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We report a case of acute necrotizing eosinophilic myocarditis (ANEM) secondary to drug rash with eosinophilia and systemic symptoms (DRESS) related to administration of minocycline. Myocarditis is a rare complication of DRESS and can manifest as either a self-limited hypersensitivity myocarditis or as the frequently fatal ANEM. Due to the high morbidity and mortality caused by this disease, emergency physicians should be aware of the potential of ANEM in patients with history of DRESS and new-onset cardiac dysfunction. This case reviews the clinical presentation and management of ANEM and the potential role of extracorporeal membrane oxygenation use in the emergency department.

Study objectiveTo identify critical emergency medicine-focused firearm injury research questions and develop an evidence-based research agenda.MethodsNational content experts were recruited to a technical advisory group for the American College of Emergency Physicians Research Committee. Nominal group technique was used to identify research questions by consensus. The technical advisory group decided to focus on 5 widely accepted categorizations of firearm injury. Subgroups conducted literature reviews on each topic and developed preliminary lists of emergency medicine-relevant research questions. In-person meetings and conference calls were held to iteratively refine the extensive list of research questions, following nominal group technique guidelines. Feedback from external stakeholders was reviewed and integrated.ResultsFifty-nine final emergency medicine-relevant research questions were identified, including questions that cut across all firearm injury topics and questions specific to self-directed violence (suicide and attempted suicide), intimate partner violence, peer (nonpartner) violence, mass violence, and unintentional ("accidental") injury. Some questions could be addressed through research conducted in emergency departments; others would require work in other settings.ConclusionThe technical advisory group identified key emergency medicine-relevant firearm injury research questions. Emergency medicine-specific data are limited for most of these questions. Funders and researchers should consider increasing their attention to firearm injury prevention and control, particularly to the questions identified here and in other recently developed research agendas.

Summary Recent paleobotanical discoveries have renewed interest in the distinctively recurved, seed‐bearing cupules of Mesozoic plants, which are important for understanding seed plant phylogeny and the origin of the second integument of the angiosperm ovule. Reanalysis of the enigmatic seed‐bearing organ Dordrechtites elongatus from the Triassic of South Africa, the type species of the genus, combined with information from similar material from Antarctica, Argentina and Australia, indicates that Dordrechtites is a highly modified lateral branch of a seed cone. Short lateral projections from a primary cone axis each bear several Dordrechtites units. Each unit consists of a long stalk bearing a straight to sometimes recurved cupule with a long distal extension beyond the cupule apex. Each cupule is flattened in a plane perpendicular to the stalk and distal projection and contains up to two seeds. Structural similarities between Dordrechtites and the cupules of Doyleales indicate that they are homologous, providing new evidence for a close relationship. The persistent cupule stalk and apical extension of Dordrechtites, combined with the flattened cupule, suggests modification for wind and water dispersal. [ABSTRACT FROM AUTHOR]

The second integument of the angiosperm ovule is unique among seed plants, with developmental genetics that are distinct from those of the inner integument.sup.1. Understanding how the second integument should be compared to structures in other seed plants is therefore crucial to resolving the long-standing question of the origin of angiosperms.sup.2-6. Attention has focused on several extinct plants with recurved cupules that are reminiscent of the anatropous organization of the basic bitegmic ovules of angiosperms.sup.1-6, but interpretations have been hampered by inadequate information on the relevant fossils. Here we describe abundant exceptionally well-preserved recurved cupules from a newly discovered silicified peat dating to the Early Cretaceous epoch (around 125.6 million years ago) in Inner Mongolia, China. The new material, combined with re-examination of potentially related fossils, indicates that the recurved cupules of several groups of Mesozoic plants are all fundamentally comparable, and that their structure is consistent with the recurved form and development of the second integument in the bitegmic anatropous ovules of angiosperms. Recognition of these angiosperm relatives (angiophytes) provides a partial answer to the question of angiosperm origins, will help to focus future work on seed plant phylogenetics and has important implications for ideas on the origin of the angiosperm carpel. Analysis of recurved cupules from a newly discovered Early Cretaceous silicified peat in Inner Mongolia, China and comparison with other potentially related Mesozoic plant fossils provides insight into the origins of angiosperms., Author(s): Gongle Shi [sup.1] , Fabiany Herrera [sup.2] , Patrick S. Herendeen [sup.2] , Elizabeth G. Clark [sup.3] , Peter R. Crane [sup.4] [sup.5] Author Affiliations: (1) State Key Laboratory [...]

