Determining Overall Survival and Risk Factors in Esophageal Cancer Using Censored Quantile Regression

Background: Esophageal cancer is one of the leading causes of death worldwide. The global increasing rate of thistype of cancer requires more attention. The purpose of this study was to determine the overall survival probability ofesophageal cancer after diagnosis and to assess the potential risk factors in a population of Iranian patients. Materialsand Methods: This retrospective cohort study was conducted on 127 cases with esophageal cancer in the Azarbaijanprovince, East of Iran. Participants in the study were diagnosed during 2009-2010 and were followed up for 5 years. Theevent was considered death due to esophageal cancer and those who survived until the end of the study were assumed asright censored. Censored quntile regression was fitted to find the overall survival of the patients using adjusted effects ofvariables and was compared with Cox regression model. Results: Patients’ mean and median survival time were 16.99and 10.06 months respectively and 89% off cases died by the end of the study. The 1, 3, 6, 12 and 36-month survivalprobabilities were 0.95, 0.76, 0.60, 0.43, and 0.18. The median survival time for females and males without surgerywere 21.79 and 14.76 month respectively. The accuracy of predictions were 0.99 and 0.74 for the censored quantileregression and Cox, respectively. Conclusion: We concluded that being male, not having surgery, longer wait timebetween having symptoms and being diagnosed, low socioeconomic status and old age to be significant risk factors inreducing the probability of survival from esophageal cancer.     

Minocycline Attenuates Depressive‐Like Behaviour Induced by Rat Model of Testicular Torsion: Involvement of Nitric Oxide Pathway

Testicular torsion/detorsion (T/D) can induce depression in pre‐ and post‐pubertal patients. This study was conducted to investigate the psychological impact of testicular torsion and mechanism underlying its depressive‐like behaviour, as well as antidepressant‐like activity of minocycline and possible involvement of nitric oxide (NO)/cyclic GMP pathway in this paradigm in male rats undergoing testicular T/D. Unilateral T/D was performed in 36 male adult Wistar rats, and different doses of minocycline were injected alone or combined with N^ω‐nitro‐l ‐arginine methyl ester (l ‐NAME), non‐specific NO synthase (NOS) inhibitor; aminoguanidine (AG), specific inducible NOS inhibitor; l ‐arginine, an NO precursor; and selective PDE5I, sildenafil. After assessment of locomotor activity in open‐field test, immobility times were recorded in the forced swimming test (FST). Moreover, 30 days after testicular T/D, testicular venous testosterone and serum nitrite concentrations were measured. A correlation was observed between either a decrease in plasma testosterone or an increase in serum nitrite concentrations with prolongation in immobility time in the testicular T/D‐operated rats FST. Minocycline (160 mg/kg) exerted the highest significant antidepressant‐like effect in the operated rats in the FST (p < 0.001). Furthermore, combination of subeffective doses of minocycline (80 mg/kg) and either l ‐NAME (10 mg/kg) or AG (50 mg/kg) demonstrated a significant robust antidepressant‐like activity in T/D group (p < 0.01). Consequently, NO/cGMP pathway was involved in testicular T/D‐induced depressive‐like behaviour and antidepressant‐like activity of minocycline in the animal model. Moreover, a contribution was observed between either decreased testosterone or elevated serum nitrite levels and depressive‐like behaviour following testicular T/D.     

Formulation,in vitro evaluation and kinetic analysis of chitosan–gelatin bilayer muco-adhesive buccal patches of insulin nanoparticles

The present study was performed to optimise the formulation of a muco-adhesive buccal patch for insulin nanoparticles (NPs) delivery. Insulin NPs were synthesised by an ionic gelation technique using N-di methyl ethyl chitosan cysteine (DMEC-Cys) as permeation enhancer biopolymer, tripolyphosphate (TPP) and insulin. Buccal patches were developed by solvent-casting technique using chitosan and gelatine as muco-adhesive polymers. Optimised patches were embedded with 3?mg of insulin-loaded NPs with a homogeneous distribution of NPs in the muco-adhesive matrix, which displayed adequate physico-mechanical properties. The drug release characteristics, release mechanism and kinetics were investigated. Data fitting to Peppas equation with a correlation coefficient indicated that the mechanism of drug release followed an anomalous transport that means drug release was afforded through drug diffusion along with polymer erosion. In vitro drug release, release kinetics, physical and mechanical studies for all patch formulations reflected the ideal characteristics of this buccal patch for the delivery of insulin NPs.     

