Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.

METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.

FINDINGS

The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.

INTERPRETATION

Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere.

FUNDING

Bill & Melinda Gates Foundation.

Crosstalk between obesity and cancer: a role for adipokines

Adipose tissue is a complex organ that is increasingly being recognised as the largest endocrine organ in the body. Adipocytes among multiple cell types of adipose tissue can secrete a variety of adipokines, which are involved in signalling pathways and these can be changed by obesity and cancer. There are proposed mechanisms to link obesity/adiposity to cancer development including adipocytokine dysregulation. Among these adipokines, leptin acts through multiple pathways including the STAT3, MAPK, and PI3K pathways involved in cell growth. Adiponectin has the opposite action from leptin in tumour growth partly because of increased apoptotic responses of p53 and Bax. Visfatin increases cancer cell proliferation through ERK1/2, PI3K/AKT, and p38 which are stimulated by proinflammatory cytokines. Omentin through the PI3K/Akt-Nos pathway is involved in cancer-tumour development. Apelin might be involved through angiogenesis in tumour progressions. PAI-1 via its anti-fibrinolytic activity on cell adhesion and uPA/uPAR activity influence cancer cell growth.

Mixture effects of trace element levels on cardiovascular diseases and type 2 diabetes risk in adults using G-computation analysis

There is an increasing concern about the health effects of exposure to a mixture of pollutants. This study aimed to evaluate the associations between serum levels of heavy/essential metals ([Arsenic (As), Cadmium (Cd), Mercury (Hg), Lead (Pb), Nickel (Ni), Chromium (Cr), Copper (Cu), Iron (Fe), and Zinc (Zn)]) and the risk of developing cardiovascular diseases (CVDs) and type 2 diabetes mellitus (T2D). Data were collected from 450 participants (150 with CVDs, 150 with T2D, and 150 healthy subjects) randomly selected from the Ravansar Non-Communicable Disease (RaNCD) cohort in Western Iran, covering the years 2018-2023. Trace element levels in the serum samples were assayed using ICP-MS. Logistic regression was performed to estimate the adjusted risk of exposure to single and multi-metals and CVD/T2D. Odds ratios were adjusted for age, sex, education, residential areas, hypertension, and BMI. The mixture effect of exposure to multi-metals and CVD/T2D was obtained using Quantile G-computation (QGC). In the logistic regression model, chromium, nickel, and zinc levels were associated with CVD, and significant trends were observed for these chemical quartiles (P < 0.001). Arsenic, chromium, and copper levels were also associated with T2D. The weight quartile sum (WQS) index was significantly associated with both CVD (OR 4.17, 95% CI 2.16-7.69) and T2D (OR 11.96, 95% CI 5.65-18.26). Cd, Pb, and Ni were the most heavily weighed chemicals in these models.The Cd had the highest weight among the metals in the CVD model (weighted at 0.78), followed by Hg weighted at 0.197. For T2D, the serum Pb (weighted at 0.32), Ni (weighted at 0.19), Cr (weighted at 0.17), and Cd (weighted at 0.14) were the most weighted in the G-computation model. The results showed the significant role of toxic and essential elements in CVDs and T2D risk. This association may be driven primarily by cadmium and mercury for CVDs and Pb, Ni, Cr, and Cd for T2D, respectively. Prospective studies with higher sample sizes are necessary to confirm or refute our preliminary results as well as to determine other important elements.

High prevalence of antibiotic resistance and biofilm formation in Salmonella Gallinarum

Background and Objectives

Antibiotic resistance is an indicator of the passively acquired and circulating resistance genes. Salmonella Gallinarum significantly affects the poultry food industry. The present study is the first study of the S. Gallinarum biofilm in Iran, which is focused on the characterization of the S. Gallinarum serovars and their acquired antibiotic resistance genes circulating in poultry fields in central and northwestern Iran.

Materials and Methods

Sixty isolates of S. Gallinarum serovar were collected from feces of live poultry. The bacteria were isolated using biochemical tests and confirmed by Multiplex PCR. Biofilm formation ability and the antibacterial resistance were evaluated using both phenotypic and genotypic methods. The data were analyzed using SPSS software.

Results

According to Multiplex PCR for ratA, SteB, and rhs genes, all 60 S. Gallinarum serovars were Gallinarum biovars. In our study, the antibiotic resistance rate among isolated strains was as follows: Penicillin (100%), nitrofurantoin (80%), nalidixic acid (45%), cefoxitin (35%), neomycin sulfate (30%), chloramphenicol (20%), and ciprofloxacin (5%). All isolates were susceptible to imipenem, ertapenem, ceftriaxone, ceftazidime, and ceftazidime+clavulanic acid. All sixty isolates did not express the resistance genes IMP, VIM, NDM, DHA, blaOXA48, and qnrA. On the other hand, they expressed GES (85%), qnrB (75%), Fox M (70%), SHV (60%), CITM (20%), KPC (15%), FOX (10%), MOXM (5%), and qnrS (5%). All S. Gallinarum isolates formed biofilm and expressed sdiA gene.

Conclusion

Considering that the presence of this bacteria is equal to the death penalty to the herd, the distribution of resistance genes could be a critical alarm for pathogen monitoring programs in the region. This study showed a positive correlation between biofilm formation and 50% of tested resistance genes. Also, it was found that the most common circulating S. gallinarum biovars are multidrug-resistant.

Design and computational analysis of an effective multi-epitope vaccine candidate using subunit B of cholera toxin as a build-in adjuvant against urinary tract infections

Introduction

Urinary tract infection (UTI) is one of the most common infections, usually caused by uropathogenic Escherichia coli (UPEC). However, antibiotics are a usual treatment for UTIs; because of increasing antibiotic-resistant strains, vaccination can be beneficial in controlling UTIs. Using immunoinformatics techniques is an effective and rapid way for vaccine development.

Methods

Three conserved protective antigens (FdeC, Hma, and UpaB) were selected to develop a novel multi-epitope vaccine consisting of subunit B of cholera toxin (CTB) as a mucosal build-in adjuvant to enhance the immune responses. Epitopes-predicted B and T cells and suitable linkers were used to separate them and effectively increase the vaccine's immunogenicity. The vaccine protein's primary, secondary, and tertiary structures were evaluated, and the best 3D model was selected. Since CTB is the TLR2 ligand, molecular docking was made between the vaccine protein and TLR2. Molecular dynamic (MD) simulation was employed to evaluate the stability of the vaccine protein-TLR2 complex. The vaccine construct was subjected to in silico cloning.

