Interhospital transportation of mass burn casualties

Aim of Study: To establish the impact of the transportation on the condition and outcome of the victims of the Volendam fire incident. Methods: Medical and logistic parameters from all victims in the Intensive Care Unit (ICU) were retrospectively collected. Physiologic parameters in the first 24 h and outcome parameters were compared between the transported and the non-transported patients. Results: The first 24 h, 105 patients were admitted to an ICU: 47 of them were relocated during that same day. The pH value was significantly lower in the transported group (p = 0.016). Systolic blood pressure, bicarbonate, carbon dioxide, temperature, APACHE II score and fluctuation during the first day, as well as condition during the sec

Management of multiple burn casualties from the Volendam disaster in the emergency departments of general hospitals

Objective To establish the level of medical care provided in the emergency department of general hospitals to the victims of the Volendam café fire on 1 January 2001. Methods A retrospective review was done based on a standardized chart, for all victims seen at the emergency departments of 19 hospitals. Diagnostic findings and logistic aspects were inventoried. Treatment described in the Emergency Management of Severe Burns protocol was used as a gold standard against which the care provided to the victims was assessed. Results Data from 233 patients were included in the analysis. The documentation rate was low. Suspected inhalation injury and burns were the most frequently documented diagnoses. Most patients with suspected inhalation injury, for whom treatment records were available, received oxygen therapy (81%). Intubation was performed in 43% of patients with suspected inhalation injury and 14% of the remaining patients required intubation after admission to the intensive care unit. Most patients with circulatory problems (83%) and/or more than 15% of total body surface area burned (97%), for whom treatment records were available, received intravenous lines. Pain treatment seemed to have had low priority. Two patients (3%) were re-admitted after having been released earlier from the emergency department. Conclusion Treatment and triage of the burn casualties after the Volendam café fire was adequate. The documentation rate was low. Not all steps in diagnosis and treatment may be of equal importance in disaster circumstances

Analysis of the pre-incident education and subsequent performance of emergency medical responders to the Volendam café fire

Objective At this moment, in the Netherlands, rescue workers are not given any specific standardized training in disaster response or disaster management.After the café fire in Volendam, the Netherlands, on New Year’s Eve 2000, around 200 rescue workers were deployed on-site. The aim of this study is to investigate the rescue workers’ experiences with regard to their level of preparation for the emergency response. Methods In 2002, 30 members of the medical and paramedical personnel were requested to participate in a structured interview, focused on education, task perception, triage and registration. Results Twenty-seven participated. Twenty-two rescue workers received previous training in emergency medicine. During the alarm phase, 11 rescue workers had a clear perception of their tasks. Twenty-four were involved in triage and injury assessment. Three rescue workers used a protocol for triage and 15 for injury assessment. Twenty-five rescue workers gave on-scene treatment and 15 used a protocol. Eight registered their findings. Conclusions Preparation for the emergency response lacked standardized procedures. The use of triage protocols was extremely poor, as was documentation of actions. Slightly more than half of the personnel followed treatment protocols. It is advisable that all rescue workers become familiar with the basic uniform principles and protocols regarding disaster management. A dedicated and standardized national disaster management course is needed for all rescue workers

What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?

Context: Ankle sprains are common problems in acute medical care. The variation in treatment observed for the acutely injured lateral ankle ligament complex in the first week after the injury suggests a lack of evidence-based management strategies for this problem. Objective: To analyze the effectiveness of applying rest, ice, compression, and elevation (RICE) therapy begun within 72 hours after trauma for patients in the initial period after ankle sprain. Study Selection: Eligible studies were published original randomized or quasi-randomized controlled trials concerning at least 1 of the 4 subtreatments of RICE therapy in the treatment of acute ankle sprains in adults. Data Sources: MEDLINE, Cochrane Clinical Trial Register, CINAHL, and EMBASE. The lists of references of retrieved publications also were checked manually. Data Extraction: We extracted relevant data on treatment outcome (pain, swelling, ankle mobility or range of motion, return to sports, return to work, complications, and patient satisfaction) and assessed the quality of included studies. If feasible, the results of comparable studies were pooled using fixed- or random-effects models. Data Synthesis: After deduction of the overlaps among the different databases, evaluation of the abstracts, and contact with some authors, 24 potentially eligible trials remained. The full texts of these articles were retrieved and thoroughly assessed as described. This resulted in the inclusion of 11 trials involving 868 patients. The main reason for exclusion was that the authors did not describe a well-defined control group without the intervention of interest. Conclusions: Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. Treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guideline

Expression of the Antiapoptotic Protein BAG3 Is a Feature of Pancreatic Adenocarcinoma and Its Overexpression Is Associated With Poorer Survival. Turco MC: Corresponding Author

Pancreatic ductal adenocarcinoma (PDAC) is one of the most deadly cancers, being the fourth leading cause of cancer-related deaths. Long-term survival reaching 15% is achieved in less than 5% of patients who undergo surgery, and median survival is only 6 months in those with inoperable lesions. A deeper understanding of PDAC biologic characteristics as well as novel prognostic markers are therefore required to improve outcomes. Herein we report that BAG3, a protein with recognized anti-apoptotic activity, was expressed in 346 PDACs analyzed, but was not expressed in the surrounding nonneoplastic tissue. In a cohort of 66 patients who underwent radical resection (R0), survival was significantly shorter in patients with high BAG3 expression (median, 12 months) than in those with low BAG3 expression (median, 23 months) (P = 0.001). Furthermore, we report that BAG3 expression in PDAC-derived cell lines protects from apoptosis and confers resistance to gemcitabine, offering a partial explanation for the survival data. Our results indicate that BAG3 has a relevant role in PDAC biology, and suggest that BAG3 expression level might be a potential marker for prediction of patient outcom

Establishment of patient-derived xenograft models and cell lines for malignancies of the upper gastrointestinal tract

The upper gastrointestinal tract is home to some of most notorious cancers like esophagogastric and pancreatic cancer. Several factors contribute to the lethality of these tumors, but one that stands out for both tumor types is the strong inter- as well as intratumor heterogeneity. Unfortunately, genetic tumor models do not match this heterogeneity, and for esophageal cancer no adequate genetic models exist. To allow for an improved understanding of these diseases, tissue banks with sufficient amount of samples to cover the extent of diversity of human cancers are required. Additionally, xenograft models that faithfully mimic and span the breadth of human disease are essential to perform meaningful functional experiments. We describe here the establishment of a tissue biobank, patient derived xenografts (PDXs) and cell line models of esophagogastric and pancreatic cancer patients. Biopsy material was grafted into immunocompromised mice and PDXs were used to establish primary cell cultures to perform functional studies. Expression of Hedgehog ligands in patient tumor and matching PDX was assessed by immunohistochemical staining, and quantitative real-time PCR as well as flow cytometry was used for cultured cells. Cocultures with Hedgehog reporter cells were performed to study paracrine signaling potency. Furthermore, SHH expression was modulated in primary cultures using lentiviral mediated knockdown. We have established a panel of 29 PDXs from esophagogastric and pancreatic cancers, and demonstrate that these PDXs mirror several of the (immuno)histological and biochemical characteristics of the original tumors. Derived cell lines can be genetically manipulated and used to further study tumor biology and signaling capacity. In addition, we demonstrate an active (paracrine) Hedgehog signaling mode by both tumor types, the magnitude of which has not been compared directly in previous studies. Our established PDXs and their matching primary cell lines retain important characteristics seen in the original tumors, and this should enable future studies to address the responses of these tumors to different treatment modalities, but also help in gaining mechanistic insight in how some tumors respond to certain regimens and others do no