Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

BACKGROUND: In peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously. METHODS: This retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk. RESULTS: Using joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as −0.720 (95% confidence interval [CI], −0.971 to −0.472) for diabetic and −0.784 (95% CI, −0.963 to −0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients. CONCLUSION: The results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period.

Innate lymphoid cells and cytokines of the novel subtypes of helper T cells in asthma

BACKGROUND: In this study, the expression of interleukin-9 (IL-9), IL-17, IL-22, and IL-25 genes that might be the potential predisposing factors for asthma as well as count of innate lymphoid cells (ILCs) as another source of inflammatory cytokines have been evaluated. OBJECTIVE: The aim of this study was to evaluate the expression of newly identified helper T cells signature cytokines and amount of ILCs. METHODS: Blood and sputum samples from 23 patients with moderate to severe asthma and 23 healthy volunteers were collected. The types of allergens to which our patients were sensitive were defined using immunoblotting method. Gene expression of studied cytokines was evaluated using quantitative transcription-polymerase chain reaction and ILCs were counted by the flow cytometry method. RESULTS: In this research, the gene expressions of IL-9, IL-17, IL-22, and IL-25 were significantly higher in asthmatics, especially in the severe form of the disease. This increase was even higher in serum samples compared with sputum samples. Counting ILCs revealed their increase in comparison with normal people. CONCLUSION: We showed the importance of IL-25, IL-22, IL-17, and IL-9 cytokines in patients with asthma as their expression levels are increased and these increase are correlated with the severity of the disease. We also showed that the increased amount of ILCs in asthmatics could confirm their potential role in the immunopathogenesis of asthma as another source of inflammatory cytokines.

Child weight growth trajectory and its determinants in a sample of Iranian children from birth until 2 years of age

Growth is one of the most important indices in child health. The best and most effective way to investigate child health is measuring the physical growth indices such as weight, height and head circumference. Among these measures, weight growth is the simplest and the most effective way to determine child growth status. Weight trend at a given age is the result of cumulative growth experience, whereas growth velocity represents what is happening at the time. This longitudinal study was conducted among 606 children repeatedly measured from birth until 2 years of age. We used linear mixed model to analyze repeated measures and to determine factors affecting the growth trajectory. LOWESS smooth curve was used to draw velocity curves. Gender, child rank, birth status and feeding mode had a significant effect on weight trajectory. Boys had higher weight during the study. Infants with exclusive breast feeding had higher weight than other infants. Boys had higher growth velocity up to age 6 month. Breast fed infants had higher growth velocity up to 6 month, but thereafter the velocity was higher in other infants. Many of the studies have investigated child growth, but most of them used cross-sectional design. In this study, we used longitudinal method to determine effective factors on weight trend in children from birth until 2-year-old. The effects of perinatal factors on further growth should be considered for prevention of growth disorders and their late complications

Predictor of trend of hemoglobin A1c in type 2 diabetes: a longitudinal linear mixed model

There are some evidences that control the blood sugar decreasing the risk of diabetes complications, and even fatal. There are so many studies, but they are mostly cross-sectional and ignore the trend and hence it is necessary to implement a longitudinal study. The aim of this prospective study is to find the trend of glycosylated hemoglobin [HbA1c] over time and the associative factors on it. Participants of this longitudinal study were 3440 eligible diabetes patients referred to Isfahan Endocrine and Metabolism Research Center during 2000-2012 who are measured 2-40 times. A linear mixed model was applied to determine the association between HbA1c and variables, including lipids, systolic, diastolic blood pressure and complications such as nephropathy, and retinopathy. Furthermore, the effect of mentioned variables on trend of HbA1c was determined. The fitted model showed total cholesterol, retinopathy, and the method of therapy including oral antidiabetic drugs [OADs] plus insulin and insulin therapy decreased the trend of HbA1c and high-density lipoprotein, weight, hyperlipidemia and the method of therapy including diet, and OADs increased the trend of HbA1c. The present study shows that regular visits of diabetic patients as well as controlling blood pressure, lipid profile, and weight loss can improve the trend of HbA1c levels during the time

Positive and negative regulation of Th17 cell differentiation: evaluating the impact of RORC2

