wildlife Disease Association organised a workshop to both collate knowledge and experience from countries that had started or expanded WHS programmes and to translate this information into practical recommendations. Presentations were given by invited representatives of European countries with different WHS levels. Events that led to the start-up and fostered growth spurts of WHS were highlighted, including action plan creation, partnership formation, organisation restructuring and appraisal by external audit. Challenges to programme development, such as a lack of funding, data sharing, infrastructural provision and method harmonisation, were explored. Recommendations to help overcome key challenges were summarised as: understanding and awareness; cross-sectoral scope; national-scale collaboration; harmonisation of methods; government support; academic support; other funding support; staff expertise and capacity; leadership, feedback and engagement; and threat mitigation and wildlife disease management. This resource may enable the development of WHS programmes in Europe and beyond.

Experimental study on the performances of second-harmonic dispersion interferometers at 10.6 µm and 1064 nm for plasma density measurements.

Two common-path interferometers based on CO2 and Nd:Y3Al5O12 (Nd:YAG) lasers are benchmarked with a two-arm microwave interferometer on a hydrogen plasma produced by an RF discharge and injected into a large magnetic-confinement vessel. The ∼1019m-2 line-integrated electron density is clearly measured in agreement by the interferometers. The frequency spectrum of the measured data is analyzed on the 20 kHz range for all interferometers and up to 600 kHz for the Nd:YAG laser-based interferometer. Mechanical vibration measurements performed on the components of the two common-path interferometers result in a peak-to-peak displacement up to about one and twenty wavelengths for the CO2 and Nd:YAG laser-based interferometers, respectively. Such results set for the first time, to the best of our knowledge, a quantitative limit for the displacement that the two second-harmonic dispersion interferometers can sustain while still providing a high sensitivity for accurate plasma density measurements.

Resistance to carbapenems and other antibiotics in Klebsiella pneumoniae found in seals indicates anthropogenic pollution.

BACKGROUND: The beta-lactamase enzyme OXA-48 has spread widely in recent years in Enterobacteriaceae associated with man, disseminated primarily on incompatibility group L/M plasmids. OXA-48 confers resistance to carbapenems, important antimicrobials for treating highly resistant bacterial infections in humans. This enzyme has rarely been detected in bacteria from animals. Furthermore, the use of carbapenem compounds is not permitted in food-producing animals in Europe and to our knowledge has not been reported in food-producing animals globally. METHODS: Bacterial isolates from lesions in stranded, free-living, juvenile common seals (Phoca vitulina) were identified. Antimicrobial susceptibility testing and whole genome sequencing analysis were used to characterise antimicrobial resistance genes carried by the bacteria. RESULTS: Here, we report the detection of Klebsiella pneumoniae subspecies pneumoniae carrying the bla OXA-48 gene on an incompatibility group L/M plasmid from an infection in a common seal. CONCLUSION: Evidence is accruing that marine mammals may be infected with bacteria originating from anthropogenic sources, such as human sewage, contaminating the environment.

Biomimetic electromechanical stimulation to maintain adult myocardial slices in vitro.

Adult cardiac tissue undergoes a rapid process of dedifferentiation when cultured outside the body. The in vivo environment, particularly constant electromechanical stimulation, is fundamental to the regulation of cardiac structure and function. We investigated the role of electromechanical stimulation in preventing culture-induced dedifferentiation of adult cardiac tissue using rat, rabbit and human heart failure myocardial slices. Here we report that the application of a preload equivalent to sarcomere length (SL) = 2.2 µm is optimal for the maintenance of rat myocardial slice structural, functional and transcriptional properties at 24 h. Gene sets associated with the preservation of structure and function are activated, while gene sets involved in dedifferentiation are suppressed. The maximum contractility of human heart failure myocardial slices at 24 h is also optimally maintained at SL = 2.2 µm. Rabbit myocardial slices cultured at SL = 2.2 µm remain stable for 5 days. This approach substantially prolongs the culture of adult cardiac tissue in vitro.

