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Plasma filaments have been measured with alkali beam emission spectroscopy in the plasma edge, divertor island, and scrape-off layer of Wendelstein 7-X. Due to the high intensity of a 1–2 kHz plasma mode, a new, correlation based conditional averaging algorithm was used to search for filaments in the signals. With that method, effects of different magnetic configurations and density levels on filament properties are observed. In configurations where the islands are small and do not play an important role for the connection length topology, filaments behave similar to tokamaks. In contrast, in configurations with larger magnetic islands and more complex connection length profiles, filaments behave quite differently, for instance they may or may not appear in the inner side of the divertor island depending on the plasma parameters. Coupling between the filaments and lower frequency events are also showed. The role of filaments in the global and local particle transport is briefly discussed.

Drifts affect particle, momentum, and energy transport in the scrape-off layer (SOL) of tokamaks and stellarators, altering plasma flows and creating asymmetries between divertors. To understand how drifts affect SOL transport in the W7-X island divertor, an experiment was performed to compare plasmas with matched core parameters but opposite magnetic field directions, and therefore opposite drift transport directions. Parallel flow measurements made with coherence imaging spectroscopy are interpreted with the aid of a diagnostic forward model and a 1D simple SOL model that includes the $\boldsymbol{\mathbf{E}} \times \boldsymbol{\mathbf{B}}$ drift. In low-density plasmas ( $\overline{n}_\mathrm{e} \lt 2 \times 10^{19}$ m ^−3 ), the poloidal $\boldsymbol{\mathbf{E}} \times \boldsymbol{\mathbf{B}}$ drift induces a large poloidal density asymmetry within the island SOL, as measured by divertor Langmuir probes. This in turn causes the parallel flow stagnation point to shift from the position halfway between targets to the X-point in the drift direction, leading to near-unidirectional flow throughout the SOL. As density increases, the effects of the poloidal $\boldsymbol{\mathbf{E}} \times \boldsymbol{\mathbf{B}}$ drift decrease substantially, resulting in a smaller density asymmetry and the development of a counter-streaming flow pattern. For the entire density range probed in this experiment ( $\overline{n}_\mathrm{e} = 1.5-6\times 10^{19}$ m ^−3 ), the experimental observations are more consistent with the effects of the poloidal $\boldsymbol{\mathbf{E}} \times \boldsymbol{\mathbf{B}}$ drift than the radial $\boldsymbol{\mathbf{E}} \times \boldsymbol{\mathbf{B}}$ drift.

During its second operational campaign (OP 1.2a) W7-X operated with an edge island divertor. Much higher densities (1020m−3) than in to the previous, limiter campaign were achieved. In order to asses this improved performance and the nature of transport with regard to the expected higher densities and other parameters such as the electron and ion temperature, the electric field and plasma flow, measurements at the plasma edge were conducted with reciprocating probe, mounted on a Manipulator. The probe contains a set of Langmuir pins, Mach probes, compensation coils and a set of 3D pick up coils for the measurement of the local magnetic field and fluctuations, and an ion sensitive probe. It has been observed, in addition to differences due to the magnetic configurations, that the magnetic topology is sensitive to the plasma conditions, especially to changes due to a evolving toroidal plasma current. Measurements from divertor cameras showed that an increasing toroidal current in the standard configuration broadened the heat flux and shifted the strike line considerably. These down-stream observation can be complemented with the measurements at the mid-plane with the manipulator mounted probes. During the experiments the edge island remnant was identified with the measured edge plasma profiles and compared with the predictions from the field line tracing code. Those electron densities and temperatures have been used as an input for understanding edge transport with the EMC3-EIRENE modeling. The results from EMC3-EIRENE also help improve the caculated density profiles, since the modelling provides a profile of the effective charge Zeff. Keywords: W7-X, Langmuir probes, Magnetic islands, Plasma edge transport