Th17 cells are known to be involved in some types of inflammations and autoimmune disorders. RORC2 is the key transcription factor coordinating Th17 cell differentiation. Thus, blocking RORC2 may be useful in suppressing Th17-dependent inflammatory processes. The aim was to silence RORC2 by specific siRNAs in naive T cells differentiating to Th17. Time-dependent expression of RORC2 as well as IL-17 and IL-23R were considered before and after RORC2 silencing. In this experimental study, naive CD4+ T cells were isolated from human cord blood samples. Cytokines TGFbeta plus IL-6 and IL-23 were used to polarize the naive T cells to Th17 cells in X-VIVO 15 serum free medium. A mixture of three siRNAs specific for RORC2 was applied for blocking its expression. RORC2, IL-17 and IL-23R mRNA and protein levels were measured using qRT-PCR, ELISA and flow cytometry techniques. Pearson correlation and one-way ANOVA were used for statistical analyses. Significant correlations were obtained in time-dependent analysis of IL-17 and IL-23R expression in relation with RORC2 [R=0.87 and 0.89 respectively, p<0.05]. Silencing of RORC2 was accompanied with almost complete suppression of IL-17 [99.3%; p<0.05] and significant decrease in IL-23R gene expression [77.2%, p<0.05]. Our results showed that RORC2 is the main and the primary trigger for upregulation of IL-17 and IL-23R genes in human Th17 cell differentiation. Moreover, we show that day 3 could be considered as the key day in the Th17 differentiation process

direct medical costs of breast cancer in Iran: analyzing the patient's level data from a cancer specific hospital in Isfahan

Breast cancer is one of the main causes of mortality and morbidity world-wide. The estimation of the direct medical costs of breast cancer can help payers of the cost to understand the burden of breast cancer on their limited financial resources as well as the society. We used a cross-sectional study to calculate the direct medical costs of breast cancer among women in Isfahan, Iran. The medical records of all patients which were registered in Seyed Al-Shohada Hospital between March 2005 and March 2010 were reviewed. The relevant data from patients' profiles extracted. The direct medical costs of received services were calculated with both public and private tariffs. The total numbers of 467 patients in various disease stages were included into the study. The average age of patients was 49 years. The average direct cost per patient per month in stages I to IV were 222.17, 224.61, 316.51 and 828.52 US$, respectively. The surgery cost was the main cost driver for stages I and II with private tariffs. However for stages III and IV, the medication cost was the main cost component for managing breast cancer. The direct economic cost of breast cancer in Iran is very high; nonetheless, as the age of breast cancer in Iran is nearly 10 years lower than Western countries, the burden of the disease in Iran is expected to be significantly high. Medication therapy is the main cost component of the breast cancer

First report on self-rated health in a nationally-representative sample of Iranian adolescents: the Caspian-III study

To evaluate predictive factors of adolescents' appraisal of their health. The nationwide study, entitled "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Diseases [CASPIAN] study," was conducted in 2010 among Iranian school students, aged 10-18. In addition to demographic factors and physical examination, variables as family structure, nutrition habits, physical activity, smoking, hygienic habits, violence, school attachment, family smoking, and family history of chronic diseases were assessed. The dependent variable is the self-rated health [SRH] and it was measured by 12 items, which had already been combined through latent class analysis. We had taken a dichotomous variable, i.e. the higher values indicate better SRH. The dependent variable was regressed on all predictors by generalized additive models. 75% of adolescents had a good SRH. The linear and smooth effects of independent variables on SRH were observed. Among all the variables, physical activity had a positive linear effect on SRH [beta = 0.08, P value = 0.003]. Smoking, violence, and family history of disease associated to SRH non-linearly [P value < 0.05]. Family smoking [beta = -0.01] and hygienic habits [beta = 0.27] related to SRH both linearly and non-linearly. Physical health and high risk behavior, either of linear or non-linear effect, are factors, which seem to shape the adolescents' perception of health

RORC2 gene silencing in human Th17 cells by siRNA: design and evaluation of highly efficient siRNA

