Linear and nonlinear analysis of brain dynamics in children with cerebral palsy

This study was carried out to determine linear and nonlinear changes of brain dynamics and their relationships with the motor dysfunctions in CP children. For this purpose power of EEG frequency bands (as a linear analysis) and EEG fractality (as a nonlinear analysis) were computed in eyes-closed resting state and statistically compared between 26 CP and 26 normal children. Based on these characteristics accuracy of the classification between the two groups was obtained by enhanced probabilistic neural network (EPNN). Severity of gross motor and manual disabilities was determined by standard systems and the relation between the deficient brain dynamics and severity of the motor dysfunctions was obtained by Pearson's correlation coefficient. A definitely higher delta and lower theta and alpha powers, and higher EEG complexity in CP patients. As such a high accuracy of 94.8% in distinguishing the two groups was obtained. Moreover significant positive correlations were found between beta power and severity of manual disabilities and gross motor dysfunctions in the boys with CP. It is concluded that the obtained brain dynamics’ characteristics are useful in diagnosis of CP. Furthermore severity of the motor dysfunctions in boys with CP could be evaluated by the beta activity.     

The effect of demographic and lifestyle changes on the burden of breast cancer in Iranian women: A projection to 2030

Iran is rapidly becoming an “ageing society” with a related increase in cancer incidence including breast cancer. This paper evaluates the trend in breast cancer incidence from the past to the present, in order to predict the future burden in Iran and to quantify the effect of changes in known risk factors on incidence over time. Currently, breast cancer incidence in Iran is low with approximately 5000 new cases annually. Under conservative assumptions, the number of new cases of breast cancer in 2030 will be more than 15000. In addition to demographic factors, changes in the prevalence of established risk factors such as reproductive factors and obesity are likely to result in changes in breast cancer patients over time. Extrapolating the increasing prevalence of obesity to the future, we expect that this specific factor will strongly contribute to the increased breast cancer incidence in the future unless preventive measures counteract this effect.     

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.     

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.     

Related and unrelated nonmyeloablative hematopoietic stem cell transplantation for malignant diseases

Patients with advanced hematological malignancies ineligible for conventional myeloablative allogeneic hematopoietic stem cell transplantation (HSCT) due to advanced age or medical contraindications were enrolled in multi-center study to investigate the safety and efficacy of nonmyeloablative HSCT using a 2 Gy total body irradi ation (TBI)-based regimen. A total of 192 patients (median age 55) were treated with HLA-matched sibling peripheral blood stem cell (PBSC) grafts, and 63 patients (median age 53) received a 10 of 10 HLA-antigen matched unrelated donor (URD) HSCT (PBSC graft, n = 48; marrow graft, n = 15). Diagnoses included multiple myeloma (n = 61), myelodysplastic syndrome (n = 55), chronic myeloid leukemia (n = 31), non-Hodgkin lymphoma (n = 31), acute myeloid leukemia (n = 28), chronic lymphocytic leukemia (n = 24), Hodgkin Disease (n = 14). The conditioning regimen was fludarabine 30 mg/m2/d x 3 days and 2 Gy TBI. Ninety-five related HSCT patients received 2 Gy TBI without fludarabine. Postgrafting immunosuppression was combined mycophenolate mofetil an cyclosporine. Transplants were well tolerated with a median of 0 days of hospitalization in the first 60 days for eligible patients. For related HSCT recipients, median follow-up was 289 (100-1,188) days. Nonfatal graft rejection occurred in 6.8%. Of those with sustained engraftment, graft-versus-host disease (GVHD) occurred in 49% (33% grade II, 11% grade III, 5% grade IV). Day-100 non-relapse mortality was 6%. Overall, 59% (114/192) of patients were alive. The relapse/disease progression mortality was 18%, and non-relapse mortality was 22%. The projecte 2-year survival and progression-free survival were 50% and 40%. For the URD HSCT recipients, median follow-up was 190 (100-468) days. Graft rejection occurred in 27% (17/63) of patients, mostly in recipients of marrow grafts (9/15). Acute GVHD occurred in 63% (50% grade II, 13% grade III) of 46 engrafted patients. Chronic GVHD requiring therapy occurred in 50% of patients. Of the 63 URD HSCT patients, 54% were alive, 37% in CR, 3% PR, and 14% with disease progression or relapse. Related and unrelated nonmyeloablative HSCT is feasible and potentially curative in patients with advanced hematological malignancies who have no other treatment options.     

