The Relationship between Mortality of Lung Transplant Recipients and Serum Cyclosporine Levels: Joint Modeling of Time-to-Event Data and Longitudinal Data.

BACKGROUND: Lung transplantation (LTx) is a well-accepted treatment that can prolong survival of patients with advanced lung disease. OBJECTIVE: To evaluate the association between serum cyclosporine level (SCL) pattern and mortality of LTx recipients. METHODS: This retrospective cohort study included 1019 observations on 38 patients who underwent LTx in Masih Daneshvari Hospital from 2000 to 2013. The analysis applied a joint model with shared random effects. RESULTS: The mean±SD age of the recipients was 36±14.5 years. The findings indicated that sex, age, body mass index (BMI), the underlying disease, and cytomegalovirus infection were not associated with mortality. The mortality risk for the recipients with acute rejection (AR) history was 1.54 times that of the recipients who had none (95% CI: 1.08-2.19). The association parameter in the joint model (α = 0.8) showed that higher SCL was associated with lower mortality risk (95% CI: 1-1.011). A slightly linear decreasing trend in SCL mean was found after 10 months post-LTx; a significant 2% per month (95% CI: -0.03 to -0.019). CONCLUSION: AR history was found to be a risk factor in mortality in Iranian LTx recipients. Given the association between the higher SCL and lower mortality found in this study, it is recommended to pay serious attention to SCL changes in the overall post-transplantation survival assessment in Iranian LTx recipients.

Dietary carbohydrate composition is associated with polycystic ovary syndrome: a case-control study.

BACKGROUND: The present study aimed to investigate the association between dietary carbohydrate components and polycystic ovary syndrome (PCOS) in Iran. METHODS: In this case-control study, the diagnosis of PCOS was made based on the Rotterdam criteria in hospital clinics. Dietary assessments were performed using a validated semi-quantitative food frequency questionnaire. In total, 281 women with incident PCOS and 472 age-matched controls were assessed. Participants were interviewed through the clinics in Tehran, Iran, from February 2012 until March 2014. Average dietary glycaemic index (GI) and glycaemic load (GL) were calculated using GI of Iranian Foods Table and international tables of GI and GL values. We also assessed total dietary carbohydrate, refined grains, whole grains and fibre intakes. RESULTS: Participation rates were 97.5% among cases and 96.3% among controls. Mean (SD) dietary GI values among the controls and cases were 51.8 (4.7) and 59.7 (5.9) (P = 0.02) and GL values were 155.34 (35.2) and 173.6 (39.1) (P < 0.001), respectively. The multivariate adjusted odds ratio (OR) comparing the highest tertile of dietary GI and GL with the lowest tertile were 2.18 [95% confidence interval (CI) = 1.29-3.81; P-test for trend = 0.012] and 2.39 (95% CI = 1.23-3.01; P-test for trend = 0.001), respectively, with a significant trend. Fibre intake was inversely associated with PCOS (OR = 0.73; 95% CI = 0.49-0.91; P-test for trend = 0.013). CONCLUSIONS: The findings of the present study suggest that high dietary GI and GL and low fibre intake are significantly associated with PCOS.

Relationship between Dietary Approaches to Stop Hypertension score and Alternative Healthy Eating Index score with plasma asymmetrical dimethylarginine levels in patients referring for coronary angiography.

BACKGROUND: Asymmetrical dimethyl arginine (ADMA) is a competitive inhibitor in the production of nitric oxide (NO) from arginine and NO plays an important role in the preservation of vascular dilation. Elevated ADMA is a strong predictive factor for coronary artery disease (CAD). Dietary Approaches to Stop Hypertension (DASH) and Alternative Healthy Eating Index (AHEI) patterns contain factors that may influence plasma ADMA levels. The present study examined the association between the DASH score and AHEI score with plasma ADMA concentration in people with suspected heart disease selected for coronary angiography. METHODS: This cross-sectional study was conducted in 148 people aged 40-80 years who were referred for coronary angiography. The DASH diet score and AHEI score were calculated for each individual based on food groups. Plasma ADMA levels were measured by high-performance liquid chromatography. RESULTS: ADMA concentrations were higher in the CAD group compared to the non-CAD group [0.98 (0.37) µmol L(-1) compared to 0.84 (0.42) µmol L(-1) ; P = 0.02]. There was a significant negative association between the quartile DASH score and ADMA concentration (standardised ß = -0.172, P = 0.038). The ADMA concentration was lower in patients who were at the highest quartile of DASH score compared to patients with the lowest quintile score. The ADMA concentration and quartiles of AHEI score were not significantly associated. CONCLUSIONS: Higher scores of the DASH diet are associated with lower plasma ADMA levels and with reduced coronary artery stenosis.