A 1–2 kHz electromagnetic mode is present in a large fraction of W7-X discharges in the standard magnetic field configurations with 5/5 edge island structure. The power in the mode is significantly reduced in other magnetic configurations. The mode can appear spontaneously and persist for the full duration of a discharge. Its full width at half maximum is typically 100–300 Hz.The 1–2 kHz mode was first observed in visible light emissions from the divertor [1]. Matching spectral peaks were found in measurements of both global and edge plasma parameters, including line-integrated density, diamagnetic energy, and edge floating potential and ion saturation current [2]. An infrared camera recording shows a temperature modulation of ~ 2.5 K due to this mode on a divertor tile where the average temperature was 600 °C. Separate correlation analyses of the high-speed camera recordings, Langmuir probe signals, and Mirnov coil signals all indicate a poloidal velocity of 0.5–10 km/s and m = 2 as a likely poloidal mode number. Langmuir probes mounted on the Multi-Purpose Manipulator show that the fluctuation is present in one of the magnetic islands over a radial distance of at least 5 mm.A database of various diagnostic measurements and dB/dt signals from a Mirnov coil was created using a majority of the discharges from the 2018 campaign on W7-X, in order to shed light on the plasma parameters that are correlated with the existence of the 1–2 kHz mode. The power in the mode is positively correlated to the toroidal current, total external heating power, and core electron temperature. It is negatively correlated with plasma density.

Several risk stratification tools were developed to predict disease progression in coronavirus disease 2019, with no external validation to date. We attempted to validate three previously published risk-stratification tools in a multicenter study. Primary outcome was a composite outcome of development of severe coronavirus disease 2019 disease leading to ICU admission or death censored at hospital discharge or 30 days. We collected data from 169 patients. Patients were 73 years old (59–82 yr old), 66 of 169 (39.1%) were female, 57 (33.7%) had one comorbidity, and 80 (47.3%) had two or more comorbidities. Area under the receiver operating characteristic curve (95% CI) for the COVID-GRAM score was 0.636 (0.550–0.722), for the CALL score 0.500 (0.411–0.589), and for the nomogram 0.628 (0.543–0.714).

In this work we present an analysis of fast-camera imaging of Alcator C-Mod's divertor region and of the plasma cross section in the W7-X stellarator. In C-Mod, the dynamics of intermittent edge plasma filaments are imaged at 397,100 frames per second in an oblique view. An automatic pipeline was developed to reconstruct the filament motion in the R, Z plane of the divertor using EFIT field line projections. Next, we added our fast-framing camera to W7-X's diagnostic suite for the 2017 run campaign, the first with a divertor. It has a tangential view of the machine cross section, including part of a divertor module. The view is coupled to the camera via a coherent fiber bundle. The spatial resolution is 2–4 cm and the typical plasma brightness limits the fastest usable frame rate to 30k frames/s. We observe filaments in the plasma boundary that rotate around the magnetic axis during radiative collapse; filaments were observed in steady state in the limiter configuration of W7-X by Kocsis et al. [1]. We also observe for the first time a 1–2 kHz quasi-coherent fluctuation in divertor target emissions in the W7-X “standard” magnetic configuration. Finally, a rough analysis of edge gas fueling efficiency using fast camera data and S/XB coefficients finds that fueling is less efficient at densities higher than 4 × 1019 m−3. Keywords: C-Mod, W7-X, Filaments, Blobs, Turbulence, Fluctuation

The formation of the radial electric field, $E_\textrm{r}$ in the scrape-off layer (SOL) has been experimentally studied for attached divertor conditions in stellarator W7-X. The main objective of this study is to test the validity in a complex three-dimensional (3D) island divertor of simple models, typically developed in tokamaks, relating $E_\textrm{r}$ in the SOL to the sheath potential drop gradient at the target. Additionally, we investigate the effect of the edge $E_\textrm{r}$ shear on the reduction of density fluctuation amplitude, a well-established phenomenon according to the existing bibliography. The main diagnostic for measurements in the SOL is a V-band Doppler reflectometer that can provide the measurement of the $E_\textrm{r}$ and density fluctuations with good spatial resolution. 3D measurements of divertor parameters have been carried out using infrared cameras, with the exponential decay length of the divertor heat flux ( $\lambda_\mathrm{q}$ ) resulting in a suitable proxy for the model-relevant $\lambda_\mathrm{T}$ , the exponential decay length of the temperature at the divertor. In the investigated attached regimes, it is shown for the first time that the formation of the $E_\textrm{r}$ in the SOL depends on parameters at the divertor, following a $E_\textrm{r} \propto T_\mathrm{e}/\lambda_\mathrm{q}$ qualitatively similar to that found in a tokamak. Then, from the analyzed plasmas, the observed $E_\textrm{r}$ shear at the edge is linked to a moderate local reduction of the amplitude of density fluctuations.

