The effects of coenzyme Q10 supplementation on biomarkers of exercise-induced muscle damage, physical performance, and oxidative stress: A GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials

PURPOSE

This study aims to elucidate the dose-dependent effect of coenzyme Q10 supplementation (CoQ10) on exercise-induced muscle damage (EIMD), physical performance, and oxidative stress in adults.

METHODS

A systematic search was conducted through PubMed, Scopus, and ISI Web of Science databases up to August 2023, focusing on randomized control trials (RCTs) that investigated the effects of CoQ10 supplementation on EIMD recovery, physical performance and oxidative stress mitigation in adults. The weighted mean difference (WMD) and 95 % confidence interval (95 %CI) were estimated using the random-effects model.

RESULTS

The meta-analysis incorporated 28 RCTs, encompassing 830 subjects. CoQ10 supplementation significantly decreased creatine kinase (CK) (WMD: -50.64 IU/L; 95 %CI: -74.75, -26.53, P < 0.001), lactate dehydrogenase (LDH) (WMD: -52.10 IU/L; 95 %CI: -74.01, -30.19, P < 0.001), myoglobin (Mb) (WMD: -21.77 ng/ml; 95 %CI: -32.59, -10.94, P < 0.001), and Malondialdehyde (MDA) (WMD: -0.73 μmol/l; 95 %CI: -1.26, -0.20, P = 0.007) levels. No significant alteration in total antioxidant capacity was observed post-CoQ10 treatment. Each 100 mg/day increase in CoQ10 supplementation was correlated with a significant reduction in CK (MD: -23.07 IU/L, 95 %CI: -34.27, -11.86), LDH (WMD: -27.21 IU/L, 95 %CI: -28.23, -14.32), Mb (MD: -7.09 ng/ml; 95 %CI: -11.35, -2.83) and MDA (WMD: -0.17 μmol/l, 95 %CI: -0.29, -0.05) serum levels. Using SMD analysis, "very large" effects on LDH and "moderate" effects on CK and MDA were noted, albeit nonsignificant for other outcomes.

CONCLUSION

CoQ10 supplementation may be effective in reducing biomarkers of EIMD and oxidative stress in adults. Nevertheless, given the preponderance of studies conducted in Asia, the generalizability of these findings warrants caution. Further RCTs, particularly in non-Asian populations with large sample sizes and extended supplementation durations, are essential to substantiate these observations.

The effects of intermittent fasting diet on quality of life, clinical symptoms, inflammation, and oxidative stress in overweight and obese postmenopausal women with rheumatoid arthritis: study protocol of a randomized controlled trial

BACKGROUND

Rheumatoid arthritis (RA) is known as a chronic systemic autoimmune disorder that primarily targets synovial joints, and may cause pain and functional limitations. Studies show diet can have beneficial effects on symptoms and oxidative stress of this disease. Intermittent fasting (IF) is a dietary approach with cycles of fasting and intake. The current study aims to investigate the effect of IF on quality of life, clinical symptoms, inflammation, and oxidative stress in overweight and obese postmenopausal women with RA.

METHODS

The current study is a randomized clinical trial, in which 44 patients with mild to moderate severity of RA will be randomly allocated to receive either IF (n = 22) or the usual diet (n = 22) for 8 weeks. Anthropometric measures and biochemical indicators including serum concentrations of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and total oxidant and antioxidant capacity (TOC and TAC) will be assessed at the baseline and end of the study. Also, disease severity will be assessed by Disease Activity Score-28 (DAS-28) and clinical disease activity index (CDAI), and disability index will be assessed by Health Assessment Questionnaire-Disability Index (HAQ-DI) questionnaire.

DISCUSSION

Studies show fasting has beneficial effects on inflammatory markers and results in an improvement in the health of different populations. Literature review shows it seems there is no study in this field to evaluate the effects of IF on RA patients, and they are limited to other types of fasting. However, studies show IF can have many positive effects on chronic and autoimmune diseases. Therefore, IF may have positive effects on these patients.

TRIAL REGISTRATION

IRCT20230217057441N1. Registered on 14 February 2023. https://en.irct.ir/user/trial/68669 .

Diagnosis and treatment of malignant eyelid tumors

BACKGROUND

Malignant tumors of the eyelid are much less frequent than benign eyelid alterations. These are frequently incidental findings without symptoms which are often overlooked or misinterpreted by patients.

OBJECTIVE

This article gives an overview of clinical aspects, diagnostics and treatment of the five most common malignant eyelid tumors and exemplarily explains the essential principles of evidence-based treatment of malignant eyelid tumors.

METHODS

This narrative review was prepared based on a selective literature search. The depiction of the treatment of eyelid tumors is supported by illustrations of clinical cases.

RESULTS

The medical history and inspection provide initial indications of malignancy. Every eyelid change suspected of being malignant should be examined histologically to confirm a diagnosis. By far the most common malignant eyelid tumor in Europe is basal cell carcinoma, which metastasizes only in exceptional cases. Squamous cell carcinomas, sebaceous adenocarcinomas, melanomas and Merkel cell carcinomas occur much less frequently. In these cases, potential metastasis in particular must be considered when making the diagnosis and staging has to be initiated. Surgical excision into healthy tissue with tumor-free margins is the gold standard for malignant eyelid tumors. Non-surgical adjuvant or neoadjuvant forms of evidence-based treatment can be initiated based on the individual case to minimize the risk of recurrence and metastasis.

CONCLUSION

It is essential to recognize eyelid changes at an early stage, to classify them correctly and to initiate the appropriate treatment. The interaction between the general condition and the personal needs of a patient as well as state of the art medicine are the keys to a good personalized treatment.

