The Investigation of Risk Factors Impacting Breast Cancer in Guilan Province

Introduction: Breast cancer is multifactorial therefore more recognition of risk factors is important in its prevention. Objective: This study was conducted in order to determine the factors influencing breast cancer in women referred to health centers in Guilan province in 2015-2016. Method: In a case- control study, 225 women with breast cancer were investigated. The control group consisted of 225 healthy women of the relatives (third-rank) whose phone numbers were obtained from the patients. Data were collected through telephone interviews. Results: The risk of breast cancer raised in women who have a family history of other cancers (OR= 3.5; 95% CI= 1.96-6.6) ,exposure to X-Ray (OR= 2.5; 95% CI=1.1-5.5), having more than 4 children (OR= 2.695% CI=1.2-4.8), age more than 36 years at first pregnancy(OR=2.3; 95% CI=0.7-5.1),primary levelof education (OR= 5.4;95% CI=2.8-11.2) and inadequate intake of fruit (OR=1.5; 95% CI=1-2.2). Also, presence of the following factors reduced breast cancer risk: regular menstruation (OR= 0.66; CI=0.4- 0.9), duration of breastfeeding more than 12 months, less than 6 months and 7-12 months (OR=0.23; 95% CI=0.09-0.59 , OR=0.29; 95% CI=0.17-0.49 and OR=0.03; 95% CI=0.01-0.08) and parity (OR=0.4; 95% CI=0.27-0.83) In multiple linear regression analysis of higher education (OR=0.16; 95% CI=0.03-0.77), using contraceptives for more than 16 years (OR=2.3; 95% CI=1.4-3.9), family history of other cancers (OR=6.1; 95% CI=1.9-19.3) and a history of X-Ray exposure (OR=4.4; 95% CI=1.07-18.1) were considered as predictive factors. Conclusion: The results of this study emphasize the importance of informing women about breast cancer risk factors. So, identification of these risk factors is required as important means of prevention and treatment of breast cancer.     

Objective assessment of obstructive sleep apnea in normal pregnant and preeclamptic women

Objective: Obstructive sleep apnea (OSA) is a risk factor for adverse pregnancy outcomes. The aim of this study was to evaluate the association between OSA and preeclampsia. Methods: Between 30 and 39 weeks gestation, objective sleep apnea were evaluated in 38 normal pregnant and 40 preeclamptic women. Preeclampsia was defined by having a blood pressure (BP) > 140/90 mmHg on two occasions after the 20th week of pregnancy with excess protein in the urine (> 300 mg in 24 h) or 30 mg persistent proteinuria (+ 1 in dipsticks) in random samples. Objective sleep apnea was evaluated using an overnight in-hospital sleep evaluation using the SOMNOwatch plus Respiratory Screener. OSA was defined as an apnea–hypopnea index (AHI) ≥ 5, and further grouped into severity categories: mild (5–14.9), moderate (15–29.9), and severe (≥ 30). Results: Mean AHI was 33.3 ± 12.1 in preeclamptic women and was 23.8 ± 15.8 in normal pregnant women (p = 0.008). There was significant difference in prevalence of OSA severity (none, mild, moderate, or severe) between groups. Out of 33 preeclamptic women, 11 women had moderate and 22 women had severe OSA. Whereas, among 33 normal pregnant women, 8, 13, and10 women had mild, moderate, and severe OSA, respectively. Two normal pregnant women had no OSA (AHI< 5). Conclusion: Our study suggests women are susceptible to developing OSA during pregnancy that is associated with an increased risk of preeclampsia.     

Hypertrophic lichen planus on lip mimicking SCC

The lichen planus (LP) is an inflammatory and immune‐mediated disorder that can affect the hair, mucous membranes, nails, and skin. Lichen planus rarely affects the lips. In cases of lip involvement, it presents as radiated streaks, lace‐like papules, and erosions. There is no report of lip LP presenting as hypertrophic plaque. Here, we report interesting and rare clinical presentations of LP in a 45‐year‐old male patient that presented with a verrucous hyperkeratotic plaque on the lower lip mimicking squamous cell carcinoma. However, oral examination revealed, reticulated white patches on the bilateral buccal mucosa, and a biopsy of the lip lesion revealed lichenoid dermatitis which led to the diagnosis of hypertrophic lichen planus. Familiarity with the different clinical presentations of LP and its variants is essential for prompt diagnosis and effective treatment.     

Sharp thresholds limit the benefit of defector avoidance in cooperation on networks

Consider a cooperation game on a spatial network of habitat patches, where players can relocate between patches if they judge the local conditions to be unfavorable. In time, the relocation events may lead to a homogeneous state where all patches harbor the same relative densities of cooperators and defectors, or they may lead to self-organized patterns, where some patches become safe havens that maintain an elevated cooperator density. Here we analyze the transition between these states mathematically. We show that safe havens form once a certain threshold in connectivity is crossed. This threshold can be analytically linked to the structure of the patch network and specifically to certain network motifs. Surprisingly, a forgiving defector avoidance strategy may be most favorable for cooperators. Our results demonstrate that the analysis of cooperation games in ecological metacommunity models is mathematically tractable and has the potential to link topics such as macroecological patterns, behavioral evolution, and network topology.

