Improvement in Activity of Daily Living and Fatigue in Multiple Sclerosis Patients: the Impact of Nutrition Education

Background: Fatigue is one of the most common complications of Multiple Sclerosis (MS). However, a few studies are available on the effect of nutrition education on fatigue and Activities of Daily Living (ADL) in patients with MS. Objectives: This study aimed to assess the effect of nutrition education on fatigue and ability to perform ADL in patients with MS. Methods: This quasi-experimental one group, pretest and posttest study was performed on 40 patients with MS, who were conveniently recruited among patients, registered at the Iranian MS Society. Data were collected through a demographic questionnaire, the Fatigue Severity Scale (FSS), a standard ADL scale, and a 24-hour food recall for two days. The instruments were completed at the start and two months after the intervention. Descriptive statistics and paired t test were used to analyze the data. Results: Sixty percent of the patients had severe fatigue before the intervention while, 90% of them reported mild fatigue after the intervention. The mean posttest ADL was increased by 12.45 units after the intervention when compared with the pretest value (P<0.001). Moreover, the daily intake of vitamin D and E, calcium and omega3 were lower than 75% of the Dietary Reference Intake (DRI) in most of the patients. Conclusions: The present study showed the beneficial effects of nutritional training on fatigue and ADL in patients with MS. Therefore, nurses and dietitians should regularly assess the patients’ dietary pattern and train them and their families about appropriate diet

Manipulating Structure and Properties of Colloidal In2O3 Nanocrystals

Transparent conducting oxides (TCOs) have attracted extensive attention for decades due to their remarkable applications in optoelectronic devices. The development of functional nanostructured TCOs with unique properties, and an expansion of their functionalities are therefore research directions of significant current interest. Among TCOs, In2O3 is widely applied because of its high charge carrier concentration and mobility, as well as the ease with which it can be deposited as a thin film. The important role of surfaces in tuning properties in materials shows the importance of studying nanostructured materials with high surface areas. In this thesis I examined the synthesis of phase-controlled In2O3 nanocrystals (NCs) and showed the effect of doping and composition on the materials properties. Owing to the relevance of size, structure, and composition for manipulating properties of nanomaterials, synthesis of well-defined nanocrystals of pure and doped In2O3 has been of considerable interest for fundamental studies as well as for technological applications. Phase controlled synthesis of colloidal In2O3 NCs was achieved via a size-structure correlation. The study of the morphological and phase transformations of In2O3 NCs during their growth in solution implies that corundum (rh-In2O3) is a transient structure in the formation of cubic bixbyite (bcc-In2O3) phase. The formation of NCs smaller than 5 nm leads to the spontaneous stabilization of metastable phases owing to the surface energy and/or surface stress contributions, both of which are dependent on size. The growth beyond the critical size lowers the potential energy barrier height and causes the nanocrystal phase transformation. In addition, phase transformation of colloidal In2O3 NCs in the temperature range of 210-260 ˚C during their synthesis in solution was studied using a combination of structural and spectroscopic methods, including X-ray diffraction (XRD), transmission electron microscopy (TEM) and extended X-ray absorption fine structure (EXAFS) spectroscopy, and analyzed data using Johnson-Mehl-Avrami-Erofeyev-Kholmogorov (JMAEK) and interface nucleation models. The phase transformation occurs via nucleation of bcc-In2O3 phase at the interface between contacting rh-In2O3 NCs, and propagates rapidly throughout the NC volume. In situ high temperature XRD patterns collected during nonisothermal treatment of In2O3 NCs reveal that phase transformation of smaller NCs occurs at a faster rate and lower temperature, which is associated with the higher packing density and contact formation probability of smaller nanoparticles. Owing to the fact that NC surfaces and interfaces play a key role in phase transformation, their control through the synthesis conditions and reaction kinetics is an effective route to manipulating NC structure and properties. Although, doping semiconductor NCs is crucial for enhancing and manipulating their functional properties, the doping mechanism and the effects of dopants on the nanocrystal growth and structure are not well understood. We show that dopant adsorption to the surfaces of colloidal In2O3 NCs during incorporation inhibit NC growth and leads to the formation of metastable rh-In2O3 for nanocrystals smaller than ca. 5 nm. Direct comparison between Cr3+ and Mn3+ dopants indicates that the nanocrystal structure directly determines the dopant incorporation limits and the dopant electronic structure, and can be predicted and controlled. These results enable a new approach to designing multifunctional nanostructures and understanding the early stages of crystal growth in the presence of impurities. Nanocrystalline films fabricated from colloidal Cr3+- and Mn3+- doped In2O3 nanocrystals exhibit strong ferromagnetic ordering up to room temperature. The absence of ferromagnetism in the free standing transition metal (TM)-doped In2O3 NCs and appearance of ferromagnetism only in TM:In2O3 films prepared from colloidal NCs, are attributed to the formation of extended structural defects, proposed to be oxygen vacancies at the NC interfaces. In fact, in TM:In2O3 NCs with high surface to volume ratios, more oxygen vacancies are present at the surface of NCs and networking of NCs in the prepared film causes an increase in grain-boundary defects at the interfaces. A comparative study of magnetic circular dichroism (MCD) spectra of Cr3+-doped bcc-In2O3 and Cr3+-doped rh-In2O3 revealed that Cr3+ ions distinctly occupy different symmetry sites in corundum and bixbyite crystal structure of In2O3. In fact, a change in the crystal structure of In2O3 from bixbyite to corundum changes the electronic configuration of Cr3+. By manipulating the NC composition and structure in solution we applied a one-step synthesis of ternary gallium indium oxide (GIO) nanocrystals with variable crystal structures. The structures and sizes of GIO NCs can be simultaneously controlled, owing to the difference in the growth kinetics of In2O3 and Ga2O3 NCs, and the polymorphic nature of both materials. These dependences, induced by the interactions between specific defect sites acting as electron donors and acceptors, were used to achieve broad emission tunability in the visible spectral range at room temperature. The nature of the photoluminescence is identified as donor -acceptor pair (DAP) recombination and changes with increasing indium content owing to the changes in the energy states of, and interactions between, donors and acceptors. Structural analysis of GIO nanocrystals by extended X-ray absorption fine structure spectroscopy reveals that In3+ occupies only octahedral, rather than tetrahedral, sites in the spinel-type γ-Ga2O3 nanocrystal host lattice, until reaching the substitutional incorporation limit of ca. 25%. The emission decay dynamics is also strongly influenced by the nanocrystal structure and composition

