Validity of SMART-COP score in prognosis and severity of community acquired pneumonia in the emergency department

BackgroundDetermining prognosis in community acquired pneumonia (CAP), is very important. Many scores are introduced up to now for prediction of pneumonia prognosis like SMART-COP.ObjectiveTo evaluate validity of SMART-COP score in prognosis and severity of CAP in emergency department (ED).MethodsAll patients older than 18 years old with clinical suspicion of CAP (meeting the inclusion criteria), were enrolled in our study. In this prospective study, patients were admitted to the ED of a tertiary referral center. Hospital length of stay, rate of intensive care unit (ICU) admission, mortality rate, number of intensive respiratory or vasopressor support (IRVS) use, patients' SMART-COP scores and all demographic data were recorded. Validity of SMART-COP in the prediction of IRVS rate and its correlation with other variables were determined.ResultsIn this study, 47.6% and 52.4% of patients were females and males respectively. The mean age of patients was 68.13 ± 16.60 years old. The mean hospital length of stay was 13.49 ± 5.62 days. Of all patients entered in our study, 55 cases (38.5%) needed ICU admission, 29 cases (20.3%) were expired within 1 month and 44 cases (30.8%) needed IRVS during their treatment. SMART-COP ≥5 (high risk CAP) accurately predicted the rate of ICU admission, one-month mortality and IRVS need (p-value = 0.001).ConclusionsSMART-COP≥5 had a high sensitivity and specificity in the prediction of patients' prognosis with severe CAP in the ED.     

A Summary of Planarian Signaling Pathway for Regenerative Medicine

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Regenerative medicine has been increased for helping crucial diseases and injuries. Planarians have appeared...     

Endoscopic electronic record: A new approach for improving management of colorectal cancer prevention

Digestive endoscopy is currently the main diagnostic procedure for investigation of the digestive tract when a digestive disease is suspected.The use of computers and electronic medical records for the management of endoscopic data are an important key to improving endoscopy unit efficiency and productivity.This technology supports optimal program operation,monitoring and evaluation colorectal cancer screening.This article is a comprehensive survey of endoscopic electronic medical records and information systems.Computerized clinical records have the capability of identifying patients due for screening and to calculate baseline rates of colorectal cancer screening by patient characteristics and by primary care physician and practice group.This paper describes data flow in the endoscopy unit,the minimum data set of colorectal cancer and key features of endoscopic electronic medical record.In addition,the researchers state standards in different aspects,especially terminology standards and interoperability standards for image and text.     

蜂王浆对女性2型糖尿病患者血糖控制及氧化应激因素的作用：一项随机临床试验

Objective:It has been proposed that royal jelly has antioxidant properties and may improve oxidative stress and glycemic control.Therefore,we investigated the effects of royal jelly supplementation in diabetic females.Methods:In this pilot,parallel design randomized clinical trial,50 female volunteers with type2 diabetes were randomly allocated to the supplemented(25,cases)and placebo(25,cases)groups,based on random block procedure produced by Random Allocation Software,given a daily dose of 1,000 mg royal jelly soft gel or placebo,respectively,for 8 weeks.Before and after intervention,glycemic control indices,antioxidant and oxidative stress factors were measured.Results:After royal jelly supplementation,the mean fasting blood glucose decreased remarkably(163.05142.51 mg/dL vs.149.68±42.7 mg/dL).Royal jelly supplementation resulted in significant reduction in the mean serum glycosylated hemoglobin levels(8.67%±2.24%vs.7.05%±1.45%,P=0.001)and significant elevation in the mean insulin concentration(70.28±29.16 pmol/L vs.86.46±27.50 pmol/L,P=0.01).Supplementation significantly increased erythrocyte superoxidase dismutase and glutathione peroxidase activities and decreased malondialdehyde levels(P0.05).At the end of study,the mean total antioxidant capacity elevated insignificantly in both groups.Conclusions:On the basis of our findings,it seems that royal jelly supplementation may be beneficial in controlling diabetes outcomes.Further studies with larger sample size are warranted.     

