Clinical Implications and Prognostic Value of Leucine-Rich G Protein-Coupled Receptor 5 Expression as A Cancer Stem Cell Marker in Malignancies: A Systematic Review and Meta-Analysis

Leucine-rich G protein-coupled receptor 5 (LGR5) is a marker of cancer stem cells (CSCs) in various cancers.Based on different studies, conflicting reports exist on correlation between LGR5 expression and poor prognosis/clinicopathological parameters in cancer patients. Therefore, our purpose in conducting this study was to investigatecorrelation between LGR5 expression and outcomes of cancer patients under study through a systematic review andmeta-analysis. Relevant articles were searched and collected using EMBASE, PubMed, Science Direct, and Scopusdatabases until December 21, 2022. This study was conducted to examine correlation between LGR5 expression anddifferent clinical outcomes, such as recurrence-free survival (RFS), disease-free survival (DFS), overall survival (OS),and clinicopathological characteristics of the included cancer patients. To achieve this, hazard ratios (HRs) with 95%confidence intervals (CIs) and odds ratios (ORs) with 95% CIs were used as statistical measures. A meta-analysis wasconducted using STATA 12.0 software. Finally, 53 studies including 9523 patients met the inclusion criteria. Significantly,high-level expression of LGR5 was related to poor prognosis in terms of OS, higher tumor stage, presence of distantmetastasis, and presence of lymph node metastasis. It was discovered through subgroup analysis that several factors,including the study area, evaluation method, and type of cancer, can influence the correlation between LGR5 expressionand negative prognosis in cancer patients. According to the results of our study, LGR5 overexpression was related topoor OS in cancer patients. In addition, clinicopathological data indicated an unfavorable prognosis in cancer patientswith high LGR5 expression. In conclusion, LGR5 may serve as a potential prognostic marker for predicting survival incertain cancer types

A Systematic Review and Meta-analysis on the Prevalence of Zinc Deficiency in Iranian Population

Objectives: This study aims to assess the zinc deficiency prevalence in Iran during the past two decades and compare it with other countries. Methods: We searched PubMed, Google Scholar, Web of Sciences, Scientific Information Database (SID), and Magiran for English and Persian reports on zinc deficiency prevalence in Iran. The search terms were “zinc”, zinc deficiency”, “low zinc level”, “low zinc concentration”, “prevalence”, “epidemiology”, “status”, “Iran”, “Iranian”, and “Persian”, using Boolean operators ‘AND’ or ‘OR.’ The preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist were applied during the review. Two authors reviewed the articles independently. We included all articles published from 2001 to 2021 that reported zinc deficiency prevalence based on serum zinc levels (μg/dL) in the Iranian population. We excluded clinical intervention studies and studies on pregnant women, children with stunting or malnutrition, and patients with a particular disease. The effect sizes of prevalence rates were extracted from original studies. Meta-analysis with the random-effects model was used to estimate the pooled prevalence of zinc deficiency. Publication bias was evaluated by Egger’s test and the Funnel plot. Results: This systematic review and meta-analysis included 20 studies (12 for males, 13 for females, and 18 for both that involved 16138 participants; 8424 males and 9053 females). Using the random effect model, the overall prevalence of zinc deficiency in the general population was 16% (95% CI, 11%-20%), and in males and females, 18.4% (95% CI, 0.12%-0.24%) and 15% (95% CI, 10%-20%), respectively. In subgroup analysis, the prevalence rates of zinc deficiency for 6 years old children and adolescents were 29% and 12%, respectively.  Conclusions: The overall prevalence of zinc deficiency in the Iranian population was 16%, lower than the 20% set by IZiNCG (the International Zinc Nutrition Consultative Group) to indicate the need for national intervention programs. However, the COVID-19 pandemic and climate changes threaten this fragile margin. Dietary diversification/modifications, supplementation programs, fortification, and bio-fortification can be used to minimize the problem in high-risk populations. Since this study evaluates the adult healthy population of Iran, we should be cautious about generalizing its results on other population groups like children

Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

Background: In peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously. Methods: This retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk. Results: Using joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as −0.720 (95% confidence interval [CI], −0.971 to −0.472) for diabetic and −0.784 (95% CI, −0.963 to −0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients. Conclusion: The results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period

Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

Background: In peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously. Methods: This retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk. Results: Using joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as −0.720 (95% confidence interval [CI], −0.971 to −0.472) for diabetic and −0.784 (95% CI, −0.963 to −0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients. Conclusion: The results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period

Systematic review and meta-analysis of nutritional interventions to prevent of gestational hypertension or/and preeclampsia among healthy pregnant women

