Showing papers by "Shahid Beheshti University of Medical Sciences and Health Services published in 2015"

Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication

Abstract: Introduction: The importance of content validity in the instrument psychometric and its relevance with reliability, have made it an essential step in the instrument development. This article attempts to give an overview of the content validity process and to explain the complexity of this process by introducing an example. Methods: We carried out a methodological study conducted to examine the content validity of the patient-centered communication instrument through a two-step process (development and judgment). At the first step, domain determination, sampling (item generation) and instrument formation and at the second step, content validity ratio, content validity index and modified kappa statistic was performed. Suggestions of expert panel and item impact scores are used to examine the instrument face validity. Results: From a set of 188 items, content validity process identified seven dimensions includes trust building (eight items), informational support (seven items), emotional support (five items), problem solving (seven items), patient activation (10 items), intimacy/friendship (six items) and spirituality strengthening (14 items). Content validity study revealed that this instrument enjoys an appropriate level of content validity. The overall content validity index of the instrument using universal agreement approach was low; however, it can be advocated with respect to the high number of content experts that makes consensus difficult and high value of the S-CVI with the average approach, which was equal to 0.93. Conclusion: This article illustrates acceptable quantities indices for content validity a new instrument and outlines them during design and psychometrics of patient-centered communication measuring instrument.

Human intracellular ISG15 prevents interferon-α/β over-amplification and auto-inflammation

Abstract: Intracellular ISG15 is an interferon (IFN)-α/β-inducible ubiquitin-like modifier which can covalently bind other proteins in a process called ISGylation; it is an effector of IFN-α/β-dependent antiviral immunity in mice. We previously published a study describing humans with inherited ISG15 deficiency but without unusually severe viral diseases. We showed that these patients were prone to mycobacterial disease and that human ISG15 was non-redundant as an extracellular IFN-γ-inducing molecule. We show here that ISG15-deficient patients also display unanticipated cellular, immunological and clinical signs of enhanced IFN-α/β immunity, reminiscent of the Mendelian autoinflammatory interferonopathies Aicardi-Goutieres syndrome and spondyloenchondrodysplasia. We further show that an absence of intracellular ISG15 in the patients' cells prevents the accumulation of USP18, a potent negative regulator of IFN-α/β signalling, resulting in the enhancement and amplification of IFN-α/β responses. Human ISG15, therefore, is not only redundant for antiviral immunity, but is a key negative regulator of IFN-α/β immunity. In humans, intracellular ISG15 is IFN-α/β-inducible not to serve as a substrate for ISGylation-dependent antiviral immunity, but to ensure USP18-dependent regulation of IFN-α/β and prevention of IFN-α/β-dependent autoinflammation.

Part 1: Simple Definition and Calculation of Accuracy, Sensitivity and Specificity.

Abstract: Emergency physicians, like other specialists, are faced with different patients and various situations each day. They have to use ancillary diagnostic tools like laboratory tests and imaging studies to be able to manage them. In most cases, numerous tests are available. Tests with the least error and the most accuracy are more desirable. The power of a test to separate patients from healthy ones determines its accuracy and diagnostic value. Therefore, a test with 100% accuracy should be the first choice. This does not happen in reality as the accuracy of a test varies for different diseases and in different situations. For example, the value of D-dimer for diagnosing pulmonary embolism varies based on pre-test probability. It shows high accuracy in low risk patient and low accuracy in high risk ones. The characteristics of a test that reflects the aforementioned abilities are accuracy, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios. In this educational review, we will simply define and calculate the accuracy, sensitivity, and specificity of a hypothetical test.

Human TYK2 deficiency: Mycobacterial and viral infections without hyper-IgE syndrome