Introduction: The Choosing Wisely campaign currently recommends avoiding computed tomography(CT) of the head in low-risk emergency department (ED) patients with minor head injury, based onvalidated decision rules. However, the degree of adherence to this guideline in clinical practice isunknown. The objective of this study was to evaluate adherence to the Choosing Wisely campaign’srecommendations regarding head CT imaging of patients with minor head injury in the ED.Methods: We conducted a retrospective cohort study of adult ED patients at a Level I traumacenter. Patients aged ≥ 18 years who presented to the ED with minor head injury were identified viaInternational Classification of Diseases, 9th Revision, Clinical Modification codes. Medical recordabstraction was conducted to determine the presence of clinical symptoms of the NEXUS II criteria,medical resource use, and head CT findings. We used descriptive statistics to characterize the studysample, and proportions were used to quantify guidelines adherence.Results: A total of 489 subjects met inclusion criteria. ED providers appropriately applied the ChoosingWisely criteria for 75.5% of patients, obtaining head CTs when indicated by the NEXUS II rule (41.5%),and not obtaining head CTs when the NEXUS II criteria were not met (34.0%). However, ED providersobtained non-indicated CTs in 23.1% of patients. Less than 2% of the sample did not receive a headCT when imaging was indicated by NEXUS II.Conclusion: ED providers in our sample had variable adherence to the Choosing Wisely head-CTrecommendation, especially for patients who did not meet the NEXUS II criteria. [West J EmergMed. 2017;18(5)821-829.]

Premise: The Aptian–Albian (121.4–100.5 Ma) was a greenhouse period with global temperatures estimated as 10–15°C warmer than pre‐industrial conditions, so it is surprising that the most reliable CO2 estimates from this time are <1400 ppm. This low CO2 during a warm period implies a very high Earth‐system sensitivity in the range of 6 to 9°C per CO2 doubling between the Aptian‐Albian and today. Methods: We applied a well‐vetted paleo‐CO2 proxy based on leaf gas‐exchange principles (Franks model) to two Pseudotorellia species from three stratigraphically similar samples at the Tevshiin Govi lignite mine in central Mongolia (~119.7–100.5 Ma). Results: Our median estimated CO2 concentration from the three respective samples was 2132, 2405, and 2770 ppm. The primary reason for the high estimated CO2 but with relatively large uncertainties is the very low stomatal density in both species, where small variations propagate to large changes in estimated CO2. Indeed, we found that at least 15 leaves are required before the aggregate estimated CO2 approaches that of the full data set. Conclusions: Our three CO2 estimates all exceeded 2000 ppm, translating to an Earth‐system sensitivity (~3–5°C/CO2 doubling) that is more in keeping with the current understanding of the long‐term climate system. Because of our large sample size, the directly measured inputs did not contribute much to the overall uncertainty in estimated CO2; instead, the inferred inputs were responsible for most of the overall uncertainty and thus should be scrutinized for their value choices. [ABSTRACT FROM AUTHOR]

Premise: We studied the 3D morphology of a small, well‐preserved cone from the Pennsylvanian Mazon Creek Lagerstätte to characterize its structure and determine its systematic affinity. Previously tentatively assigned to the enigmatic Tetraphyllostrobus, we show that it differs in key respects from that genus as described. Methods: We systematically compared the new fossil with relevant Paleozoic cone genera and employed advanced imaging techniques, including scanning electron microscopy, Airyscan confocal super‐resolution microscopy, optical microscopy, and X‐ray microcomputed tomography to visualize and reconstruct the fossil cone in 3D. Results: The analyses demonstrate unequivocally that the sporophylls of the new Mazon Creek cone are arranged in whorls of six and have characters typical of Sphenophyllales, including epidermal cells with undulatory margins and in situ spores assignable to Columinisporites. The combination of characters, including sporophyll arrangement, anatomy, and spore type, supports the establishment of Hexaphyllostrobus kostorhysii gen. et sp. nov. within Sphenophyllales. Furthermore, we show that Tetraphyllostrobus, although originally described as possessing smooth monolete spores, actually possesses Columinisporites‐type spores, indicating that it, too, was most likely a sphenophyll. Conclusions: The recognition of Hexaphyllostrobus contributes to our knowledge of Pennsylvanian sphenophyll diversity, and in particular increases the number of species with in situ Columinisporites‐type spores. Attribution of Hexaphyllostrobus to Sphenophyllales calls into question current interpretations of Tetraphyllostrobus suggesting that future research on better‐preserved macrofossil material may demonstrate a sphenophyllalean relationship. [ABSTRACT FROM AUTHOR]