Zusammenfassung  Lokal- und Regionalanästhesieverfahren sind fester Bestandteil der täglichen chirurgischen Praxis. Neben der Schmerzausschaltung für den operativen Eingriff selbst können kontinuierliche Regionalanästhesieverfahren postoperative Schmerzen lindern, das operative Ergebnis verbessern und den Patientenkomfort erhöhen. Während die Epiduralanästhesie besonders bei viszeral- und thoraxchirurgischen Eingriffen vorteilhaft ist, stellen periphere Regionalanästhesieverfahren die Methode der Wahl bei Extremitäteneingriffen dar. Trotz der hohen Sicherheit der Regionalanästhesieverfahren muss jederzeit die Notfalltherapie lebensbedrohlicher Komplikationen gewährleistet sein. [ABSTRACT FROM AUTHOR]

The ex-utero intra-partum (EXIT) procedure enables the surgeon to perform invasive procedures in an infant during cesarean section before clamping the umbilical cord. Specific anesthesiological concepts are necessary for ensuring sufficient umbilical perfusion. We report the case of a 33-year-old female undergoing cesarean section in the 36th week of pregnancy because of a large fetal cervical tumor. The EXIT procedure was performed in order to secure the infant’s airway during delivery. The anesthesiological management and interdisciplinary tasks are discussed in the literature review. [ABSTRACT FROM AUTHOR]

Introduction: Understanding sex differences in the clinical presentation of patients with suspected stroke is important to reduce sex-related disparities and improve care. We aimed to characterize presenting symptoms in women and men with suspected stroke evaluated at our comprehensive stroke center., Methods: This was a retrospective analysis of consecutive patients with suspected stroke treated at the University Hospital Essen between January 2017 and December 2021. Patient characteristics, signs and symptoms as well as final diagnoses in women and men were compared. Logistic regression analysis was performed to assess the association of individual symptoms with a diagnosis of cerebrovascular disease., Results: We included 6069 patients in our analysis. Cerebrovascular disease was diagnosed in 85.2% (2576/3022) of women and 88.0% (2681/3047) of men (p = 0.002). Aphasia (31.4% vs. 27.7%, p = 0.002), neglect (15.5% vs. 12.8%, p = 0.003), gaze deviation (21.0% vs. 18.8%, p = 0.034), as well as nonfocal symptoms including impairments in consciousness (17.0% vs 14.6%, p = 0.012), orientation (42.5 vs. 36.4%, p < 0.001) and completion of tasks (31.2% vs. 26.0%, p < 0.001) were more common among women. Limb ataxia (8.1% vs. 11.2%, p < 0.001) and dysarthria (44.0% vs. 46.8%, p = 0.030) were less frequent in women. Neglect and gaze deviation were independent positive predictors of cerebrovascular disease in women but not in men., Conclusion: Although clinical presentation was similar in both sexes, cortical and nonfocal symptoms were more common among women with suspected stroke. Awareness of sex differences and acknowledgement of the full clinical picture are important to ensure optimal management for women and men with suspected stroke. Our findings might serve as a target for educational programs in order to improve preclinical stroke detection in patients with predominantly nonfocal or subtle symptoms., (The Author(s). Published by S. Karger AG, Basel.)