Abstract: Autosomal recessive, complete TYK2 deficiency was previously described in a patient (P1) with intracellular bacterial and viral infections and features of hyper-IgE syndrome (HIES), including atopic dermatitis, high serum IgE levels, and staphylococcal abscesses. We identified seven other TYK2-deficient patients from five families and four different ethnic groups. These patients were homozygous for one of five null mutations, different from that seen in P1. They displayed mycobacterial and/or viral infections, but no HIES. All eight TYK2-deficient patients displayed impaired but not abolished cellular responses to (a) IL-12 and IFN-α/β, accounting for mycobacterial and viral infections, respectively; (b) IL-23, with normal proportions of circulating IL-17+ T cells, accounting for their apparent lack of mucocutaneous candidiasis; and (c) IL-10, with no overt clinical consequences, including a lack of inflammatory bowel disease. Cellular responses to IL-21, IL-27, IFN-γ, IL-28/29 (IFN-λ), and leukemia inhibitory factor (LIF) were normal. The leukocytes and fibroblasts of all seven newly identified TYK2-deficient patients, unlike those of P1, responded normally to IL-6, possibly accounting for the lack of HIES in these patients. The expression of exogenous wild-type TYK2 or the silencing of endogenous TYK2 did not rescue IL-6 hyporesponsiveness, suggesting that this phenotype was not a consequence of the TYK2 genotype. The core clinical phenotype of TYK2 deficiency is mycobacterial and/or viral infections, caused by impaired responses to IL-12 and IFN-α/β. Moreover, impaired IL-6 responses and HIES do not appear to be intrinsic features of TYK2 deficiency in humans.

Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial).

Abstract: Introduction: Knee osteoarthritis (OA) is the most common articular disease. Different methods are used to alleviate the symptoms of patients with knee OA, including analgesics, physical therapy, exercise prescription, and intra-articular injections (glucocorticoids, hyaluronic acid [HA], etc). New studies have focused on modern therapeutic methods that stimulate cartilage healing process and improve the damage, including the use of platelet-rich plasma (PRP) as a complex of growth factors. Due to the high incidence of OA and its consequences, we decided to study the long-term effect of intra-articular injection of PRP and HA on clinical outcome and quality of life of patients with knee OA. Method: This non-placebo-controlled randomized clinical trial involved 160 patients affected by knee OA, grade 1–4 of Kellgren–Lawrence scale. In the PRP group (n = 87), two intra-articular injections at 4-week interval were applied, and in the HA group (n = 73), three doses of intra-articular injection at 1-week interval were applied. All patients were prospectively evaluated before and at 12 months after the treatment by Western Ontario and McMaster Universities Arthritis Index (WOMAC) and SF-36 questionnaires. The results were analyzed using SPSS 16.1 software (RCT code: IRCT2014012113442N5). Results: At the 12-month follow-up, WOMAC pain score and bodily pain significantly improved in both groups; however, better results were determined in the PRP group compared to the HA group (P < 0.001). Other WOMAC and SF-36 parameters improved only in the PRP group. More improvement (but not statistically significant) was achieved in patients with grade 2 OA in both the groups. Conclusion: This study suggests that PRP injection is more efficacious than HA injection in reducing symptoms and improving quality of life and is a therapeutic option in select patients with knee OA who have not responded to conventional treatment.

Burden of Hepatitis C in Iran Between 1990 and 2010: findings from the Global Burden of Disease Study 2010.

Abstract: BACKGROUND: Hepatitis C virus (HCV) is the foremost cause of deaths attributable tocirrhosis and hepatocellular carcinoma. The Global Burden of Disease (GBD) study from 2010 quantifies and compares the degree of health loss as a result of diseases, injuries, and risk factors by age, sex, and geography overtime. This study aimed to present and critique the burden of hepatitis C and its trend in Iran between 1990 and 2010 by using the GBD 2010 study. METHODS: We used results of GBD 2010 between 1990 and 2010 for Iran to measure rates and trends for mortality, causes of deaths, years of life lost (YLLs), years lived with disability (YLDs), anddisability-adjusted lifeyears (DALYs). Hepatitis C was defined as the presence of hepatitis C virus in the serum. Data were presented in three categories: acute hepatitis C, cirrhosis secondary to hepatitis C, and liver cancer secondary to hepatitis C. RESULTS: HCV infection (including the three categories of the study) led to 57.29, 59.92, and 66.45 DALYs (per 100,000 population) in 1990, 2000, and 2010, respectively. DALYs and death rates showed a slight decreasing trend for HCV cirrhosis; however, DALYs and death rates increased for acute hepatitis and liver cancer due to patients with HCV. The majority of deaths and DALYs were in individuals aged 70 years and above in all three categories of HCV. YLLs made the greatest contributions to DALYs. CONCLUSION: DALYs due to HCV infection are increasing in Iran according to GBD 2010; however, the estimations of DALYs using GBD 2010 are mostly from model-based data and there are significant uncertainties for extrapolated data. In this regard, acomprehensive study such asthe National and Subnational Burden of Diseases (NASBOD) study would be needed to estimate and calculate precisely prevalence and burden of HCV-related disease at national and subnational levels.