Results

The designed vaccine protein has multiple properties in the analysis. The HADDOCK outcomes show an excellent interaction between vaccine protein and TLR2. The MD results confirm the stability of the vaccine protein- TLR2 complex during the simulation. In silico cloning verified the expression efficiency of our vaccine protein.

Conclusion

The results of this study suggest that our designed vaccine protein could be a promising vaccine candidate against UTI, but further in vitro and in vivo studies are needed.

Impact of modifiable risk factors on prediction of 10-year cardiovascular disease utilizing framingham risk score in Southwest Iran

BACKGROUND

This cohort study was conducted to examine the association between modifiable risk factors, including hypertension, smoking, physical activity, diabetes, cholesterol, and high-density lipoprotein with Framingham risk score in the prediction of 10-year-risk of cardiovascular diseases (CVD) between men and women in an Arab community of Southwest Iran, Hoveyzeh.

MATERIALS AND METHODS

A total of 8,526 people aged 35-70 participated in this cohort study. Framingham was used to estimate the 10-year risk of CVD. Also, the linear regression models were used to assess the relationship between modifiable risk factors and the 10-year risk of CVD. Finally, the area under the receiver operating characteristic curve (AUC) was used to measure the ability of modifiable risk factors to predict the 10-year risk of CVD.

RESULTS

Our results of linear regression models showed that hypertension, smoking, PA, diabetes, cholesterol, and HDL were independently associated with the CVD risk in men and women. Also, AUC analysis showed that hypertension and diabetes have the largest AUC in men 0.841; 0.778 and in women 0.776; 0.715, respectively. However, physical activity had the highest AUC just in women 0.717.

CONCLUSION

Hypertension and diabetes in both gender and physical activity in women are the most important determinant for the prediction of CVD risk in Hoveyzeh. Our cohort study may be useful for adopting strategies to reduce CVD progression through lifestyle changes.

In silico design and in vivo evaluation of two multi-epitope vaccines containing build-in adjuvant with chitosan nanoparticles against uropathogenic Escherichia coli

BACKGROUND

Urinary pathogenic Escherichia coli (UPEC) is one of the most important bacterial causes of urinary tract infections (UTIs). Rising antimicrobial resistance and serious clinical challenges such as persistent and recurrent UTIs make it a serious public health concern. Therefore, preventative approaches such as vaccinations are required.

METHODS

In this study, we selected three conserve and protective antigens (FdeC, Hma and UpaB) and also subunit B of cholera toxin (as build-in adjuvant) to design two multi-epitope vaccines (construct B containing B cell epitopes and construct T containing T epitopes) using different bioinformatics methods. The expression of the recombinant protein was performed using the BL21(DE3)/pET28 expression system and purified through a Ni-NTA column. Vaccine proteins were encapsulated in chitosan nanoparticles (CNP) based on ionic gelation via a microfluidic system. Mice were immunized intranasally with different vaccine formulations. Antibody responses and also cytokine expression (IFN-γ and IL-4) were measured by ELISA and real-time PCR respectively. The effectiveness of immune responses was assessed by bladder challenge.

RESULTS

Based on the in silico study, construct B and construct T have high confidence value and stable structure in vivo. High yield expression of both constructs was confirmed by SDS-PAGE and western blot assay. Immunization of mice with construct B induced strong Th2 (IgG1 and IL4) responses and construct T shift immune responses to Th1 (IFNγ and IgG2a). Vaccine protein-encapsulated CNP elicited higher levels of antibodies and cell-mediated responses than the vaccine proteins alone.

CONCLUSIONS

The results of this study suggest that intranasal administration of the construct B has the potential to enhance humoral immunity and construct T has the potential to stimulate cellular immunity. In addition, the combination of CTB as a build-in adjuvant and CNP can be proposed as a potent adjuvant for the development of a novel vaccine against UTI.

Association between Food Insecurity and Vision Impairment among Older Adults: A Pooled Analysis of Data from Six Low- and Middle-Income Countries

OBJECTIVES

Food insecurity has gained attention as a potential risk factor for vision impairment. However, research on this topic is limited. This objective of this study was to investigate the relationship between food insecurity and visual impairment among adults aged 50 years or older using data from six low-and middle-income countries (LMIC).

DESIGN AND SETTING

Data from the longitudinal Study on global AGEing and adult health (SAGE) were analyzed in a community-based, cross-sectional, and nationally representative sample.

PARTICIPANTS

Adults aged 50 years or older from six low- and middle-income countries (LMICs) including China, India, Mexico, Russia, South Africa, and Ghana.

MEASUREMENTS

Food insecurity was evaluated using a questionnaire comprised of two questions that addressed the frequency of eating inadequately and hunger due to a lack of food in last 12 months. Distance and/or near vision impairment was considered as a visual acuity score of less than 6/18 in the eye with better vision.

RESULTS

The analytical sample consisted of 29,804 adults (mean (SD) for age: 63.2 (9.54) years; 54.3% female). The prevalence of food insecurity, near vision and distance vision impairment in the sample was 16.4%, 36.7%, and 13.9%, respectively. Adjusted pooled analyses across countries revealed a significant association between food insecurity and distance (OR: 1.16; 95% CI: 1.01, 1.33; P=0.04, significant individually in India and South Africa) and near (OR: 1.12; 95% CI: 1.02, 1.22; P=0.01, significant individually in South Africa) vision impairment, and a between-country heterogeneity of 46.30% and 25.99%, respectively.

CONCLUSION

Food insecurity was associated with both distance and near vision impairment in adults aged 50 years or older across six LMIC. Food policies and intervention programs targeted at decreasing food insecurity in vulnerable households are essential.

The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally.

METHODS

The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented.

FINDINGS

Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]).

INTERPRETATION

The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden.

FUNDING

Bill & Melinda Gates Foundation.

A case-control study on the relationship between urine trace element levels and autism spectrum disorder among Iranian children

Autism spectrum disorder (ASD) is a type of neurodevelopmental disorder characterized mainly by qualitative deficiencies in social communication skills, accompanied by repetitive and restricted behavior patterns. This study was conducted to investigate the associations between the risk of ASD development in children and exposure to trace elements (arsenic (As), cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), lead (Pb), nickel (Ni), and zinc (Zn)). Two groups of children, including 44 ASD and 35 typically developing (TD) children, were selected, and their fasting urine samples were obtained. The concentration levels of trace elements were assayed using ICP-MS. The results showed that as compared to the TD group, the concentration levels of As (p = 0.002) and Pb (p < 0.001) and also Cr (p < 0.001), Cu (p = 0.001), and Ni (p < 0.001) were significantly higher among ASD children. In terms of gender, boys with ASD showed elevated levels of Cr, Cu, Ni, and Pb, whereas the urine levels of As, Cr, Cu, Ni, and Pb were markedly higher among girls when compared to the non-ASD children. Under the logistic regression model, the risk difference for As, Co, Cr, Cu, Ni, Pb, and Zn remained significant when adjustment was applied for age and gender confounders.