How Linear Elastic Material Properties Affect Lung Tumor Motion and Deformation: A Finite Element Analysis

PURPOSE/OBJECTIVE(S)

Radiation therapy (RT) is a common method for treating lung cancer; however, targeting the moving tumor while sparing the surrounding healthy lung tissue is challenging. One of the methods proposed is tracking the tumor at the time of treatment and using multi leaf collimators (MLCs) to precisely target the tumor shape. One of the most accurate ways to predict the position and shape of the tumor is simulating the respiratory process at the time of RT delivery. However, an efficient and accurate way to find patient-specific material characteristics of lung and tumor as input for the simulation is still to be found. In this work, we have i) studied the effect that lung and tumor material properties have on tumor displacement and deformation and ii) found out that a simple, linear, elastic model may be sufficient for examining the effect of the material properties on the tumor displacement and deformation.

MATERIALS/METHODS

A model was constructed in a simulation environment. STL meshes of a lung and a tumor were imported and set up to have separate material property values assigned for elastic modulus, Poisson's ratio, and density. Boundary conditions on the lung included a fixed surface located at the top of the lung and a distributed boundary load on the lower surfaces of the lung. The boundary load provided a 2.5cm displacement of the lower surfaces to imitate the diaphragm motion during the inhalation phase of the breathing cycle.

RESULTS

Lung density showed no effect on tumor movement or deformation. Tumor displacement differences as a function of material property values ranged from 0.0043-1.53cm. The lung elastic modulus had the greatest effect on tumor displacement, with displacements ranging from 0.041- 1.53cm, or a range of approximately 1.5cm. Lung Poisson's ratio values affected displacement with a maximum displacement range of 0.1942cm. Tumor elastic modulus showed an insignificant effect on displacement of the tumor, with displacement ranges up to 0.0043cm. Tumor displacement was also insensitive to tumor Poisson's ratio values with a maximum range of displacement of 0.0005cm.

CONCLUSION

We found out that a simple, linear, elastic model was useful for examining the effect of the material properties on the tumor displacement and deformation. Tumor properties and Poisson's ratio of the lung did not affect the tumor displacement and deformation significantly; however, having a patient-specific approximated value for the lung elastic modulus is required for optimal modeling of the process. Implementation of MLC-based tracking in RT, although an effective technique, is complex and time-consuming. Finding simplifications that make this more cost- and time-efficient can potentially increase the accuracy of delivery techniques, especially for lung cancer. Improvements that can be easily adopted to the RT workflow can improve overall therapy outcomes and quality of life for more patients.

The effects of pro-, pre-, and synbiotics supplementation on polycystic ovary syndrome: an umbrella review of meta-analyses of randomized controlled trials

Background

Synbiotics, refer to a combination of probiotics and prebiotics in a form of synergism that beneficially affect the host's health by alternating the composition and/or function of the gut microbiota. Numerous meta-analyses of randomized clinical trials have proven that pro, pre-, and synbiotics supplementation has health outcomes in women with polycystic ovary syndrome (PCOS). However, the strength and quality of this evidence in aggregate have not yet been synthesized in great detail.

Methods

PubMed, Scopus, Web of Sciences, and Google Scholar were searched up to March 2023. We pooled the mean difference and its 95% confidence interval (CI) by applying a random-effects model.

Results

Overall, nine meta-analyses including a total of 12 trials were identified. The results of the present study indicated that probiotic supplementation significantly reduced the homeostatic model assessment for insulin resistance (HOMA-IR; WMD: -0.29, 95% CI: -0.57 to -0.02, p = 0.03, n = 4; moderate certainty) and fasting glucose concentration (FGC; WMD: -7.5 mg/dL, 95% CI: -13.60 to -0.51, p = 0.03; n = 4; low certainty). Moreover, synbiotic supplementation had beneficial effects on glycemic control, lipid profile, and hormonal parameters, but the certainty of the evidence was rated as low to very low. However, supplementation with pro-/synbiotics did not affect inflammation and oxidative stress in women with PCOS. Furthermore, waist/hip circumference, fasting glucose concentration, lipid profile, dehydroepiandrosterone sulfate, high-sensitivity C-reactive protein, and hirsutism score were significantly reduced after prebiotics supplementation with low certainty of evidence.

Conclusion

Although pro-, pre-, and synbiotics supplementation had beneficial effects on some PCOS-related outcomes, the certainty of the evidence was rated as low to very low. Therefore, further well-designed RCTs might help to confirm our findings in women with PCOS.

The Association between Total Protein, Animal Protein, and Animal Protein Sources with Risk of Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis of Cohort Studies

We aimed to conduct this dose-dependent meta-analysis to examine the relation between total protein, animal protein, and its sources with inflammatory bowel disease (IBD). We searched databases, comprising PubMed/Medline, Web of Science (ISI), Embase, and Google Scholar, for the published studies up to 28 March 2023. Prospective cohort study designs that investigated associations between dietary intake of various animal protein sources and with risk of IBD in the general population were identified. Eleven prospective cohort studies with 4,302,554 participants and 8067 cases were considered eligible. Findings indicated that higher intake of dairy was significantly associated with a lower risk of IBD (relative risk [RR]: 0.81; 95% confidence interval [CI]: 0.72, 0.90), Crohn disease (RR: 0.69; 95% CI: 0.56, 0.86), and ulcerative colitis (RR: 0.84; 95% CI: 0.75, 0.94). There was no association between different sources of animal protein and the risk of IBD. The dose-response analysis suggested that each 100 g/d increment in dietary total meat consumption was associated with a 38% greater risk of IBD. Moreover, a positive linear association was found between total meat intake and risk of IBD (Pnonlinearity = 0.522, Pdose-response = 0.005). Overall, among the dietary sources of protein, the risk of IBD increased only with increasing total meat intake, and the consumption of protein from dairy products was found to be a protective factor against the IBD risk. This trial was registered at PROSPERO as CRD42023397719.