Household recycling knowledge, attitudes and practices towards solid waste management

Abstract: A questionnaire survey consisting of 2400 householders was performed on Abadan residents to evaluate their knowledge, attitudes, and practices (KAP) towards solid waste (SW) reduction, source separation and recycling, collection and willingness to pay (WTP) for SW services. The study has also covered the relationship between demographic variables and KAP towards SW management. The data analyzed suggests that the studied community had a very positive attitude to take part in SW source separation and recycling plans. However, the respondents not only showed low intimate knowledge of different steps of SW management, but were also weak to take practices about these steps. The KAP of SW source separation and recycling was influenced by demographic factors of age, education level, gender and occupation. It was further found that education level and occupation were two significant factors affecting residents’ WTP (χ2 = 24.083, p-value

Pre-treatment with metformin activates Nrf2 antioxidant pathways and inhibits inflammatory responses through induction of AMPK after transient global cerebral ischemia.

Abstract: Global cerebral ischemia arises in patients who have a variety of clinical conditions including cardiac arrest, shock and asphyxia. In spite of advances in understanding of the brain ischemia and stroke etiology, therapeutic approaches to improve ischemic injury still remain limited. It has been established that metformin can attenuate cell death in cerebral ischemia. One of the main functions of metformin is proposed to be conducted via AMP-activated protein kinase (AMPK)-dependent pathway in the experimental cerebral ischemia model. It is also established that metformin can suppress inflammation and activate Nuclear factor erythroid 2-related factor (Nrf2) pathways in neurons. In the current study, the role of metformin in regulating inflammatory and antioxidant pathways in the global cerebral ischemia was investigated. Our results indicated that pretreatment of rats by metformin attenuated cellular levels of nuclear factor-κB, Tumor Necrosis Factor alpha and Cyclooxygenase-2 which are considered as three important proteins involved in the inflammation pathway. Pretreatment by metformin increased the level of Nrf2 and heme oxygenase-1 in the hippocampus of ischemic rats compared with untreated ischemic group. Moreover, pretreatment by metformin enhanced the level of glutathione and catalase activities compared with them in ischemic group. Such protective changes detected by metformin pretreatment were reversed by injecting compound c, an AMPK inhibitor. These findings suggested that metformin might protect cells through modulating inflammatory and antioxidant pathways via induction of AMPK. However, more experimental and clinical trial studies regarding neuroprotective potential of metformin and the involved mechanisms, especially in the context of cerebral ischemic injuries, are necessary.

A review on colistin nephrotoxicity.

Abstract: Colistin is an antibiotic that was introduced many years ago and was withdrawn because of its nephrotoxicity. Nowadays, reemergence of this antibiotic for multi-drug resistant Gram-negative infections, and a new high dosing regimen recommendation increases concern about its nephrotoxicity. This review attempts to give a view on colistin nephrotoxicity, its prevalence especially in high doses, the mechanism of injury, risk factors, and prevention of this kidney injury. The data collection was done in PubMed, Scopus and Cochrane databases. The keywords for search terms were “colistin”, “nephrotoxicity”, “toxicity”, “renal failure”, “high dose”, and “risk factor”. Randomized clinical trials and prospective or retrospective observational animal and human studies were included. In all, 60 articles have been reviewed. Colistin is a nephrotoxic antibiotic; a worldwide increase in nosocomial infections has led to an increase in its usage. Nephrotoxicity is the concerning adverse effect of this drug. The mechanism of nephrotoxicity is via an increase in tubular epithelial cell membrane permeability, which results in cation, anion and water influx leading to cell swelling and cell lysis. There are also some oxidative and inflammatory pathways that seem to be involved in colistin nephrotoxicity. Risk factors of colistin nephrotoxicity can be categorized as dose and duration of colistin therapy, co-administration of other nephrotoxic drugs, and patient-related factors such as age, sex, hypoalbuminemia, hyperbilirubinemia, underlying disease and severity of patient illness.

Inherited and acquired immunodeficiencies underlying tuberculosis in childhood.

