Correspondence / American Journal of Emergency Medicine 38 (2020) 1679–1694 1691

B. Riley

C. Anstey

Department of Intensive Care Medicine, Sunshine Coast Hospital and

Health Service, Birtinya, QLD, Australia

U. Malla

N. Snels

A. Mitchell

C. Abi-Fares

W. Basson

L. White* Department of Anaesthesia and Perioperative Medicine, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia

*Corresponding author at: Department of Anaesthesia and Perioperative Medicine, Sunshine Coast Hospital and Health Service, Birtinya,

QLD, Australia.

E-mail address: [email protected].

30 December 2019

https://doi.org/10.1016/j.ajem.2020.01.007

References

1. Medha Mohta PV, Saxena AK, Sethi AK, Tyagi A, Girotra G. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs–a pilot study. Journal of Trauma In- jury, Infection and Critical Care 2009;66(4):1096-101.
2. Samuel Michael Galvagno CES, Varon AJ, Hasenboehler EA, Sultan S, Shaefer G, To KB, et al. Pain management for blunt Thoracic trauma: a joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anes- thesiology Society. J Trauma Acute Care Surg 2016;81(5):936-51.
3. S. D. Adhikary, W.M.L., E. Fuller, H. Cruz-Eng and K. J. Chin, The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia, 2019. 74: p. 585-593.
4. Ahiskalioglu A, Yayik AM, Aydin ME. (MS21362) A technical dilemma: single shot or continuous injection for novel plane blocks? Am J Emerg Med 2020; 38(2):393.
5. Piraccini E, Bagaphou TC, Righetti R. Rhomboid intercostal block for multiple rib fractures: should we add a continuous infusion? Am J Emerg Med 2020;38(2): 392-3.
6. Luftig J, Mantuani D, Herring AA, Dixon B, Clattenburg E, Nagdev A. Successful emer-

   gency pain control for Posterior rib fractures with ultrasound-guided erector spinae plane block. Am J Emerg Med 2020;38(2):392-3.

   Peter Fu, P.D.W., Christopher A. J. Webb, Case report of serratus plane catheter for pain management in a patient with multiple rib fractures and an inferior scapular fracture. A&A Case Reports, 2017. 8(6): p. 132-135.

7. ANZCA, FPM. opioid dose Equivalence. http://fpm.anzca.edu.au/documents/opioid- dose-equivalence.pdf; 2019.
8. Mahlon A, Kerr-Valentic MA, Mullins RJ, Pearson TE, Mayberry JC. Rib fracture pain and disability: can we do better? The Journal of TRAUMA Injury, Infection, and Crit- ical Care 2003;54(6):1058-64.
9. Riley B, Malla U, Snels N, Mitchell A, Abi-Fares C, Basson W, et al. Erector spinae nerve block for the management of rib fractures: a retrospective pro- pensity matched cohort study protocol. Anesthesia and Critical Care 2019;1: 29-33.

   Collegiate EMS providers’ role in vaping education

   Vaping is a nationwide epidemic that has gained well-deserved at- tention due to recent case reports seeming to increase in number daily. These realities of deaths related to e-cigarette usage has sparked medical community discussion ranging from an entire section desig- nated on this topic in the New England Journal of Medicine (NEJM) to an ever-present media coverage featuring anecdotal experiences with the addictive effects of vaping, accusations of misinformation from the manufacturers of the products, and research advances that bring to light potential culprits for the harms of vaping [1].

   Much has been reported on the indisputable fact that our nation has been faced with an ever present and growing public health crisis rooted in e-cigarette and vaping device effects on users’ respective health.

   The focus of many publications centers around the misuse of these products among adolescents and young adults [2-4]. This particular focus of research is rightfully targeted at this age group due to the dis- proportionate use of e-cigarette products that young adults represent in terms of usage in comparison to adult age groups.

   2015 research presented by the U.S. surgeon general reported noted e-cigarette and vaping produCT usage among high school students had increased by 900%- and nearly half of these users further specified never having regularly used tobacco products in addition or instead of vaping devices [3]. Rather than conducting another survey exploring the potential leading reasons why e-cigarette usage is particularly pop- ular among Young people, it is more pressing to shift the frame of work targeted at addressing this crisis. Alternatively, it is more beneficial to combat this issue by offering a lense into the intricate social practices and culture that has kindled the widespread e-cigarette illnesses throughout the country.