A redox-dependent thiol-switch and a Ca2+ binding site within the hinge region hierarchically depend on each other in α7β1 integrin regulation

Integrin-mediated cell contacts with the extracellular matrix (ECM) are essential for cellular adhesion, force transmission, and migration. Several effectors, such as divalent cations and redox-active compounds, regulate ligand binding activities of integrins and influence their cellular functions. To study the role of the Ca²⁺ binding site within the hinge region of the integrin α7 subunit, we genetically abrogated it in the α7hiΔCa mutant. This mutant folded correctly, associated with the β1 subunit and was exposed on the cell surface, but showed reduced ligand binding and weaker cell adhesion to laminin-111. Thus, it resembles the α7hiΔSS mutant, in which the redox-regulated pair of cysteines, closeby to the Ca²⁺ binding site within the hinge, was abrogated. Comparing both mutants in adhesion strength and cell migration revealed that both Ca²⁺ complexation and redox-regulation within the hinge interdepend on each other. Moreover, protein-chemical analyses of soluble integrin ectodomains containing the same α7 hinge mutations suggest that integrin activation via the subunit α hinge is primed by the formation of the cysteine pair-based crosslinkage. Then, this allows Ca²⁺ complexation within the hinge, which is another essential step for integrin activation and ligand binding. Thus, the α hinge is an allosteric integrin regulation site, in which both effectors, Ca²⁺ and redox-active compounds, synergistically and hierarchically induce far-ranging conformational changes, such as the extension of the integrin ectodomain, resulting in integrin activation of ECM ligand binding and altered integrin-mediated cell functions.

Environmental arsenic exposure and its toxicological effect on thyroid function: a systematic review

OBJECTIVES

This study was performed to review epidemiological evidence related to Arsenic (As) effects on the thyroid function by focusing on the serum thyroid hormone concentration.

CONTENT

As, one of the main pollutants, has been recognized as an endocrine-disrupting agent that may affect the function of thyroid as shown by experimental studies.

SUMMARY

This systematic study indicates the association between As exposure and thyroid dysfunction. The studies have shown an association between serum and urine concentration of arsenic and thyroid dysfunction. Most of them reported the association between increase in the serum or urine As levels and decrease in the triiodothyronine (T3) and thyroxine (T4), and also elevation in the thyrotropic hormone (TSH) levels.

OUTLOOK

Our findings related to the effects of As on the function of thyroid in humans are still limited and future studies should be done to address this question.

Reducing Proteoglycan Synthesis and NOX Activity by ROCK Inhibitors: Therapeutic Targets in Atherosclerosis

Atherosclerosis is a chronic inflammatory disease of the arteries characterized by accumulation of inflammatory cells in the arterial wall. Hypertension, dyslipidemia, and hyperglycemia are major risk factors of atherosclerosis. Rho-associated protein kinase (ROCK), a serine/threonine kinase, is a downstream effector of the small GTPase RhoA. ROCK is involved in different stages of atherosclerosis. Accumulating evidence has demonstrated that ROCK signaling plays vital roles in various cellular functions, such as contraction, migration, and proliferation of smooth muscle cells. Dysregulation of the ROCK pathway is associated with atherosclerosis and hypertension. Experimental studies have shown that ROCK inhibitors may have favorable effects in ameliorating atherosclerosis. ROCK signaling has a role in proteoglycan synthesis through transactivation of the TGF-β receptor Type I (TβRI) mediated by G-protein-coupled receptor (GPCR) agonists (endothelin-1, angiotensin II and …), and ROCK inhibitors could decrease proteoglycan synthesis and atherosclerotic plaque formation. Based on the hypothesis that targeting ROCK pathway may be effective in ameliorating atherosclerosis, we suggest that ROCK inhibitors may have a potential therapeutic role in inhibition or slowing atherogenesis. However, for this hypothesis more research is needed.

Effect of Magnesium Status on Microalbuminuria in Type 2 Diabetic Patients

BACKGROUND

There are several controversies regarding the association between serum magnesium depletion and microalbuminuria in type 2 diabetic patients.

OBJECTIVE

Therefore, this study aimed to assess serum magnesium concentrations in Type 2 diabetic patients with microalbuminuria and normoalbuminuria in Birjand, Iran, in 2019.

METHODS

In this cross-sectional study, 25 type 2 diabetes patients with microalbuminuria were enrolled as the case group and 25 type 2 diabetes patients with normoalbuminuria as the control group. Both groups were matched for age, sex, hypertension, and dyslipidemia. Blood samples were obtained for serum magnesium measurement.

RESULTS

Our findings showed no significant difference between serum magnesium concentration in the case and control groups (mean serum magnesium concentration for case group: 2.34 ± 0.35 mg/dl and control group: 2.27 ± 0.33 mg/dl). Pearson correlation coefficient analysis did not show any correlation between serum magnesium levels and urine albumin levels in patients with microalbuminuria versus patients with normoalbuminuria (r = 0.06, p = 0.67).

CONCLUSION

This study did not indicate a correlation between serum magnesium concentrations and microalbuminuria in Type 2 diabetic patients.

Evaluation of Safety and Side Effects COVID-19 Vaccine in Cancer Patients Being Treated

According to the instructions of Iran’s National Corona Response Committee in the Iranian Ministry of Health and Medical Education, patients undergoing treatments for their cancer are prioritized in Covid-19 vaccination. The present study was therefore conducted to investigate the toxicity and acute side-effects of a Covid-19 vaccine in cancer patients presenting to Medical Oncology Clinic of Kermanshah University of Medical Science. After excluding the patients with active infection and the recently-infected ones with Covid-19, they underwent the vaccination. The patients with cell counts exceeding 3,000 received two doses of the vaccine with a 21-day interval and treatment of their underlying disease was postponed for 7 days. The side-effects were mild and tolerable and included fever (case 10), pain at the injection site (7), dizziness (7), body pain (6), abdominal pain (6), myalgia (6), headache (6), chills (3), shortness of breath (3), diarrhea (1), runny nose (1) and dryness of the throat (1). No significant toxicity was reported in the patients who were safely vaccinated under the supervision of the medical oncology clinic.