Effect of the Pro12Ala polymorphism of the PPARg2 gene on serum adiponectin changes

The Pro12Ala polymorphism of the peroxisome proliferator-activated receptor gamma 2 (PPARγ2) gene and adiponectin, a protein secreted from adipose tissue, have been associated with insulin sensitivity. The present study demonstrates that in Finnish servicemen who were on a high-caloric diet for 6 mo only subjects with the Ala 12 allele of PPARγ2 had a significant increase in adiponectin levels with weight loss induced by heavy exercise. This study demonstrates an interaction of genetic and environmental factors in the regulation of serum adiponectin concentrations. Department of Medicine, University of Kuopio, Finland.     

Pediatric reference values for serum zinc concentration in Iranian subjects and an assessment of their dietary zinc intakes

ObjectivesTo determine pediatric reference values for serum zinc concentration in Iranian subjects.Design and methodsSerum zinc concentration was measured by flame atomic absorption spectrometry in 699 children and adolescents. Reference values for serum zinc were determined according to the Clinical and Laboratory Standards Institute/International Federation of Clinical Chemistry guidelines. Dietary zinc intake was assessed using a validated semiquantitative food frequency questionnaire.ResultsOverall 95% reference values for serum zinc concentrations were 9.7–31.5, 9.2–30.9, and 9.3–31.1 μmol/L in boys, girls, and total population respectively. Serum zinc concentrations were comparable in boys and girls (17.5 ± 5.3 μmol/L vs. 17.2 ± 5.6 μmol/L, p = 0.242). The dietary zinc intake of 7.6% (4.9% boys and 10.2% girls, p < 0.01) was lower than the estimated average requirement.ConclusionsThis study presents pediatric reference values for serum zinc concentrations, values that could help diagnose and manage zinc deficiency in pediatrics.     

Biliary brush cytology in the assessment of biliary strictures at a tertiary center in Iran

Background: Confirmation of cholangiocarcinoma and other malignant bile duct stenosis is challenging. The aim of the current study was to assess the accuracy of brush cytology for diagnosis of malignant biliary strictures. Methods: 105 patients with hepatic biliary strictures undergoing ERCP were included in this study. Prospectively collected data included symptoms, results of biochemical testing and imaging procedures, as well as details of ERCP. Exclusion criteria were: 1) strictures that would not permit passage of guidewire and brush accession; and 2) post-operative strictures. Brushings of the bile duct strictures were performed. All patients were followed for at least 6 months. The final diagnosis was confirmed following surgery, histopathological diagnosis of the lesion, radiological infiltration of adjacent organs or metastases, or after at least a 6-month follow-up. Results: 88 brush samples from 88 patients were of appropriate quality. The overall diagnostic sensitivity and specificity for malignant nature of biliary strictures were 40.7% and 100%, respectively. The sensitivity was 66.6 % for ampullary carcinomas, 36.3% for pancreatic cancer and 32.5% for cholangiocarcinomas. Conclusions: Despite the low sensitivity, due to the relative ease and safety, brush cytology should remain the first choice for diagnosis of causes of biliary strictures.     

Dietary fatty acid composition and metabolic syndrome in Tehranian adults

Objective

Several studies have shown that dietary and plasma fatty acid (FA) composition can modulate the development of metabolic syndrome, but epidemiologic data are scarce. The aim of this study was to evaluate the association between dietary FA composition and metabolic syndrome in Tehranian adults.

Methods

Dietary FA composition and symptoms of metabolic syndrome were assessed in a population-based cross-sectional study of 822 participants (354 men and 468 women, 18–74 y old) as part of the Tehran Lipid and Glucose Study. Metabolic syndrome was defined according to the guidelines presented by the Adult Treatment Panel III.

Results

The means ± standard deviations for dietary FA composition of total fat, linoleic acid, oleic acid, and saturated FA were 30.3 ± 7.5%, 1.43 ± 1.76%, 2.87 ± 2.19%, and 5.7 ± 2.2% of daily consumed energy, respectively. No significant correlation between the percentage of linoleic or oleic acids and metabolic syndrome was observed. Participants whose consumption of saturated FA was in the highest quartile had a significantly increased probability of acquiring metabolic syndrome (odds ratios by quartile 1, 0.83, 0.91, 0.95, P for trend <0.03). The odds ratios decreased after adjusting for indicators of a healthy lifestyle, including diet.

Conclusion

The data from this study indicate that increased consumption of dietary total fat, especially saturated FA, is associated with a higher risk of metabolic syndrome in Tehranian adults. The relation, apparently, is influenced by an individual’s lifestyle.