231 research outputs found
What′s new in emergencies, trauma, and shock? Correlating rapid prehospital transport and survival
No full text[No abstract available
Emergency response to mass casualty incidents in Lebanon.
No full textThe emergency response to mass casualty incidents in Lebanon lacks uniformity. Three recent large-scale incidents have challenged the existing emergency response process and have raised the need to improve and develop incident management for better resilience in times of crisis. We describe some simple emergency management principles that are currently applied in the United States. These principles can be easily adopted by Lebanon and other developing countries to standardize and improve their emergency response systems using existing infrastructure
Disaster metrics: Quantitative estimation of the number of ambulances required in trauma-related multiple casualty events
No full textIntroduction Estimating the number of ambulances needed in trauma-related Multiple Casualty Events (MCEs) is a challenging task. Hypothesis-Problem Emergency medical services (EMS) regions in the United States have varying best practicesa for the required number of ambulances in MCE, none of which is based on metric criteria. The objective of this study was to estimate the number of ambulances required to respond to the scene of trauma-related MCE in order to initiate treatment and complete the transport of critical (T1) and moderate (T2) patients. The proposed model takes into consideration the different transport times and capacities of receiving hospitals, the time interval from injury occurrence, the number of patients per ambulance, and the pre-designated time frame allowed from injury until the transfer care of T1 and T2 patients. Methods The main theoretical framework for this model was based on prehospital time intervals described in the literature and used by EMS systems to evaluate operational and patient care issues. The North Atlantic Treaty Organization (NATO) triage categories (T1-T4) were used for simplicity. Results The minimum number of ambulances required to respond to the scene of an MCE was modeled as being primarily dependent on the number of critical patients (T1) present at the scene any particular time. A robust quantitative model was also proposed to dynamically estimate the number of ambulances needed at any time during an MCE to treat, transport and transfer the care of T1 and T2 patients. Conclusion A new quantitative model for estimation of the number of ambulances needed during the prehospital response in trauma-related multiple casualty events has been proposed. Prospective studies of this model are needed to examine its validity and applicability. Bayram JD, Zuabi S, El Sayed MJ. © 2012 World Association for Disaster and Emergency Medicine
Out-of-hospital cardiac arrest survival in Beirut, Lebanon
No full textBackground: Out-of-hospital cardiac arrest (OHCA) is used to evaluate the performance of the emergency medical service (EMS) system. Our study examined the characteristics and outcomes of OHCA cases presenting to a tertiary care center in Beirut, Lebanon. Methods: A retrospective chart review of all adult OHCA patients admitted to the emergency department (ED) over a 3-year period was carried out. Data collection and analysis was performed using the Utstein guidelines. Results: A total of 214 OHCA patients were presumed to have cardiac etiology; of them 205 (95.8percent) underwent ED resuscitation. The mean age was 69±15.4 years. More than half of the patients (54.2percent) were witnessed, but unfortunately the bystander cardiopulmonary resuscitation rate was low (4.2percent). Most of them were transported by EMS (71.5percent). An automatic external defibrillator was rarely used (0.9percent). Asystole was the predominant presenting rhythm in ED (81.8percent). Eleven patients (5.5percent) survived to hospital discharge and five (45.4percent) had good neurological outcome. Conclusion: The OHCA survival rate in Beirut, Lebanon, is low. Bystander cardiopulmonary resuscitation and early defibrillation should be prioritized to achieve better outcomes. © 2014 Wolters Kluwer Health | Lippincott Williams and Wilkins.El Sayed Mazen J, 2013, Prehosp Disaster Med, V28, P163, DOI 10.1017-S1049023X12001732; Fraga-Sastrías Juan Manuel, 2009, Prehosp Disaster Med, V24, P121; HERLITZ J, 1994, RESUSCITATION, V28, P27, DOI 10.1016-0300-9572(94)90051-5; Hiltunen P, 2012, SCAND J TRAUMA RESUS, V20, DOI 10.1186-1757-7241-20-80; Hostler D, 2010, RESUSCITATION, V81, P826, DOI 10.1016-j.resuscitation.2010.02.005; Liu JM, 2008, PREHOSP EMERG CARE, V12, P339, DOI 10.1080-10903120802101330; McNally Bryan, 2011, Morbidity and Mortality Weekly Report, V60, P1; Myers JB, 2008, PREHOSP EMERG CARE, V12, P141, DOI 10.1080-10903120801903793; Rittenberger JC, 2011, RESUSCITATION, V82, P1036, DOI 10.1016-j.resuscitation.2011.03.034; CHAMBERLAIN D, 1991, RESUSCITATION, V22, P1, DOI 10.1016-0300-9572(91)90061-30
Rational deployment of antimalarial drugs in Africa: should first-line combination drugs be reserved for paediatric malaria cases?