Early vs delayed enteral nutrition or parenteral nutrition in hospitalized patients: An umbrella review of systematic reviews and meta-analyses of randomized trials

We conducted an umbrella review to summarize the existing evidence on the effect of early enteral nutrition (EEN) compared with other approaches, including delayed enteral nutrition (DEN), parenteral nutrition (PN), and oral feeding (OF) on clinical outcomes in hospitalized patients. We performed a systematic search up to December 2021, in MEDLINE (via PubMed), Scopus, and Institute for Scientific Information Web of Science. We included systematic reviews with meta-analyses (SRMAs) of randomized trials investigating EEN compared with DEN, PN, or OF for any clinical outcomes in hospitalized patients. We used "A Measurement Tool to Assess Systematic Reviews" (AMSTAR2) and the Cochrane risk-of-bias tool for assessing the methodological quality of the systematic reviews and their included trial, respectively. The certainty of the evidence was rated using the "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE) approach. We included 45 eligible SRMAs contributing with a total of 103 randomized controlled trials. The overall meta-analyses showed that patients who received EEN had statistically significant beneficial effects on most outcomes compared with any control (ie, DEN, PN, or OF), including mortality, sepsis, overall complications, infection complications, multiorgan failure, anastomotic leakage, length of hospital stay, time to flatus, and serum albumin levels. No statistically significant beneficial effects were found for risk of pneumonia, noninfectious complications, vomiting, wound infection, as well as number of days of ventilation, intensive care unit days, serum protein, and pre-serum albumin levels. Our results indicate that EEN may be preferred over DEN, PN, and OF because of the beneficial effects on many clinical outcomes.

Evaluating the Effects of Lidocaine Alone versus Combination of Lidocaine with Pethidine for the Intravenous Regional Anesthesia in Upper Limb Soft Tissue Surgery

Background: Intravenous regional anesthesia (IVRA) has been used as a common anesthetic technique for several types of operations. However, there are various concerns regarding the efficacy of this anesthetic method. The aim of this study was to evaluate the effects of lidocaine alone versus concomitant use of lidocaine and pethidine for the IVRA in upper limb surgery. Methods: In this randomized, double-blind, controlled clinical, 50 eligible individuals were randomly divided to receive either a combination of 1.5 mg/kg lidocaine 2% and 1.5 mg/kg pethidine or placebo (3 mg/kg lidocaine 2%) for IVRA. After the surgery, the onsets and durations of sensory and motor block, the pain intensity in recovery room, the subjects' first demand of morphine, and the total amount of morphine injected within 24 hours were measured. Results: The combination of lidocaine and pethidine was significantly effective in accelerating the onset of both sensory and motor blocks [(P=0.001), (P=0.001), respectively]. However, no differences were found between groups in sensory and motor block durations after surgery. Intervention with lidocaine plus pethidine caused a significant reduction of the pain intensity in recovery room (P=0.02). Also, concomitant use of lidocaine and pethidine led to a longer time of the first demand of morphine (P=0.04). Moreover, the total amount of morphine injected within 24 hours after surgery was considerably lower in individuals treated by lidocaine plus pethidine (P=0.003). Conclusion: The results of the current study suggest that adding pethidine to lidocaine can be considered as an appropriate approach for better management of IVRA.

[Clinical procedures for intraocular lymphomas]

BACKGROUND

The classification of intraocular lymphomas is based on their anatomical location. They are divided into uveal lymphomas with involvement of the choroid, ciliary body or iris and vitreoretinal lymphomas with isolated or combined involvement of the vitreous body and/or retina. Over the last decades it has become increasingly possible to work out the clinical and pathobiological features of the various subtypes, thereby reducing the diagnostic hurdles and creating improved treatment options.

OBJECTIVE

A summary of the various types of intraocular lymphoma in terms of clinical features, diagnostics, treatment and prognosis is given as well as recommendations for follow-up care.

METHODS

A selective literature search was carried out on the subject of intraocular lymphomas using PubMed and Google Scholar.

RESULTS

Intraocular lymphomas affect different structures, so that the symptoms can also be very different. The diagnostic spectrum ranges from typical ocular examination methods to sample biopsies with subsequent cytological, histological and molecular pathological processing. The treatment pillars available are percutaneous irradiation and intravitreal drug administration as local treatment and systemic treatment or a combination of systemic and local treatment. The prognosis depends mainly on the subtype of the lymphoma and the extent of the infestation when the diagnosis is confirmed. Even though some effective treatment options are now available, it has not yet been possible to significantly reduce the mortality rate.

CONCLUSION

Many different options are available for the diagnostics and treatment of intraocular lymphomas, which require close interdisciplinary cooperation. The further developments in the field of molecular pathology allow a faster and more accurate diagnosis and could open up new treatment options in the future.

