Seventeen Years’ Experience of Peritoneal Dialysis in Iran: First Official Report of the Iranian Peritoneal Dialysis Registry

♦ Background: To facilitate planning, national renal registries provide reliable and up-to-date information on numbers of patients with end-stage renal disease (ESRD), developing trends, treatment modalities, and outcomes. To that end, the present publication represents the first official report from Iranian Peritoneal Dialysis Registry.♦ Methods: The prevalence, demographics, and clinical characteristics of patients on peritoneal dialysis (PD) were collected from all PD centers throughout the country.♦ Results: By the end of 2009, the prevalence of ESRD was 507 per million population in Iran. The most common renal replacement modality was hemodialysis (51.2%), followed by kidney transplantation (44.7%), and then PD (4.1%). The mean age of PD patients was 46 years, and the most common causes of ESRD were diabetes (33.5%), hypertension (24.4%), and glomerulonephritis (8.2%). Overall patient mortality was 25%, with cardiac events (46%), cerebral stroke (10%), and infection (8%) being the main causes of death. The 1-, 3-, and 5-year survivals were 89%, 64%, and 49% respectively. The most common cause of dropout was peritonitis (17.6%). Staphylococcus (coagulase-negative and S. aureus) was the most prevalent causative organism in peritonitis episodes; however, in more than 50% of episodes, a sterile culture was reported. Mean baseline serum hemoglobin and albumin were 10.7 g/dL and 3.6 g/dL respectively.♦ Conclusions: Our registry results, representing the second largest report of PD in the Middle East, is almost comparable to available regional data. We hope that, in future, we can improve our shortcomings and lessen the gap with developed countries.     

Book Reviews

Aim: The aim of the study was to create reference values for weight, height and body mass index (BMI) of school children living in Tehran.

Method and samples: The study subjects consisted of 1420 girls between 6 and 17 years of age and 1515 boys between 6 and 15 years of age. Samples were collected by a multistage sampling method from schools in different areas of Tehran. All participants were established to be healthy and their height, weight and BMI evaluated. Reference standard values estimated by the LMS method using LMS Light software and 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 97th and 85th (only for BMI) centiles were constructed and the results compared with US reference values.

Results: The centiles provided a good fit to the data. In boys, there were some significant differences of mean standard deviation scores (SDS) of height and BMI from zero, but there were no significant differences in weight. In girls, the mean SDS of height, weight and BMI were significantly lower than zero, especially for 7–9 years of age. Among 12–13-year-old girls, the mean SDS of height, weight and BMI came closer to zero, and the differences were not significant. Thereafter, although girls seemed to be shorter than US reference measures, their weight and BMI did not differ from reference values significantly.

Conclusion: Our results for boys between 6 and 15 years are comparable with US reference values; however, the US reference values, especially for height, are not applicable for Iranian girls between 6 and 17 years.

Résumé.Objectif: Cette étude a pour but d’établir les valeurs de référence du poids, de la stature et de l’indice de masse corporelle (IMC) des écoliers vivant à Téhéran.

Méthode et Echantillons: Les échantillons?: 1420 filles entre 6 et 17 ans et 1515 garçons entre 6 et 15 ans, rassemblés par une méthode d’échantillonnage a stades multiples dans des écoles de différentes parties de Téhéran. On a mesuré la stature, le poids et l’IMC après s’être assuré que tous les participants étaient en bonne santé. Les valeurs des standards de référence ont été estimées par la méthode des moindres carrés au moyen du programme LMS Light. Les 3^ème, 5^ème, 10^ème, 25^ème, 50^ème, 90^ème, 97^ème centiles et le 85ème (uniquement pour l’IMC) ont été construits et les résultats comparés avec les références US.

Résultats: Les centiles permettent un bon ajustement des données. Chez les garçons on observe quelques écarts au zéro significatifs des scores d’écart-type moyen (SETM) pour la stature et l’IMC, mais non pour le poids. Chez les filles, les SETM de la stature, du poids et de l’IMC sont significativement inférieurs à zéro, en particulier pour les sujets entre 7 et 9 ans. Chez les filles âgées de 12 à 13 ans, le SETM de la stature, du poids et de l’IMC sont plus proches de zéro et les différences ne sont pas significatives. Par suite, bien que les filles paraissent plus faibles que les valeurs de référence CDC, leur poids et IMC ne diffèrent pas significativement des valeurs de référence.

Zusammenfassung.Ziel: Das Ziel dieser Studie war, Referenzwerte für Gewicht, Körperhöhe und Körpermasse-Index (body mass index, BMI) für Schulkinder aus Teheran zu konstruieren.

Methode und Stichproben: Die Probanden dieser Studie bestanden aus 1420 Mädchen zwischen 6 und 17 Jahren und 1515 Knaben zwischen 6 and 15 Jahren. Die Stichproben wurden mit einer mehrstufigen Erhebungsmethode in Schulen aus verschiedenen Gegenden von Teheran zusammengestellt. Alle Teilnehmer wurden hinsichtlich Körperhöhe, Gewichts und BMI als gesund betrachtet. Es wurden die Referenzstandardwerte mit LMS-Methode unter Verwendung der LMS Light software bestimmt, die 3., 5., 10., 25., 50., 75., 90., 97. und 85. (nur für BMI) Perzentile konstruiert und die Ergebnisse mit US-Amerikanischen Referenzwerten verglichen.

