'Background': Triage plays a critical role in mass casualty incidents by optimizing the use of medical resources. The Formosa Fun Coast (Baxian Water Park) dust explosion incident in 2015 revealed ...the lack of resources in the Taiwanese medical system to handle large-scale burn and scald casualties; however, this incident resulted in only 3% mortalities (15/499) by the end of 2015.
'Objective': This study aims to examine the key features and correlated factors of the prehospital setting in 15 mortalities.
'Materials and methods': This retrospective cohort study enrolled all patients from the Formosa Fun Coast incident (N = 499). The follow-up period was from 27 June to 31 December 2015. We first examined the correlation between patient survival and various variables and then tested the correlation between survival-correlated variables and the level of hospitals that provided treatment.
'Results': The survivor and nonsurvivor groups shared similar distributions of all study variables. Emergency medical technician performed the triage assessment, and the Baux score correlated with patient survival. This study further tested whether the hospital level correlated with the emergency medical technician-performed triage assessment or Baux score. A chi-square test revealed that the emergency medical technician-performed triage assessment and Baux score correlated with patient survival, thereby indirectly affirming the planning, training, and auditing of the Taiwanese emergency medical technician system.
'Conclusion': The lack of the effect of the hospital level on patient mortality indicated that mortality might be related to the severity of burn injury rather than the level of hospital chosen for initial treatment, besides being related to a satisfactory emergency medical technician-performed triage system.
Cervical disc arthroplasty (CDA) has been recognized as a popular option for cervical radiculopathy or myelopathy caused by disc problems that require surgery. There have been prospective randomized ...controlled trials comparing CDA to anterior cervical discectomy and fusion (ACDF) for 1- and 2-level disc herniations. However, the indications for CDA have been extended beyond the strict criteria of these clinical trials after widespread real-world experiences in the past decade. This article provides a bibliometric analysis with a review of the literature to understand the current trends of clinical practice and research on CDA.
The PubMed database was searched using the keywords pertaining to CDA in human studies that were published before August 2022. Analyses of the bibliometrics, including the types of papers, levels of evidence, countries, and the number of disc levels involved were conducted. Moreover, a systematic review of the contents with the emphasis on the current practice of multilevel CDA and complex cervical disc problems was performed.
A total of 957 articles published during the span of 22 years were analyzed. Nearly one-quarter of the articles (232, 24.2%) were categorized as level I evidence, and 33.0% were categorized as levels I or II. These studies clearly demonstrated the viability and effectiveness of CDA regarding clinical and radiological outcomes, including neurological improvement, maintenance, and preservation of segmental mobility with relatively low risks for several years postoperation. Also, there have been more papers published during the last decade focusing on multilevel CDA and fewer involving the comparison of ACDF. Overall, there was a clustering of CDA papers published from the US and East Asian countries. Based on substantial clinical data of CDA for 1- and 2-level disc diseases, the practice and research of CDA show a trend toward multilevel and complex disease conditions.
CDA is an established surgical management procedure for 1- and 2-level cervical disc herniation and spondylosis. The success of motion preservation by CDA-with low rates of complications-has outscored ACDF in patients without deformity. For more than 2-level disc diseases, the surgery shows a trend toward multiple CDA or hybrid ACDF-CDA according to individual evaluation for each level of degeneration.
To date, 1841 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported worldwide, with 652 deaths. We used a publically available case line list to explore the ...effect of relevant factors, notably underlying comorbidities, on fatal outcome of Middle East respiratory syndrome (MERS) cases up to the end of October 2016. A Bayesian Weibull proportional hazards regression model was used to assess the effect of comorbidity, age, epidemic period and sex on the fatality rate of MERS cases and its variation across countries. The crude fatality rate of MERS cases was 32.1% (95% credibility interval (CI): 29.9%, 34.3%). Notably, the incremental change of daily death rate was most prominent during the first week since disease onset with an average increase of 13%, but then stabilized in the remaining two weeks when it only increased 3% on average. Neither sex, nor country of infection were found to have a significant impact on fatality rates after taking into account the age and comorbidity status of patients. After adjusting for age, epidemic period, MERS patients with comorbidity had around 4 times the risk for fatal infection than those without (adjusted hazard ratio of 3.74 (95% CI: 2.57, 5.67)).
Epidermal growth factor receptor (EGFR) abnormalities relevant to tumor progression. A newly developed strategy for cancer therapy is induction of EGFR degradation. GMI, an immunomodulatory protein ...from the medicinal mushroom Ganoderma microsporum, exhibits anticancer activity. However, its role in the intracellular trafficking and degradation of EGFR remains unclear. In this study, we discovered that GMI inhibits the phosphorylation of multiple tyrosine kinases. Specifically, GMI was discovered to suppress lung cancer cells harboring both wild-type and mutant EGFR by inhibiting EGFR dimerization and eliminating EGFR-mediated signaling. Functional studies revealed that GMI binds to the extracellular segment of EGFR. GMI interacts with EGFR to induce phosphorylation of EGFR at tyrosine1045, which triggers clathrin-dependent endocytosis and degradation of EGFR. Furthermore, in the mouse models, GMI was discovered to suppress tumor growth. Knockdown of EGFR in lung cancer cells abolishes GMI's anticancer activity in vivo and in vitro. Our results reveal the interaction mechanisms through which GMI induces EGFR degradation and abolishes EGFR-mediated intracellular pathway. Our study indicates that GMI is an EGFR degrader for inhibiting EGFR-expressing tumor growth.
•EGFR is one of the membrane targets of GMI.•GMI inhibits cell viability of EGFR positive cancer cells.•GMI induces EGFR endocytosis and degradation.•GMI binds to extracellular domain of EGFR and abolishes EGFR dimerization.•Knockdown of EGFR alleviates the anti-cancer activity of GMI.
•Special budgetary allocation from the national government is often necessary for mass casualty events.•We estimated the effect of a full financial support by the government on mortality ...reduction.•Medical care utilization increased significantly for the mass casualty patients.•Patient outcomes only improved marginally compared with the control group.
The aim of this study was to estimate the effect on medical resource use and mortality of full financial support from the government for treatment costs after a mass burn casualty event in Taiwan.
All patients with burn injuries from the event were included (n = 483). Each burn patient from this incident was matched to a separate burn patient identified from the National Health Insurance database. Medical care usage and mortality were compared between groups at 1-, 3-, 6-, 9-, and 12-month intervals.
Regarding outpatient expenditure, burn patients from the mass casualty event had significantly higher levels of medical expenditure compared with their control counterparts at all intervals and levels of medical institution. For inpatient expenditure, patients from the mass casualty event only had higher expenditure for the first month, and excess procedures used by these patients mainly consisted of nonvital procedures such as rehabilitation training. The mortality rate was only slightly lower for this group of burn patients compared with their control counterparts.
Full financial support by the government in terms of medical treatment may engender only marginal additional benefits in terms of mortality if burn treatment procedures are already well established in the country.
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