Validation of a CT-based motion model with in-situ fluoroscopy for lung surface deformation estimation

Many surrogate-based motion models (SMMs), proposed to guide motion management in radiotherapy, are constructed by correlating motion of an external surrogate and internal anatomy during CT-simulation. Changes in this correlation define model break down. We validate a methodology that incorporates fluoroscopic images (FL) acquired during treatment for SMM construction and update. Under a prospective IRB, 4DCT scans, VisionRT surfaces, and orthogonal FLs were collected from five lung cancer patients. VisionRT surfaces and two FL time-series were acquired pre- and post-treatment. A simulated annealing optimization scheme was used to estimate optimal lung deformations by maximizing the mutual information between digitally reconstructed radiographs (DRRs) of the SMM-estimated 3D images and FLs. Our SMM used partial-least-regression and was trained using the optimal deformations and VisionRT surfaces from the first breathing-cycle. SMM performance was evaluated using the mutual information score between reference FLs and the corresponding SMM or phase-assigned 4DCT DRRs. The Hausdorff distance for contoured landmarks was used to evaluate target position estimation error. For four out of five patients, two principal components approximated lung surface deformations with submillimeter accuracy. Analysis of the mutual information score between more than 4,000 pairs of FL and DRR demonstrated that our model led to more similarity between the FL and DRR images compared to 4DCT and DRR images from a model based on an a priori correlation model. Our SMM consistently displayed lower mean and 95^th percentile Hausdorff distances. For one patient, 95^th percentile Hausdorff distance was reduced by 11mm. Patient-averaged reductions in mean and 95^th percentile Hausdorff distances were 3.6mm and 7mm for right-lung, and 3.1mm and 4mm for left-lung targets. FL data were used to evaluate model performance and investigate the feasibility of model update. Despite variability in breathing, use of post-treatment FL preserved model fidelity and consistently outperformed 4DCT for position estimation.

Certain haplotypes of the 3'-UTR region of the HLA-G gene are linked to breast cancer

Background: Human leukocyte antigen G belongs to the family of non-classical HLA class I genes, its expression considered an important immune escape mechanism of cancer cells. The polymorphisms in the 3'-untranslated region (UTR) region of HLA-G influence the magnitude of the protein by modulating HLA-G mRNA stability. We hypothesised links between any of eight (UTR) single nucleotide polymorphisms (SNPs) and their haplotype of the HLA-G gene with breast cancer. Materials and Methods: Peripheral blood DNA from 100 patients affected by breast cancer and 100 controls was PCR sequenced for genotyping of 25 HLA-G 3'-UTR regions, including rs371194629 (+2960), rs1707 (+3003), rs1710 (+3010), rs17179101 (+3027), rs1063320 (+3142), rs9380142 (+3187), rs1610696 (+3196), and rs1233331 (+3227). Results: The 14-bp deletion (p = 0.01), and the +3010 (p = 0.021), +3142 (p = 0.006) and +3187 (p = 0.046) variants were significantly more prevalent in patients than in controls. In combining these data, two haplotypes of all eight SNPs and deletion/insertion (UTR-1 and UTR-4) are associated with breast cancer. Conclusion: Certain variants in the 3-UTR, and their combination as a haplotype, of the HLA-G gene are linked to breast cancer.

Development and prospective in-patient proof-of-concept validation of a surface photogrammetry + CT-based volumetric motion model for lung radiotherapy

PURPOSE

We develop and validate a motion model that uses real-time surface photogrammetry acquired concurrently with four-dimensional computed tomography (4DCT) to estimate respiration-induced changes within the entire irradiated volume, over arbitrarily many respiratory cycles.

METHODS

A research, couch-mounted, VisionRT (VRT) system was used to acquire optical surface data (15 Hz, ROI = 15 × 20 cm² ) from the thoraco-abdominal surface of a consented lung SBRT patient, concurrently with their standard-of-care 4DCT. The end-exhalation phase from the 4DCT was regarded as reference and for each remaining phase, deformation vector fields (DVFs) with respect to the reference phase were computed. To reduce dimensionality, the first two principal components (PCs) of the matrix of nine DVFs were calculated. In parallel, ten phase-averaged VRT surfaces were created. Surface DVFs and corresponding PCs were computed. A principal least squares regression was used to relate the PCs of surface DVF to those of volume DVFs, establishing a relationship between time-varying surface and the underlying time-varying volume. Proof-of-concept validation was performed during each treatment fraction by concurrently acquiring 30 s time series of real-time surface data and "ground truth" kV fluoroscopic data (FL). A ray-tracing algorithm was used to create a digitally reconstructed fluorograph (DRF), and motion trajectories of high-contrast, soft-tissue, anatomical features in the DRF were compared with those from kV FL.

RESULTS

For five of the six fluoroscopic acquisition sessions, the model out-performed 4DCT in predicting contour Dice coefficient with respect to fluoroscopy-derived contours. Similarly, the model exhibited a marked improvement over 4DCT for patch positions on the diaphragm. Model patch position errors varied from 5 to -15 mm while 4DCT errors ranged between 5 and -22.4 mm. For one fluoroscopic acquisition, a marked change in the a priori internal-external correlation resulted in model errors comparable to those of 4DCT.

CONCLUSIONS

We described the development and a proof-of-concept validation for a volumetric motion model that uses surface photogrammetry to correlate the time-varying thoraco-abdominal surface to the time-varying internal thoraco-abdominal volume. These early results indicate that the proposed approach can result in a marked improvement over 4DCT. While limited by the duration of the fluoroscopic acquisitions as well as the resolution of the acquired images, the DRF-based proof-of-concept technique developed here is model-agnostic, and therefore, has the potential to be used as an in-patient validation tool for other volumetric motion models.

