High body mass index and young age are not associated with post-mastectomy pain syndrome in breast cancer survivors: a case-control study

Surgery is usually the first treatment for breast cancer which is followed by some complications such as chronic pain. Post mastectomy pain syndrome [PMPS] is a common complication among breast cancer survivors and is considered as a chronic neuropathic pain in the side of surgery which persists more than three months. The exact mechanisms and related risk factors of the chronic pain after breast surgery are unknown. The aim of this study was to investigate the association of body mass index [BMI] and age with PMPS. In this case-control study, a total of 122 women were assessed; of these, 61 women were diagnosed with PMPS and selected as cases and 61 pain-free patients were selected as controls. The demographic and clinical characteristics of participants were collected through questionnaires and medical record of patients. Logistic regression model was used to determine the association of BMI and age with PMPS, adjusted for demographic and clinical characteristics. No significant differences were found in means of weight [68.02 +/- 8.80 vs. 68.67 +/- 11.82, p=0.726], BMI [26.38 +/- 3.28 vs. 27.10 +/- 6.03, p=0.410], and age [46.34 +/- 11.67 vs. 48.54 +/- 12.57, p=0.319] between those with PMPS and those not reporting PMPS. A non-significant slight increase in odds ratio of PMPS was observed in obese category compared to normal weight category [OR=1.152 [95% CI 0.405-3.275], p=0.908], but after adjusting the confounding factors, the risk of pain development was attenuated in obese subjects [OR=0.748 [95% CI 0.228-2.459], p=0.633]. Also, non-significant decrease in odds ratios of PMPS was found in 20-39 y, 40-49 y, and 50-59 y ages categories compared to oldest age category [adjusted OR= 0.781 [95% CI 0.213-2.866], p=0.576; adjusted OR=0.485 [95% CI 0.152- 1.554], p=0.183; adjusted OR=0.735 [95% CI 0.206-2.627], p=0.628; respectively]. In contrast with some observational studies, present study showed that high BMI and younger age might not be associated with increased risk of PMPS development. Further research is necessary to determine the main risk factors and directionality and causal mechanisms for associations of these risk factors with chronic pain after mastectomy

Calorie shifting diet versus calorie restriction diet: a comparative clinical trial study

Finding new tolerable methods in weight loss has largely been an issue of interest for specialists. Present study compared a novel method of calorie shifting diet [CSD] with classic calorie restriction [CR] on weight loss in overweight and obese subjects. Seventy-four subjects [body mass index >/= 25; 37] were randomized to 4 weeks control diet, 6 weeks CSD or CR diets, and 4 weeks follow-up period. CSD consisted of three phases each lasts for 2 weeks, 11 days calorie restriction which included four meals every day, and 4 h fasting between meals follow with 3 days self-selecting diet. CR subjects receive determined low calorie diet. Anthropometric and metabolic measures were assessed at different time points in the study. Four weeks after treatment, significant weight, and fat loss started [6.02 and 5.15 kg] and continued for 1 month of follow-up [5.24 and 4.3 kg], which was correlated to the restricted energy intake [P < 0.05]. During three CSD phases, resting metabolic rate tended to remain unchanged. The decrease in plasma glucose, total cholesterol, and triacylglycerol were greater among subjects on the CSD diet [P < 0.05]. Feeling of hunger decreased and satisfaction increased among those on the CSD diet after 4 weeks [P < 0.05]. The CSD diet was associated with a greater improvement in some anthropometric measures, Adherence was better among CSD subjects. Longer and larger studies are required to determine the long-term safety and efficacy of CSD diet

Caffeine treatment prevented from weight regain after calorie shifting diet induced weight loss

Low calorie diets are always difficult for obese subjects to follow and lead to metabolic and behavioral adaptation. Therefore, we evaluated the effect of caffeine treatment with calorie shifting diet [CSD] on weight loss. Female subjects [n=60; BMI>25] completed 4-weeks control diet, 6-weeks CSD [3 repeated phases; each 2-weeks] and 4-weeks follow-up diet, with or without caffeine treatment [5 mg/Kg/day]. The first 11 days of each phase included calorie restriction with four meals every day and 4 hours intervals. Significant weight and fat loss were observed after 4-weeks of CSD [5.7 +/- 1.24 Kg and 4.84 +/- 1.53 Kg] or CSD+Caffeine [7.57 +/- 2.33 Kg and 5.24 +/- 2.07 Kg] which was consistent for one month of the follow-up [CSD: 5.24 +/- 1.83 Kg and 4.3 +/- 1.62 Kg, CSD+Caffeine: 12.11 +/- 2.31 Kg and 9.85 +/- 1.6 Kg, p < 0.05 vs CSD group] and correlated to the restricted energy intake [p < 0.05]. During three CSD phases. RMR tended to remain unchanged in both groups. While, CSD or CSD + Caffeine treatments, significantly decreased plasma glucose, total-cholesterol, and triacylglycerol [p < 0.05], even during follow-up period [p < 0.05]. HDL-cholesterol was not changed by CSD. Feeling of hunger decreased and subject's satisfaction increased after 4-weeks of CSD [p < 0.05] and remained low to the end of study, while satiety was not affected. Coffeine increased the effect of CSD on feeling of hunger and subject's satisfaction after week 7 [p < 0.05 vs. CSD]. These findings indicated that combination of caffeine treatment with CSD could be an effective alternative approach to weight and fat loss with small changes in RMR and improved tolerance of subjects to the new diet

BCL-2 and bax expression in skin flaps treated with finasteride or azelaic acid

Despite all modern surgical techniques, skin flap that is considered as the main method in most reconstructive surgeries puts the skin tissue at danger of necrosis and apoptosis derived from ischemia. Therefore, finding a treatment for decreasing the apoptosis derived from flap ischemia will be useful in clinic. In present study, we evaluated the effect of azelaic acid 20% and finasteride on expression of BCL-2 and bax proteins after the skin flap surgery. For this purpose, 21 rats were entered in three groups including control, azelaic acid 20% and finasteride, all experienced skin flap surgery and then flap tissue was assessed for determining the expression of proteins in 5 slices prepared from each rat that were graded between - to +++ scales. Both azelaic acid and finasteride increased the expression of BCL-2 protein [p < 0.05] and decrease the expression of bax protein [p < 0.05]. These results suggested an antiapoptotic role for finasteride and azelaic acid in preserving the flap after the ischemia reperfusion insult