Dietary Quality among Tehranian Adults in Relation to Lipid Profile: Findings from the Tehran Lipid and Glucose Study

The prevalence of dyslipidaemia has been increasing in developing countries that are undergoing nutrition transition. However, the association of diet quality and lipid profile has not been well-understood in these countries. The aim of the current study was to compare the ability of three diet quality indices—the Mediterranean diet scale (MDS), healthy eating index-2005 (HEI-2005), and diet quality index-international (DQI-I) in relation to changes in lipid profile between baseline and 6.7 years of follow-up. Baseline data from two 24-hour dietary recalls provided by 469 adults with mean age of 38.7±12.3 years, who were participants of the Tehran Lipid and Glucose Study, were analyzed to describe dietary intakes. Data on anthropometry, sociodemography, physical activity, and other lifestyle variables were recorded, and a comparison of baseline and follow-up data revealed changes in the concentrations of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). A general linear model was used in assessing changes in lipid profile depending on adherence to diet quality indices at baseline, after adjustment for age, smoking status, waist-circumference, body mass index, physical activity, and energy intake. A significant interaction was observed between scores and sex, and upon stratification, males in the highest quartile score of the HEI-2005 had significantly lower TG changes than those in the lowest quartile, after adjusting for confounders (-8.8 vs 2.9, p=0.038). No association was apparent in females (-0.2 vs 11.2, p=0.297). In addition, a positive association was found between DQI-I and HDL-C (Q1=0.6 vs Q4=-2.0, p=0.044) in males. In both sexes, all these indices were weakly associated with TC while none was associated with LDL-C. It is concluded: adherence to the HEI-2005 recommendations was weakly associated with reduced TG concentration in an urban Iranian adult population. The MDS and DQI-I were not related to change in lipid profile.Key words: Diet quality index-international, Healthy eating index-2005, Lipid profile, Mediterranean diet scale     

Microkeratome-assisted posterior lamellar keratoplasty in pseudophakic and aphakic corneal edema

PURPOSE: To evaluate the outcome of microkeratome-assisted posterior lamellar keratoplasty for replacing diseased endothelium in pseudophakic and aphakic corneal edema. METHODS: Microkeratome-assisted posterior lamellar keratoplasty was performed on 10 eyes with pseudophakic or aphakic corneal edema. A nasal hinged 130- to 250-microm-thick flap was created with an automated microkeratome. The underlying 7.0-mm trephined button of deep stroma and endothelium was substituted with the same size donor button prepared by removing a same-sized flap and trephination of the remaining donor bed. The donor lenticule was fixated without sutures in position; the retracted flap was repositioned and sutured to the peripheral recipient tissue. The viscoelastic content of the anterior chamber was replaced by air to hold the graft in position. RESULTS: All surgeries were uneventful except for one case of donor button posterior dislocation forming a secondary anterior chamber, which was corrected through donor button exchange 1 month postoperatively. All uncomplicated cases had stable refraction and corneal topography as early as 1 month after surgery, which was maintained in follow-up examinations. In two eyes, corneal astigmatism > 5.00 diopters was recorded. One case of prolonged re-epithelialization and two cases of epithelial interface ingrowth occurred. CONCLUSIONS: Microkeratome-assisted posterior lamellar keratoplasty is an alternative to conventional penetrating keratoplasty for patients with diseased corneal endothelium, significantly reducing the time of visual rehabilitation. Determination of the relative advantages of this technique over penetrating keratoplasty and other recent alternative endothelial graft procedures relies on controlled prospective studies.     