Predicting the probability of mortality of gastric cancer patients using decision tree.

BACKGROUND: Gastric cancer is the fourth most common cancer worldwide. This reason motivated us to investigate and introduce gastric cancer risk factors utilizing statistical methods. AIM: The aim of this study was to identify the most important factors influencing the mortality of patients who suffer from gastric cancer disease and to introduce a classification approach according to decision tree model for predicting the probability of mortality from this disease. METHODS: Data on 216 patients with gastric cancer, who were registered in Taleghani hospital in Tehran,Iran, were analyzed. At first, patients were divided into two groups: the dead and alive. Then, to fit decision tree model to our data, we randomly selected 20% of dataset to the test sample and remaining dataset considered as the training sample. Finally, the validity of the model examined with sensitivity, specificity, diagnosis accuracy and the area under the receiver operating characteristic curve. The CART version 6.0 and SPSS version 19.0 softwares were used for the analysis of the data. RESULTS: Diabetes, ethnicity, tobacco, tumor size, surgery, pathologic stage, age at diagnosis, exposure to chemical weapons and alcohol consumption were determined as effective factors on mortality of gastric cancer. The sensitivity, specificity and accuracy of decision tree were 0.72, 0.75 and 0.74 respectively. CONCLUSIONS: The indices of sensitivity, specificity and accuracy represented that the decision tree model has acceptable accuracy to prediction the probability of mortality in gastric cancer patients. So a simple decision tree consisted of factors affecting on mortality of gastric cancer may help clinicians as a reliable and practical tool to predict the probability of mortality in these patients.

The effect of withholding gonadotropin (a coasting period) on the outcome of in vitro fertilization cycles.

OBJECTIVE: The purpose of this study was to evaluate the effects of coasting (withdrawing gonadotropin administration) on the cycle outcomes, including total number and quality of oocytes and embryos and pregnancy rate in patients undergoing in vitro fertilization. STUDY DESIGN: Sixty-seven patients undergoing coasting were evaluated in a retrospective study at the Royan Institute between May 2002 and June 2003. All patients underwent standard long protocol with gonadotropin-releasing hormone (GnRH) analogue and human menopausal gonadotropin (HMG) and then in vitro fertilization and embryo transfer (IVF-ET). Coasting was considered when the estradiol level was more than 3000 pg/ml and the number of follicles >10 in each ovary. HCG was administered whenever estradiol reached < or =3000 pg/ml and then the (IVF-ET) program was carried out. According to coasting periods, patients were divided into two groups: coasting period < or =3 days and coasting period >3 days. Statistical comparisons were performed using Student's t test and Fisher's exact test. RESULTS: There were no significant differences between the two groups with regard to mean age, body mass index (BMI), number of polycystic ovary syndrome (PCOS) patients, number of HMG ampoules and stimulation duration. The total number of retrieved oocytes decreased significantly in patients with more than 3 days of coasting (P=0.04). The number of high quality oocytes also decreased in this group; however, this did not reach significant levels. There were no significant differences between the two groups with regard to fertilization and pregnancy rate. None of the patients developed severe ovarian hyperstimulation syndrome (OHSS). CONCLUSION: This study reveals that a long coasting period (>3 days) has a negative effect on the number of oocytes, although the fertilization and pregnancy rates are not affected. Prospective randomized studies with larger sample sizes are needed to compare coasting with other procedures.