Evaluation of choroidal substructure perfusion in patients affected by systemic sclerosis: an optical coherence tomography angiography study

Objective: Vasculopathy in systemic sclerosis (SSc) is characterized by the obliteration of arterioles and a reduced capillary density in various tissues. In SSc, atrophic alterations of the choroid have been suggested based on morphological data acquired by optical coherence tomography (OCT). In this study, we aimed to assess the choroid in eyes of patients with SSc from a microcirculatory, dynamic point of view by adding optical coherence tomography angiography (OCTA) to the diagnostic spectrum.Method: SSc patients were enrolled, and age- and gender-matched healthy subjects were used as controls. In addition to basic ophthalmological and rheumatological examinations, individuals underwent enhanced-depth imaging OCT and OCTA. Subfoveal thicknesses of the choroid as well as all three choroidal vascular sublayers were measured and submacular perfusion values were evaluated.Results: In total, 12 patients with SSc and 12 matched controls were included. The median age of participants was 64 years. Submacular perfusion was significantly lower in the choriocapillaris (Δ = 0.72%; p = 0.045), Sattler's layer (Δ = 2.87%; p = 0.001), and Haller's layer (Δ = 2.69%; p = 0.018) of SSc patients compared to controls. Subfoveal thicknesses of Sattler's layer (Δ = 15 µm; p = 0.026) and Haller's layer (Δ = 41 µm; p = 0.045) were also significantly smaller in the SSc group.Conclusion: Choroidal microcirculation is impaired in SSc, even in patients without ophthalmological symptoms. Choroidal OCT and OCTA may offer additional biomarkers for SSc activity.

Synthesis, NMR Characterisation, X–ray Crystal Structure and Solution Studies of Ni(II) Complexes of a Pyridine Containing Self–assembling System

X-ray analysis of Ni(II) complexes of the self-assembling system LH2, [pyda.H2][pydc] (pydc.H2 = 2,6-pyridinedicarboxylic acid and pyda = 2,6-pyridinediamine), indicated that two six-coordinated anionic [pyda.H]2[Ni(pydc)2].H2O (I) and neutral [Ni(pydc.H)2].3H2O (II) complexes are formed at different temperature conditions in water; in agreement with the results obtained from potentiometric pH titrations in the pH range 3.5–5.5.

Ferromagnetic resonance measurements of (Co/Ni/Co/Pt) multilayers with perpendicular magnetic anisotropy

Multilayers of [Co/Ni(t)/Co/Pt]×8 with varying Ni thickness were investigated for possible use as a free layer in magnetic tunnel junctions and spintronics devices. The thickness t of the Ni sub-layer was varied from 0.3 nm to 0.9 nm and the resulting magnetic properties were compared with (Co/Ni) and (Co/Pt) multilayers. As determined from magnetic force microscopy, magnetometry and ferromagnetic resonance measurements, all multilayers exhibited perpendicular magnetic anisotropy. Compared with (Co/Pt) multilayers, the sample with t of 0.9 nm showed almost the same anisotropy field of μ 0 H k = 1.15 T but the damping constant was 40% lower. These characteristics make these multilayers attractive for spin torque based magnetoresistive devices with perpendicular anisotropy.

Urinary Biomarkers of Polycyclic Aromatic Hydrocarbons Are Associated with Cardiometabolic Health Risk

BACKGROUND

Polycyclic aromatic hydrocarbons (PAH) are both man-made and naturally occurring environmental pollutants that may be related to cardiometabolic health risk.

OBJECTIVE

To determine whether PAH is associated with obesity in the adult population and to examine whether urinary concentrations of PAH metabolites are associated with differences in how obesity relates to 3 or more risk factors for the metabolic syndrome (3RFMetS), type 2 diabetes (T2D), hypertension, and dyslipidemia.

METHODS

A total of 4765 adult participants from the 2001-2008 National Health and Nutrition Examination Survey were examined. The association between 8 urinary hydroxylated PAH metabolites, obesity, and health were examined using weighted logistic regressions adjusting for age, sex, ethnicity, PIR, smoking status, and urinary creatinine.

RESULTS

There was a positive dose-dependent association between obesity and 2-phenanthrene quintiles (P trend <0.0001). Contrarily, higher quintiles of 1-naphthalene were associated with lower risk of obesity (P trend = 0.0004). For a given BMI, those in the highest quintile of 2-naphthalene, 2-fluorene, 3-fluorene and 2-phenanthrene had a 66-80% greater likelihood of 3RFMetS (P≤0.05) compared to low levels. Higher quintiles of 1-naphthalene, 2-naphthalene, 2-phenanthrene and 1-pyrene were associated with a 78-124% greater likelihood of T2D (P≤0.05) compared to low levels while high 1-naphthalene, 2-naphthalene, 2-fluorene, 3-fluorene and 2-phenanthrene were associated with a 38-68% greater likelihood of dyslipidemia (P≤0.05) compared to lower levels. Finally, 2-naphthalene and 2-phenanthrene were positively associated with hypertension (P trend = 0.008 and P trend = 0.02 respectively).

CONCLUSIONS

PAH is related to obesity and the expression of a number of obesity-related cardiometabolic health risk factors. Future research is needed to bring to light the mechanistic pathways related to these findings.