Immune checkpoints in targeted-immunotherapy of pancreatic cancer: New hope for clinical development

Immunotherapy has been recently considered as a promising alternative for cancer treatment. Indeed, targeting of immune checkpoint (ICP) strategies have shown significant success in human malignancies. However, despite remarkable success of cancer immunotherapy in pancreatic cancer (PCa), many of the developed immunotherapy methods show poor therapeutic outcomes in PCa with no or few effective treatment options thus far. In this process, immunosuppression in the tumor microenvironment (TME) is found to be the main obstacle to the effectiveness of antitumor immune response induced by an immunotherapy method. In this paper, the latest findings on the ICPs, which mediate immunosuppression in the TME have been reviewed. In addition, different approaches for targeting ICPs in the TME of PCa have been discussed. This review has also synopsized the cutting-edge advances in the latest studies to clinical applications of ICP-targeted therapy in PCa.KEY WORDS: Immune checkpoint, Pancreatic cancer, Tumor microenvironment, Immunotherapy, Clinical development     

Role of 3D sonohysterography in the investigation of uterine synechiae/asherman's syndrome: Pictorial assay

Several imaging methods have been applied for evaluation of suspected uterine synechiae; however, sonohysterography is yet recognised as a valid and accurate modality. Performing three‐dimensional (3D) imaging along with sonohysterography enables evaluation of the uterus in the coronal plane to detect and grade the adhesions that characterise this condition. Thus, 3D sonohysterography is a minimally invasive and cost‐effective tool for investigating suspected synechiae and is particularly useful when the transvaginal sonography findings are normal.     

Evolutionary model of brain tumor circulating cells: Cellular galaxy

BACKGROUNDAlthough circulating tumor cells (CTCs) have been the focus of consideration for a decade, a categorized cell-based diagnostic strategy is unavailable. The personalized management and complementary/analytical-strategy of data require an alphabetic guide. Therefore, we aimed to determine the behavior of CTCs in tumor and blood in order to provide the hypothetical-based agenda in the brain neoplasms. Exploring the protein expression (PE) using a single cell-based method would clarify the heterogeneity and diversity in tumor and blood, which are key events in the evolution in brain tumors. In fact, heterogeneity, diversity, and evolution are required for cancer initiation and progression. AIMTo explore CTCs in brain tumors and blood cells and to assay intensity of PE through personalized insight.METHODSThe focal population included 14 patients with meningioma, and four patients with metastatic brain tumors (T). PE was assayed by immunofluorescence in tumors cells and CTCs in 18 patients with brain tumors. Ratio test was applied between the T cells and CTCs in tumor tissue and in vascular system. T/CTC ratio-based classification of PE in macrophage chemoattractant chemokine ligand 2 (CCL2), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), CD133, cyclin E, neurofilament marker, cytokeratin 19, and leukocyte common antigen (CD45) were investigated. RESULTSTotal analyzed cells ranged between 10794-92283 for tumor cells and between 117-2870 for CTCs. Characteristics of histopathologic and status of an ataxia-telangiectasia mutated polymorphism (D1853N) in 18 patients affected with brain tumors were also provided. The course of evolution and metastatic event relied on the elevated protein expression in CTCs, which could be considered as a prognostic value. Diverse protein expression of the migrated cells into the blood stream and the tumor was indicative of the occurrence of evolution. Besides, the harmonic co-expression between CCL2/EGF and CCL2/VEGF could facilitate the tumor progression including the metastatic event. Expression of these proteins in the migrated vasculature and into the buccal tissue offered a non-invasive follow-up detection in neoplastic disorders. PE-exploration of neurofilament marker/CD133/VEGF of the CTCs in meningioma and cytokeratin 19/CD45/ cyclin E in the patients with metastatic brain tumor would clarify the tumor biology of the brain neoplastic disorders. CONCLUSIONThe alphabetical base of the evolutionary mechanisms relies on dual-, triple-, and multi-models with diverse intensity of expression. In fact, cross-talk between initiative and the complementary channels defines the evolutionary insight in cancer. A diverse-model of protein expression, including low, medium, and high intensity, is the key requirement for the completed model. The cluster of cells with diverse expression and remarkable co-expression between CCL2/EGF/VEGF and NM/CD133/VEGF in CTCs may be indicative of probable invasiveness of the tumor. Furthermore, the mode of cytokeratin-19⁺/CD45^- can be traced in the metastatic patients.     