Is chromium an important element in HIV-positive patients with metabolic abnormalities? An hypothesis generating pilot study

BACKGROUND: Chromium plays a role in insulin sensitivity. OBJECTIVES: To compare chromium measurements in HIV-positive patients with or without (N) antiretroviral therapy (ART) to that of healthy controls (HC) and, to determine if there is any association between chromium levels and abnormalities in body composition, glucose and lipid metabolism. DESIGN: A cross-sectional study in 91 HIV patients (75 HIV-ART, 16 HIV-N) and 13 HC. Chromium was assessed in the diet, plasma, toenails, and urine. Fasting blood glycemia and lipids, lipodystrophy score and body fat were also determined. RESULTS: Dietary intake of chromium was similar in the 3 groups. Plasma and toenail Cr were lower in HIV compared to HC, but urinary chromium was similar. However, when the HIV-positive patients on ART were compared to those who were na?ve to therapies, urinary excretion of chromium was higher in HIV-ART. In addition, urinary excretion of chromium significantly and positively correlated with lipodystrophy score and negatively with various parameters of metabolic syndrome. CONCLUSION: Despite a similar dietary intake, chromium levels were lower in HIV-positive patients and urinary chromium excretion correlated with some metabolic parameters. Low chromium levels may be due to increased chromium losses. These results support further studies on chromium in HIV patients.     

CPAF,HSP60 and MOMP antigens elicit pro-inflammatory cytokines production in the peripheral blood mononuclear cells from genital Chlamydia trachomatis-infected patients

Background

Persistent inflammation caused by Chlamydia trachomatis in the female genital compartment represents one of the major causes of pelvic inflammatory disease (PID), ectopic pregnancy and infertility in females. Here, we examined the pro-inflammatory cytokine response following stimulation with three different types of C. trachomatis antigens, viz. chlamydial protease-like factor (CPAF), heat shock protein 60 (HSP60) and major outer membrane protein (MOMP).

Lived experiences of young adults facing a recent diagnosis of cancer: A phenomenological study

Introduction

Young adulthood is a period of prosperity and freshness characterized by developmental achievement, which can be inhibited by various diseases such as cancer. Typically considered a terminal disease, if diagnosed in young adulthood, cancer may trigger a tremendous psychosomatic shock. The nature of facing a recent cancer diagnosis affects the whole coping process. Addressing young adults' experiences at the confirmation point of cancer diagnosis will facilitate supporting them through the early recognition of probable problems in the future. Therefore, the present study aimed to analyse the lived experiences of young adults facing a recent cancer diagnosis.

Methods

This qualitative study adopted an interpretive phenomenology design. In this study, 12 patients (with an age range of 20–40) were selected using the purposive sampling method. Data collection was done through in-depth, semistructured interviews. The data were analysed following the method proposed by Diekelmann et al.

Findings

Three main themes and nine subthemes were extracted from the data: (1) spiritual detachment and then acceptance through spirituality in the form of denial and then forced acceptance, sense of guilt and spiritual help-seeking, and anger towards God and then humbleness, (2) the shock of facing an extraordinary life shaped by disturbed role-play and unusual lifestyle, (3) anticipatory anxiety concerning the sense of rejection, negative perspective towards future, inability to afford the costs and worries about the future of the family members.

Conclusion

This was the first study providing significant insights into the experiences of young adults facing a recent cancer diagnosis. The diagnosis of cancer can shadow all aspects of young adults' lives. The findings of the present study empower healthcare professionals to provide newly diagnosed young adults with appropriate health services.