   The subsequent perspective aims to synthesize the historical and so- cial experiences that many of my generation have been influenced by as an ultimate means of equipping providers with a unique framework into the reasons that have led to the predicament at hand. This wide- spread misunderstanding held by many who use vaping or similar de- vices for non-medical reasons is most appropriately addressed through offering pragmatic solutions from a provider who has garnered unique perspectives about this epidemic to foster a dialogue that subse- quently offers potential legislative and larger scale advocacy changes that only can begin to truly get at the root of the issue after providers understand the issue from this perspective.

   As noted in recent literature, a population particularly using e- cigarettes is college aged individuals in environments where vaping is a common communal practice. to social and environmental influences is college aged young adults in university living and learning environ- ments [3]. Why then has the thousands of publications in recent years focused on e-cigarette prevalence in the young adult population does not have a single review in the literature discussing the role of campus based EMS systems in combating this epidemic [4]? Quite simply, it is rather rare, from an even broader perspective, to focus research on Col- legiate based EMS. As such, scarce literature is available discussing the specific role that EMS providers in a campUS setting have within the scope of the vaping crisis. Nonetheless, it is crucial to call for heightened involvement in educational and social means of promoting awareness and safe utilization of these products from the very population affected by their use.

   An evidence-informed analysis of data surveying college-based e- cigarette usage and opinions showed that “nearly 29 % of respondents reported observing e-cigarette use on campus, and more than half of these reported seeing e-cigarette use indoors. More than 42 % did not know whether their school’s policy prohibited e-cigarette use on cam- pus [5].”

   The potential gap in knowledge of school policies and more gener- ally usage of e-cigarette devices on college campuses presents the chance for meaningful impact on campuses across the nation to address the gap in knowledge. Specifically, by utilizing already established and robust collegiate EMS systems, peer health care providers are an excep- tional unique population to provide outreach and education peers on the implications of e-cigarette use.

   Indeed, the exhaustive literature affirming the public health crisis is best augmented by a proposal further excavating a way to promote meaningful ways of supportive care, educational modalities, and medical research practices to holistically address this public health crisis.

   Christopher Gaeta

   Swarthmore College, University of Pennsylvania, Children’s Hospital of

   Philadelphia, United States of America E-mail address: [email protected].

   1692 Correspondence / American Journal of Emergency Medicine 38 (2020) 1679-1694

   https://doi.org/10.1016/j.ajem.2020.01.008

   References

   31 December 2019

   gradually decreased with the duration of the disease. Also, there was a correlation between inflammatory responses and migraine.

   In conclusion, the two studies by Gokdemir et al. [1] and Ceylan et al. [6], respectively, are very meaningful and have provided a directional guide for our further research.

   Yannone T. Here’s what you need to know about the vaping crisis. Boston Magazine; 11 Sept. 2019 Boston Magazine www.bostonmagazine.com/health/2019/09/10/ vaping-crisis-lung-disease/.

10. Youth Risk Behavior Surveillance System (YRBSS). 2017 data and results. Atlanta: Centers for Disease Control and Prevention; 2017. https://www.cdc.gov/ healthyyouth/data/yrbs/index.htm.
11. E-cigarette use among youth and young adults: a report of the surgeon general–ex- ecutive summary. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease prevention and Health Promotion, Office on Smoking and Health; 2016.
12. Demissie Z, Everett Jones S, Clayton HB, King BA. Adolescent risk behaviors and use of electronic vapor products and cigarettes. Pediatrics 2017;139(2):e20162921.
13. Brown EM, Henes AL, Olson LT. E-cigarette policies on college campuses: student use behaviors, awareness, and policy support. J Community Health 2016;41(6):1110-5. https://doi.org/10.1007/s10900-016-0262-y.

    Funding

    None.

    Declaration of competing interest

    The authors report no conflicts of interest in this work.