Dietary protein sources in early adulthood and breast cancer incidence: prospective cohort study

Objective: To investigate the association between dietary protein sources in early adulthood and risk of breast cancer. Design: Prospective cohort study. Setting: Health professionals in the United States. Participants: 88 803 premenopausal women from the Nurses’ Health Study II who completed a questionnaire on diet in 1991. Main outcome measure Incident cases of invasive breast carcinoma, identified through self report and confirmed by pathology report. Results: We documented 2830 cases of breast cancer during 20 years of follow-up. Higher intake of total red meat was associated with an increased risk of breast cancer overall (relative risk 1.22, 95% confidence interval 1.06 to 1.40; Ptrend=0.01, for highest fifth v lowest fifth of intake). However, higher intakes of poultry, fish, eggs, legumes, and nuts were not related to breast cancer overall. When the association was evaluated by menopausal status, higher intake of poultry was associated with a lower risk of breast cancer in postmenopausal women (0.73, 0.58 to 0.91; Ptrend=0.02, for highest fifth v lowest fifth of intake) but not in premenopausal women (0.93, 0.78 to 1.11; Ptrend=0.60, for highest fifth v lowest fifth of intake). In estimating the effects of exchanging different protein sources, substituting one serving/day of legumes for one serving/day of red meat was associated with a 15% lower risk of breast cancer among all women (0.85, 0.73 to 0.98) and a 19% lower risk among premenopausal women (0.81, 0.66 to 0.99). Also, substituting one serving/day of poultry for one serving/day of red meat was associated with a 17% lower risk of breast cancer overall (0.83, 0.72 to 0.96) and a 24% lower risk of postmenopausal breast cancer (0.76, 0.59 to 0.99). Furthermore, substituting one serving/day of combined legumes, nuts, poultry, and fish for one serving/day of red meat was associated with a 14% lower risk of breast cancer overall (0.86, 0.78 to 0.94) and premenopausal breast cancer (0.86, 0.76 to 0.98). Conclusion: Higher red meat intake in early adulthood may be a risk factor for breast cancer, and replacing red meat with a combination of legumes, poultry, nuts and fish may reduce the risk of breast cancer