No full textArtemisinin-based combination therapy is exerting novel selective pressure upon populations of Plasmodium falciparum across Africa. Levels of resistance to non-artemisinin partner drugs differ among parasite populations, and so the artemisinins are not uniformly protected from developing resistance, already present in South East Asia. Here, we consider strategies for prolonging the period of high level efficacy of combination therapy for two particular endemicities common in Africa. Under high intensity transmission, two alternating first-line combinations, ideally with antagonistic selective effects on the parasite genome, are advocated for paediatric malaria cases. This leaves second-line and other therapies for adult cases, and for intermittent preventive therapy. The drug portfolio would be selected to protect the 'premier' combination regimen from selection for resistance, while maximising impact on severe disease and mortality in children. In endemic areas subject to low, seasonal transmission of Plasmodium falciparum, such a strategy may deliver little benefit, as children represent a minority of cases. Nevertheless, the deployment of other drug-based interventions in low transmission and highly seasonal areas, such as mass drug administration aimed to interrupt malaria transmission, or intermittent preventive therapy, does provide an opportunity to diversify drug pressure. We thus propose an integrated approach to drug deployment, which minimises direct selective pressure on parasite populations from any one drug component. This approach is suitable for qualitatively and quantitatively different burdens of malaria, and should be supported by a programme of routine surveillance for emerging resistanc
Efficient syntheses of the unknown quinolino[2,3- c ]cinnolines; Synthesis of neocryptolepines
No full textA facile, efficient, three-step protocol for the synthesis of the unknown quinolino[2,3-c]cinnoline 5 is introduced. In addition, a new approach for the preparation of the biologically active neocryptolepines 8 in good overall yields is described. © 2010 American Chemical Society.Altun Y, 2004, J SOLUTION CHEM, V33, P479, DOI 10.1023-B:JOSL.0000037772.55748.a3; ARSHAD A, 1980, J CHEM RES S, P208; BALASUBRAMANIAN M, 1996, DD, V5, P245; BERGSTROM FW, 1944, CHEM REV, P153; Bjorsvik HR, 2005, J ORG CHEM, V70, P3218, DOI 10.1021-jo047919b; BOGER DL, 1984, J ORG CHEM, V49, P4405, DOI 10.1021-jo00197a015; Deb I, 2009, BIOORGAN MED CHEM, V17, P5782, DOI 10.1016-j.bmc.2009.07.024; El Sayed I, 2009, J MED CHEM, V52, P2979, DOI 10.1021-jm801490z; Engqvist R, 2004, ORG PREP PROCED INT, V36, P386; Farhadi S, 2007, ACTA CHIM SLOV, V54, P647; [Guo Wei 郭维], 2004, [合成化学, Chinese Journal of Synthetic Chemistry], V12, P12; Ho TL, 2002, HELV CHIM ACTA, V85, P3823, DOI 10.1002-1522-2675(200211)85:113823::AID-HLCA38233.0.CO;2-S; Jonckers THM, 2002, J MED CHEM, V45, P3497, DOI 10.1021-jm011102i; Kakadiya R, 2010, BIOORGAN MED CHEM, V18, P2285, DOI 10.1016-j.bmc.2010.01.061; KALJURAND, 2005, A J ORG CHEM, V70, P1019; Kouznetsov VV, 2005, CURR ORG CHEM, V9, P141, DOI 10.2174-1385272053369196; Larsen R.-D., 2005, SCI SYNTHESIS, V15, P389; Lavrado J, 2010, CURR MED CHEM, V17, P2348; MANSKE RHF, 1953, ORG REACTIONS, V7, P59; Molina P, 1997, J NAT PRODUCTS, V60, P747; Schmittel M, 1998, ANGEW CHEM INT EDIT, V37, P2371, DOI 10.1002-(SICI)1521-3773(19980918)37:172371::AID-ANIE23713.3.CO;2-E; SCOBIE M, 1994, J CHEM SOC CHEM COMM, P2451, DOI 10.1039-c39940002451; SCOBIE M, 1993, J CHEM SOC CHEM COMM, P1756, DOI 10.1039-c39930001756; Shepherd T., 1987, J CHEM SOC P1, P507; SHEPHERD T, 1987, J CHEM SOC P1, P495; SHEPHERD T, 1987, J CHEM SOC PERK T 1, P501, DOI 10.1039-p19870000501; Teng C, 2009, ORG LETT, V11, P5542, DOI 10.1021-ol9022936; UPADHAYAYA B, 2009, J BIOORG MED CHEM, V17, P4681; Van Miert S., 2005, ACTA HORTIC, V677, P9113151
