Value of Canadian C-spine rule versus the NEXUS criteria in ruling out clinically important cervical spine injuries: derivation of modified Canadian C-spine rule.

PURPOSE: Although, Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS) criteria in ruling out clinically important cervical spine injuries have been validated using large prospective studies, no consensus exist as to which rule should be endorsed. Therefore, the aim of the present study was to compare the accuracy of the Canadian C-spine and NEXUS criteria in ruling out clinically important cervical spine injuries in trauma patients. Finally, we introduced the modified Canadian C-spine rule. METHODS: A prospective diagnostic accuracy study was conducted on trauma patients referred to four emergency departments of Iran in 2018. Emergency physicians evaluated the patients based on the Canadian C-spine rule and NEXUS criteria in two groups of low risk and high risk for clinically important cervical spine injury. Afterward, all patients underwent cervical imaging. In addition, modified Canadian C-spine rule was derived by removing dangerous mechanism and simple rear-end motor vehicle collision from the model. RESULTS: Data from 673 patients were included. The area under the curve of the NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 0.76 [95% confidence interval (CI) 0.71-0.81)], 0.78 (95% CI 0.74-0.83), and 0.79 (95% CI 0.74-0.83), respectively. The sensitivities of NEXUS criteria, Canadian C-spine, and modified Canadian C-spine rule were 93.4%, 100.0% and 100.0%, respectively. CONCLUSIONS: The modified Canadian C-spine rule has fewer variables than the original Canadian C-spine rule and is entirely based on physical examination, which seems easier to use in emergency departments.

Mesenchymal Stromal Cells Derived Conditioned Medium in Pulmonary Fibrosis: A Systematic Review and Meta-analysis.

BACKGROUND: A definitive conclusion on the efficacy of mesenchymal stromal cells-derived conditioned medium (MSCs-CM) in pulmonary fibrosis has not yet been reached. Therefore, the present meta-analysis intends to investigate the efficacy of MSCs-CM administration on improvement of pulmonary fibrosis. METHODS: An extensive search was performed on the Medline, Embase, Scopus and Web of Science databases by the end of August 2019. Outcomes in the present study included pulmonary fibrosis score, lung collagen deposition, lung collagen expression, transforming growth factor ß1 (TGF-ß1) expression and interleukin-6 expression. Finally, the data were pooled and an overall standardized mean difference (SMD) with a 95% confidence interval (CI) was reported. RESULTS: Data from seven studies were included. Analyses showed that administration of MSCs-CM significantly improved pulmonary fibrosis (SMD = -2.36; 95% CI: -3.21, -1.51). MSCs-CM administration also attenuated lung collagen deposition (SMD = -1.70; 95% CI: -2.18, -1.23) and decreased expression of type I collagen (SMD = -6.27; 95% CI: -11.00, -1.55), type III collagen (SMD = -5.16; 95% CI: -9.86, -0.47), TGF- ß1 (SMD = -3.36; 95% CI: - 5.62, -1.09) and interleukin-6 (SMD = -1.69; 95% CI: - 3.14, -0.24). CONCLUSION: The present meta-analysis showed that administration of MSCs-CM improves pulmonary fibrosis. It seems that the effect of MSCs-CM was mediated by reducing collagen deposition as well as inhibiting the production of inflammatory chemokines such as TGF-ß1 and interleukin 6 (IL-6). Since there is no evidence on the efficacy of MSCs-CM in large animals, further studies are needed to translate the finding to clinical studies.

The incidence, age at diagnosis of breast cancer in the Iraqi Kurdish population and comparison to some other countries of Middle-East and West.

BACKGROUND: Studies on breast cancer among Iraqi Kurdish are limited. The incidence of breast cancer is lower, more common in younger age and a significant proportion of cases occur in premenopausal women. The aims of this study are to estimate the age-standardized incidence rate, age-specific rates and their comparison with some countries of Middle-East and West, and clarify the association of family history and premenopausal status with breast cancer. MATERIALS AND METHODS: This retrospective case control study was conducted in Sulaimanyah governorate (North of Iraq). Data were collected regarding demographical profile of 536 patients who were registered in Hewa Hematology and Oncology Hospital during 2011-2013, and 496 age-matched controls. RESULTS: There were 536 cases of breast cancer, 526 of them were female. The age range was 20-82 years. The mean age at diagnosis was 49.42±11.66 years compared to control 46.7±10.2 (p˂0.001, 95% CI: 1.7-3.7). The age-standardized rate was 17.9/100,000 Kurdish women population/year. Five year age-specific rates show the peak incidence for the age group 45-49 years (79.3/100,000). A significant percentage of patients were premenopausal at the time of diagnosis, which is account 55.52% of cases compared to control 59.67% (p=0.53). About 13.49% of cases have family history of breast cancer compared to control 3.2% (p=0.02). CONCLUSION: Among Kurdish people in Iraq, the incidence of breast cancer is less than Middle-East and Western countries with higher incidence in younger age group than western society, but similar to Middle-East countries. More than half of Kurdish women with breast cancer are premenopausal.