Previous studies have demonstrated that stress may increase prodynorphin gene expression, and kappa opioid agonists suppress drug reward. Therefore, we tested the hypothesis that stress-induced release of endogenous dynorphin may mediate behavioral responses to stress and oppose the rewarding effects of cocaine. C57Bl/6 mice subjected to repeated forced swim testing (FST) using a modified Porsolt procedure at 30 degrees C showed a characteristic stress-induced immobility response and a stress-induced analgesia observed with a tail withdrawal latency assay. Pretreatment with the kappa opioid receptor antagonist nor-binaltorphimine (nor-BNI; 10 mg/kg, i.p.) blocked the stress-induced analgesia and significantly reduced the stress-induced immobility. The nor-BNI sensitivity of the behavioral responses suggests an activation of the kappa opioid receptor by a stress-induced release of dynorphin peptides. Supporting this hypothesis, transgenic mice possessing a disrupted prodynorphin gene showed no increase in immobility or stress-induced analgesia after exposure to repeated FST. Because both stress and the kappa opioid system can modulate the response to drugs of abuse, we tested the effects of forced swim stress on cocaine-conditioned place preference (CPP). FST-exposed mice conditioned with cocaine (15 mg/kg, s.c.) showed significant potentiation of place preference for the drug-paired chamber over the responses of unstressed mice. Surprisingly, nor-BNI pretreatment blocked stress-induced potentiation of cocaine CPP. Consistent with this result, mice lacking the prodynorphin gene did not show a stress-induced potentiation of cocaine CPP, whereas wild-type littermates did. The findings suggest that chronic swim stress may activate the kappa opioid system to produce analgesia, immobility, and potentiation of the acute rewarding properties of cocaine in C57Bl/6 mice.

STEMI nETworkSThe implementation of dedicated networks for urgent revascularization in patients with ST-elevation myocardial infarction (STEMI) have been proved to represent a lifesaving strategy and is currently the goal of many healthcare systems. 6-10In patients with acute myocardial infarction, survival depends largely on the amount of viable myocardium remaining after the infarction. 11-13 The recovery of myocardial tissue is the main goal of therapy in emergency settings and can be achieved by urgent revascularization. 14-16In order to be effective, reperfusion of an occluded coronary artery should be achieved in the first 12 hours after the onset of chest pain. 17 While many precious hours are lost by the patients who do not present in time to the specialized services, sustained organizational efforts have been made in order to shorten the time from presentation to revascularization. 18-22One of the first regional STEMI networks has been initiated in the USA in Minnesota, including referral hospitals located at a radius of 210 miles from the pPCI center.The geographic territory surrounding the pPCI center was

The role of cardiac biomarkers in diagnosing acute myocardial infarction is undoubted. In the 2020 guidelines of the European Society of Cardiology, the measurement of cardiac peptides to gain prognostic information has a class IIa indication in all patients with ACS. In emergency care, ruling out a non-ST elevation myocardial infarction requires documentation of normal levels of cardiac biomarkers, which remain stable or have very small variations within several hours. This review aims to summarize the current knowledge and recent progresses in the field of cardiac biomarker discovery, from their routine use in emergency rooms to their prognostic roles in modern risk assessment tools. Integrated approaches combining cardiac troponin with other biomarkers of ventricular dysfunction or inflammation, or with modern cardiac imaging in emergency care are also presented, as well as the role of modern algorithms for serial troponin measurement in the modern management of emergency departments.

IntroductIonAcute myocardial infarction (MI) remains one of the leading causes of death worldwide. 1 Of all the types of acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the highest mortality rates during hospitalization, followed by non-ST elevation MI (NSTEMI) and unstable angina (UA). However, during the six-month follow-up period, the highest death rate is recorded among NSTEMI patients, followed by STEMI and UA. 2 According to the OPERA registry, one-year mortality rates are also higher for NSTEMI compared to STEMI patients (11.6% vs. 9%). 3The primary cause of the high mortality associated with NSTEMI may be due to the severity of the patients' clinical status. It is well-known that in a relatively high percentage, NSTEMI patients are significantly older, with various associated comorbidities, which in turn lead to an increased risk of cardiovascular events. Approximately one-third of patients presenting with NSTEMI are aged over 75 years, and this age factor has been proven to be one of the most significant risk predictors of NSTEMI, the incidence of complications increasing with age. 4 Patients that present with non-ST elevation acute coronary syndromes frequently present with several comorbidities, ABStrActNon-ST elevation myocardial infarction (NSTEMI) has the highest long-term mortality rates of all acute coronary syndromes. Usually, NSTEMI occurs in elderly patients (>75 years of age) with multiple associated diseases. The complication rate for NSTEMI, including heart failure or hemorrhages, is significantly higher than that in ST-elevation myocardial infarction patients.The case reported is of a 70 year-old male, with a history of ventriculoperitoneal shunt for obstructive hydrocephalus following a traumatic brain injury, who presented with NSTEMI.

The concept of mobile Health (mHealth) refers to the use of diagnostic devices which can provide information from a remote distance, via internet pathways, that can influence the therapeutic management in a variety of disorders.Several electronic tools have been tested and proven useful in simplifying the cardiovascular management of patients, more specifically mobile applications that are compatible with the Android system, which have led to a 25.5% improvement in quality of primary medical care, patient prognosis, as well as better efficacy of measures for secondary cardiovascular prevention. 1 Such applications include remote monitoring devices for evaluation of cardiac rhythms via iECG, which uses a smartphone (iPhone) with incorporated monitoring electrodes for telemetric cardiac rhythm recordings. Furthermore, such devices include blood pressure measurement tools, which have the configuration of a smartwatch or bracelet that uses the applanation tonometry technique. 2 For heart failure patients, mHealth applications include a remote monitoring device that records the filling pressures within the left ventricle and the pulmonary artery, which is based on a micro-electromechanical system that is implanted at the level of the pulmonary artery. 3 Technological advancements have led to the development of a remote cardiac ultrasound system composed of a transducer connected to a smart mobile phone, which has the capacity to store and transfer the acquired imaging data towards a specialized center for further analysis and interpretation within a clinical context. 4 Telemedicine applications for telephone transmission of ECG recordings from underserved regions have led to a drastic decrease in myocardial infarction-related mortality from 16.4% to 4.8% in 30 days, thus introducing, for the first time, the concept of iICU (internet-based intensive care unit). 5 Electronic devices applied in cardiac care can be used in every phase of patient management, both in acute and long-term care settings, including mobile health in cardiac arrest, rhythm disturbances, acute myocardial infarction, or heart failure. Out-of-hospital cardiac arrest (OHCA) is related to high mortality rates, and timely initiation of correct resuscitation maneuvers could be life -saving. 6 Mobile life-saver is a smartphone application that can identify and alert volunteers that have been trained in cardio-pulmonary resuscitation, and which led to a faster time from OHCA to chest compression. 7 In acute myocardial infarction, it is well known that a decreased time from onset of symptoms to interventional treatment is associated with a significant improvement in survival, as well as short-and long-term complications. 8 However, although in case of activation of a STEMI network by a non-cardiologist specialist reduces times to treatment, it may also increase the rate of false positive activation of such networks. 9 The use of transtelephonic ECG interpretation by a remote cardiology specialist has been shown to reduce STEMI network times, to improve pr...