Abstract: Tuberculosis (TB), caused by Mycobacterium tuberculosis (M.tb) and a few related mycobacteria, is a devastating disease, killing more than a million individuals per year worldwide. However, its pathogenesis remains largely elusive, as only a small proportion of infected individuals develop clinical disease either during primary infection or during reactivation from latency or secondary infection. Subacute, hematogenous, and extrapulmonary disease tends to be more frequent in infants, children, and teenagers than in adults. Life-threatening primary TB of childhood can result from known acquired or inherited immunodeficiencies, although the vast majority of cases remain unexplained. We review here the conditions conferring a predisposition to childhood clinical diseases caused by mycobacteria, including not only M.tb but also weakly virulent mycobacteria, such as BCG vaccines and environmental mycobacteria. Infections with weakly virulent mycobacteria are much rarer than TB, but the inherited and acquired immunodeficiencies underlying these infections are much better known. Their study has also provided genetic and immunological insights into childhood TB, as illustrated by the discovery of single-gene inborn errors of IFN-γ immunity underlying severe cases of TB. Novel findings are expected from ongoing and future human genetic studies of childhood TB in countries that combine a high proportion of consanguineous marriages, a high incidence of TB, and an excellent clinical care, such as Iran, Morocco, and Turkey.

A comparative study of electrocoagulation, electrochemical Fenton, electro-Fenton and peroxi-coagulation for decolorization of real textile wastewater: Electrical energy consumption and biodegradability improvement

Abstract: The main problem of textile wastewater is strong color which must be removed before discharge to the environment. Electrochemical processes have been separately studied for decolorization of synthetic dyes and colored wastewater. In this study, iron-based electrochemical processes including electrocoagulation (EC), electrochemical Fenton (ECF), electro-Fenton (EF) and peroxi-coagulation (PC) were applied for real textile wastewater decolorization in similar conditions. The effects of initial pH, electrical current and electrolysis time on decolorization were evaluated. COD removal, electrical energy consumption, iron consumption and BOD 5 /COD ratio of each process were compared. All the processes sufficiently removed color from the wastewater in as much as between 77% and 94% decolorization efficiency was gained. The results indicated that decolorization efficiency in EC and EF processes was strongly dependent on initial pH. At optimum conditions, the highest energy consumption and iron consumption were found in EF and PC respectively. Electrochemical processes based on Fenton reagent (ECF, EF and PC) enhanced BOD 5 /COD ratio from 0.137 to over 0.3 while EC process could not increase BOD 5 /COD ratio significantly. All the processes followed the second order kinetic for COD parameter in optimum conditions. As a comparison from the obtained results, the ECF process was more effective than the other processes with regard to color and COD removals.

Relationship between ICU nurses’ moral distress with burnout and anticipated turnover

Abstract: Background:Moral distress is one of intensive care unit nurses’ major problems, which may happen due to various reasons, and has several consequences. Due to various moral distress outcomes in intensive care unit nurses, and their impact on nurses’ personal and professional practice, recognizing moral distress is very important.Research objective:The aim of this study was to determine correlation between moral distress with burnout and anticipated turnover in intensive care unit nurses.Research design:This study is a descriptive-correlation research.Participants and research context:A total of 159 intensive care unit nurses were selected from medical sciences universities in Iran. Data collection instruments included “demographic questionnaire,” “ICU Nurses’ Moral Distress Scale,” “Copenhagen Burnout Inventory” and “Hinshaw and Atwood Turnover Scale.” Data analysis was done by using SPSS19.Ethical considerations:Informed consent from samples and research approval was obtained from Shahid Beheshti Medical ...

Inherited CARD9 deficiency in otherwise healthy children and adults with Candida species-induced meningoencephalitis, colitis, or both

Abstract: Invasive infections of the central nervous system (CNS) or digestive tract caused by commensal fungi of the genus Candida are rare and life-threatening. The known risk factors include acquired and inherited immunodeficiencies, with patients often displaying a history of multiple infections. Cases of meningoencephalitis, colitis, or both caused by Candida species remain unexplained.

