The total collapse of a multiple-story building immediately kills most of its occupants. In the present study, the few surviving victims were located at the lower floors. The majority of hospitalized victims were outside the building at the moment of the blast. Rapid overcrowding of the emergency department with minor and moderate injuries that do not require hospitalization should be anticipated by disaster management plans. Centralization of severely injured patients in critical areas seems appropriate, because this method keeps major cases from spreading through different wards.
BACKGROUND:Reliable biomarkers for early detection of hepatocellular carcinoma (HCC) in patients with cirrhosis are lacking. We evaluated the use of miR-122, alpha-fetoprotein (AFP) and protein induced by vitamin k absence/antagonist II (PIVKA-II) for HCC risk prediction in patients with HBV-related cirrhosis under surveillance.
METHODS:We first analyzed a group of 63 patients with HBV-related liver cirrhosis of whom 33 had HCC. Then we performed a retrospective analysis on another group of 13 cirrhotic patients who developed HCC during surveillance, of whom serial serum samples were available (at time of HCC diagnosis [T0], 6-9 months [T-1] and 12-18 months [T-2] before HCC detection). Serum miR-122 levels were assessed by quantitative real time-PCR, whereas AFP and PIVKA-II were measured by fully automated chemiluminescent enzyme immunoassay. RESULTS: Serum levels of miR-122, AFP and PIVKA-II were different between patients with cirrhosis and those with HCC (P=0.024, P<0.001 and P<0.001, respectively). Areas under the curve (AUC) were 0.675 for miR-122, 0.791 for AFP and 0.846 for PIVKA-II, while their combination improved the discrimination power between cirrhosis and HCC (AUC=0.918). In the longitudinal study, we found a significant variation overtime for the biomarkers combination (P=0.011) but not for each single biomarker (miR-122, P=0.163; AFP, P=0.170; PIVKA-II, P=0.447). Combined miR-122+AFP+PIVKA-II adjusted Hazard Ratio for HCC development was 10.63, 95% confidence interval 1.87-60.28 (P<0.001).
CONCLUSIONS:In HBV-related cirrhosis, the combination of miR-122, AFP and PIVKA-II enables the identification of patients at higher risk of HCC development that could benefit from closer monitoring.
Nowadays, the finding of a mummified body preserved by chance in a domestic environment is an occasional but not rare event in urban society [1]. Mummification can maintain intact a dead body, or parts of it, in a warm dry environment with an air current, such as in closed apartments [2]. The time of death is often difficult to estimate, requiring a multidisciplinary team of forensic pathologists, geneticists, entomologists, and possibly forensic psychiatrists. Mummification usually occurs in about 12 weeks, and the early stages may involve putrefactive changes. Elderly people are at greater risk of dying suddenly and unnoticed by others [3,4]. Victims' corpses can remain undiscovered in their homes for several months or years after their death, being well preserved if environmental conditions promote their desiccation [5]. The delayed discovery is often explained by the social isolation of the subjects when alive, with limited contact with other people and society. In addition, the absence of family support and poor neighborly relationships can worsen their social living conditions [6,7].
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.