In contrast to ST-elevation myocardial infarction (STEMI), in non-STEMI (NSTEMI) patients the need for continuous rhythm monitoring in a coronary care unit, respective incidence and timing of serious ...arrhythmias are poorly defined.
We used a derivation-validation design and data from two independent prospective cohorts of consecutive haemodynamically stable NSTEMI patients to evaluate the incidence and timing of serious arrhythmias after successful early percutaneous revascularization. Serious arrhythmia was prospectively defined as any arrhythmia that requires immediate medical attention including persistent ventricular tachycardia (>30 s), ventricular fibrillation, asystole, and high degree atrioventricular (AV)-block requiring pacemaker insertion during hospitalization.
In the derivation cohort, among 228 NSTEMI patients who underwent successful early percutaneous revascularization, one patient (0.4%, 95% confidence interval 0.02-2.8%) had a serious arrhythmia which occurred 21 h after revascularization. In the validation cohort, among 293 NSTEMI patients who underwent successful early percutaneous revascularization, no patient (0%, 95% confidence interval 0-1.6%) had a serious arrhythmia after revascularization.
The incidence of serious arrhythmias in NSTEMI patients after successful early revascularization seems to be very low.
Background: The early non-invasive discrimination of Type 2 versus Type 1 Myocardial Infarction (T2MI, T1MI) is a major unmet clinical need. We aimed to externally validate a recently derived ...clinical score (Neumann) combing female sex, no radiating chest pain, and high-sensitivity cardiac troponin I (hs-cTnI) concentration ≤40.8 ng/L. Methods: Patients presenting with acute chest discomfort to the emergency department were prospectively enrolled into an international multicenter diagnostic study. The final diagnoses of T2MI and T1MI were centrally adjudicated by two independent cardiologists using all information including cardiac imaging and serial measurements of hs-cTnT/I according to the fourth universal definition of MI. Model performance for T2MI diagnosis was assessed by formal tests and graphical means of discrimination and calibration. Results: Among 6684 enrolled patients, MI was the adjudicated final diagnosis in 1079 (19%) patients, of which 242 (22%) had T2MI. External validation of the Neumann Score showed a moderate discrimination (C-statistic 0.67 (95%CI 0.64–0.71)). Model calibration showed underestimation of the predicted probabilities of having T2MI for low point scores. Model extension by adding the binary variable heart rate >120/min significantly improved model performance (C-statistic 0.73 (95% CI 0.70–0.76, p < 0.001) and had good calibration. Patients with the highest score values of 3 (Neumann Score, 9.9%) and 5 (Extended Neumann Score, 3.3%) had a 53% and 91% predicted probability of T2MI, respectively. Conclusion: The Neumann Score provided moderate discrimination and suboptimal calibration. Extending the Neumann Score by adding heart rate >120/min improved the model’s performance.
The ~ 10 km
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strewn field of the Twannberg type IIG iron meteorite is located in the Swiss Jura Mountains, 30 km northwest of Bern. The strewn field has been mapped by a group of citizen scientists ...since 2006, yielding more than 2000 meteorite fragments with a total mass of 152.7 kg until the end of 2022. With a terrestrial age of 176 ± 19 ka and a minimum pre-atmospheric mass of ~ 250 t, the Twannberg meteorite is a local time marker in an area with a poorly-known paleoenvironmental history. The Twannberg strewn field is located just outside of the maximum extent of ice during the Last Glacial Maximum (LGM). On the Mont Sujet, meteorites are size-sorted in a 6-km long section of the primary strewn field (altitude 945–1370 m a.s.l.), indicating a fall direction from east-northeast to west-southwest (azimuth approximately 250°). On the Twannberg plateau and in the Twannbach gorge, meteorites are not size-sorted and occur in a ~ 5.7-km long area associated with till and recent stream sediments (altitude 430–1075 m a.s.l.). The mass distribution of meteorites on the Twannberg plateau demonstrate that these meteorites were not found where they fell but that they must have been transported up to several km by glacier ice flow after the fall. The distribution of meteorites and of glacially transported Alpine clasts on the Mont Sujet and on the Chasseral chain indicates the presence of local ice caps and of an approximately 200-m higher Alpine ice surface with respect to the LGM at the time of fall. This high ice level during MIS 6 (Marine Isotopic Stage 6, 191–130 ka) indicated by the meteorite distribution is consistent with surface exposure ages of 50–144 ka from nearby resting erratic boulders at altitudes of up to 1290 m a.s.l., including the newly dated Jobert boulder (63 ka). These boulders indicate an ice level ~ 400 m higher than during LGM at a time not later than MIS 6. Post-LGM luminescence ages of loess-containing meteorites on the Mont Sujet and
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C ages of materials associated with meteorite finds indicate relatively young pedoturbation and increased oxidation of meteorites since ~ 7300 cal BP, possibly correlated with deforestation and enhanced erosion resulting from increased human activities since the Neolithic. This study shows that Twannberg meteorites in their palaeoenvironmental context provide valuable information about ice levels and transport directions during MIS 6 and about their interaction with the post-LGM environmental conditions. The unique Twannberg strewn field has the potential to reveal more valuable information.
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