Monogenic mutations differentially affect the quantity and quality of T follicular helper cells in patients with human primary immunodeficiencies

Abstract: Background Follicular helper T (T FH ) cells underpin T cell–dependent humoral immunity and the success of most vaccines. T FH cells also contribute to human immune disorders, such as autoimmunity, immunodeficiency, and malignancy. Understanding the molecular requirements for the generation and function of T FH cells will provide strategies for targeting these cells to modulate their behavior in the setting of these immunologic abnormalities. Objective We sought to determine the signaling pathways and cellular interactions required for the development and function of T FH cells in human subjects. Methods Human primary immunodeficiencies (PIDs) resulting from monogenic mutations provide a unique opportunity to assess the requirement for particular molecules in regulating human lymphocyte function. Circulating follicular helper T (cT FH ) cell subsets, memory B cells, and serum immunoglobulin levels were quantified and functionally assessed in healthy control subjects, as well as in patients with PIDs resulting from mutations in STAT3 , STAT1 , TYK2 , IL21 , IL21R , IL10R , IFNGR1/2 , IL12RB1 , CD40LG , NEMO , ICOS , or BTK . Results Loss-of-function (LOF) mutations in STAT3 , IL10R , CD40LG , NEMO , ICOS , or BTK reduced cT FH cell frequencies. STAT3 and IL21/R LOF and STAT1 gain-of-function mutations skewed cT FH cell differentiation toward a phenotype characterized by overexpression of IFN-γ and programmed death 1. IFN-γ inhibited cT FH cell function in vitro and in vivo , as corroborated by hypergammaglobulinemia in patients with IFNGR1/2 , STAT1 , and IL12RB1 LOF mutations. Conclusion Specific mutations affect the quantity and quality of cT FH cells, highlighting the need to assess T FH cells in patients by using multiple criteria, including phenotype and function. Furthermore, IFN-γ functions in vivo to restrain T FH cell–induced B-cell differentiation. These findings shed new light on T FH cell biology and the integrated signaling pathways required for their generation, maintenance, and effector function and explain the compromised humoral immunity seen in patients with some PIDs.

Withholding and Withdrawal of Life-Sustaining Treatments in Intensive Care Units in Asia

Abstract: Importance Little data exist on end-of-life care practices in intensive care units (ICUs) in Asia. Objective To describe physicians’ attitudes toward withholding and withdrawal of life-sustaining treatments in end-of-life care and to evaluate factors associated with observed attitudes. Design, Setting, and Participants Self-administered structured and scenario-based survey conducted among 1465 physicians (response rate, 59.6%) who manage patients in ICUs (May-December 2012) at 466 ICUs (response rate, 59.4%) in 16 Asian countries and regions. Results For patients with no real chance of recovering a meaningful life, 1029 respondents (70.2%) reported almost always or often withholding whereas 303 (20.7%) reported almost always or often withdrawing life-sustaining treatments; 1092 respondents (74.5%) deemed withholding and withdrawal ethically different. The majority of respondents reported that vasopressors, hemodialysis, and antibiotics could usually be withheld or withdrawn in end-of-life care, but not enteral feeding, intravenous fluids, and oral suctioning. For severe hypoxic-ischemic encephalopathy after cardiac arrest, 1201 respondents (82.0% [range between countries, 48.4%-100%]) would implement do-not-resuscitate orders, but 788 (53.8% [range, 6.1%-87.2%]) would maintain mechanical ventilation and start antibiotics and vasopressors if indicated. On multivariable analysis, refusal to implement do-not-resuscitate orders was more likely with physicians who did not value families’ or surrogates’ requests (adjusted odds ratio [AOR], 1.67 [95% CI, 1.16-2.40];P = .006), who were uncomfortable discussing end-of-life care (AOR, 2.38 [95% CI, 1.62-3.51];P Conclusions and Relevance Whereas physicians in ICUs in Asia reported that they often withheld but seldom withdrew life-sustaining treatments at the end of life, attitudes and practice varied widely across countries and regions. Multiple factors related to country or region, including economic, cultural, religious, and legal differences, as well as personal attitudes, were associated with these variations. Initiatives to improve end-of-life care in Asia must begin with a thorough understanding of these factors.

Burden of gastrointestinal cancer in Asia; an overview

Abstract: The cancers in the digestive system including gastric cancer, colorectal cancer, liver cancer, esophageal cancer and pancreatic cancer are one of the most common cancers in Asia. The burden of GI cancer is increasing in Asia because of aging, growth of the population and the risk factors including smoking, obesity, changing lifestyle and high prevalence of H pylori, HBV and HCV. In most Asian countries, cancer control programs or early detection and treatment services are limited despite this increase. There are many people in the developing countries inside Asia who have no health insurance and many of them are too poor to go for screening tests, early detection or medical treatments. Therefore, it is important for the health organizations and governments in each country to recognize these groups and reduce the incidence and mortality of gastrointestinal cancers, using simple and economic screening test, vaccination and changing risk factors such as smoking, diet and lifestyle by education programs.

MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation

Abstract: Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.

Interaction of Pattern Recognition Receptors with Mycobacterium Tuberculosis

Abstract: Tuberculosis (TB) is considered a major worldwide health problem with 10 million new cases diagnosed each year. Our understanding of TB immunology has become greater and more refined since the identification of Mycobacterium tuberculosis (MTB) as an etiologic agent and the recognition of new signaling pathways modulating infection. Understanding the mechanisms through which the cells of the immune system recognize MTB can be an important step in designing novel therapeutic approaches, as well as improving the limited success of current vaccination strategies. A great challenge in chronic disease is to understand the complexities, mechanisms, and consequences of host interactions with pathogens. Innate immune responses along with the involvement of distinct inflammatory mediators and cells play an important role in the host defense against the MTB. Several classes of pattern recognition receptors (PRRs) are involved in the recognition of MTB including Toll-Like Receptors (TLRs), C-type lectin receptors (CLRs) and Nod-like receptors (NLRs) linked to inflammasome activation. Among the TLR family, TLR1, TLR2, TLR4, and TLR9 and their down-stream signaling proteins play critical roles in the initiation of the immune response in the pathogenesis of TB. The inflammasome pathway is associated with the coordinated release of cytokines such as IL-1β and IL-18 which also play a role in the pathogenesis of TB. Understanding the cross-talk between these signaling pathways will impact on the design of novel therapeutic strategies and in the development of vaccines and immunotherapy regimes. Abnormalities in PRR signaling pathways regulated by TB will affect disease pathogenesis and need to be elucidated. In this review we provide an update on PRR signaling during M. tuberculosis infection and indicate how greater knowledge of these pathways may lead to new therapeutic opportunities.

The effects of resveratrol supplementation on cardiovascular risk factors in patients with non-alcoholic fatty liver disease: a randomised, double-blind, placebo-controlled study

Abstract: Non-alcoholic fatty liver disease (NAFLD) is usually associated with insulin resistance, central obesity, reduced glucose tolerance, type 2 diabetes mellitus and hypertriacylglycerolaemia. The beneficial effects of resveratrol on metabolic disorders have been shown previously. The aim of this study was to evaluate the effects of resveratrol supplementation on cardiovascular risk factors in patients with NAFLD. In this randomised double-blinded placebo-controlled clinical trial, fifty NAFLD patients were supplemented with either a 500-mg resveratrol capsule or a placebo capsule for 12 weeks. Both groups were advised to follow an energy-balanced diet and physical activity recommendations. resveratrol supplementation reduced alanine aminotransferase (ALT) and hepatic steatosis significantly more than placebo (P 0·05). There were no significant changes in blood pressure, insulin resistance markers and TAG in either group (P>0·05). Our data have shown that 12-week supplementation of 500 mg resveratrol does not have any beneficial effect on anthropometric measurements, insulin resistance markers, lipid profile and blood pressure; however, it reduced ALT and hepatic steatosis in patients with NAFLD.

A green one-pot three-component synthesis of tetrahydrobenzo[b]pyran and 3,4-dihydropyrano[c]chromene derivatives using a Fe3O4@SiO2–imid–PMAn magnetic nanocatalyst under ultrasonic irradiation or reflux conditions

Abstract: An efficient and environmentally benign procedure for the synthesis of tetrahydrobenzo[b]pyran and 3,4-dihydropyrano[c]chromene derivatives has been developed by a one-pot three-component reaction of various aldehydes, malononitrile, and dimedone or hydroxycoumarin in the presence of Fe3O4@SiO2–imid–PMAn nanoparticles as magnetic catalysts under ultrasonic irradiation or reflux conditions in water. This new procedure has notable advantages such as operational simplicity, excellent yields, short reaction time, and absence of any tedious workup or purification. In addition, the excellent catalytic performance in a water medium and the easy preparation, thermal stability and separation of the catalyst make it a good heterogeneous system and a useful alternative to other heterogeneous catalysts. Also, the catalyst can be easily recovered by a magnetic field and reused for eight consecutive reaction cycles without significant loss of activity.