RNA interference-based gene silencing has recently been applied as an efficient tool for functional gene analysis. RORC2 is the key transcription factor orchestrating Th17 cells differentiation, the cells that are known as the pathogenic elements in various autoimmune diseases. The aim of this study was to design efficient siRNAs specific for RORC2 and to evaluate different criteria affecting their functionality. Three siRNA duplexes specific for RORC2 mRNA were designed. Th17 cells were produced from IL-6 and IL-1 treated cord blood CD4[+] T cells. The T cells were transfected with three different designed siRNAs against RORC2 and the expression of RORC2 gene was measured using quantitative real time PCR. Different levels of RORC2 down regulation were observed in the presence of each of the designed siRNAs. Efficient siRNA with 91.1% silencing activity met the majority of the established bioinformatics criteria while the one with 46.6% silencing activity had more deviations from these criteria. The more bioinformatics criteria are considered, the more functionality were observed for silencing RORC2. However, the importance of the type of criteria per se should not be neglected. Although all recommended criteria are important for designing siRNA but their value is not the same

effects of isoproterenol and propranolol on cytokine profile secretion by cultured tumor-infiltrating lymphocytes derived from colorectal cancer patients

Anti-tumor immunity and cytokine profiles have important roles in the development of cancer. Norepinephrine [NE] release due to sympathetic activation leads to a Th2 deviation via the beta-2 adrenergic receptor [beta -2AR] and could increase cancer progression. This study intends to determine the effects of isoproterenol [ISO; betaagonist] and propranolol [PRO; beta-antagonist] on the production of IFN-gamma, IL-4, and IL-17. Cytokine levels have been examined in tumor-infiltrating lymphocytes [TILs] and peripheral blood mononuclear cells [PBMCs] of patients with colorectal cancer [CRC]. The beta-2AR expression on lymphocyte subsets was also assessed. In this experimental study, TILs were isolated from fresh CRC tissue and patient PBMCs were obtained just prior to surgery. The cells were cultured in medium for 72 hours. Concomitantly, cells were stimulated with 10 micro g/ ml phytohemagglutinin [PHA] alone or in the presence of either 1 micro mol/L of PRO or 1 micro mol/L ISO. The concentration of cytokines in the supernatants was measured by ELISA. Three-color flow cytometry was used to determine the expression of beta-2AR on the lymphocyte subsets. Statistical analyses were performed via paired or independent t-test. Levels of IFN-gamma, IL-4 and IL-17 were elevated after PHA-stimulation of PBMCs and TILs. However, the elevation of IFN-gamma and IL-17 production by TILs in response to PHA was significantly lower than PBMCs. In the presence of ISO, the IFN-gamma/IL-4 ratio reduced in all groups, but this reduction was very low in TILs. Interestingly, the effects of PRO on cytokine production were, at least partially, comparable to those of ISO. Depressed levels of beta-2AR expression were demonstrated on CD4+IFN-gamma+ and CD4+IL-17+ lymphocytes in patients' PBMCs and TILs. This study has demonstrated the effects of ISO and PRO on cytokine production by TILs and determined beta-2AR expression on these cells. ISO failed to induce a shift toward the expected Th2 cytokine profile in CRC patients' TILs, which might be due to the downregulation of beta-2AR expression on TILs. Additionally, in this study, PRO induced a shift to a Th2 profile in PBMCs

Cancer incidence and prevalence in Isfahan: application of mortality data to estimates and projects for the period 2001-2015

The aim of this study was to show up-to-date estimates of incidence and prevalence in Isfahan for all cancers, except non-melanoma skin cancer over the period 2001-2010 to provide projections up to 2015, based on a statistical method that uses mortality and cancer patients' survival data. Mortality data in Isfahan province were collected from various sources such as hospitals, medical forensic, cemetery, and health centers. In addition, population data by sex, age, location, and calendar year in the period of 2001-2010 were acquired from the Statistical Center of Iran. Relative survival probabilities for all cancers combined and for selected specific cancers were estimated based on observed cancer death and expected mortality data. Incidence and prevalence estimates were computed with Mortality-incidence Analysis Model [MIAMOD] method. The estimated age-standardized cancer incidence rate had higher increase rate for urban females than for males. Also, the number of prevalent cancers was higher among females, which was mostly due to better cancer survival rates in women. Age-adjusted incidence was estimated to increase by 6.9 and 8.7 per 100000 annually, between 2001 and 2015, in males and females, respectively. The prevalence is to increase by 24 and 40 and mortality by 2.8 and 2.5 per 100000 between 2001 and 2015. The present study does not only show the incidence and prevalence estimates of all cancers combined, but also gives information about cancer burden, which can be used as a bases for planning healthcare management and allocating recourses in public health

Changes in the position of mandibular third molars following extraction and non-extraction orthodontic treatments