Cooperation, behavior that leads to benefits for others at a cost to oneself, is widespread across biological systems, ranging from cells cooperating to form organisms, to cooperation among individuals in populations and among microbiotic and macrobiotic taxa in ecosystems. In many cases the costs of cooperation are high. Hence, how cooperative behavior persists in a population represents a fundamental question in biology (1–8). In general, cooperation is most likely to evolve and persist if there are mechanisms that directly or indirectly benefit cooperators’ reproductive success. Examples include kin selection, punishment of defectors who forgo the cooperative investment, or a direct self-benefit such as in cases of investment into a common good (4).Among the most general mechanisms that can favor cooperation is the notion of network or spatial reciprocity (1, 9–11). In classical examples of reciprocity, cooperation creates favorable conditions for other proximal cooperators (4). A result is the emergence of cooperative havens, where the rewards generated by mutual cooperation have enriched some physical or topological neighborhoods. The formation of cooperative neighborhoods in structured populations, where individuals interact with only a limited subset of the population, has traditionally been studied on networks, where each node represents an individual agent and an edge means that the two connected individuals play against each other (1, 10, 12–19). By assuming weak selection and treating space implicitly, the resulting systems can often be analyzed mathematically. Although this framework has become a powerful tool for conceptual understanding, it represents a strong abstraction from real-world ecology where interactions, and hence cooperative behaviors, occur often randomly within a location that is itself embedded in a larger spatial context (20–23). By focusing on spatially explicit models of cooperation, we gain the opportunity to understand feedbacks between the rules of the game, movement strategies, and long-term persistence of cooperation at larger scales (10, 20, 23–27).Here we study a model of cooperation in spatially structured populations inspired by ecological metacommunities (21–23, 28), where network nodes—instead of individuals—represent habitat patches containing many interacting individuals, and edges mean that two patches are connected by dispersal of those individuals (Fig. 1A). Each patch is a location where games are played, harboring cooperator and defector subpopulations which grow and shrink in time due to internal interactions and movement among locations. Metacommunity models allow one to represent the effects of physical spatial structure directly and explicitly. Moreover, they can be analyzed using master stability functions, which can be used to untangle the impacts of local dynamics and network structure (28–30). We use this ability to explore how different movement strategies impact the outcomes of a cooperation game as a function of network structure.Open in a separate windowFig. 1.Emergence of a heterogeneous stationary state on a two-patch network. (A) Schematic of the spatial game, showing local payoff (Π) relationships among cooperators and defectors occupying the same patch (gray circles) and the dispersal route between them. (B) Difference in equilibrium densities of both types in patches 1 and 2 as link strength is varied. Arrows refer to the example time series shown in C and D. Initial conditions were uniformly drawn from [10−4,10−3], and the patch with the largest initial cooperator density is patch 1. (C) The homogeneous steady state, with the same equilibrium densities of C and D across locations. (Inset) Network showing the proportions of each type in each patch. (D) The same game but with faster diffusion (larger δ), showing emergence of a heterogeneous steady state with higher cooperator densities in patch 1. Parameters are R = 3, S=2, T = 5, P=0.2, μ = 1, and α=3.     

Effect of intraumbilical vein oxytocin injection on third stage of labor

ObjectiveManual removal of placenta is performed in 1–3% of cases, and although it is a well-established and relatively safe procedure, it is not without complications. We carried out this study to determine whether intraumbilical vein oxytocin injection reduces the need for manual removal of placenta and shortens the third stage of labor, in comparison with placebo.Materials and MethodsIn this randomized clinical trial, 178 women with singleton pregnancy and normal delivery were studied in 1 year. Immediately after fetus delivery, oxytocin infusion (20 IU/L) was started in both groups. Moreover, 10 IU oxytocin and 1 mL normal saline were injected into the umbilical vein of women in the experimental and control groups, respectively. The duration of third-stage labor, need for manual delivery of placenta, and drug side effects were evaluated in both groups. With regard to the mean level of hemoglobin before and after delivery, the two groups were compared using the Levene test and independent t test, and other qualitative variables of the two groups were compared using the χ² test.ResultsThe women who received intraumbilical vein oxytocin had a shorter third stage of labor as compared with the placebo group (4.24 ± 3.27 min vs. 10.66 ± 7.41) (p < 0.001) and there was less need for manual delivery of placenta in the experiment group (1.1% vs. 5.1%) (p = 0.024).ConclusionIt was concluded that intraumbilical vein administration of 10 IU (1 mL) oxytocin immediately after fetus delivery was clinically effective in shortening the third stage of labor.     

Proprioception,dynamic balance and maximal quadriceps strength in females with knee osteoarthritis and normal control subjects

Background: Osteoarthritis (OA) is one of the most common musculoskeletal complaints worldwide. The knee is the most frequently involved joint of the lower limb in OA. Knee joint proprioception, dynamic balance and maximal quadriceps strength may be impaired in patients with knee OA. Objective: To investigate whether females with knee OA have reduced knee joint proprioception, balance responses and quadriceps strength compared with normal controls. Methods: We undertook a cross‐sectional study of 30 females with knee OA and 30 controls. Knee joint proprioception was measured using electrogoniometer. Dynamic balance response was determined using a step test. Quadriceps strength was measured isometrically using a modified Tornvall chair. Results: Subjects with OA had greater mean error, poorer dynamic balance and less quadriceps strength than non‐symptomatic ones (P < 0.001). Increasing age was associated with a decline in proprioceptive acuity for both controls and patients (r = 0.40, P < 0.001). In subjects with knee OA, decreased dynamic balance was associated with increasing weight (r = 0.30, P < 0.001) and reduced quadriceps strength (r = –0.37, P = 0.002). Conclusion: Compared with age and sex‐matched controls, females with symptomatic knee OA have reduced knee proprioception, balance responses and quadriceps strength.