Acute respiratory infections are a significant challenge in primary care and hospital settings. Viruses are the most common etiology and the overlapping symptomatology among major respiratory viruses, such as influenza, severe acute respiratory syndrome coronavirus 2, and respiratory syncytial virus, requires the use of diagnostic tests that deliver early and accurate results. With the increasing availability of rapid antigen tests (RATS), it is tempting to prefer them over polymerase chain reaction (PCR) tests. However, compelling arguments support the existing recommendations in some European countries to maintain PCR testing for patient management throughout the year. RATs show sensitivities below 30% with lower viral loads, which are common and can have significant clinical implications. RATs perform well at lower cycle threshold (Ct) values, with sensitivity reaching 97.9% for Ct values below 20, which drops significantly for values above 25. Factors affecting viral load include disease stage, vaccination status, and viral variants, all of which can compromise the accuracy of antigen tests. Multi-target PCR tests effectively overcome these issues, ensuring reliable diagnosis. Additionally, the early detection of paucisymptomatic cases is essential in primary care and hospital settings to facilitate isolation and prevent secondary infections. Economic analyses support the use of comprehensive PCR tests, such as triplex-type tests, detecting SARS-CoV-2, influenza viruses, and RSV, as a first-line approach, as they can reduce case numbers and healthcare resource utilization. Maintaining PCR testing year-round is therefore crucial for the effective management of respiratory infections.

Respiratory syncytial virus (RSV) is a seasonal virus known to cause significant morbidity in pediatric patients; however, morbidity in adult patients has not been well investigated. We aimed to characterize adult patients with RSV infection in the emergency department (ED) and their clinical course. During the winter term 2022/23, all adult ED patients were screened for RSV, severe acute respiratory syndrome coronavirus type 2, and influenza infection using point-of-care polymerase chain reaction tests. All symptomatic RSV+ patients were further characterized based on their clinical presentation and course. A group comparison between RSV+ inpatients and RSV+ outpatients was conducted. The potential risk factors for inpatient treatment were evaluated using univariate and multivariate analyses. Of the 135 symptomatic RSV+ patients, 51.9% (70/135) were inpatients. Their length of stay were 9.4 (±10.4) days. Inpatients had a significantly higher mean age, lower oxygen saturation, higher leukocyte count, and higher C-reactive protein levels than outpatients. Among the preconditions, pulmonary diseases, tumors, and immunosuppression were significantly more frequent in the inpatient group. Thirty percent (21/70) of the inpatients required ICU treatment, 11% (8/70) required mechanical ventilation, and 9% (6/70) died. Malaise (P = .021, odds ratio 8.390) and detection of pulmonary infiltrations (P < .001, odds ratio 12.563) were the only independent predictors of inpatient treatment in the multivariate analysis. Our data show that RSV is a medically relevant pathogen among adult ED patients, often requiring inpatient treatment. In particular, elderly patients with some medical preconditions seem to be more prone to a severe course of infection requiring inpatient treatment. Lower respiratory tract involvement, proven by pulmonary infiltrates, seems to be crucial for a more severe disease course., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: We evaluated the ability of the assessment of regional wall motion abnormalities (RWMA) detected via transthoracic echocardiography to predict the presence of obstructive coronary artery disease (CAD) in patients presenting with acute chest pain to the emergency department., Design: Prospective single-centre observational study., Setting: Tertiary care university hospital emergency unit., Participants: Patients presenting to the emergency department with acute chest pain suggestive of obstructive CAD., Primary Outcome Measure: The primary endpoint was defined as the presence of obstructive CAD, requiring revascularisation therapy., Results: Overall, 657 patients (age 58.1±18.0 years, 53% men) were included in our study. RWMA were detected in 76 patients (11.6%). RWMA were significantly more frequent in patients reaching the primary endpoint (26.2% vs 7.6%, p<0.001). In multivariable regression analysis, the presence of RWMA was associated with threefold increased odds of the presence of obstructive CAD (3.41 (95% CI 1.99 to 5.86), p<0.001). Adding RWMA to a multivariable model of the Thrombolysis in Myocardial Infarction (TIMI) risk score, cardiac biomarkers and traditional risk factors significantly improved the area under the curve for prediction of obstructive CAD (95% CI 0.777 to 0.804, p=0.0092)., Conclusion: RWMA strongly and independently predicts the presence of obstructive CAD in patients presenting with acute chest pain to the emergency department., Trial Registration: The study has been registered online (NCT03787797)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

