Coronary computed tomographic angiography (CCTA) has a very high negative predictive value for the detection of coronary
disease, but its usefulness in determining whether discharge of patients from the emergency department is safe is not well established.
METHODS
We randomly assigned low-to-intermediate-risk patients presenting with possible acute coronary syndromes, in a 2: 1 ratio, to undergo CCTA or to receive traditional care. Patients were enrolled at five centers in the United States. Patients older than 30 years of age with a Thrombolysis in Myocardial Infarction risk score of 0 to 2 and signs or symptoms warranting admission or testing were eligible. The primary outcome was safety, assessed in the subgroup of patients with a negative CCTA examination, with safety defined as the absence of myocardial infarction and cardiac Nepicastat concentration death during the first 30 days after presentation.
RESULTS
We enrolled 1370 subjects: 908 in the CCTA group and 462 in the group receiving traditional care. The baseline Stattic characteristics were similar in the two groups. Of 640 patients with a negative CCTA examination, none died or had a myocardial infarction within 30 days (0%; 95% confidence interval [CI], 0 to 0.57). As compared with patients
receiving traditional care, patients in the CCTA group had a higher rate of discharge from the emergency department (49.6% vs. 22.7%; difference, 26.8 percentage points; 95% CI, 21.4 to 32.2), a shorter length of stay (median, 18.0 hours vs. 24.8 hours; P<0.001), and a higher rate of detection of coronary disease (9.0% vs. 3.5%; difference,
5.6 percentage points; 95% CI, 0 to 11.2). There was one serious adverse event in each group.
CONCLUSIONS
A CCTA-based strategy for low-to-intermediate-risk patients presenting with a possible acute coronary syndrome appears selleck products to allow the safe, expedited discharge from the emergency department of many patients who would otherwise be admitted. (Funded by the Commonwealth of Pennsylvania Department of Health and the American College of Radiology Imaging Network Foundation; ClinicalTrials.gov number, NCT00933400.)”
“Aims: To investigate the antibiofilm effect of cinnamaldehyde on methicillin-resistant Staphylococcus aureus (MRSA) and analyse the effect of subminimum inhibitory concentrations (MICs) of cinnamaldehyde on the expression of the biofilm-related gene sarA.
Methods and Results: The MICs and minimum bactericidal concentrations (MBCs) were determined using a microtitre broth dilution method. Biofilm susceptibility was determined using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) staining and colony forming unit (CFU) counting assays.