Ergebnisse: Die Perzentilen ermöglichten eine gute Datenanpassung. Bei Knaben gab es einige signifikante Unterschiede der mittleren z-Werte (standard deviation scores, SDS) für Körperhöhe und BMI von Null, aber es gab keine signifikanten Gewichtsunterschiede. Bei den Mädchen lagen die mittleren SDS für Körperhöhe, Gewicht und BMI signifikant unter Null, besonders im Alter von 7--9 Jahren. Bei den 12--13-jährigen Mädchen lagen die mittleren SDS für Körperhöhe, Gewicht und BMI näher bei Null, und die Unterschiede waren nicht signifikant. Obgleich Mädchen kleiner erschienen als die CDC-Referenzmessungen, waren ihre Gewichte und BMI im späteren Verlauf nicht signifikant von den Referenzwerten verschieden.

Resumen. Objetivo: El objetivo del estudio fue crear valores de referencia para el peso, la estatura y el índice de masa corporal (IMC) de los escolares residentes en Teherán.

Método y Muestras: Los sujetos estudiados fueron 1.420 chicas de entre 6 y 17 años de edad, y 1.515 chicos de entre 6 y 15 años de edad. Las muestras se recogieron mediante el método de muestreo multietapa en escuelas de diferentes áreas de Teherán. Todos los participantes estaban sanos y se evaluó su estatura, peso e IMC. Los valores estándares de referencia fueron estimados con el método LMS, utilizando el programa LMS Light, y se construyeron los centiles 3, 5, 10, 25, 50, 75, 90, 97 y 85 (sólo para el IMC); los resultados fueron comparados con valores de referencia estadounidenses.

Resultados: Los centiles proporcionaron un buen ajuste de los datos. En los chicos, había algunas diferencias significativas de las SDS de la estatura y el IMC con respecto al cero, pero no había diferencias significativas en el peso. En las chicas, las SDS medias de la estatura, el peso y el IMC fueron significativamente menores que cero, especialmente entre los 7-9 años de edad. Entre las chicas de 12-13 años, las SDS medias de la estatura, peso e IMC estaban próximas a cero, y las diferencias no fueron significativas. Por tanto, aunque las chicas parecían ser más bajas que las medidas CDC de referencia, su peso e IMC no diferían significativamente de los valores de referencia.     

β-Adrenergic blockade during reactivation reduces the subjective feeling of remembering associated with emotional episodic memories

In contrast to neutral events, emotionally arousing events often are remembered vividly and with great detail. Although generally adaptive to survival, this emotional memory enhancement may contribute to psychopathology. Blocking the arousal-related noradrenergic activity with a β blocker shortly after learning prevents the emotional enhancement of memory. In the present experiment, we tested in 48 healthy subjects whether the administration of the β blocker propranolol before the reactivation of already consolidated emotional episodic memories may interfere with their reconsolidation and, thus, reduce the subsequent feeling of remembering associated with these memories. Our results show that propranolol before reactivation abolished the superior memory for emotional relative to neutral stimuli and decreased ‘remember’ judgments for emotional items, suggesting that β-adrenergic blockade during reactivation made emotional memories comparable to neutral memories.     

Serum Lipids,Neuroendocrine, and Cardiovascular Responses to Stress in Men and Women with Mild Hypertension

Abstract

In this study, we examined the relation between serum lipid levels, gender, and cardiovascular and neuroendocrine stress reactivity in patients with mild hypertension. Ninety-nine individuals (62 men, 37 women) with mild hypertension performed four mental stress tasks: mental arithmetic, public speaking, cold stress, and a computer videogame. Cardiovascular reactivity scores were computed by subtracting the minimum resting blood pressure (BP) and heart rate (HR) values from the maximum values obtained during each task. Neuroendocrine reactivity was calculated as the change from epinephrine and norepinephrine values from mean rest to mean task. High and low reactors were identified on the basis of median splits of reactivity scores, averaged across all four stressors. High systolic blood pressure reactors had higher levels of total (TC), low-density lipoprotein cholesterol (LDL-C), and apo-B than did low reactors. High diastolic blood pressure reactors had lower levels of high-density lipoprotein cholesterol (HDL-C) and higher levels of LDL-C and apo-B than did low reactors. High HR reactors had higher apo-AI:apo-AII ratios than low reactors. Lipid levels were not different for high and low epinephrine and norepinephrine reactors. Although women were noted to have more favorable lipid profiles than men, both male and female hypertensive patients who were high reactors had less favorable lipid profiles than low reactors.     

