Combined therapy of silymarin and desferrioxamine in patients with β-thalassemia major: a randomized double-blind clinical trial

Silymarin, a flavonolignan complex isolated from Silybum marianum , has a strong antioxidant, hepatoprotective, and iron chelating activities. The present study was designed to investigate the therapeutic activity of orally administered silymarin in patients with thalassemia major under conventional iron chelation therapy. A 3-month randomized, double-blind, clinical trial was conducted in 59 β-thalassemia major patients in two well-matched groups. Patients were randomized to receive a silymarin tablet (140 mg) three times a day plus conventional desferrioxamine therapy. The second group received the same therapy but a placebo tablet instead of silymarin. Clinical laboratory tests were assessed at the beginning and the end of the trial, except for serum ferritin level that was assessed at the middle of the trial as well. Results of this study revealed that the combined therapy was well tolerated and more effective than desferrioxamine in reducing serum ferritin level. Significant improvement in liver alkaline phosphatase and glutathione levels of red blood cells was also observed in silymarin-treated β-thalassemia patients. However, no significant difference in serum ferritin levels was detected between silymarin and placebo groups after 1.5 and 3 months treatment, probably because of insufficient sample size to detect subtle changes in ferritin levels between groups. This is the first report showing the beneficial effects of silymarin in thalassemia patients and suggests that silymarin in combination with desferrioxamine can be safely and effectively used in the treatment of iron-loaded patients.     

The prognostic significance of frailty compared to peak oxygen consumption and B‐type natriuretic peptide in patients with advanced heart failure

Frailty assessment has become an integral part of the evaluation of potential candidates for heart transplantation and ventricular assist device (HTx/VAD). The impact of frailty, as a heart failure risk factor or to identify those who will derive the greatest benefit with HTx/VAD remains unclear. The aim of this study was to evaluate the independent prognostic relevance of frailty assessment from peak oxygen consumption (peak VO₂) or B‐type natriuretic peptide (BNP) on mortality in patients referred for advanced heart failure therapies. Frailty was measured using modified Fried frailty criteria. In 201 consecutive patients, during a median follow‐up of 17.5 months (IQR 11‐29.2), there were 25 (12.4%) deaths. One‐year survival was 100%, 94%, and 78% in nonfrail, prefrail, and frail patients, respectively (log rank P = .0001). Frailty was associated with a twofold increase risk of death (HR 2.01, P < .0001, 95% CI 1.42‐2.84). When adjusted for BNP or peak VO₂, frailty was not associated with a significant risk of all‐cause death. However, when peak VO₂ is stratified into two categories (≥12 mL/kg/min vs <12 mL/kg/min), frailty was associated with increased mortality in patients with a lower peak VO₂ (HR 1.72, P = .006).     

Cognitive and default‐mode resting state networks: Do male and female brains “rest” differently?

Variability in human behavior related to sex is supported by neuroimaging studies showing differences in brain activation patterns during cognitive task performance. An emerging field is examining the human connectome, including networks of brain regions that are not only temporally‐correlated during different task conditions, but also networks that show highly correlated spontaneous activity during a task‐free state. Both task‐related and task‐free network activity has been associated with individual task performance and behavior under certain conditions. Therefore, our aim was to determine whether sex differences exist during a task‐free resting state for two networks associated with cognitive task performance (executive control network (ECN), salience network (SN)) and the default mode network (DMN). Forty‐nine healthy subjects (26 females, 23 males) underwent a 5‐min task‐free fMRI scan in a 3T MRI. An independent components analysis (ICA) was performed to identify the best‐fit IC for each network based on specific spatial nodes defined in previous studies. To determine the consistency of these networks across subjects we performed self‐organizing group‐level ICA analyses. There were no significant differences between sexes in the functional connectivity of the brain areas within the ECN, SN, or the DMN. These important findings highlight the robustness of intrinsic connectivity of these resting state networks and their similarity between sexes. Furthermore, our findings suggest that resting state fMRI studies do not need to be controlled for sex. Hum Brain Mapp, 2010. © 2010 Wiley‐Liss, Inc.     

Metastasis and its Related Factors in Female Breast Cancer Patients in Kerman,Iran

Background: Metastasis is important in survival and the quality of life of female breast cancer patients. This study was run in order to investigate metastasis and its related factors in female breast cancer patients in Kerman province from 2005 to 2015. The aim of this study was to investigate the factors associated with secondary metastasis in female breast cancer patients in the largest province of Iran (Kerman). Materials and Methods: In this case-control study, medical records of women diagnosed with breast cancer between the years of 2005 to 2015 were studied. Among them, 200 breast cancer patients with secondary metastasis were randomly selected as cases and 400 patients without metastasis were selected as the control group. Backward logistic regression, chi-square test, t-test and Mann-Whitney-U test were performed for comparing the two groups in SPSS 22. Results: Disease stage at diagnosis was significantly associated with secondary metastasis (p<0.001). Female patients with stage III breast cancer at the time of diagnosis had a higher chance OR=9.11 (CI 95%=2.99-27.76) of metastasis than women with stage 0 and 1 at diagnosis. Also, patients from rural areas had a higher chance for metastasis OR=1.89 (CI 95%=1.04-3.41). Other factors such as age, tumor size, tumor grade at diagnosis, hormone receptor status of estrogen and progesterone and Her-2 showed no significant association with metastasis (p>0.05). Conclusion: Stage at diagnosis and the residential location of patients were the most important factors related to secondary metastasis. These results emphasize the importance of early diagnosis, adequate education and awareness for breast cancer screening.