Evaluation of Cognitive Impairment in Refractory Temporal Lobe Epilepsy Patients With Respect to Structural Brain Lesions

Introduction: Temporal lobe epilepsy (TLE) is the most prevalent form of drug resistant epilepsy with concurrent cognitive impairment. Prevention, earlier diagnosis, and personalized management of cognitive deficits in TLE require more understanding of underlying structural and functional brain alterations. No study has evaluated performance of TLE patients in different cognitive domains based on their structural brain lesions. Methods: In this study, 69 refractory TLE patients have undergone magnetic resonance imaging (MRI) epilepsy protocol and several neuropsychological tests, consisting of Wechsler adult intelligence scale-revised, Rey-Osterrieth complex figure test, verbal fluency test, digit span test, spatial span test, Wechsler memory scale-III, design fluency test, Rey visual design learning test, auditory-verbal learning test, and trail making test. MRI findings were classified to following groups: focal cortical dysplasia, gliosis, atrophy, mesial temporal sclerosis (MTS), tumor, vascular malformation, and other lesions or normal. Results of neuropsychological tests were compared between MRI groups using generalized linear model with gamma distribution and log link. Results: Patients with MTS showed better performance in general intellectual functioning, working memory, attentional span, and auditory-verbal learning compared to patients with non-MTS MRI lesions. Atrophy and focal cortical dysplasia had the largest differences from MTS. Conclusion: Cognitive performance of refractory TLE patients varies with respect to structural brain alterations. Further neuroimaging studies of TLE lead to prevention and more accurate management of cognitive decline in clinical settings.

Removal of lead from aqueous solutions using three biosorbents of aquatic origin with the emphasis on the affective factors

The biosorptive potentials of three aquatics-based biosorbents, including shells of a bivalve mollusk and scales of two fish species for Pb removal from aqueous solutions were evaluated, for the first time. A Box-Behnken design with the response surface methodology was used to investigate the effects of the seven important variables (contact time, temperature, initial concentration, dosage, size, salinity and pH) on the sorption capacity of the sorbents. Among the seven studied factors, the effects of biosorbent dosage, initial concentration and pH were significant for all the response variables, while biosorbent size was not significant for any of the responses. The initial concentration was the most influential factor. The presence of Pb ions on the surfaces of the biosorbents after the adsorption was clearly confirmed by the SEM-EDX and XRF analyses. The maximum sorption capacities of the biosorbents were comparable to the literature and the descending order was as follows: scales of Rutilus kutum and Oncorhynchus mykiss and the shells of Cerastoderma glaucum. The isotherm studies revealed Langmuir model applicability for the Pb adsorption by R. kutum and O. mykiss scales, while Freundlich model was fitted to the adsorption C. glaucum shells.

Assessment of Iodofolic Supplementation on Thyroid Function in Pregnant Women with Iodine Sufficient Status and their Infants in Birjand

BACKGROUND

Maintaining iodine at sufficient levels is necessary throughout the pregnancy to prevent adverse outcomes in infants. This study aimed to assess iodofolic supplementation's impact on thyroid function in women at the end of the third trimesters of gestation.

METHODS

This case-control study was conducted on 130 pregnant women in the Birjand, east of Iran, during the period from August 2017 to February 2019. We assessed iodofolic supplementation effect in the women at the first trimesters of gestation and followed them at the end of the third trimesters and also their infants on days 3-5. Serum samples were obtained from women and infants for measuring levels of thyroid-stimulating hormone (TSH). Urinary iodine concentration (UIC) was also determined at the end of the third trimester.

RESULTS

The median serum TSH concentration in the folic acid consumed group (3.26 ± 1.91) did not significantly differ from another group (2.98 ± 1.41), (p = 0.68). There is also no considerable difference in the mean serum TSH concentration between infants born from mothers who consumed folic acid in the first trimester of pregnancy and another group (p = 0.50). The TSH concentration in all infants was below 5 μM/L. The significant difference in the mean of UIC was also not observed between pregnant women in the folic acid consumed group (188.02 ± 105.38) and iodofolic consumed group (225.77 ± 130.26), (p = 0.13).

CONCLUSION

Iodine intake in our study was sufficient according to the WHO recommendation and idofolic supplementation was not emphasized.

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults.

METHODS

Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults.

FINDINGS

There were 1·19 million (95% UI 1·11-1·28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5-65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8-57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9-15·6] per 100 000 person-years) and middle SDI (13·6 [12·6-14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9-25·2) DALYs to the global burden of disease, of which 2·7% (1·9-3·6) came from YLDs and 97·3% (96·4-98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally.

INTERPRETATION

Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts.

FUNDING

Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute.

Functionally Assessing the Age-Related Decline in the Detection Rate of Photons by Cone Photoreceptors

Age-related decline in visual perception is usually attributed to optical factors of the eye and neural factors. However, the detection of light by cones converting light into neural signals is a crucial intermediate processing step of vision. Interestingly, a novel functional approach can evaluate many aspects of the visual system including the detection of photons by cones. This approach was used to investigate the underlying cause of age-related visual decline and found that the detection rate of cones was considerably affected with healthy aging. This functional test enabling to evaluate the detection of photons by cones could be particularly useful to screen for retinal pathologies affecting cones such as age-related macular degeneration. However, the paradigm used to functionally measure the detection of photons was complex as it was evaluating many other properties of the visual system. The aim of the current mini review is to clarify the underlying rationale of functionally evaluating the detection of photons by cones, describe a simpler approach to evaluate it, and review the impact of aging on the detection rate of cones.

Lovastatin attenuates glyoxal-induced toxicity on rat liver mitochondria

Alpha-dicarbonyls such as glyoxal (GO) trigger mitochondrial dysfunction resulting in the development of different diabetic complications. The present study investigated the effects of lovastatin against GO-induced toxicity on rat liver mitochondria. The rat liver mitochondria (0.5 mg protein/mL) were treated with various concentrations of lovastatin (1, 5, 10 µM) at 37°C for 30 min and then exposed to GO (3 mM) at 37°C for 30 min. Oxidative stress markers including MDA, reactive oxygen species (ROS), glutathione (GSH) and protein carbonylation (PC) level were measured. Mitochondrial complex II activity and mitochondrial membrane potential (MMP) were assessed for evaluating mitochondrial function. Glyoxal significantly increased the level of ROS, PC and MDA. This effect was associated with the reduction of MMP, complex II activity and GSH content. Pre-treatment with lovastatin potentially reversed GO-induced mitochondrial toxicity. These results suggest that lovastatin have a protective effect against GO-induced toxicity in isolated rat liver mitochondria.

