Articles: adult.
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Stroke is a medical emergency as it is the third commonest cause of death and the most important cause of acquired severe disability in adults. Stroke services, funding and research have lagged behind cardiac medicine but evidence is now available to support a much more interventional approach to the assessment and management of patients with ischaemic stroke. Randomised controlled trials and meta-analyses of the most important interventions are the main sources of evidence for this review. ⋯ Patients not eligible for thrombolysis should receive aspirin and specialised care in a stroke unit. Many other treatments have been evaluated for acute ischaemic stroke of which some have been shown to be ineffective such as haemodilution or anticoagulation, whilst other interventions have not been adequately investigated such as neuroprotection and blood pressure lowering strategies. There is now good evidence to support a much more active assessment and treatment of patients with stroke but it is recognised that stroke services still need substantial development to maximise the benefits from the current proven interventions.
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Patients admitted with acute and potential acute coronary syndromes (ACS) frequently required accompaniment by a registered nurse from the emergency department (ED) to inpatient telemetry beds. We tested the hypothesis that telemetry transport monitoring for patients with acute and potential ACS is of limited utility. We conducted a prospective cohort study of patients who were admitted from the ED with acute and potential ACS. ⋯ The total nurse time out of the ED spent transporting was 13.6 minutes (SD 5.2, range 4-40). The routine use of nurses accompanying patients admitted with acute and potential acute coronary syndromes is of limited utility. Patient transportation without nurses may help alleviate ED overcrowding by saving almost 15 minutes of nursing time currently being used for transport without measurable benefit.
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The anterior cingulate cortex (ACC) plays an important role in higher brain functions including learning, memory, and persistent pain. Long-term potentiation of excitatory synaptic transmission has been observed in the ACC after digit amputation, which might contribute to plastic changes associated with the phantom pain. Here we report a long-lasting membrane potential depolarization in ACC neurons of adult rats after digit amputation in vivo. ⋯ The depolarization is activity-dependent, since peripheral application of lidocaine significantly reduced it. Furthermore, the depolarization was significantly reduced by a NMDA receptor antagonist MK-801. Our results provide direct in vivo electrophysiological evidence that ACC pyramidal cells undergo rapid and prolonged depolarization after digit amputation, and the amputation-induced depolarization in ACC neurons might be associated with the synaptic mechanisms for phantom pain.