Patient Contributions

To identify and recruit the participants, we explained the objectives of the present study to the unit managers either by phone or in person. The participants were approached and interviewed by three authors. Participation was voluntary and the participants received no financial contribution for their time.     

Two superoxide dismutase prion strains transmit amyotrophic lateral sclerosis–like disease

Amyotrophic lateral sclerosis (ALS) is an adult-onset degeneration of motor neurons that is commonly caused by mutations in the gene encoding superoxide dismutase 1 (SOD1). Both patients and Tg mice expressing mutant human SOD1 (hSOD1) develop aggregates of unknown importance. In Tg mice, 2 different strains of hSOD1 aggregates (denoted A and B) can arise; however, the role of these aggregates in disease pathogenesis has not been fully characterized. Here, minute amounts of strain A and B hSOD1 aggregate seeds that were prepared by centrifugation through a density cushion were inoculated into lumbar spinal cords of 100-day-old mice carrying a human SOD1 Tg. Mice seeded with A or B aggregates developed premature signs of ALS and became terminally ill after approximately 100 days, which is 200 days earlier than for mice that had not been inoculated or were given a control preparation. Concomitantly, exponentially growing strain A and B hSOD1 aggregations propagated rostrally throughout the spinal cord and brainstem. The phenotypes provoked by the A and B strains differed regarding progression rates, distribution, end-stage aggregate levels, and histopathology. Together, our data indicate that the aggregate strains are prions that transmit a templated, spreading aggregation of hSOD1, resulting in a fatal ALS-like disease.     

Enhancement of role modelling in clinical educators: A randomized controlled trial

Abstract

Introduction: Role models have an important impact on the professional behavior of medical students. Previous investigations help us understand how to improve role modelling. However, studies aiming at enhancing role modelling among clinical educators are very limited and generally lack comprehensive evaluations of the designed programs. We intended to gather robust evidence on the effectiveness of a longitudinal program for enhancing role modelling.

Methods: Clinical educators were divided into intervention and control groups. The longitudinal program, developed based on the exposure phase of the ‘Positive Doctor Role Modelling’ framework, was delivered during three months of onsite and online sessions. The effectiveness of the program was assessed in three levels of reaction, learning, and behavior.

Results: In the intervention group (N?=?18), the mean score of satisfaction was 4.7 (SD?=?0.5), and the learning (awareness about role modelling) improved significantly after the program (3.33–4.34), comparing to the control group (3.53–3.63). There was no significant difference in terms of behavior improvement between the two groups, before and after the program.

Conclusions: Our findings indicate that our longitudinal faculty development program on role modelling was highly appreciated by clinical educators, and improved their awareness and deliberate role modelling.     

Prevalence and associated features of restless legs syndrome in a population of Iranian women during pregnancy

Objective

To investigate the prevalence of restless legs syndrome (RLS) during pregnancy and to evaluate factors associated with RLS in a population of Iranian pregnant women.

Methods

In the present cross-sectional study, 443 consecutive pregnant women admitted for delivery underwent an interview within 2 days of parturition. The diagnosis of RLS was established by the 4 criteria of the International Restless Legs Syndrome Study Group (IRLSSG). The severity of RLS was assessed through the IRLSSG Rating Scale.

Results

Seventy-nine (17.8%) women met the RLS diagnostic criteria, with most (74.7%) having RLS of moderate severity. The mean RLS duration before delivery was 3.1 ± 2.1 months among 69 (87.3%) women; 10 (12.7%) had RLS onset before pregnancy. Sleep disturbances including insomnia and early awakening were significantly more common among women with RLS than among those without (P < 0.001), and the frequency of cesarean delivery was also significantly higher (58.2% versus 44.5%, P = 0.027; odds ratio 2.4). There were no significant differences between the 2 groups in terms of age, number of pregnancies, folate and iron supplementation, hemoglobin level, and neonatal anthropometric data.

Conclusion

Restless legs syndrome is common during pregnancy and is associated with poor sleep and an increased risk of cesarean delivery.