Relationship between gestational diabetes and serum trace element levels in pregnant women from Eastern Iran: a multivariate approach

The prevalence of gestational diabetes mellitus (GDM) has increased over the recent decades. Exposure to environmental contaminants may be a risk factor for the development of GDM, but this is heavily dependent on particular circumstances. Studies on various areas linking various factors are therefore needed. We examined the associations between serum trace element levels and incidents of GDM among 102 pregnant women (diabetic n = 60 and healthy n = 42) living in Birjand (Iran). Blood serum samples were analyzed for concentrations of elements linked to particulate matter air pollution such as As, Cd, Cu, Hg, Mn, Ni, V, and Zn. Concentrations of As (8.58 vs. 3.15 μg/L), Cd (6.74 vs. 0.52 μg/L), and Hg (2.60 vs. 0.90 μg/L) were significantly higher in women with GDM. Risk difference (RD) estimation showed that As, 0.516 (0.355, 0.677); Cd, 0.719 (0.534, 0.904); and Hg, 0.505 (0.276, 0.735) increase GDM probability, while V lower that risk, -0.139 (-0.237, -0.042). With the principal component analysis, we were able to separate subjects according to their GDM status based on element levels. Such classification revealed very high efficiency with a true positive rate of 93%, according to linear discriminant analysis. GDM subjects presented higher levels of As, Cd, and Hg, indicating that these elements may disturb insulin metabolism and promote the development of GDM. Therefore, we conclude that systematic monitoring of trace elements followed by multivariate modeling in women planning pregnancy should be carried out to prevent the development of GDM.

Genetic polymorphisms in DNA repair genes and hepatocellular carcinoma risk

Hepatocellular carcinoma (HCC) is one of the most frequent types of tumors worldwide. Its occurrence and development have been related to various risk factors, such as chronic infection with hepatitis B or C viruses and alcohol addiction. DNA repair systems play a critical role in maintaining the integrity of the genome. Defects in these systems have been related to increased susceptibility to various types of cancer. Multiple genetic polymorphisms in genes of DNA repair systems have been reported that may affect DNA repair capacity (DRC) and modulate risk to cancer. Several studies have been conducted to assess the role of polymorphisms of DNA repair genes on the HCC risk. Identifying these polymorphisms and their association with HCC risk may help to improve prevention and treatment strategies. In this study, we review investigations that evaluated the association between genetic polymorphisms of DNA repair genes and risk of HCC.

Effects of opioids and psychoactive drugs on blood lipid and glucose indices; a systematic review of population-based evidences

BACKGROUND

Based on a common belief among people, narcotic substances and psychoactive drugs may help to reduce blood glucose and lipid profile leading to reduced risk of cardiovascular diseases. This hypothesis has been verified in several studies; however, there is no conclusive agreement on the reducing effects of opium and other opioid derivatives on blood glucose and lipids. In the present review, we collected all related literature to evaluate the effects of opioids and psychoactive drugs abuse in altering blood glucose and lipid profile, and discuss their long-term effects.

METHODS

A systematic literature search was performed in January 2021 using "lipid profile", "glucose", and "opium" including all their equivalents, main derivatives and similar terms. The data were then extracted and reported qualitatively.

RESULTS

Overall, 46 articles with 37407 participants were included after several step-by-step procedures of article selection. Findings of this study suggested that opioids may reduce blood glucose and low-density lipoproteins, while increasing triglyceride. However, these effects are temporary, and long-term substance abuse exacerbates glucose and lipid-associated diseases such as diabetes and atherosclerosis.

CONCLUSION

Although there are many confounding factors that may affect the results of the included literature; however, based on the findings of these studies, the long-term beneficial effects of opioids on lipid profile and blood glucose cannot be accepted.

Development of Hormonal Intravaginal Rings: Technology and Challenges

Intravaginal rings (IVRs) are minimally invasive polymeric devices specifically designed to be used for the sustained and prolonged release of various type of drugs such as hormones. One of the benefits of using topical drug delivery systems (e.g., IVRs) is the fact that systemic drug delivery may cause drug resistance due to elevated drug levels. Topical drug delivery also provides higher concentrations of the drug to the target site and has fewer side effects. In addition, when a drug is administered vaginally, the hepatic first-pass effect is avoided, resulting in higher absorption. Contraception and treatments for specific diseases such as endometriosis and hormone deficiencies can be improved by the administration of hormones via an IVR. This article aims to classify and compare various designs of commercially available and non-commercial hormonal IVRs and to analyze their performance. Current challenges affecting the development of IVRs are investigated, and proposed solutions are discussed. A comprehensive search of publications in MEDLINE/PubMed and of commercial product data of IVRs was performed, and the materials, designs, performance, and applications (e.g., contraception, endometriosis, estrogen deficiency and urogenital atrophy) of hormonal IVRs were thoroughly evaluated. Most hormonal IVRs administer female sex hormones, i.e., estrogen and progestogens. In terms of material, IVRs are divided into 3 main groups: silicone, polyurethane, and polyethylene-co-vinyl acetate IVRs. As regards their design, there are 4 major designs for IVRs which strongly affect their performance and the timing and rate of hormone release. Important challenges include reducing the burst release and maintaining the bioavailability of hormones at their site of action over a prolonged period of administration as well as lowering production costs. Hormonal IVRs are a promising method which could be used to facilitate combination therapies by administering multiple drugs in a single IVR while eliminating the side effects of conventional drug administration methods. IVRs could considerably improve womenʼs quality of life all over the world within a short period of time.

Lack of Association Between TNF-alpha rs1800629 (-308G > A) Polymorphism and Nephrotic Syndrome

INTRODUCTION

Idiopathic Nephrotic Syndrome is a multifactorial disease that accompanying with immune system dysfunction. Cytokines as potent immunomodulators have a key role in pathogenesis of the disease. We aimed to evaluate the association between TNFα -308G > A polymorphism with Idiopathic Nephrotic Syndrome and its effect on the response to steroid therapy.

METHODS

This case-control study was performed on 168 patients with Nephrotic Syndrome and 153 healthy children. Genotyping of TNF-α rs1800629 (-308G > A) variant was detected by polymerase chain reaction restriction fragment length polymorphism method (PCR-RFLP).