Adolescent fiber intake and mammographic breast density in premenopausal women

Background: To date, there is limited and inconsistent epidemiologic evidence for associations of adolescent diet with mammographic breast density, a strong and consistent predictor of breast cancer. We investigated the association of adolescent fiber intake with mammographic density in premenopausal women. Methods: This study included 743 cancer-free premenopausal women (mean age, 44.9 years) within the Nurses’ Health Study II cohort. Percent breast density, absolute dense and non-dense areas were measured from digitized film mammograms using a computer-assisted thresholding technique. Adolescent and adult diet were assessed with a food frequency questionnaire; energy-adjusted nutrient intakes were estimated for each food item. Information regarding breast cancer risk factors was obtained from baseline or biennial questionnaires closest to the mammogram date. We used generalized linear regression to quantify associations between quartiles of adolescent fiber intake and each of the breast density measures, adjusted for potential confounders. Associations were examined separately for total fiber intake; fiber from fruits, vegetables, legumes, and cereal; and food sources of fiber (fruits, vegetables, and nuts). Results: In multivariable analyses, total fiber intake during adolescence was not associated with percent breast density (p for trend = 0.64), absolute dense area (p for trend = 0.80), or non-dense area (p for trend = 0.75). Similarly, neither consumption of fiber from fruits, vegetables, legumes, or cereal nor specific sources of fiber intake (fruits, vegetables, or nuts) during adolescence were associated with any of the mammographic density phenotypes. Conclusions: Our findings do not support the hypothesis that adolescent fiber intake is associated with premenopausal mammographic breast density

Intake and metabolism of omega-3 and omega-6 polyunsaturated fatty acids: nutritional implications for cardiometabolic diseases

Prospective observational studies support the use of long-chain omega-3 polyunsaturated fatty acids (PUFAs) in the primary prevention of atherosclerotic cardiovascular disease; however, randomised controlled trials, have often reported neutral findings. There is a long history of debate about the potential harmful effects of a high intake of omega-6 PUFAs, although this idea is not supported by prospective observational studies or randomised controlled trials. Health effects of PUFAs might be influenced by Δ-5 and Δ-6 desaturases, the key enzymes in the metabolism of PUFAs. The activity of these enzymes and modulation by variants in encoding genes (FADS1-2-3 gene cluster) are linked to several cardiometabolic traits. This Review will further consider non-genetic determinants of desaturase activity, which have the potential to modify the availability of PUFAs to tissues. Finally, we discuss the consequences of altered desaturase activity in the context of PUFA intake, that is, gene–diet interactions and their clinical and public health implications

Emotional stress as a trigger of myasthenic crisis and concomitant takotsubo cardiomyopathy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Myasthenia gravis is a neuromuscular junction post-synaptic autoimmune disorder. Myasthenic crisis is characterized by respiratory failure requiring mechanical ventilation. Takotsubo cardiomyopathy is a rare clinical syndrome defined as a profound but reversible left ventricular dysfunction in the absence of coronary artery disease.</p> <p>Case presentation</p> <p>We report a unique case of a 60-year-old Hispanic woman with myasthenia gravis who developed takotsubo cardiomyopathy and concomitant myasthenic crisis that appear to have been triggered by a stressful life event. On admission, she presented with severe mid-sternal chest pain and shortness of breath shortly after a personally significant stressful life event. A pertinent neurological examination showed bilateral facial weakness and right ptosis. The left ventriculogram showed apical ballooning with hyperdynamic proximal segments with sparing of the apex. Her troponin I level was elevated, while cardiac catheterization revealed no significant coronary artery disease. The findings were consistent with takotsubo cardiomyopathy. Shortly after cardiac catheterization, she developed bilateral ophthalmoparesis and significant bulbar and respiratory muscle weakness. Forced vital capacity values were persistently less than 1 L. The patient developed respiratory failure and required endotracheal intubation. After plasmapheresis and corticosteroid treatment, her clinical course improved with successful extubation. A normal left ventricle chamber size and a normal ejection fraction were noted by an echocardiogram repeated 10 months later.</p> <p>Conclusion</p> <p>This is the first reported case of the simultaneous triggering of both takotsubo cardiomyopathy and myasthenic crisis by the physiologic consequences of a state of severe emotional stress. We hypothesize that the mechanism underlying the rare association of takotsubo cardiomyopathy with myasthenic crisis involves excessive endogenous glucocorticoid release, a high-catecholamine state, or a combination of both. We advocate careful cardiac monitoring of myasthenia gravis patients during acute emotional or physical stress, as there is potential risk of developing takotsubo cardiomyopathy.</p

Dietary linoleic acid and risk of coronary heart disease: A systematic review and meta-analysis of prospective cohort studies