For many years, ventilation has been an essential part of advanced life support (ALS) in cardiopulmonary resuscitation (CPR). Nevertheless, there is little evidence about the best method of ventilation during resuscitation for both out-of-hospital cardiac arrest (OHCA) and inhospital cardiac arrest (IHCA) patients. Effective ventilation is one of the two main keys to successful resuscitation. In this context, the question always arises as to which airway management, along with which ventilation mode, constitutes the best strategy. Conventional ventilation modes are not designed for cardiac arrest and show important limitations that must be considered when used in CPR. Manual ventilation without the use of an automated transport ventilator (ATV) could be shown to be uncontrolled in applied volumes and pressures and should be avoided. Mechanical ventilation with an ATV is therefore superior to manual ventilation, but both volume- and pressure-controlled ventilation modes are significantly influenced by chest compressions. With the newly designed chest compression synchronized ventilation (CCSV), a special ventilation mode for resuscitation is available. Further research should be conducted to obtain more evidence of the effect of ventilation during CPR on outcomes following OHCA and not only about how to secure the airway for ventilation during CPR., (© 2024. The Author(s).)

Patients with potential or proven cardiovascular diseases represent a relevant proportion of the total spectrum in the emergency department. Their monitoring for cardiovascular surveillance until the diagnostics and acute treatment are initiated, often poses an interdisciplinary and interprofessional challenge, because resources are limited, nevertheless a high level of patient safety has to be ensured and the correct procedure has a major prognostic significance. This consensus paper provides an overview of the practical implementation, the modalities of monitoring and the application in a selection of cardiovascular diagnoses. The article provides specific comments on the clinical presentations of acute coronary syndrome, acute heart failure, cardiogenic shock, hypertensive emergency events, syncope, acute pulmonary embolism and cardiac arrhythmia. The level of evidence is generally low as no randomized trials are available on this topic. The recommendations are intended to supplement or establish local standards and to assist all physicians, nursing personnel and the patients to be treated in making decisions about monitoring in the emergency department., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Stroke mimics are common in the emergency department (ED) and early detection is important to initiate appropriate treatment and withhold unnecessary procedures. We aimed to compare the frequency, clinical characteristics and predictors of non-neurological and neurological stroke mimics transferred to our ED for suspected stroke., Methods: This was a cross-sectional study of consecutive patients with suspected stroke transported to the ED of the University Hospital Essen between January 2017 and December 2021 by the city's Emergency Medical Service. We investigated patient characteristics, preclinical data, symptoms and final diagnoses in patients with non-neurological and neurological stroke mimics. Multinominal logistic regression analysis was performed to assess predictors of both etiologic groups., Results: Of 2167 patients with suspected stroke, 762 (35.2%) were diagnosed with a stroke mimic. Etiology was non-neurological in 369 (48.4%) and neurological in 393 (51.6%) cases. The most common diagnoses were seizures (23.2%) and infections (14.7%). Patients with non-neurological mimics were older (78.0 vs. 72.0 y, p < 0.001) and more likely to have chronic kidney disease (17.3% vs. 9.2%, p < 0.001) or heart failure (12.5% vs. 7.1%, p = 0.014). Prevalence of malignancy (8.7% vs. 13.7%, p = 0.031) and focal symptoms (38.8 vs. 57.3%, p < 0.001) was lower in this group. More than two-fifths required hospitalization (39.3 vs. 47.1%, p = 0.034). Adjusted multinominal logistic regression revealed chronic kidney and liver disease as independent positive predictors of stroke mimics regardless of etiology, while atrial fibrillation and hypertension were negative predictors in both groups. Prehospital vital signs were independently associated with non-neurological stroke mimics only, while age was exclusively associated with neurological mimics., Conclusions: Up to half of stroke mimics in the neurological ED are of non-neurological origin. Preclinical identification is challenging and a high proportion requires hospitalization. Awareness of underlying etiologies and differences in clinical characteristics is important to provide optimal care.