RESULTS

The results revealed that there was no significant difference in allele (P > .05, OR = 0.92, 95% CI: 0.59 to 1.43) or genotype (P > .05, OR = 1.00; 95% CI: 0.62 to 1.65) frequency of TNF-α rs1800629 (-308G > A) between childhood cases of nephrotic syndrome and healthy controls. Also no association was found between genotype (P > .05, OR = 2.28; 95% CI: 1.03 to 5.04), and allele frequency (P > .05, OR = 1.93; 95% CI: 0.97 to 3.87) among the SSNS and SRNS groups.

CONCLUSION

Our results did not support any association between the TNF polymorphism and the risk of nephrotic syndrome in a sample of southeast Iranian population.

Novel pathogenic variants in NLRP7, NLRP5, and PADI6 in patients with recurrent hydatidiform moles and reproductive failure

Recurrent hydatidiform moles (RHMs) are human pregnancies with abnormal embryonic development and hyperproliferating trophoblast. Biallelic mutations in NLRP7 and KHDC3L, members of the subcortical maternal complex (SCMC), explain the etiology of RHMs in only 60% of patients. Here we report the identification of seven functional variants in a recessive state in three SCMC members, five in NLRP7, one in NLRP5, and one in PADI6. In NLRP5, we report the first patient with RHMs and biallelic mutations. In PADI6, the patient had four molar pregnancies, two of which had fetuses with various abnormalities including placental mesenchymal dysplasia and intra-uterine growth restriction, which are features of Beckwith-Wiedemann syndrome and Silver Russell syndrome, respectively. Our findings corroborate recent studies and highlight the common oocyte origin of all these conditions and the continuous spectrum of abnormalities associated with deficiencies in the SCMC genes.

Redox proteomics reveals an interdependence of redox modification and location of adhesome proteins in NGF-treated PC12 cells

Proteomics studies have revealed that adhesomes are assembled from a plethora of proteins at integrin-mediated cellular contact sites with the extracellular matrix. By combining dimedone-trapping of sulfenylated proteins with the purification of the adhesome complex, we extended previous proteomics approaches on adhesomes to a redox proteomic analysis. This added a new aspect of adhesome complexity as individual adhesome proteins change their redox state in response to environmental signals. As model system, rat pheochromocytoma PC12 cells were studied in contact with type IV collagen and in response to nerve growth factor (NGF). NGF stimulates the endogenous production of reactive oxygen species (ROS) and the formation of neurite-like cell protrusions, which are anchored to the substratum via adhesomes. Dimedone detects the reversible oxidation of cysteine thiol groups into sulfenic acid groups which was used in proteomic analysis of adhesome proteins revealing that sulfenylation and location of proteins mutually influence each other. For some proteins, identified by the redox proteomics approach, among them Nck-associated protein-1 (Nap-1), proximity ligation analysis and co-immunoprecipitation assays proved that protein sulfenylation sites colocalize with adhesomes of protrusions. In conclusion, the suprastructural composition and function of adhesomes is redox-regulated by ROS. Of interest in this respect, isoform-selective pharmacological inhibition of NADPH-oxidases (Noxs) reduced the adhesomal location of the collagen-binding α1β1 integrin and the length of the outgrowing neurites, indicative of a role of Nox isoforms in the redox-regulation of adhesomes. Thus, our novel redox proteomics approach not only revealed redox-modifications and the potential redox-regulation of adhesomes and their constituents but it may also provide a tool to analyze the ROS-stimulated neurite repair of peripheral neurons.

Effect of hatching time on time to first feed intake, organ development, enzymatic activity and growth in broiler chicks hatched on-farm

The conventional commercial hatcheries used today do not allow the newly hatched chicks to consume feed or water. Combined with natural variation in hatching time, this can lead to early hatched chicks being feed-deprived for up to 72 h before being unloaded at the rearing site. This study investigated the effects of hatching time on time to first feed intake and development of organs, digestive enzymes and productivity in terms of growth and feed conversion ratio in chicks hatched on-farm. Chicks were divided into three hatching groups (early, mid-term and late), and assessed over a full production cycle of 34 days. The results revealed that chicks remain inactive for a considerable amount of time before engaging in eating-related activities. Eating activity of 5% (i.e. when 5% of birds in each hatching group were eating or standing close to the feeder) was recorded at an average biological age (BA) of 25.4 h and a proportion of 50% birds with full crop was reached at an average BA of 30.6 h. Considering that the hatching window was 35 h in this study, the average chick probably did not benefit from access to feed and water immediately post-hatch in this case. At hatch, mid-term hatchlings had a heavier small intestine (30.1 g/kg bw) than both early (26.4 g/kg bw) and late (26.0 g/kg bw) hatchlings. Relative length of the small intestine was shorter in late hatchlings (735 cm/kg bw) than in mid-term (849 cm/kg bw) and early (831 cm/kg bw) hatchlings. However, the relative weight of the bursa fabricii was greater in mid-term (1.30 g/kg bw) than in early hatchlings (1.01 g/kg bw). At hatch, late hatchlings were heavier than early and mid-term hatchlings (P < 0.05), but by 3 days of age early hatchlings were heavier than mid-term and late hatchlings (P < 0.01). The only effect persisting throughout the study was a difference in the relative weight of the small intestine, where late hatchlings had heavier intestines than early hatchlings (P < 0.05). Thus, while there were differences between hatching groups, this study showed that the hatchlings seemed capable of compensating for these as they grew.

Incidence of symptomatic venous thromboembolism following hospitalization for coronavirus disease 2019: Prospective results from a multi-center study

Background

Thrombosis and pulmonary embolism appear to be major causes of mortality in hospitalized coronavirus disease 2019 (COVID-19) patients. However, few studies have focused on the incidence of venous thromboembolism (VTE) after hospitalization for COVID-19.

Methods

In this multi-center study, we followed 1529 COVID-19 patients for at least 45 days after hospital discharge, who underwent routine telephone follow-up. In case of signs or symptoms of pulmonary embolism (PE) or deep vein thrombosis (DVT), they were invited for an in-hospital visit with a pulmonologist. The primary outcome was symptomatic VTE within 45 days of hospital discharge.