The Influence of Urinary Concentrations of Organophosphate Metabolites on the Relationship between BMI and Cardiometabolic Health Risk

The objective was to determine whether detectable levels of OP metabolites influence the relationship between BMI and cardiometabolic health. This cross-sectional study was conducted using 2227 adults from the 1999-2008 NHANES datasets. Urinary concentrations of six dialkyl phosphate metabolites were dichotomized to above and below the detection limit. Weighted multiple regression analysis was performed adjusting for confounding variables. Independent of BMI, individuals with detectable metabolites had higher diastolic blood pressure (for dimethylphosphate, diethylphosphate, and diethyldithiophosphate; P < 0.05), lower HDL (for diethyldithiophosphate; P = 0.02), and higher triglyceride (for dimethyldithiophosphate; P = 0.05) than those below detection. Contrarily, those with detectable dimethylthiophosphate had better LDL, HDL, and total cholesterol, independent of BMI. Individuals at a higher BMI range who had detectable diethylphosphate (interaction: P = 0.03) and diethylthiophosphate (interaction: P = 0.02) exhibited lower HDL, while little difference existed between OP metabolite detection statuses at lower BMIs. Similarly, individuals with high BMIs and detectable diethylphosphate had higher triglyceride than those without detectable levels, while minimal differences between diethylphosphate detection statuses were observed at lower BMIs (interaction: P = 0.02). Thus, cardiometabolic health outcome differs depending on the specific OP metabolite being examined, with higher BMIs amplifying health risk.

Study of vitellogenin in Boophilus annulatus tick larvae and its immunological aspects

Boophilus annulatus is an important one-host tick in the Mediterranean regions and Iran. It can transmit the Babesia bigemina, Babesia bovis and Anaplasma marginale to cattle. Nowadays, immunization programs by tick proteins is one of the potential methods for the control and prevention of tick infestations. Therefore, the characterization and identification of various tick proteins are necessary. Vitellogenin is a precursor of vitellin that is produced in mid gut cells and fat bodies in ticks. In this study, we characterized vitellogenin protein of B. annulatus unfed larvae using one- and two-dimensional electrophoresis and immunoblotting. In one-dimensional immunoblotting, 48, 70, 100, 130 and >250 kDa protein bands positively reacted with immune sera. In two-dimensional immunoblotting many protein spots positively reacted with immune sera. Six of them were analyzed by MALDI-TOF and MALDI-TOF- TOF mass spectrometry. The results showed that amino acid sequences of four immunogenic proteins with molecular weights of 38, 43, 85 and 97 kDa had identity to tick vitellogenin and its homologues (GP80), based on the Mascot search results. It seems that more knowledge on tick proteins including vitellogenin and their characterization could be useful for the development of anti-tick vaccines.

Monitoring of the therapeutic efficacy of chloroquine for the treatment of uncomplicated,Plasmodium falciparummalaria in Iran

Between 2002 and 2004, the standardized 28-day protocol recently developed by the World Health Organization was used to explore the efficacy of chloroquine, in the treatment of uncomplicated, Plasmodium falciparum malaria, in five sentinel sites in southern Iran. All but 14 of the 158 patients enrolled (128, 28 and two from the provinces of Sistan-Baluchestan, Hormozgan and Kerman, respectively) were successfully followed-up. The overall frequency of treatment failure by day 28 was 78.5%, with 17.4% of the patients being classed as early treatment failures, 34.7% as late clinical failures, and 26.4% as late parasitological failures. There appeared to be no significant change in the frequency of treatment failure between the 2002-2003 and 2003-2004 transmission seasons, nor any significant between-site variation in the efficacy of chloroquine. Given these observations, the replacement of chloroquine, as the first-line drug for the treatment of uncomplicated, P. falciparum malaria in Iran, was inevitable. Artesunate-sulfadoxine-pyrimethamine is now the recommended first-line treatment, with artemether-lumefantrine used for second-line treatment. The efficacies of these combination therapies are currently being evaluated and monitored.

Lessons learnt from malaria epidemics in the Islamic Republic of Iran

The Islamic Republic of Iran is in the pre-elimination phase of malaria control, but malaria epidemics are still a concern in the south of the country. This retrospective study presents the epidemiological characteristics and predisposing factors of 60 of the malaria epidemics reported in Sistan va Baluchestan province during 2005-09. A zero-truncated negative binomial model was used to investigate the relation between predictor variables and the total number of malaria cases. Malaria epidemics occurred mainly in the southern part of the province, mostly between July and October, peaking in August. Most malaria epidemics were small-scale (68.3% were < 100 cases) and short (51.7% lasted < 1 month). Plasmodium falciparum was present in 46.7% of the epidemics. An increase in the rainfall rate as well as population movements were the most significant predisposing factors. The results may help inform an epidemic investigation and reporting system as the country approaches the malaria elimination phase.

Antimicrobial evaluation of some novel derivatives of 3,4-dihydropyrimidine-2(1H)-one

The antimicrobial activity of thirty six novel dihydropyrimidine derivatives was evaluated against common pathogenic bacteria. Significant antimicrobial activity (MIC=32, 64 μg/ml) was observed. Escherichia coli and Pseudomonas aeruginosa as Gram-negative bacteria and Staphylococcus aureus as Gram-positive bacteria were determined to be the most susceptible pathogens in this study. The highest inhibitory activity was observed against Gram-negative microorganisms. The widest spectrum of antibacterial activity was exerted by C6 and C22. Most of the compounds had remarkable antifungal activity (MIC=32 μg/ml).