Early treatment is the mainstay of sepsis therapy. We suspected that early recognition of sepsis by prehospital healthcare providers may shorten the time for antibiotic administration in the emergency department. We retrospectively evaluated all patients above 18 years of age who were diagnosed with sepsis or severe infection in our emergency department between 2018 and 2020. We recorded the suspected diagnosis at the time of presentation, the type of referring healthcare provider, and the time until initiation of antibiotic treatment. Differences between groups were calculated using the Kruskal-Wallis rank sum test. Of the 277 patients who were diagnosed with severe infection or sepsis in the emergency department, an infection was suspected in 124 (44.8%) patients, and sepsis was suspected in 31 (11.2%) patients by referring healthcare providers. Time to initiation of antibiotic treatment was shorter in patients where sepsis or infection had been suspected prior to arrival for both patients with severe infections ( p = 0.022) and sepsis ( p = 0.004). Given the well-described outcome benefits of early sepsis therapy, recognition of sepsis needs to be improved. Appropriate scores should be used as part of routine patient assessment to reduce the time to antibiotic administration and improve patient outcomes.

Problem: Regarding transmissible viral diseases such as those caused by SARS-CoV-2 virus, one of the key challenges is isolation management until final diagnosis. This study investigates the influence of SARS-CoV-2 point-of-care (POC) PCR on workflow and efficiency in an emergency department (ED) of a tertiary university hospital., Method: An analysis of 17,875 ED patients receiving either SARS-CoV-2 POC PCR (rapid PCR, 11,686 patients) or conventional laboratory SARS-CoV-2 PCR (conventional PCR, 6,189 patients) was performed. The pathways for both groups were mapped and compared, and process times from admission to diagnosis were measured. Effects on resource management within the ED were quantified. Direct costs due to isolation, loss of capacities, and revenues were calculated for inpatients., Results: The mean time from admission to result was 1.62 h with rapid PCR and 16.08 h with conventional PCR (p < 0.01), reducing the isolation time by 14.46 h. In the first 2 h after testing, test results were available for > 75% of the rapid PCR group and none of the conventional PCR group. Ninety percent of the results were available within 3 h for the rapid PCR and within 21 h for the conventional PCR group. For the conventional PCR group, an increase in direct costs of €35.74 and lost revenues of €421.06 for each inpatient case was detected., Conclusion: Rapid PCR significantly reduces the time-to-results and time for isolation relative to conventional PCR. Although testing costs for rapid PCR are higher, it benefits workflow, reduces total costs, and frees up ward capacity., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Fistera et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Determining SARS-CoV-2 immunity is critical to assess COVID-19 risk and the need for prevention and mitigation strategies. We measured SARS-CoV-2 Spike/Nucleocapsid seroprevalence and serum neutralizing activity against Wu01, BA.4/5 and BQ.1.1 in a convenience sample of 1,411 patients receiving medical treatment in the emergency departments of five university hospitals in North Rhine-Westphalia, Germany, in August/September 2022. 62% reported underlying medical conditions and 67.7% were vaccinated according to German COVID-19 vaccination recommendations (13.9% fully vaccinated, 54.3% one booster, 23.4% two boosters). We detected Spike-IgG in 95.6%, Nucleocapsid-IgG in 24.0%, and neutralization against Wu01, BA.4/5 and BQ.1.1 in 94.4%, 85.0%, and 73.8% of participants, respectively. Neutralization against BA.4/5 and BQ.1.1 was 5.6- and 23.4-fold lower compared to Wu01. Accuracy of S-IgG detection for determination of neutralizing activity against BQ.1.1 was reduced substantially. We explored previous vaccinations and infections as correlates of BQ.1.1 neutralization using multivariable and Bayesian network analyses. Given a rather moderate adherence to COVID-19 vaccination recommendations, this analysis highlights the need to improve vaccine-uptake to reduce the COVID-19 risk of immune evasive variants. The study was registered as clinical trial (DRKS00029414)., (© 2023. The Author(s).)