Results

Of 1529 COVID-19 patients discharged from hospital, a total of 228 (14.9%) reported potential signs or symptoms of PE or DVT and were seen for an in-hospital visit. Of these, 13 and 12 received Doppler ultrasounds or pulmonary CT angiography, respectively, of whom only one patient was diagnosed with symptomatic PE. Of 51 (3.3%) patients who died after discharge, two deaths were attributed to VTE corresponding to a 45-day cumulative rate of symptomatic VTE of 0.2% (95%CI 0.1%–0.6%; n = 3). There was no evidence of acute respiratory distress syndrome (ARDS) in these patients. Other deaths after hospital discharge included myocardial infarction (n = 13), heart failure (n = 9), and stroke (n = 9).

Conclusions

We did not observe a high rate of symptomatic VTE in COVID-19 patients after hospital discharge. Routine extended thromboprophylaxis after hospitalization for COVID-19 may not have a net clinical benefit. Randomized trials may be warranted.

•

In a large multi-center study, the incidence of venous thromboembolism in COVID-19 patients followed for 45 days after hospitalization was relatively low.

•

Routine extended thromboprophylaxis in COVID-19 patients who have been discharged from the hospital may not have a net clinical benefit.

•

Older age, history of recent cancer, and history of recent diabetes were associated with higher risk of mortality after hospital discharge

The Epidemiology of Aggression and Associated Factors among Iranian Adult Population: A National Survey

Background: This survey was conducted to determine the level of aggression among the Iranian adult population and underlying predisposing factors.

Study design: A cross-sectional study.

Methods: This cross-sectional study included 10,957 participants, involving 23 out of the 31 provinces of Iran in 2019. The outcome of interest was aggression, evaluated by the Buss & Perry aggression questionnaire. The association between aggression and 34 demographic, behavioral, social, and cultural characteristics was assessed using simple and multiple linear regression.

Results: The overall mean (SD) score of aggression was 77.10 (22.53). Based on the severity of aggression, the participants were categorized into four groups as follows: 2,464 (23.1%) nonaggressive, 4,692 (43.9%) mild, 3,071 (28.8%) moderate, and 454 (4.2%) severe aggressive. Aggression was more likely to occur in people with the following characteristics: younger ages, having several siblings, lower ranks of birth, having an intimate friend of the opposite sex, having an aggressive father/mother, history of parental divorce, interest in watching action/porn movies, listening to music, history of escape from home/school, using neuropsychiatric drugs, using illicit drugs, history of suicidal thoughts/attempt, and family conflict and hostility. Aggression was less likely to occur with the following characteristics: reading, regular physical exercise, the ability to control anger, regular prayer, adherence to avoid lying, respect to other people's rights, sexual satisfaction, and attachment to parents.

Conclusions: A majority of the population has some degree of aggression. Aggression is a multifactorial behavior corresponding with several demographical, social, cultural, and religious factors, some of which back to early childhood events.

Demographics, laboratory parameters and outcomes of 1061 patients with coronavirus disease 2019: a report from Tehran, Iran

We aimed to determine the characteristics of coronavirus disease 2019 (COVID-2019) among the Iranian population. In this study, we collected and analysed the demographics, laboratory findings and outcomes of patients with COVID-19 who were admitted to Masih Daneshvari Hospital in Tehran, Iran between 20 February 2020 and 2 April 2020. Among 1061 patients, 692 (65.2%) were male and the median age was 55 years (interquartile range (IQR), 44–66 years). Totally, 129 (12.2%) patients died during hospitalization in the ward or intensive care unit. From the remaining 932 individuals, 46 (5.0%) were admitted to the intensive care unit and 886 (95.0%) were hospitalized in the ward. Those patients who died were significantly older than those hospitalized in the ward (p < 0.001). The median absolute number of lymphocytes was 1.2 × 10³/μL (IQR 0.9 × 10³ to 1.6 × 10³/μL) and 708 (66.7%) patients had lymphopenia (absolute lymphocyte count <1500/μL). Among the laboratory tests, D-dimer, serum ferritin and albumin had the strongest correlations with mortality (r = 0.455, r = 0.412, r = –0.406, respectively; p < 0.001 for each one). In conclusion, laboratory findings could provide useful information with regard to the management of individuals with COVID-19.

Computational evaluation of modified peptides from human neutrophil peptide 1 (HNP-1)

The development of bacterial resistance toward antibiotics has been led to pay attention to the antimicrobial peptides (AMPs). The common mechanism of AMPs is disrupting the integrity of the bacterial membrane. One of the most accessible targets for α-defensins human neutrophil peptide-1 (HNP-1) is lipid II. In the present study, we performed homology modeling and geometrical validation of human neutrophil defensin 1. Then, the conformational and physicochemical properties of HNP-1 derived peptides 2Abz¹⁴S²⁹, 2Abz²³S²⁹, and HNP1ΔC18A, as well as their interaction with lipid II were studied computationally. The overall quality of the predicted model of full protein was -5.14, where over 90% of residues were in the most favored and allowed regions in the Ramachandran plot. Although HNP-1 and HNP1ΔC18A were classified as unstable peptides, 2Abz¹⁴S²⁹ and 2Abz²³S²⁹ were stable, based on the instability index values. Molecular docking showed similar interaction pattern of peptides and HNP-1 to lipid II. Molecular dynamic simulations revealed the overall stability of conformations, though the fluctuations of amino acids in the modified peptides were relatively higher than HNP-1. Further, the binding affinity constant (Kd) of HNP-1 and 2Abz²³S²⁹ in complex with lipid II was 10 times stronger than 2Abz¹⁴S²⁹ and HNP1ΔC18A. Overall, computational studies of conformational and interaction patterns have signified how derived peptides could have displayed relatively similar antimicrobial results compared to HNP-1 in the reported experimental studies. Chemical modifications not only have improved the physicochemical properties of derived peptides compared to HNP-1, but also they have retained the similar pattern and binding affinity of peptides. Communicated by Ramaswamy H. Sarma.