Background—Previous studies on intake of linoleic acid (LA), the predominant n-6 fatty acid, and coronary heart disease (CHD) risk have generated inconsistent results. We performed a systematic review and meta-analysis of prospective cohort studies to summarize the evidence regarding the relation of dietary LA intake and CHD risk. Methods and Results—We searched MEDLINE and EMBASE databases through June 2013 for prospective cohort studies that reported the association between dietary LA and CHD events. In addition, we used unpublished data from cohort studies in a previous pooling project. We pooled the multivariate-adjusted relative risk (RR) to compare the highest with the lowest categories of LA intake using fixed-effect meta-analysis. We identified 13 published and unpublished cohort studies with a total of 310 602 individuals and 12 479 total CHD events, including 5882 CHD deaths. When the highest category was compared with the lowest category, dietary LA was associated with a 15% lower risk of CHD events (pooled RR, 0.85; 95% confidence intervals, 0.78–0.92; I2=35.5%) and a 21% lower risk of CHD deaths (pooled RR, 0.79; 95% confidence intervals, 0.71–0.89; I2=0.0%). A 5% of energy increment in LA intake replacing energy from saturated fat intake was associated with a 9% lower risk of CHD events (RR, 0.91; 95% confidence intervals, 0.87–0.96) and a 13% lower risk of CHD deaths (RR, 0.87; 95% confidence intervals, 0.82–0.94). Conclusions—In prospective observational studies, dietary LA intake is inversely associated with CHD risk in a dose– response manner. These data provide support for current recommendations to replace saturated fat with polyunsaturated fat for primary prevention of CHD

Anti-diabetic effect of a preparation of vitamins, minerals and trace elements in diabetic rats: a gender difference

BACKGROUND: Although multivitamin products are widely used as dietary supplements to maintain health or as special medical food in certain diseases, the effects of these products were not investigated in diabetes mellitus, a major cardiovascular risk factor. Therefore, here we investigated if a preparation of different minerals, vitamins, and trace elements (MVT) for human use affects the severity of experimental diabetes. METHODS: Two days old neonatal Wistar rats from both genders were injected with 100 mg/kg of streptozotocin or its vehicle to induce diabetes. At week 4, rats were fed with an MVT preparation or vehicle for 8 weeks. Well established diagnostic parameters of diabetes, i.e. fasting blood glucose and oral glucose tolerance test were performed at week 4, 8 and 12. Moreover, serum insulin and blood HbA1c were measured at week 12. RESULTS: An impaired glucose tolerance has been found in streptozotocin-treated rats in both genders at week 4. In males, fasting blood glucose and HbA1c were significantly increased and glucose tolerance and serum insulin was decreased at week 12 in the vehicle-treated diabetic group as compared to the vehicle-treated non-diabetic group. All of the diagnostic parameters of diabetes were significantly improved by MVT treatment in male rats. In females, streptozotocin treatment resulted in a less severe prediabetic-like phenotype as only glucose tolerance and HbA1c were altered by the end of the study in the vehicle-treated diabetic group as compared to the vehicle-treated non-diabetic group. MVT treatment failed to improve the diagnostic parameters of diabetes in female streptozotocin-treated rats. CONCLUSION: This is the first demonstration that MVT significantly attenuates the progression of diabetes in male rats with chronic experimental diabetes. Moreover, we have confirmed that females are less sensitive to STZ-induced diabetes and MVT preparation did not show protection against prediabetic state. This may suggest a gender difference in the pathogenesis of diabetes

"I'd be just as happy with a cup of tea": Women's accounts of sex and affection in long-term heterosexual relationships

This article reports a feminist analysis of interview data with 10 British women, in which they discuss sex and affection in their heterosexual relationships. We explore the popular cultural notion that women lack sexual desire and are more concerned with love and affection. Feminist research has highlighted how in mainstream cultural discourses, men's sexuality has been positioned as superior to women's. Women's (lack of) desire is viewed as problematic and men's (active) 'need' for sex contrasts sharply with the construction of women as (passive) recipients of men's desire. The women in this research reported a lack of sexual desire, but positioned themselves as wanting to want sex, or 'desiring desire'. They expected penis-in-vagina intercourse to be an inherent part of (hetero)sex, and some participated in unwanted (consensual) sex in order to satisfy what they perceived as men's inherent 'need' for sex. We conclude by discussing the implications of our findings for feminist research and practice. © 2012 Elsevier Ltd