Low carbohydrate diet is associated with reduced risk of metabolic syndrome in Tehranian adults

This cohort study was conducted to examine the association of low carbohydrate diet (LCD) score with risk of incident metabolic syndrome (MetS) and its components after 3.6 years of follow-up in 2044 healthy adults within framework of the Tehran Lipid and Glucose Study. The LCD was calculated according to intakes of carbohydrate, monounsaturated fatty acids, refined grains, vegetable protein, fiber, n3/n6 polyunsaturated fatty acids ratio and glycemic load (GL), using a food frequency questionnaire at baseline. In the final model, after adjustment for age, gender, smoking status, physical activity and energy intake, there was significant association between LCD score and fasting plasma glucose (β: ?0.002, 95%CI: ?0.005, ?0.001), triglycerides (TGs) (β: ?0.002, 95%CI: ?0.004, ?0.001), BP (β: ?0.001, 95%CI: ?0.002, 0.000), WC-BMI (β: ?0.003, 95%CI: ?0.005, ?0.001) and MetS risk Z-scores (β: ?0.015, 95%CI: ?0.021, ?0.002). In conclusion, LCD may be associated with a decreased risk of MetS and its components in adults.     

Relation between stress and other life style factors

Objective: To describe and evaluate the relationship between stress and other lifestyle behaviors. Methods: A cross‐sectional study within the context of an Isfahan Healthy Heart Program (IHHP). Demographic details (age, gender, marital status and educational level) and lifestyle variables including diet (fruit and vegetable consumption), smoking status, daily physical activity and psychological distress were recorded. Data were analyzed by t‐test, χ² and logistic regression. Setting: Central Iranian country of Isfahan, Najaf‐Abad and Arak. Participants: Five thousand and eight hundred and ninety‐two adults over 19 years of age. Results: Mean age of all participants was 40.5 (15.4) years and 36 per cent of them had high stress levels. High stress levels were negatively associated with fruit and vegetable consumption, non‐smoking and marriage. Conversely, the female gender and less than 6 years of education were positively associated with stress levels. Physical activity was not found to be associated with stress. Conclusion: This study demonstrated an association between high stress levels and other unhealthy lifestyle factors. Hence, special attention must be paid to intervention programs aimed at modifying lifestyle and providing education on stress management techniques. Copyright © 2006 John Wiley & Sons, Ltd.     

Allografting with nonmyeloablative conditioning following cytoreductive autografts for the treatment of patients with multiple myeloma

The full potential of a graft-versus-myeloma effect after allogeneic hematopoietic cell transplantation (HCT) for patients with multiple myeloma (MM) has not been realized because of excessive early transplantation-related mortality (TRM) with conventional HCT. Autologous HCTs have been characterized by almost universal disease recurrences. The current trial combined autologous HCT with subsequent nonmyeloablative allogeneic HCT to maintain the benefits of both approaches with acceptable toxicity. Fifty-four patients, 52 years of age (median; range, 29-71 years), with previously treated stage II or III MM (52% refractory or relapsed disease) were given melphalan 200 mg/m2 and autologous HC transplants. Regimen-related toxicities after autologous HCT were moderate with a median of 6 days of neutropenia, 7 days of hospitalization, and 1 death from infection. Forty to 229 days later (median, 62 days), 52 patients received a single fraction dose of 2 Gy total body irradiation and HC transplants from HLA-identical siblings with postgrafting immunosuppression with mycophenolate mofetil (MMF) and cyclosporine (CSP). Patients experienced medians of 0 days of hospitalization, neutropenia, and thrombocytopenia. Sustained engraftment was uniform. With a median follow-up of 552 days after allografting, overall survival is 78%. One patient (2%) died before day 100 from disease progression. Thirty-eight percent of patients developed acute graft-versus-host disease (GVHD; grade II in all but 4 cases) and 46% chronic GVHD requiring therapy. Tumor responses occurred slowly. Thus far, 57% of patients have achieved complete remissions and 26% have achieved partial remissions for an overall response of 83%. Despite being evaluated in elderly patients with MM, this 2-step approach has reduced the acute toxicities of allogeneic HCT while achieving potent antitumor activities.