The quinoxaline di-N-oxide DCQ blocks breast cancer metastasis in vitro and in vivo by targeting the hypoxia inducible factor-1 pathway
No full textBackground: Although tumor hypoxia poses challenges against conventional cancer treatments, it provides a therapeutic target for hypoxia-activated drugs. Here, we studied the effect of the hypoxia-activated synthetic quinoxaline di-N-oxide DCQ against breast cancer metastasis and identified the underlying mechanisms.Methods: The human breast cancer cell lines MCF-7 (p53 wildtype) and MDA-MB-231 (p53 mutant) were treated with DCQ under normoxia or hypoxia. Drug toxicity on non-cancerous MCF-10A breast cells was also determined. In vitro cellular responses were investigated by flow cytometry, transfection, western blotting, ELISA and migration assays. The anti-metastatic effect of DCQ was validated in the MDA-MB-231 xenograft mouse model.Results: DCQ selectively induced apoptosis in both human breast cancer cells preferentially under hypoxia without affecting the viability of non-cancerous MCF-10A. Cancer cell death was associated with an increase in reactive oxygen species (ROS) independently of p53 and was inhibited by antioxidants. DCQ-induced ROS was associated with DNA damage, the downregulation of hypoxia inducible factor-1 alpha (HIF-1α), and inhibition of vascular endothelial growth factor (VEGF) secretion. In MCF-7, HIF-1α inhibition was partially via p53-activation and was accompanied by a decrease in p-mTOR protein, suggesting interference with HIF-1α translation. In MDA-MB-231, DCQ reduced HIF-1α through proteasomal-dependent degradation mechanisms. HIF-1α inhibition by DCQ blocked VEGF secretion and invasion in MCF-7 and led to the inhibition of TWIST in MDA-MB-231. Consistently, DCQ exhibited robust antitumor activity in MDA-MB-231 breast cancer mouse xenografts, enhanced animal survival, and reduced metastatic dissemination to lungs and liver.Conclusion: DCQ is the first hypoxia-activated drug showing anti-metastatic effects against breast cancer, suggesting its potential use for breast cancer therapy. © 2014 Ghattass et al.; licensee BioMed Central Ltd.Balamurugan K, 2010, EMBO J, V29, P4106, DOI 10.1038-emboj.2010.280; Ban HS, 2011, EXPERT OPIN THER PAT, V21, P131, DOI 10.1517-13543776.2011.547477; Brown JM, 2004, NAT REV CANCER, V4, P437, DOI 10.1038-nrc1367; Chaudary Naz, 2006, Breast Dis, V26, P55; Chen J, 2010, BRIT J CANCER, V102, P351, DOI 10.1038-sj.bjc.6605486; Currie MJ, 2012, HUM PATHOL, V12, P8177; Del Bufalo D, 2006, CANCER RES, V66, P5549, DOI 10.1158-0008-5472.CAN-05-2825; Diab-Assef M, 2002, MOL CARCINOGEN, V33, P198, DOI 10.1002-mc.10036; El-Khatib M, 2010, RADIAT ONCOL, V5, DOI 10.1186-1748-717X-5-107; Favaro E, 2011, GENOME MED, V3, DOI 10.1186-gm271; Gali-Muhtasib H, 2004, INT J ONCOL, V24, P1121; Gali-Muhtasib HU, 2001, ONCOL REP, V8, P679; Ghattass K, 2013, CURR CANCER DRUG TAR, V13, P670; Haddadin J, 1993, HETEROCYCLES, V35, P1503; Harakeh S, 2004, CHEM-BIOL INTERACT, V148, P101, DOI 10.1016-j.cbi.2004.05.002; Haykal J, 2009, RADIAT ONCOL, V4, DOI 10.1186-1748-717X-4-25; Hill RP, 2009, SEMIN RADIAT ONCOL, V19, P106, DOI 10.1016-j.semradonc.2008.12.002; Itani W, 2007, RADIAT ONCOL, V2, DOI 10.1186-1748-717X-2-1; KALLINOWSKI F, 1989, J CELL PHYSIOL, V138, P183, DOI 10.1002-jcp.1041380124; Kaluzova M, 2004, MOL CELL BIOL, V24, P5757, DOI 10.1128-MCB.24.13.5757-5766.2004; Koch U, 2010, SEMIN CANCER BIOL, V20, P116, DOI 10.1016-j.semcancer.2010.02.003; Koh MY, 2008, MOL CELL BIOL, V28, P7081, DOI 10.1128-MCB.00773-08; Lalani AS, 2007, CLIN CANCER RES, V13, P2216, DOI 10.1158-1078-0432.CCR-06-2427; Li J, 2012, PLOS, V7, P38403; Lin