Markers and the initial triage and treatment of patients with chest pain.

Emergency departments evaluate nearly 8 million patients with chest pain per year. Nearly 4 million of these individuals are admitted to inpatient units for further evaluation and treatment, but only 30% of these admitted patients ultimately have the diagnosis of acute coronary syndrome (ACS). Previously, the initial evaluation of patients with chest discomfort presenting to the emergency department (ED) involved the triad of history, physical, and ECG. Current evidence demonstrates that a fourth element, cardiac markers, serves as a valuable aid in not only determining initial diagnosis but also providing risk stratification and dictating initial patient treatment. Chest pain units (CPUs) using serial marker determinations have been successful in identifying patients with or at risk for adverse cardiac events in a timely and cost- efficient manner. New point-of-care-testing (POCT) of cardiac markers at the patient's bedside allows for even more timely determination. This article will review the use of cardiac markers in heterogeneous patients presenting to EDs with chest discomfort. We will focus on the use of markers in the risk stratification and initial treatment of the ED chest pain population and emphasize the role of CPUs and POCT.

Catfish spine envenomation: a case report and literature review.

Catfish spine envenomations are common injuries, reported in both freshwater and saltwater. Such injuries are complex puncture wounds, often complicated by severe infection. Signs and symptoms range from simple local pain and bleeding to systemic manifestations with hemodynamic compromise. Care and treatment involve aggressive pain management, judicious wound cleansing, prophylactic antibiotics, and close follow-up. A case of catfish spine envenomation from a freshwater catfish is presented here.

Purification of bovine alpha-lactalbumin by immobilized metal ion affinity chromatography.

The milk protein alpha-lactalbumin was isolated from bovine whey protein concentrate solution by immobilized metal ion affinity chromatography (IMAC) using Cu(II)-Chelating Sepharose Fast Flow. Stepwise pH (5.5-3.8) changes in sodium acetate buffer were used to elute the protein selectively, at which time it was concentrated and reapplied to an uncharged Chelating Sepharose Fast Flow column to remove the contaminating Cu(II) ions. A purity of 90% and recovery of 80% was achieved. The described method appears to be suitable for isolation of alpha-lactalbumin in a form adequate for milk formula engineering.

A comprehensive Guyton model analysis of physiologic responses to preadapting the blood volume as a countermeasure to fluid shifts.

The Guyton model of fluid, electrolyte, and circulatory regulation is an extensive mathematical model capable of simulating a variety of experimental conditions. It has been modified for use at NASA to simulate head-down tilt, a frequently used analog of weightlessness. Weightlessness causes a headward shift of body fluids that is believed to expand central blood volume, triggering a series of physiologic responses resulting in large losses of body fluids. We used the modified Guyton model to test the hypothesis that preadaptation of the blood volume before weightless exposure could counteract the central volume expansion caused by fluid shifts, and thereby attenuate the circulatory and renal responses that result in body fluid losses. Simulation results show that circulatory preadaptation, by a procedure resembling blood donation immediately before head-down bedrest, is effective in damping the physiologic responses to fluid shifts and reducing body fluid losses. After 10 hours of head-down tilt, preadaptation also produces higher blood volume, extracellular volume, and total body water for 20 to 30 days of bedrest, compared with non-preadapted control. These results indicate that circulatory preadaptation before current Space Shuttle missions may be beneficial for the maintenance of reentry and postflight orthostatic tolerance in astronauts. This paper presents a comprehensive examination of the simulation results pertaining to changes in relevant physiologic variables produced by blood volume reduction before a prolonged head-down tilt. The objectives were to study and develop the countermeasure theoretically, to aid in planning experimental studies of the countermeasure, and to identify potentially disadvantageous physiologic responses that may be caused by the countermeasure.