Variability of white matter anatomy in the subcallosal cingulate area

The subcallosal cingulate (SCC) area is a putative hub in the brain network underlying depression. Deep brain stimulation (DBS) targeting a particular subregion of SCC, identified as the intersection of forceps minor (FM), uncinate fasciculus (UCF), cingulum and fronto‐striatal fiber bundles, may be critical to a therapeutic response in patients with severe, treatment‐resistant forms of major depressive disorder (MDD). The pattern and variability of the white matter anatomy and organization within SCC has not been extensively characterized across individuals. The goal of this study is to investigate the variability of white matter bundles within the SCC that structurally connect this region with critical nodes in the depression network. Structural and diffusion data from 100 healthy subjects from the Human Connectome Project database were analyzed. Anatomically defined SCC regions were used as seeds to perform probabilistic tractography and to estimate the connectivity from the SCC to subject‐specific target areas believed to be involved in the pathology of MDD including ventral striatum (VS), UCF, anterior cingulate cortex (ACC), and medial prefrontal cortex (mPFC). Four distinct areas of connectivity were identified within SCC across subjects: (a) postero‐lateral SCC connectivity to medial temporal regions via UCF, (b) postero‐medial connectivity to VS, (c) superior‐medial connectivity to ACC via cingulum bundle, and (d) antero‐lateral connectivity to mPFC regions via forceps minor. Assuming white matter connectivity is critical to therapeutic response, the improved anatomic understanding of SCC as well as an appreciation of the intersubject variability are critical to developing optimized therapeutic targeting for SCC DBS.     

Isolated Multiple Bilateral Thyroid Metastases from Prostatic Adenocarcinoma: Case Report and Literature Review

Solitary metastasis from prostate adenocarcinoma to thyroid gland is very rare and usually associated with other distal metastasis. This report describes for the first time isolated multiple bilateral thyroid metastasis from prostatic adenocarcinoma. A 67-year-old man who is known as a case of prostatic adenocarcinoma was admitted to a hospital as a case of a multinodular goiter on the basis of clinical and CT scan findings. Total thyroidectomy was performed and histopathology result showed adenomatous goiter containing bilateral metastatic prostatic adenocarcinoma. This is the first report of isolated multiple bilateral thyroid gland metastasis from prostatic adenocarcinoma without other distal metastasis. Such lesions are very rare and can be misdiagnosed, so high index of suspicion for thyroid metastasis should be always maintained in all oncology patients with isolated thyroid mass because early resection and thyroidectomy will change the prognosis for patient.     

An observational study on the expression levels of MDM2 and MDMX proteins,and associated effects on P53 in a series of human liposarcomas

Background

Inactivation of wild type P53 by its main cellular inhibitors (MDM2 and MDMX) is a well recognised feature of tumour formation in liposarcomas. MDM2 over-expression has been detected in approximately 80% of liposarcomas but only limited information is available about MDMX over-expression. To date, we are not aware of any study that has described the patterns of MDM2 and MDMX co-expression in liposarcomas. Such information has become more pertinent as various novel MDM2 and/or MDMX single and dual affinity antagonist compounds are emerging as an alternative approach for potential targeted therapeutic strategies.

Methods

We analysed a case series of 61 fully characterized liposarcomas of various sub-types by immunohistochemistry, to assess the expression levels of P53, MDM2 and MDMX, simultaneously. P53 sequencing was performed in all cases that expressed P53 protein in 10% or more of cells to rule out mutation-related over-expression.

Results

50 cases over-expressed MDM2 and 42 of these co-expressed MDMX at varying relative levels. The relative expression levels of the two proteins with respect to each other were subtype-dependent. This apparently affected the detected levels of P53 directly in two distinct patterns. Diminished levels of P53 were observed when MDM2 was significantly higher in relation to MDMX, suggesting a dominant role for MDM2 in the degradation of P53. Higher levels of P53 were noted with increasing MDMX levels suggesting an interaction between MDM2 and MDMX that resulted in a reduced efficiency of MDM2 in degrading P53. Of the 26 cases of liposarcoma with elevated P53 expression, 5 were found to have a somatic mutation in the P53 gene.

Conclusions

The results suggest that complex dynamic interactions between MDM2 and MDMX proteins may directly affect the cellular levels of P53. This therefore suggests that careful characterization of both these markers will be necessary in tumours when considering in vivo evaluation of novel blocker compounds for MDM proteins, as a therapeutic strategy to restore wild type P53 function.

     

Investigating Dimensionality of Eskin's Attitudes Toward Suicide Scale with Mokken Scaling and Confirmatory Factor Analysis

Attitudes toward suicide are often investigated by means of questionnaires, most of which are overly long or of low psychometric quality. Eskin's (2004 Eskin , M. ( 2004 ). The effects of religious versus secular education on suicide ideation and suicidal attitudes in adolescents in Turkey . Social Psychiatry and Psychiatric Epidemiology , 39 , 536 – 542 . doi: 10.1007/s00127-004-0769-x [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) Attitudes Towards Suicide Scale is short and first investigations suggest good psychometric properties, but its factor structure has scarcely been explored. Hence, we examined this instrument by a data-analytic approach that combines Mokken scaling and confirmatory factor analysis (CFA). Results revealed 6 factors, of which 1 possessed only weak measurement properties. CFAs indicated only borderline fit of models found in prior research, but adequate fit for the scale structures revealed by Mokken scaling. Psychometric properties of these scales were satisfactory. Both the instrument as well as the methodological approach presented here can be recommended for further research.