Effects of nitrogen treatments and harvesting stages on the aconitic acid, invert sugar and fiber in sweet sorghum cultivars

Sweet sorghum is adapted to the hot and dry climatic conditions and its tolerance to slat is moderately. It can be used for different products such as food, feed, fiber and fuel. This study was carried out to evaluate the effects, three nitrogen treatments, and three harvesting stages on the aconitic acid, fiber and invert sugar of three sweet sorghum cultivars in the experimental station and the results showed that the effects were significant. Among nitrogen treatments, application of 100 kg ha(-1) urea at planting and 200 kg ha(-1) urea at 4 leaf stage had the highest aconitic acid (0.26%) and invert sugar (3.44%). Among sweet sorghum cultivars, IS2325 and Vespa had the highest aconitic acid (0.26%) and invert sugar (3.86%), respectively Plant harvested at 4 leaf stage had the highest aconitic acid (0.26%) and the highest invert sugar (3.85%). Rio had higher fiber content than Vespa and IS2325 and all cultivars had the highest fiber content before chilling harvesting stage. In general, since high invert sugar and high aconitic acid interfere crystallization of sugar so, it is suggested that to plant Vespa, apply urea 100 kg ha(-1) urea at planting, 100 kg ha' urea at 4 leaf stage and 100 kg ha(-1) urea at booting and harvested before chilling that had lowest aconitic acid and invert sugar. Thereby, it is recommended to plant Vespa, apply urea 100 kg ha(-1) urea at planting, 100 kg ha(-1) urea at 4 leaf stage and 100 kg ha(-1) urea at booting and harvested at 4 leaf stage that had the highest aconitic acid.

The interleukin-1 family gene polymorphisms and Graves' disease

Genetic factors, including cytokine gene polymorphisms, are potential contributors to the pathogenesis of the Graves' disease (GD). We attempted in this study to determine the association between GD and the following polymorphisms in the interleukin-1 (IL-1) family genes: IL-1alpha (-889C/T), IL-1ss (-511C/T), IL-1ss (+3962C/T), IL-1R (Pst-1 1970C/T) and IL-1RA (Mspa-I 11100C/T). We studied 107 patients with an established diagnosis of GD and 140 healthy controls. Cytokine typing was performed by the polymerase chain reaction with sequence-specific primers assay. Genotype distributions among patients were in Hardy-Weinberg equilibrium for all polymorphisms. The frequency of the IL-1alpha -889T allele was significantly higher in patients than in controls (51.9% vs. 31.6%, OR=2.33, 95% CI=1.61-3.38; p<0.0001). The IL-1RA Msp-I 11100C allele was significantly more frequent in patients than in controls (50.0% vs. 22.9%, OR=3.38, 95% CI=2.29-4.97, p<0.0001). No significant associations were found for other polymorphisms. Although the IL-1 family has well-known roles in GD pathogenesis, the contributions of their genetic variations to the disease are unclear. In this study, we documented a highly significant association between GD and polymorphism in IL-1alpha and IL-1RA genes. Further studies in other populations are necessary to confirm our results.

Seroprevalence of Helicobacter pylori in Nahavand: a population-based study

In this cross-sectional study, we evaluated H. pylori seroprevalence and the relevant factors in 1518 people aged > or = 6 years from the general population of Nahavand, western Islamic Republic of Iran. Questionnaires covering sociodemographic variables were completed by interview. Blood samples were taken from each individual. Sera were tested for anti-H. pylori IgG using commercial enzyme immunoassay. Overall, seroprevalence of H. pylori was high, 71.0% (95% CI: 69.0%-73.0%). There was a gradual increase with age. Based on multivariate adjustment, only female sex and age could be considered risk factors.

Neurobrucellosis: report of a rare disease in 20 Iranian patients referred to a tertiary hospital

We reviewed the clinical manifestations and outcome of 20 cases of neurobrocellosis out of 1375 patients with brucellosis admitted to the infectious diseases ward of a tertiary hospital in Hamedan, Islamic Republic of Iran. Of the 20 cases, 12 had meningitis (acute and subacute), 4 had meningoencephalitis, 2 had myelopathy, 1 had polyradiculopathy and 1 had meningovascular complications manifested by stroke. The most prevalent symptoms were headache (75%), vomiting and fever (50%) and unconsciousness (35%). Among 20 neurobrucellosis patients, 1 died and the other 19 recovered; 14 fully recovered and 5 patients had residual neurological deficits. In endemic areas, the disease should be ruled out in all patients who develop unexplained neurological symptoms.

Patient concerns regarding chronic hepatitis B and C infection

Counselling of patients with viral hepatitis is often limited to discussions about how the virus is transmitted. The aim of the present study was to document the principal concerns of patients suffering from chronic hepatitis B and C infection. The most common volunteered concerns were infecting family members (80.6%), infecting others (66.7%), side-effects of treatment (50.0%), disease progression to cirrhosis (44.4%), loss of employment (41.7%), liver transplantation (36.1%), social stigma (36.1%), change in lifestyle (33.3%), development of liver cancer (25%), costs and money (22.2%), fear of disease (5.6%) and psychological disease (5.6%). Health care providers who focus counselling efforts exclusively on viral transmission are unlikely to address other important concerns.

Survey of antibiogram tests in cholera patients in the 2005 epidemic in Hamadan, Islamic Republic of Iran

An analytical cross-sectional study determined the serogroups and serotypes of Vibrio cholerae, and their antibiotic resistance rates, in the 2005 cholera epidemic in Hamadan. All 190 patients with positive stool cultures had V. cholerae serogroup O1, biotype El Tor and serotype Inaba positive. Of 60 cases selected randomly for antibiogram testing, sensitivity to norfloxacin, ciprofloxacin, kanamycin, amikacin, tetracycline and doxycycline was 97%, 92%, 88%, 85%, 77% and 67% respectively. Resistance to furazolidone, trimethoprim-sulfamethoxazole and erythromycin was 100%, 98% and 62% respectively. Comparison with the results of the 1998 epidemic suggests a worrying increase in the resistance of V. cholerae to erythromycin, doxycycline and ciprofloxacin.