Q, 2006, J BIOL CHEM, V281, P30678, DOI 10.1074-jbc.C600120200; Lunt SJ, 2009, CLIN EXP METASTAS, V26, P19, DOI 10.1007-s10585-008-9182-2; McKeown SR, 2007, CLIN ONCOL-UK, V19, P427, DOI 10.1016-j.clon.2007.03.006; Mehlen P, 2006, NAT REV CANCER, V6, P449, DOI 10.1038-nrc1886; Milani M, 2008, EUR J CANCER, V44, P2766, DOI 10.1016-j.ejca.2008.09.025; Miyake K, 2012, EXP CELL RES, V318, P1554, DOI 10.1016-j.yexcr.2012.03.013; Miyake K, 2008, CANCER LETT, V272, P325, DOI 10.1016-j.canlet.2008.07.020; Nagaraja GM, 2006, ONCOGENE, V25, P2328, DOI 10.1038-sj.onc.1209265; Rischin D, 2010, J CLIN ONCOL, V28, P2989, DOI 10.1200-JCO.2009.27.4449; Rischin D, 2005, J CLIN ONCOL, V23, P79, DOI 10.1200-JCO.2005.01.072; Sayed Alwi S, 2012, CELL STRESS CHAPERON, V5, P529; Schwab LP, 2012, BREAST CANCER RES, V14, DOI 10.1186-bcr3087; Semenza GL, 2003, NAT REV CANCER, V3, P721, DOI 10.1038-nrc1187; Semenza GL, 2001, CURR OPIN CELL BIOL, V13, P167, DOI 10.1016-S0955-0674(00)00194-0; Sudhagar S, 2011, BRIT J CANCER, V105, P953, DOI 10.1038-bjc.2011.349; Sullivan R, 2007, CANCER METAST REV, V26, P319, DOI 10.1007-s10555-007-9062-2; Tang LL, 2013, FOOD CHEM TOXICOL, V56, P204, DOI 10.1016-j.fct.2013.02.032; Wilson WR, 2011, NAT REV CANCER, V11, P393, DOI 10.1038-nrc3064; Wind NS, 2011, INT J BREAST CANC, V2011, DOI [10.4061-2011-967419, DOI 10.4061-2011-967419]; Wong CCL, 2012, J MOL MED, V90, P803, DOI 10.1007-s00109-011-0855-y; Yang MH, 2008, NAT CELL BIOL, V10, P295, DOI 10.1038-ncb1691; Zhang J, 2010, PLOS ONE, V5, P139100
Thermoeconomics as a tool for the design and analysis of energy savings initiatives in buildings connected to district heating networks
No full textDistrict Heating (DH) is a rational way to supply heat to buildings in urban areas. This is expected to play an important role in future energy scenarios, mainly because of the possibility to recover waste heat and to integrate renewable energy sources. Even if DH is a well known technology, there are open problems to face. Some of these problems are related to tendencies to reduce design temperatures, the improvement of control strategies, connection of new users to existing networks, implementation of energy savings initiatives and the access of multiple heat producers to the same network. This paper aims to show that exergy is an appropriate quantity for the analysis of DH systems and thermoeconomics can be profitably used to improve their design and operation. Three possible applications of thermoeconomic theories are presented: variation of supply temperature along the heating season, opportunities to connect new users, effects of energy savings initiatives in buildings connected with the network
Realization of aligned three-dimensional single-crystal chromium nanostructures by thermal evaporation
No full textAligned three-dimensional single-crystal chromium nanostructures are fabricated onto a silicon substrate by thermal evaporation in a conventional thermal evaporator, where the incident angle of Cr vapor flux with respect to the substrate surface normal is fixed at 88°. The effects of the deposition time and incident angle on the morphology of the resulting nanostructures are investigated. The achieved Cr nanostructures are characterized by scanning electron microscopy, energy dispersive X-ray analysis, X-ray diffraction, transmission electron microscopy, high-resolution transmission electron microscopy, and surface area measurement. This study provides a convenient way to fabricate three-dimensional single-crystal Cr nanostructures, which is suitable for batch fabrication and mass production. Finally, the same technique is employed to fabricate the nanostructures of other metals such as Ag, Au, Pd, and Ni
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