Exercise-Induced Oxidative Stress and Dietary Antioxidants

Abstract: Context: Overproduction of reactive oxygen and nitrogen species during physical exercise, exercise induced oxidative stress and antioxidant supplementation is interesting and controversial concepts that have been considered during the past decades. Evidence Acquisition: In this review, we aimed to summarize current evidence in relation to antioxidant supplementation outcomes during exercise and physical activity. For this aim, we obtained relevant articles through searches of the Medline and PubMed databases between 1980 to 2013. Although major studies have indicated that antioxidants could attenuate biomarkers of exercise-induced oxidative stress and the use of antioxidant supplement is a common phenomenon among athletes and physically active people, there are some doubts regarding the benefits of these. Results: It seems that the best recommendations regarding antioxidants and exercise are having a balanced diet rich in natural antioxidants and phytochemicals. Conclusions: Regular consumption of various fresh fruits and vegetables, whole grains, legumes and beans, sprouts and seeds is an effective and safe way to meet all antioxidant requirements in physically active persons and athletes.

A novel risk score to predict cardiovascular disease risk in national populations (Globorisk): A pooled analysis of prospective cohorts and health examination surveys

Abstract: Background Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information. Methods We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation and data from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA). Findings The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5–10% of men and women had more than a 10% risk, and 62–76% of men and 79–82% of women had less than a 3% risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas in Mexico, the prevalence of this high risk was 15% for men and 11% for women. The prevalence of less than a 3% risk was 37% for men and 42% for women in China, and 54% for men and 68% for women in Mexico. Interpretation We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries. Funding US National Institutes of Health, UK Medical Research Council, Wellcome Trust.

Smart scaffolds in bone tissue engineering: A systematic review of literature

Abstract: AIM: To improve osteogenic differentiation and attachment of cells. METHODS: An electronic search was conducted in PubMed from January 2004 to December 2013. Studies which performed smart modifications on conventional bone scaffold materials were included. Scaffolds with controlled release or encapsulation of bioactive molecules were not included. Experiments which did not investigate response of cells toward the scaffold (cell attachment, proliferation or osteoblastic differentiation) were excluded. RESULTS: Among 1458 studies, 38 met the inclusion and exclusion criteria. The main scaffold varied extensively among the included studies. Smart modifications included addition of growth factors (group I-11 studies), extracellular matrix-like molecules (group II-13 studies) and nanoparticles (nano-HA) (group III-17 studies). In all groups, surface coating was the most commonly applied approach for smart modification of scaffolds. In group I, bone morphogenetic proteins were mainly used as growth factor stabilized on polycaprolactone (PCL). In group II, collagen 1 in combination with PCL, hydroxyapatite (HA) and tricalcium phosphate were the most frequent scaffolds used. In the third group, nano-HA with PCL and chitosan were used the most. As variable methods were used, a thorough and comprehensible compare between the results and approaches was unattainable. CONCLUSION: Regarding the variability in methodology of these in vitro studies it was demonstrated that smart modification of scaffolds can improve tissue properties.

Non-Celiac Gluten Sensitivity Has Narrowed the Spectrum of Irritable Bowel Syndrome: A Double-Blind Randomized Placebo-Controlled Trial.

Abstract: Several studies have shown that a large number of patients who are fulfilling the criteria for irritable bowel syndrome (IBS) are sensitive to gluten. The aim of this study was to evaluate the effect of a gluten-free diet on gastrointestinal symptoms in patients with IBS. In this double-blind randomized, placebo-controlled trial, 148 IBS patients fulfilling the Rome III criteria were enrolled between 2011 and 2013. However, only 72 out of the 148 commenced on a gluten-free diet for up to six weeks and completed the study; clinical symptoms were recorded biweekly using a standard visual analogue scale (VAS). In the second stage after six weeks, patients whose symptoms improved to an acceptable level were randomly divided into two groups; patients either received packages containing powdered gluten (35 cases) or patients received placebo (gluten free powder) (37 cases). Overall, the symptomatic improvement was statistically different in the gluten-containing group compared with placebo group in 9 (25.7%), and 31 (83.8%) patients respectively (p < 0.001). A large number of patients labelled as irritable bowel syndrome are sensitive to gluten. Using the term of IBS can therefore be misleading and may deviate and postpone the application of an effective and well-targeted treatment strategy in gluten sensitive patients.