Background: Triage plays a crucial role in the emergency department (ED) management of mass casualty incidents (MCIs) when resources are limited. This study aimed to compare the performance of simple triage and rapid treatment (START) with that of the Taiwan Triage and Acuity Scale (TTAS) for the ED triage of victims following an earthquake-related MCI. Methods: We retrospectively reviewed the records of victims presenting at our ED with earthquake-related injuries within 24 h of a large-scale earthquake. TTAS was initially used at our ED for this event, and START was performed by retrospectively reviewing the patient records in a blinded manner. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START and TTAS were determined for predicting ED discharge. Results: We enrolled 105 patients (predominantly women, 60.0%; median age, 45.0 years) in this study; most of them presented with traumatic injuries and were initially triaged as TTAS level III (78.1%), followed by TTAS level II (11.4%). Although the majority of the victims (81.0%) were discharged, four deaths occurred. A moderate agreement in differentiating emergency from nonemergency patients was observed between START and TTAS. Furthermore, both the triage systems showed similar predictions for ED disposition (START AUC/sensitivity/specificity: 0.709/82.35%/55.00%; TTAS AUC/sensitivity/specificity: 0.709/90.59%/45.00%). Conclusions: The present study demonstrated that START and TTAS have similar triage accuracy and ability to predict ED disposition. Our findings demonstrate that START may be used as an alternative to TTAS for the ED triage of victims following earthquake-related MCIs.

Burn injuries cause severe pain, infection risks, psychological distress, financial burdens, and mortality, necessitating effective care. Aloe vera, a traditional burn remedy, shows wound-healing potential, but its analgesic effects and efficacy with varying burn severity are uncertain. This study aims to investigate A. vera’s effect on wound healing, pain management, and infection prevention in patients with burns. A systematic search on PubMed, Embase, and CENTRAL was performed on October 9, 2023, for randomized controlled trials (RCTs). The risk of bias was examined using the Cochrane risk-of-bias tool (version 2), and the meta-analysis was carried out using a random-effects model. The primary outcome was wound-healing time, with secondary outcomes examining pain severity and wound infection. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence for each outcome. Nine RCTs were included in the current study, of which 6 provided data on the primary outcome. Aloe vera significantly reduced mean wound-healing time compared to other topicals (mean difference [MD] −3.76 days; 95% CI, −5.69 to −1.84). Additionally, the meta-analysis of the secondary outcomes found no significant differences in pain reduction (MD −0.76 points; 95% CI, −1.53 to 0.01) and wound infection risk (risk ratio 1.10; 95% CI, 0.34-3.59) between A. vera and control groups. In conclusion, A. vera expedites wound healing in patients with second-degree burns without increased infection risk compared to other antimicrobial agents. The analgesic effects on burn injuries remain uncertain.

Venom-induced consumption coagulopathy (VICC) is a serious complication of snakebites, potentially leading to life-threatening bleeding. Despite efforts to determine effective treatments other than antivenom, such as heparin, the evidence supporting their use remains insufficient. Therefore, this study aimed to perform a systematic review, meta-analysis and trial sequential analysis (TSA) to examine the effects of heparin on VICC. On 11 August 2024, a systematic search for randomized controlled trials (RCTs) investigating the effects of heparin on VICC was conducted using eight online databases. Six RCTs were included in this study. The meta-analysis revealed that heparin did not significantly reduce the mortality rate (risk ratio, 0.65; 95% CI 0.39 to 1.10). Additionally, the meta-analysis showed no significant differences in various clinical outcomes between the heparin group and control group. The TSA indicated insufficient evidence to conclude the effects of heparin on VICC mortality, and a sample size of 741 patients may be needed for further RCTs. In conclusion, our findings indicate that heparin may not significantly affect VICC outcomes. Although the current evidence is inconclusive because of the limited sample size, it highlights the need for future trials to provide more precise insights.

Flavonoids exert antioxidant activity by scavenging free radicals, chelating metals, and modulating antioxidant enzymes. The root extract of Glycine tomentella Hayata (GTE), a traditional Chinese medicinal herb contains flavonoids, particularly, isoflavones. However, its neuroprotective effects against anxiety remain unclear. In this study, the effects of GTE on anxiety-like behavior and oxidative stress in male Balb/c mice were investigated. The mice were administered GTE orally once daily for 14 d and subsequently, the anxiolytic-like effects of the extract were observed via elevated plus maze and open field tests. Oxidative stress levels in the treated mice were also measured. The results obtained identified daidzein (9.19 mg/g dry extract) and daidzin (2.95 mg/g dry extract) as the key isoflavones in GTE. Furthermore, free radical scavenging assays confirmed that GTE shows strong antioxidant activity, with an IC50 value of 8.82 μg/mL. It also showed pronounced anxiolytic effects, attenuating reactive oxygen species production in a dose-dependent manner. Mechanistic studies attributed these effects to the estrogenic activity of daidzein, which possibly modulates emotional state via estrogen receptor activation and systemic oxidative stress mitigation. These findings suggest that isoflavone-enriched GTE is a natural resource with potential for use as an antioxidant for mitigating anxiety.

Purpose: Although antibiotics are a recognized alternative to appendectomy for uncomplicated appendicitis, their specific benefit over observation alone remains unclear. This systematic review and meta-analysis aimed to isolate the antibiotic effect by directly contrasting antibiotics with observation in patients receiving nonoperative management (NOM) for uncomplicated appendicitis. Methods: We systematically searched PubMed, Embase (Ovid), the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the International Clinical Trials Registry Platform, and the International Standard Randomized Controlled Trial Number Registry from inception to October 5, 2025, to identify randomized or quasi-randomized trials comparing antibiotics versus observation (no antibiotics) for NOM. We defined treatment success at 30 days as the primary endpoint. To assess the potential risk-of-bias (ROB), the Cochrane RoB 2 instrument was employed, while the overall certainty of our findings was determined through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: Three trials involving 437 participants were included: two randomized controlled trials (RCTs) and one quasi-RCT. Analysis restricted to RCTs demonstrated no significant effect of antibiotics on initial treatment success (RR: 1.03, 95% CI: 0.92–1.15). Analysis across three studies showed no significant differences in recurrence (RR: 1.38, 95% CI: 0.68–2.80) or the need for appendectomy during follow-up (RR: 0.98, 95% CI: 0.66–1.47). Evidence certainty was low for the primary outcome and very low for secondary outcomes. Conclusion: Current evidence is insufficient to determine whether antibiotics provide additional benefit over observation for uncomplicated appendicitis. Larger, adequately powered trials are needed to establish the comparative effectiveness of these approaches.