    Jun Zhang Haili Wang Boming Xia

    Brief overview of Pentraxin 3

    Department of Clinical Medicine, Dalian Medical University, Dalian,

    Liaoning, China

    To the Editor,

    We have read with great interest study by Gokdemir et al. [1] about the “Pentraxin 3 level in acute migraine attack with aura: Patient man- agement in the emergency department”. The authors investigated the value of Pentraxin 3 (PTX3) in the diagnosis of acute migraine and the results suggested obvious effectiveness of PTX3 (sensitivity 93% and specificity 84%). The findings give us confidence in PTX3-assisted diag- nosis of acute migraine, whereas there still lacks support of evidence- based medicine. Therefore, it is necessary to perform a meta-analysis when the conditions are sufficient. At the same time, we seem to have encountered the puzzle of “Which comes first, the chicken or the egg?” (Does increased PTX3 cause migraine or does migraine cause in- creased PTX3?) To clarify this philosophical issue has guiding signifi- cance for the diagnosis and/or treatment of migraine. In addition, in order to help the readers better understand this article, we consider it necessary to have a brief overview of PTX3.

    Pentraxins (PTXs) constitute a superfamily of evolutionarily conserved proteins characterized by a cyclic multimeric structure [2]. PTX is composed of subunits with a molecular weight of 20,000 to 30,000. Under physiological conditions, the subunits tend to form pentamers (two pentagons sometimes overlap to form a decagon). Under an electron microscope, PTX appears as a regular pentagon which corresponds to its name. PTX3 is the first member of the PTX family [2]. It is a well conserved plasma protein which is involved in acute and chronic inflammation and in innate immunity [3]. PTX3, C-reactive protein (CRP), and serum amyloid protein (SAP) have similar molecular structures. PTX3, secreted mainly by dendritic cells, macrophages and Endothelial cells [4], causes complement activation and acts as a chemokine in various inflammatory cells [5].

    Ceylan et al. [6] recruited 30 migraine patients and 30 healthy

    controls to study the differences in PTX3 concentration between the two groups. The study demonstrated that PTX3 concentration was significantly higher in migraine patients compared with that in healthy controls [6]. In addition, the author’s further subgroup analysis showed that the longer the duration of migraine, the lower the serum PTX3 concentration but still higher than that in healthy controls [6]. To some extent, the results indicated a correlation between PTX3 concentration and migraine, which

    Lun Dong

    Department of neurosurgery, Clinical Medical College of Yangzhou

    University, Yangzhou, China Corresponding author at: Department of Neurosurgery, Clinical Medical College of Yangzhou University, No.98 Nantong Westroad, 225001

    Yangzhou, Jiangsu, China.

    E-mail address: [email protected].

    1 January 2020

    https://doi.org/10.1016/j.ajem.2020.01.018

    References

    Gokdemira MT, Nasb G, Gokdemir GS. Pentraxin 3 level in acute migraine attack with aura: patient management in the emergency department. Am J Emerg Med 2020;38 (1):38-42.

14. Deban L, Russo RC, Sironi M, Moalli F, Scanziani M, Zambelli et al. Regulation of leukocyte recruitment by the long pentraxin PTX3. Nat Immunol 2010,11(4), 328-334.
15. Zlibuta A, Bocsanb IC, Agoston-Coldea L. Pentraxin-3 and endothelial dysfunction. Adv

    Clin Chem 2019;91:163-79.

    Doni A, Michela M, Bottazzi B, Peri G, Valentino S. Polentarutti et al. regulation of PTX3, a key component of humoral innate immunity in human dendritic cells: stimulation by IL-10 and inhibition by IFN-?. J Leukoc Biol 2006;79: 797-802.

16. Presta MC, Salvatori G, Rusnati M. Role of the soluble pattern recognition receptor PTX3 in vascular biology. J Cell Mol Med 2007;11:723-38.
17. Ceylan M, Bayraktutan OF, Becel S, Atis O, Yalcin A, Kotan D. Serum levels of pentraxin-3 and other inflammatory biomarkers in migraine: association with mi- graine characteristics. Cephalalgia 2015;36(6):518-25.

    Association between the NACA score and clinical outcomes

    Sir,

    Leszczynski et al. [1] are to be thanked for exploring the association between the prehospital National Advisory Committee for Aeronautics (NACA) score and outcome, an important issue. In the light of our re- cently published study [2] we would like to underline some aspects rel- ative to the NACA score.