Investigating the Use of Denosumab in the Treatment of Acute Charcot Neuroarthropathy

Charcot neuroarthropathy is a devastating condition, most commonly affecting poorly controlled diabetic patients with peripheral neuropathy. Pharmacological options for the condition are currently limited. The purpose of this study was to investigate the potential of Prolia® (denosumab) as a safe and feasible option in the treatment of acute Charcot neuroarthropathy. A total of 7 consecutive subjects were enrolled and followed for 1 year. Subjects received a single one-time injection of denosumab 60 mg. Subjects also received standard of care treatment, which included total contact casting, restricted weightbearing status, and biweekly office visits until normalization of the skin temperature gradient. Overall, the pharmaceutical treatment was generally well-tolerated. One subject developed a diabetic foot infection with cellulitis of the contralateral lower extremity, which occurred following the 6-month follow-up visit and which resolved with oral antibiotics One subject identified transient muscle pain in the same upper extremity which received the injection. Subjects were found to exit the acute phase of the condition at an average of 52.00 ± 17.89 days after their injection, which was defined by normalization of skin temperature to within 2°C of the contralateral foot. Treatment of acute Charcot neuroarthropathy with denosumab was well-tolerated in this open-label, pilot study. The clinical outcomes suggest that the medication may be efficacious, though a larger sample size would be needed to confirm these preliminary results. An adequately-powered, randomized, controlled study may be an appropriate follow-up.     

Does probiotic supplementation affect pulmonary exacerbation and intestinal inflammation in cystic fibrosis: a systematic review of randomized clinical trials

Background:Patients with cystic fibrosis (CF) usually have abnormal intestinal microbiota due to massive exposure to antibiotics.Probiotics could modify the gut microbiota and hence may affect CF management.So the aim of present systematic review was evaluation of the efficacy and safety of probiotic supplementation for the management of cystic fibrosis.Data sources:We searched PubMed,Science Direct,Google Scholar,Springer Cochrane Library Databases until January 2016 for randomized controlled trials (RCTs) performed in pediatric or adult populations related to the study aim.Key words were selected based on Mesh terms.Based on the Critical Appraisal Skills Programme checklist,eligibility of included articles was evaluated.Results:Five studies included in this review represent 188 participants with a follow up period ranging from 1 month to 6 months.The results of the included studies supporting the use of probiotics in management of pulmonary exacerbation and intestinal calprotectin in patients with cystic fibrosis.However the level of evidence was limited.Conclusion:The lack of high quality RCTs makes it impossible to support a general recommendation about the use of probiotics in the treatment of CF pulmonary exacerbation and intestinal inflammation.     

In vivo biodistribution and toxicology studies of cadmium-free indium-based quantum dot nanoparticles in a rat model

Quantum dot (QD) nanoparticles are highly promising contrast agents and probes for biomedical applications owing to their excellent photophysical properties. However, toxicity concerns about commonly used cadmium-based QDs hinder their translation to clinical applications. In this study we describe the in vivo biodistribution and toxicology of indium-based water soluble QDs in rats following intravenous administration. The biodistribution measured at up to 90?days showed that QDs mainly accumulated in the liver and spleen, with similar elimination kinetics to subcutaneous administration. Evidence for QD degradation in the liver was found by comparing photoluminescence measurements versus elemental analysis. No organ damage or histopathological lesions were observed for the QDs treated rats after 24?h, 1 and 4?weeks following intravenous administration at 12.5?mg/kg or 50?mg/kg. Analysis of serum biochemistry and complete blood counts found no toxicity. This work supports the strong potential of indium-based QDs for translation into the clinic.     

Mitogen-activated protein kinase (MEK) inhibitors to treat melanoma alone or in combination with other kinase inhibitors

Introduction: Malignant melanoma (MM) is an aggressive disease with a rapidly rising incidence due to neoplasm of melanocytes. Molecular targeted therapies have demonstrated lower toxicity and improved overall survival versus conventional therapies of MM. The revealing of mutations in the BRAF/MEK/ERK pathway has led to the development of BRAF inhibitors such as vemurafenib and dabrafenib for the treatment of cutaneous MM. Though, progression of resistance to these agents has prompted attempts to target downstream proteins in this pathway. Trametinib, a MEK1/2 inhibitor, was approved in 2013 for the treatment of BRAF V600E/K mutation-positive unresectable or metastatic cutaneous melanoma patients.

Areas covered: The aim of the current review is to present an update on the role of MEK in progressive melanomas and summarize latest results of clinical studies with innovative MEK inhibitors and/or combined approaches with other kinase inhibitors such as BRAF inhibitors in the treatment of MM.

Expert opinion: Two combined treatments (i.e. trametinib plus dabrafenib and vemurafenib plus cobimetinib) target two different kinases in the BRAF/MEK/ERK pathway. The simultaneous prohibition of both MEK and BRAF is associated with more durable response rate than BRAF monotherapy and can overcome acquired resistance.