Prevalence of pulmonary embolism in patients presenting to the emergency department with syncope.

OBJECTIVES: A recent study reported a high prevalence of pulmonary embolism (PE) among patients admitted with syncope. We sought to determine whether these findings were validated in our patient population. METHODS: We performed a retrospective, secondary analysis of prospectively gathered data from patients presenting with syncope to an academic emergency department (ED) from July 2010 to December 2015. We analyzed baseline information from the time of the ED visit, recorded outcomes during the hospital stay, and contacted patients by phone at least 30days after the ED visit. The primary study outcome was the diagnosis of acute PE in the ED, during inpatient admission or ED observation unit stay, or by patient report over a 30-day follow-up period. RESULTS: Over the 5.5-year study period, 348 patients with syncope agreed to participate in the study. 52% of patients were female [95% confidence interval (CI): 46.6-57.4] and the average age was 48.4years. Of the enrolled patients, 50.1% (CI: 44.8-55.2) underwent further evaluation for syncope beyond the ED stay: 27% (CI: 22.6-31.9) of patients were admitted to an inpatient unit for further work-up and 23.9% (CI: 19.7-28.6) of patients were placed in the ED observation unit. The overall rate of PE among patients presenting to the ED with syncope was 1.4% (CI: 0.6-3.3%). 2 patients (0.6%, CI: 0.2-2.1) were diagnosed with a PE while in the ED. None of the patients were diagnosed with a PE during hospital admission or the observation stay associated with the index ED visit. 3 patients (0.9%, CI: 0.3-2.5) reported they had been diagnosed with a PE during the 30days following their ED visit, two of whom had been admitted to the hospital at the index ED visit but were not diagnosed with a PE at that time. All patients diagnosed with a PE at the time of the ED visit or during the follow-up period were Pulmonary Embolism Rule Out Criteria (PERC) positive and reported shortness of breath in the ED. CONCLUSION: In contrast to a previous study, our findings do not support a high rate of PE among ED patients presenting with syncope.

Comparative density of CCK- and PV-GABA cells within the cortex and hippocampus.

Cholecystokinin (CCK)- and parvalbumin (PV)-expressing neurons constitute the two major populations of perisomatic GABAergic neurons in the cortex and the hippocampus. As CCK- and PV-GABA neurons differ in an array of morphological, biochemical and electrophysiological features, it has been proposed that they form distinct inhibitory ensembles which differentially contribute to network oscillations and behavior. However, the relationship and balance between CCK- and PV-GABA neurons in the inhibitory networks of the brain is currently unclear as the distribution of these cells has never been compared on a large scale. Here, we systemically investigated the distribution of CCK- and PV-GABA cells across a wide number of discrete forebrain regions using an intersectional genetic approach. Our analysis revealed several novel trends in the distribution of these cells. While PV-GABA cells were more abundant overall, CCK-GABA cells outnumbered PV-GABA cells in several subregions of the hippocampus, medial prefrontal cortex and ventrolateral temporal cortex. Interestingly, CCK-GABA cells were relatively more abundant in secondary/association areas of the cortex (V2, S2, M2, and AudD/AudV) than they were in corresponding primary areas (V1, S1, M1, and Aud1). The reverse trend was observed for PV-GABA cells. Our findings suggest that the balance between CCK- and PV-GABA cells in a given cortical region is related to the type of processing that area performs; inhibitory networks in the secondary cortex tend to favor the inclusion of CCK-GABA cells more than networks in the primary cortex. The intersectional genetic labeling approach employed in the current study expands upon the ability to study molecularly defined subsets of GABAergic neurons. This technique can be applied to the investigation of neuropathologies which involve disruptions to the GABAergic system, including schizophrenia, stress, maternal immune activation and autism.

Tuberculosis: a disease without boundaries.

Tuberculosis (TB) is an airborne disease caused by Mycobacterium tuberculosis (MTB) that usually affects the lungs leading to severe coughing, fever, and chest pains. Although current research in the past four years has provided valuable insight into TB transmission, diagnosis, and treatment, much remains to be discovered to effectively decrease the incidence of and eventually eradicate TB. The disease still puts a strain on public health, being only second to HIV/AIDS in causing high mortality rates. This review will highlight the history of TB as well as provide an overview of the current literature on epidemiology, pathogenesis and the immune response, treatment, and control of TB. In this race to combat a disease that knows no boundaries, it is necessary to have a conceptual and clear understanding of TB overall with the hope of providing better treatment through novel and collaborative research and public health efforts.

The nature of altered vision near the hands: evidence for the magnocellular enhancement account from object correspondence through occlusion.

A growing body of evidence indicates that the perception of visual stimuli is altered when they occur near the observer's hands, relative to other locations in space (see Brockmole, Davoli, Abrams, & Witt, 2013, for a review). Several accounts have been offered to explain the pattern of performance across different tasks. These have typically focused on attentional explanations (attentional prioritization and detailed attentional evaluation of stimuli in near-hand space), but more recently, it has been suggested that near-hand space enjoys enhanced magnocellular (M) input. Here we differentiate between the attentional and M-cell accounts, via a task that probes the roles of position consistency and color consistency in determining dynamic object correspondence through occlusion. We found that placing the hands near the visual display made observers use only position consistency, and not color, in determining object correspondence through occlusion, which is consistent with the fact that M cells are relatively insensitive to color. In contrast, placing observers' hands far from the stimuli allowed both color and position contribute. This provides evidence in favor of the M-cell enhancement account of altered vision near the hands.