Aims: We tested the hypothesis that epicardial adipose tissue (EAT) quantification improves the prediction of the presence of obstructive coronary artery disease (CAD) in patients presenting with acute chest pain to the emergency department., Methods and Results: Within this prospective observational cohort study, we included 657 consecutive patients (mean age 58.06 ± 18.04 years, 53% male) presenting to the emergency department with acute chest pain suggestive of acute coronary syndrome between December 2018 and August 2020. Patients with ST-elevation myocardial infarction, haemodynamic instability, or known CAD were excluded. As part of the initial workup, we performed bedside echocardiography for quantification of EAT thickness by a dedicated study physician, blinded to all patient characteristics. Treating physicians remained unaware of the results of the EAT assessment. The primary endpoint was defined as the presence of obstructive CAD, as detected in subsequent invasive coronary angiography. Patients reaching the primary endpoint had significantly more EAT than patients without obstructive CAD (7.90 ± 2.56 mm vs. 3.96 ± 1.91 mm, P < 0.0001). In a multivariable regression analysis, a 1 mm increase in EAT thickness was associated with a nearby two-fold increased odds of the presence of obstructive CAD [1.87 (1.64-2.12), P < 0.0001]. Adding EAT to a multivariable model of the GRACE score, cardiac biomarkers and traditional risk factors significantly improved the area under the receiver operating characteristic curve (0.759-0.901, P < 0.0001)., Conclusion: Epicardial adipose tissue strongly and independently predicts the presence of obstructive CAD in patients presenting with acute chest pain to the emergency department. Our results suggest that the assessment of EAT may improve diagnostic algorithms of patients with acute chest pain., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: T he COVID-19 pandemic led to an alteration of algorithms in emergency medicine, which may influence the management of patients with similar symptoms but underlying cardiovascular diseases. We evaluated key differential diagnoses to acute COVID-19 infection and the prevalence and the prognosis of myocardial injury in patients presenting for suspected COIVD-19 infection., Methods: This prospective observational study includes patients presenting with symptoms suggestive of COVID-19 infection during the pandemic. In patients without COVID-19, leading diagnoses was classified according to ICD-10. Myocardial injury was defined as elevated high-sensitivity Troponin I with at least one value above the 99th percentile upper reference limit and its prevalence together with 90-days mortality rate was compared in patients with vs without COVID-infection., Results: From 497 included patients (age 62.9 ± 17.2 years, 56 % male), 314 (63 %) were tested positive on COVID-19 based on PCR-testing, while another cause of symptom was detected in 183 patients (37 %). Cardiovascular diseases were the most frequent differential diagnoses (40 % of patients without COVID-19), followed by bacterial infection (24 %) and malignancies (16 %). Myocardial injury was present in 91 patients (COVID-19 positive: n = 34, COVID-19 negative: n = 57). 90-day mortality rate was higher in patients with myocardial injury (13.4 vs 4.6 %, p = 0.009)., Conclusion: Cardiovascular diseases represent the most frequent differential diagnoses in patients presenting to a tertiary care emergency department with symptoms suggestive of an acute infection. Screening for cardiovascular disease is crucial in the initial evaluation of symptomatic patients during the COVID pandemic to identify patients at increased risk. Trial Registration: Clinicaltrials.gov Identifier: NCT04327479., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Aim: Videolaryngoscopy (VL) is a promising tool to provide a safe airway during cardiopulmonary resuscitation (CPR) and to ensure early reoxygenation. Using data from the German Resuscitation Registry, we investigated the outcome of non-traumatic out-of-hospital cardiac arrest (OHCA) patients treated with VL versus direct laryngoscopy (DL) for airway management., Methods: We analysed retrospective data of 14,387 patients from 1 January 2018 until 31 December 2021 (VL group, n = 2201; DL group, n = 12186). Primary endpoint was discharge with cerebral performance categories one and two (CPC1/2). Secondary endpoints were the rate of return of spontaneous circulation (ROSC), hospital admission, hospital admission with ongoing cardiopulmonary resuscitation, 30-day survival/ hospital discharge and airway management complications. We used multivariate binary logistic regression analysis to identify the effects on outcome of known influencing variables and of VL vs DL., Results: The multivariate regression model revealed that VL was an independent predictor of CPC1/2 survival (OR = 1.34, 95% CI = 1.12-1.61, p = 0.002) and of hospital discharge/30-day survival (OR = 1.26, 95% CI = 1.08-1.47, p = 0,004)., Conclusion: VL for endotracheal intubation (ETI) at OHCA was associated with better neurological outcome in patients with ROSC. Therefore, the use of VL for OHCA offers a promising perspective. Further prospective studies are required., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)