Hydroxyapatite as a biomaterial - a gift that keeps on giving

The synthetic analogue to biogenic apatite, hydroxyapatite (HA) has a number of physicochemical properties that make it an attractive candidate for diagnosis, treatment of disease and augmentation of biological tissues. Here we describe some of the recent studies on HA, which may provide bases for a number of new medical applications. The content of this review is divided to different medical application modes utilizing HA, including tissue engineering, medical implants, controlled drug delivery, gene therapies, cancer therapies and bioimaging. A number of advantages of HA over other biomaterials emerge from this discourse, including (i) biocompatibility, (ii) bioactivity, (iii) relatively simple synthesis protocols for the fabrication of nanoparticles with specific sizes and shapes, (iv) smart response to environmental stimuli, (v) facile functionalization and surface modification through noncovalent interactions, and (vi) the capacity for being simultaneously loaded with a wide range of therapeutic agents and switched to bioimaging modalities for uses in theranostics. A special section is dedicated to analysis of the safety of particulate HA as a component of parenterally administrable medications. It is concluded that despite the fact that many benefits come with the usage of HA, its deficiencies and potential side effects must be addressed before the translation to the clinical domain is pursued. Although HA has been known in the biomaterials world as the exemplar of safety, this safety proves to be the function of size, morphology, surface ligands and other structural and compositional parameters defining the particles. For this reason, each HA, especially when it comes in a novel structural form, must be treated anew from the safety research angle before being allowed to enter the clinical stage.

Extracellular Redox Regulation of α7β Integrin-Mediated Cell Migration Is Signaled via a Dominant Thiol-Switch

While adhering to extracellular matrix (ECM) proteins, such as laminin-111, cells temporarily produce hydrogen peroxide at adhesion sites. To study the redox regulation of α7β1 integrin-mediated cell adhesion to laminin-111, a conserved cysteine pair within the α-subunit hinge region was replaced for alanines. The molecular and cellular effects were analyzed by electron and atomic force microscopy, impedance-based migration assays, flow cytometry and live cell imaging. This cysteine pair constitutes a thiol-switch, which redox-dependently governs the equilibrium between an extended and a bent integrin conformation with high and low ligand binding activity, respectively. Hydrogen peroxide oxidizes the cysteines to a disulfide bond, increases ligand binding and promotes cell migration toward laminin-111. Inversely, extracellular thioredoxin-1 reduces the disulfide, thereby decreasing laminin binding. Mutation of this cysteine pair into the non-oxidizable hinge-mutant shows molecular and cellular effects similar to the reduced wild-type integrin, but lacks redox regulation. This proves the existence of a dominant thiol-switch within the α subunit hinge of α7β1 integrin, which is sufficient to implement activity regulation by extracellular redox agents in a redox-regulatory circuit. Our data reveal a novel and physiologically relevant thiol-based regulatory mechanism of integrin-mediated cell-ECM interactions, which employs short-lived hydrogen peroxide and extracellular thioredoxin-1 as signaling mediators.

Design Evaluation in Novel Orthoses for Patients with Medial Knee Osteoarthritis

Osteoarthritis of the knee is a debilitating condition affecting increasing numbers of individuals each year. One option for treatment is orthotic knee braces, but a little independent reviews have taken place to date on their relative outcomes for users. This study therefore evaluates the efficacy of different types of knee orthoses (braces) with regard to key aspects of use, including gait parameters, mobility and levels of comfort and compliance in subjects presenting with osteoarthritis (OA) of the knee. The collated data is presented with relevant supporting literature and appropriate descriptions in relation to each knee orthosis type that was identified, within appropriate subsections with advantages and disadvantages appropriately allocated. An analysis of each brace as presented by the corresponding article is then described further in terms of the design and structure, user outcomes and assessment summaries. According to the study carried out in this paper, it is presented and proved that applying the use of knee braces can reduce the knee adduction moment (KAM), but the amount of reduction afforded varies between designs. All of the studies reported significant pain reduction and functional improvement with the use of a knee brace, although their effect on the knee joint range of motion vary. Knee braces long-term use depends upon high levels of comfort and patient compliance, and further studies need to be conducted on larger numbers of subjects over greater time periods to reflect the long-term outcomes accurately

Thyroid dysfunction: how concentration of toxic and essential elements contribute to risk of hypothyroidism, hyperthyroidism, and thyroid cancer

This study was conducted to evaluate the levels of trace metals Fe, Cr, Co, Cd, Cu, Ni, Hg, Zn, and Pb in healthy individuals and patients with thyroid disease (hyperthyroidism, hypothyroidism, and cancerous). The serum levels of 110 participants living in Birjand City, east of Iran, were collected and analyzed using ICP-MS (Agilent 7900). Results showed that the concentration levels of Cr, Co, Zn, Cd, and Pb were significantly higher at case-patients (p < 0.05), but the levels of Fe, Ni, and Hg were similar between healthy and patient subjects (p > 0.05). In patients with high or low thyroid activity, strong mutual correlations between Cr, Ni, and Fe were noticeable (p < 0.05). In hypothyroid patients, no significant correlation between Zn and Hg, Co, and Cd was found, but Zn was moderately and positively correlated with other trace metals. The moderate negative correlations between Cd-Cr (p = - 0.46) and Cd-Fe (p = - 0.43) were also observed. Logistic regression analysis showed that the effect of Cr, Co, Pb, Cu, Zn, and Cd was significant in developing hyperthyroidism and hypothyroidism; whereas, in patients with thyroid cancer, the effect of Cr, Cd, and Pb was found to be significant. In conclusion, our findings suggest that toxic metals such as Pb, Cd, and Cr can increase the risk of developing hypothyroidism and thyroid cancer, but more research is needed to evaluate the potential toxicity mechanisms of Pb, Cd, and Cr.

Foraging behavior of Aphidius matricariae (Hymenoptera: Braconidae) on tobacco aphid, Myzus persicae nicotianae (Hemiptera: Aphididae)

The aim of this study was to investigate the foraging behavior of Aphidius matricariae (Haliday) (Hymenoptera: Braconidae) as a biological control agent of Myzus persicae nicotianae Blackman (Hemiptera: Aphididae), a key and cosmopolitan pest of tobacco fields. To achieve a strategy for the control of this pest and a mass-rearing program of the parasitoid, host stage preference, switching, functional response, and mutual interference of A. matricariae were investigated at 25 ± 1°C, 70 ± 5% RH and 16:8 h L:D photoperiod. The parasitoid showed a preference for third- and fourth-instar nymphs of tobacco aphid in both choice and no-choice experiments. Using the Murdach's model, switching behavior was observed in A. matricariae between different density proportions of third- and fourth-instar nymphs. Further, the parasitoid exhibited a type II functional response when it was offered to third-instar nymphs of M. persicae nicotianae at six densities (2, 4, 8, 16, 32, and 64). Based on the linear regression analysis, there was a significance difference between the logarithm of per capita searching efficiency and the logarithm of parasitoid density. As the wasp density increased, per capita searching efficiency decreased. The result of this study revealed that A. matricariae is an effective agent in the integrated management of M. persicae nicotianae. In addition, application of these results can be important in mass-rearing program of A. matricariae.