Has respiratory cryptosporidiosis spread to black grouse Tetrao tetrix?

Infection by Cryptosporidium baileyi was first confirmed in red grouse in northern England in 2010 and within three years spread to 48 per cent of moors. These form the last English stronghold for the rarer black grouse, and given the rapid spread of respiratory cryptosporidiosis among red grouse, concern has been expressed about possible infection. In 2010, the authors started screening black grouse for cryptosporidiosis in (1) dead birds taken for postmortem examination, (2) sample birds caught at night and (3) an observational study of birds attending leks. Between 2011 and 2016, five males were sent for postmortem examination, of which three had suspected cryptosporidiosis. No disease was found in one; the second had extensive, subacute to chronic sinusitis; and the third had severe sinusitis and unilateral conjunctivitis. PCR analysis detected cryptosporidial DNA in the third bird only; however, the parasite was not seen in stained preparations or on histopathology. No cryptosporidiosis clinical signs were observed in 69 birds caught at night or in 170 birds attending leks. The authors have no conclusive evidence that cryptosporidiosis is causing sinusitis in black grouse. However, a single positive cryptosporidia PCR result from an affected bird does raise the possibility that they may be infected with the parasite.

Reference map for liquid chromatography-mass spectrometry-based quantitative proteomics.

The accurate mass and time (AMT) tag strategy has been recognized as a powerful tool for high-throughput analysis in liquid chromatography-mass spectrometry (LC-MS)-based proteomics. Due to the complexity of the human proteome, this strategy requires highly accurate mass measurements for confident identifications. We have developed a method of building a reference map that allows relaxed criteria for mass errors yet delivers high confidence for peptide identifications. The samples used for generating the peptide database were produced by collecting cysteine-containing peptides from T47D cells and then fractionating the peptides using strong cationic exchange chromatography (SCX). LC-tandem mass spectrometry (MS/MS) data from the SCX fractions were combined to create a comprehensive reference map. After the reference map was built, it was possible to skip the SCX step in further proteomic analyses. We found that the reference-driven identification increases the overall throughput and proteomic coverage by identifying peptides with low intensity or complex interference. The use of the reference map also facilitates the quantitation process by allowing extraction of peptide intensities of interest and incorporating models of theoretical isotope distribution.

Dynamics of hyperthermal collisions of O(3P) with CO.

The dynamics of O(3P) + CO collisions at a hyperthermal collision energy near 80 kcal mol-1 have been studied with a crossed molecular beams experiment and with quasi-classical trajectory calculations on computed potential energy surfaces. In the experiment, a rotatable mass spectrometer detector was used to monitor inelastically and reactively scattered products as a function of velocity and scattering angle. From these data, center-of-mass (c.m.) translational energy and angular distributions were derived for the inelastic and reactive channels. Isotopically labeled C18O was used to distinguish the reactive channel (16O + C18O 16OC + 18O) from the inelastic channel (16O + C18O 16O + C18O). The reactive 16OC molecules scattered predominantly in the forward direction, i.e., in the same direction as the velocity vector of the reagent O atoms in the c.m. frame. The c.m. translational energy distribution of the reactively scattered 16OC and 18O was very broad, indicating that 16OC is formed with a wide range of internal energies, with an average internal excitation of approximately 40% of the available energy. The c.m. translational energy distribution of the inelastically scattered C18O and 16O products indicated that an average of 15% of the collision energy went into internal excitation of C18O, although a small fraction of the collisions transferred nearly all the collision energy into internal excitation of C18O. The theoretical calculations, which extend previously published results on this system, predict c.m. translational energy and angular distributions that are in near quantitative agreement with the experimentally derived distributions. The theoretical calculations, thus validated by the experimental results, have been used to derive internal state distributions of scattered CO products and to probe in detail the interactions that lead to the observed dynamical behavior.