Multivariate analysis of morphological variation in accessions of Aegilops crassa from Iran

Principal component and cluster analyses were used to evaluate the pattern of morphological variation in 122 accessions of Aegilops crassa for 14 quantitative characters. With the principal component analysis, the first five principal components with eigenvalues more than 1 contributed 69.5% of the variability amongst accessions, whereas PC6 to PC14 were less than unity. Plant height, stem diameter, spike length and number of spikelets per spike were the most important characters in the first principal component. The germplasm was grouped into five clusters using cluster analysis. Although each cluster had some specific characteristics of its own, but clusters were not clearly separated when plotted by the first two principal components. Mahalanobis distances (D2) determined that plant height, stem diameter, spike length, number of spikelets per spike, node width, seed length, seed width and flowering date characters as the most important characters in differentiating the accessions. The morphological variation of Aegilops crassa accessions obtained in this study provides useful information for the future collection and makes these genetic resources more accessible to breeders.

Escherichia coli, Shigella and Salmonella species in acute diarrhoea in Hamedan, Islamic Republic of Iran

This study investigated the frequency of Escherichia col, Shigella and Salmonella species in stool specimens from patients with diarrhoea presenting to health centres in Hamedan province, Islamic Republic of Iran. From 144 samples, Shigella strains were isolated in 17 cases (11.8%): 10 Sh. flexneri, 3 Sh. sonnei, 2 Sh. boydii and 2 untyped strains. No Salmonella strains were isolated. Using molecular diagnostic methods, diarrheogenic E. coli were detected in 37 cases (25.7%), the majority were enterotoxigenic (ETEC) (22 cases) and Shiga toxin-producing (STEC) strains (15 cases). In 14 cases (9.7%) there was co-infection.

Seroprevalence of hepatitis B in Nahavand, Islamic Republic of Iran

We determined the seroprevalence of hepatitis B in Nahavand in a sample of 1824 subjects > 5 years in 2002. Face-to-face interviews were conducted and blood samples taken. The association between risk factor and hepatitis B was assessed using logistic regression. The prevalence of HBsAg positive cases was 2.3%, and HBcAb and HBsAb were isolated in 7.8% and 11.6% of the participants respectively; 11.9% were positive for both HBcAb and HBsAb. History of surgery and imprisonment were the major risk factors for infection with odds ratios of 2.14 (95% CI: 1.22-3.05) and 3.57 (95% CI: 1.68-5.4) respectively.

Albendazole versus metronidazole in the treatment of patients with giardiasis in the Islamic Republic of Iran

We examined the therapeutic effects of albendazole compared to metronidazole in 120 patients with giardiasis in Hamdan. Patients were randomized to receive albendazole (400 mg, once daily for 5 days) or metronidazole (250 mg, 3 times a day for 5 days). Demographic data of the patients, results of stool examination for Giardia trophozoites before and after treatment, and drug side-effects were recorded. After treatment 6 (10.0%) of the albendazole group had trophozoites compared with 14 (23.3%) of metronidazole group (P < 0.05). Patients in the albendazole group had fewer side-effects while 43.3% of the metronidazole group experienced a metallic taste and 35.0% experienced loss of appetite. Albendazole is an easy, safe and effective treatment for giardiasis.

TLR4 polymorphism in Iranian patients with brucellosis

OBJECTIVE

Brucellosis is a zoonosis of both public health and economic significance in most developing countries. Polymorphisms in Toll-like receptor-4 (TLR4) have been reported to be associated with a blunted immune response to microbial pathogens. Information regarding any association between genetic variation of TLR4 and susceptibility to brucellosis is not available in the literatures. The main purpose of this research is to evaluate the role of polymorphic alleles of TLR4 gene in susceptibility to brucellosis.

MATERIALS AND METHODS

In this case-control study, 198 patients with brucellosis and 111 healthy volunteers matched for sex, age and geographic area were evaluated by genotyping for polymorphism in TLR4 gene (Asp299Gly) using amplification refractory mutation system (ARMS)-PCR method.

RESULTS

Allele 896G was more prevalent in patients with brucellosis compared to healthy controls (33.6% vs. 20.7%, P=0.000003). Also the frequency of G allele of TLR4 gene was significantly higher in male patients with brucellosis compared to the same sex in control group (36% vs. 21.7%, P=0.00005). Multiple logistic regression analysis demonstrated that male patients heterozygous at allele G gene had a significantly higher risk for brucellosis with an odds ratio of OR 2.89, 95% CI: 1.79-4.69, P<0.0001).

CONCLUSION

This study is the first to show an association between genetic polymorphism in TLR4 gene and susceptibility to brucellosis.

Is unintended pregnancy a risk factor for depression in Iranian women?

A study was carried out to determine the association between unintended pregnancy and pre- and postpartum depression in 163 women in Kermanshah city, Islamic Republic of Iran. Using the self-administered Beck Depression Inventory for educated women and a special interview for illiterate women, 105 intended and 58 unintended pregnancies were studied. Of the 58 women with unintended pregnancy, 43% reported attempting to abort the fetus. Depression at 37 weeks' gestation was slightly higher in the unintended than the intended pregnancy group (53.4% versus 41.0%; relative risk = 1.3) and depression 10 days postpartum was much higher in the unintended group (48.7% versus 25.6%; relative risk = 1.9). Screening for depression is recommended for pregnant women with unintended pregnancy.