Impaction of third molars can be associated with a number of sequelae, each requiring a different type of treatment. The purpose of this study was to assess the changes in the position of lower third molars following extraction and non-extraction orthodontic treatments. Pre- and post-treatment panoramic radiographs of 26 class I malocclusion patients [4 male and 22 female] who were treated on a non-extraction basis were compared with those of 30 class I malocclusion patients [5 male and 25 female] who received orthodontic treatment following the extraction of all first premolars. In each group, the lower third molar angulations and their distance from the lower border of the mandible were assessed. Paired r-tests and independent /-tests detected significant changes in the position of the lower third molars in the extraction group. Both the left and right molars became more upright and their distance from the lower border of the mandible increased. Similar changes were only seen in the position of the right mandibular third molars in the non-extraction group. Tooth extractions can bring about favorable changes in the position of mandibular third molars and possibly reduce their incidence of impaction

Risk score model for predicting sonographic non-alcoholic fatty liver disease in children and adolescents

This study aimed to develop and test the validity of a risk score to be used as a simple tool to identify those children at high risk of sonographic non-alcoholic fatty liver disease [NAFLD]. This cross-sectional study was conducted among 962 participants aged 6-18 years in Isfahan, Iran. They consisted of three groups of nearly equal number of normal-weight, overweight and obese individuals. Coefficients of the logistic regression models were used to assign a score value for each variable and the composite sonographic NAFLD risk score was calculated as the sum of those scores. Performance of model was assessed by receiver operating characteristic [ROC] curve procedure. Data of 931 participants was included in the analysis. The sonographic findings of 16.8% of participants were compatible with NAFLD. Age, sex, body mass index, waist circumference and serum triglycerides level were diagnosed as factors associated with NAFLD. The risk score was calculated as 50 for sonographic NAFLD. This study, to the best of our knowledge is the first of its kind in the pediatric age group, focuses on predicting sonographic NAFLD from easily-measured factors. It may suggest an association of hypertriglyceridemic-waist phenotype with NAFLD in the pediatric age group

[Prevalence of androgenetic alopecia among women between 20-70 years old in Isfahan province in 2008-2009]

Androgenetic alopecia is an extremely common disorder affecting both men and women. The incidence is generally considered to be greater in males than females, although some evidence suggests that the apparent differences in incidence may be a reflection of different expression in males and females. This genetically determined disorder is progressive through the gradual conversion of terminal hairs into indeterminate hairs and finally to vellus hairs. Patients have a reduction in the terminal-to-vellus hair ratio, normally at least 2:1. Following miniaturization of the follicles, fibrous tracts remain. Patients with this disorder usually have a typical distribution of hair loss. This is a cross sectional study that conducted in Isfahan health center in 2007-2008. Using simple random sampling, we selected 1800 women in urban health center areas for hair loss. We evaluated the type of hair loss by Ludwig classification. The data was collected through administration of a specifically designed questionnaire and was analyzed using SPSS software. The chi-square and student tests were used for data analysis. According to results of this study the of 1800 women, 712 [39.6%] had hair loss. Mean age of females who had hair loss was 50.4 +/- 13 years. Thyroid disorders, ferritin serum level and androgenic hormones may play role in hair loss and their existance should be assessed

[Evaluation of effectivness of Nigella sativa extracts and topical honey application versus topical honey alone along with intralesional injection of Glucantime in the treatment of acute cutaneous leishmaniasis]

There are some reports regading the anti-inflammatory and antimicrobial effect of honey and Nigella sativa and their therapeutic effects in improvement of wound healing. This study was designed to evaluate the efficacy of adding honey and Nigella sativa extract compared to honey alone in patients with cutaneous leishmaniasis receiving intralesional Glucantime. In this clinical trial, 150 patients with confirmed cutaneous leishmaniasis were randomly allocated into two groups. One group was treated with topical honey twice daily along with weekly intralesional injection of Glucantime. In the second group, patients were treated with topical honey and 60% hydroalchoholic Nigella sativa extract instead of honey alone. The patients were treated until complete healing of the ulcer or for maximum of 12 weeks. At 12 weeks, complete cure was achieved in 61 [81.3%] of patients treated with topical honey and 60% hydroalchoholic Nigella sativa extract versus 48 [64%] in the second group [P=0.002]. The efficacy of adjunct honey and Nigella sativa extract along with intralesional Glucantime is more than honey alone in increasing complete cure rate and decreasing the residual scar size and the required dose of Glucantime