Background: Researchers have shown that diet is associated with hypertensive disorders of pregnancy, and there are some reports of performed meta-analyses on observational studies. However, very few randomized-controlled trials have systematically summarized. Thus, we reviewed and meta-analyzed the effects of nutritional interventions on risks of gestational hypertension (GH) or/and preeclampsia (PE). Materials and Methods: A systematic search was performed using Medline, Cochrane library, Google Scholar, ISI Web of Science, Scopus, and ProQuest to find randomized clinical trials assessing the effect of nutritional interventions on incidences of GH or/and PE compared to control or placebo interventions. Results: After considering duplicates, 1066 articles were screened from the database searches. Full-text articles were retrieved for 116 records, while 87 did not have the inclusion criteria and were later omitted. Twenty-nine studies were eligible, but 8 studies were not included in the meta-analysis due to insufficient data. Finally, seven studies were included in qualitative analysis. Furthermore, 7 studies (693 in intervention vs. 721 in control) were pooled for managed nutritional interventions, three (1255 vs. 1257) for a Mediterranean-style diet, and 4 (409 vs. 312) for sodium restricted. Our results revealed that managed nutritional programs were effective in reducing the incidence of GH (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.15, 0.92); I2 = 66.9%; P = 0.010), but not for PE (OR = 0.50; 95% CI = 0.23, 1.07); I2 = 58.9%; P = 0.032. The Mediterranean-style diets in three trials (1255 vs. 1257) did not reduce the risk of PE (OR = 1.10; 95% CI = 0.71, 1.70); I2 = 2.3%; P = 0.359). Likewise, sodium-restricted interventions in four trials (409 vs. 312) did not decrease total risk of GH (OR = 0.99; 95% CI = 0.68, 1.45); I2 = 0%; P = 0.520). Meta-regression did not indicate any significant association between maternal age, body mass index, gestational weight gain, and start time of all interventions with the incidence of GH or/and PE (P > 0.05). Conclusion: The present meta-analysis showed that Mediterranean-style diets and sodium-restriction interventions did not decrease the incidence of GH or/and PE in healthy pregnancies; however, managed nutritional programs reduced the risk of GH, the total incidence of GH and PE, but not PE

Anthropometric predictive equations for estimating body composition

Background: Precise and accurate measurements of body composition are useful in achieving a greater understanding of human energy metabolism in physiology and in different clinical conditions, such as, cardiovascular disease and overall mortality. Dual-energy x-ray absorptiometry (DXA) can be used to measure body composition, but the easiest method to assess body composition is the use of anthropometric indices. This study has been designed to evaluate the accuracy and precision of body composition prediction equations by various anthropometric measures instead of a whole body DXA scan. Materials and Methods: We identified 143 adult patients underwent DXA evaluation of the whole body. The anthropometric indices were also measured. Datasets were split randomly into two parts. Multiple regression analysis with a backward stepwise elimination procedure was used as the derivation set and then the estimates were compared with the actual measurements from the whole-body scans for a validation set. The SPSS version 20 for Windows software was used in multiple regression and data analysis. Results: Using multiple linear regression analyses, the best equation for predicting the whole-body fat mass (R 2 = 0.808) included the body mass index (BMI) and gender; the best equation for predicting whole-body lean mass (R 2 = 0.780) included BMI, WC, gender, and age; and the best equation for predicting trunk fat mass (R 2 = 0.759) included BMI, WC, and gender. Conclusions: Combinations of anthropometric measurements predict whole-body lean mass and trunk fat mass better than any of these single anthropometric indices. Therefore, the findings of the present study may be used to verify the results in patients with various diseases or diets

Development of a scoring system using a statistical model to predict cure status in patients with cutaneous leishmaniasis

Background: The present study was performed to develop a scoring system for predicting cure status in patients with cutaneous leishmaniasis (CL). Materials and Methods: This study included 199 patients with CL from Skin Diseases and Leishmaniasis Research Center (Isfahan, Iran). Data were collected as longitudinal in each visit of patients. We applied ordinal logistic generalized estimating equation regression to predict score on this correlated data. To evaluate the fitted model, split sample validation method was applied. SPSS software was used for data analysis. Results: The regression coefficients of the fitted model were used to calculate score for cure status. Based on split-sample validation method, overall correct classification rate was 82%. Conclusion: This study suggested a scoring system predict cure status in CL patients based on clinical characteristics. Using this method, score for a CL patient is easily obtained by physicians or health workers

Reference curves of anthropometric indices in two national studies conducted among Iranian children in 2003-2004 and 2009-2010: The Caspian study

Background: Reference percentile curves are usually used as a screening tool to determine growth disorders. Anthropometric indices are population-dependent and may differ according to ethnicity, dietary pattern and lifestyle habits. This study aims to compare the curves of anthropometric measures obtained in two national studies conducted among Iranian children and adolescents in 2003-2004 and 2009-2010. Materials and Methods: Anthropometric measures obtained in two nationwide surveys conducted in 10-18-year-old Iranian students were compared. Lambda-mu-sigma (LMS) Chart Maker Pro program was used to develop age- and gender-specific percentiles and to smooth and fit the model. Results: In 2003-2004, the mean and standard deviation (SD) of body mass index (BMI) and waist circumference (WC) were 18.98 ± 3.81 kg/m 2 and 67.50 ± 11.05 cm in boys; and 19.44 ± 3.78 kg/m 2 and 66.55 ± 9.89 cm in girls, respectively. In 2009-2010, the corresponding figures were 19.16 ± 4.07 kg/m 2 , 69.42 ± 11.43 cm, 19.63 ± 4.11 kg/m 2 , and 67.29 ± 9.69 cm, respectively. Height curves did not show considerable changes in two studies. Comparison of two series of studies showed that the weight, BMI, WC, and waist-to-height ratio were lower in adolescent girls than boys especially in higher percentiles. Moreover, in both genders, weight, BMI, and WC percentiles decreased. Conclusion: The growth charts of Iranian children and adolescents aged 10-18 years have changed over 5 years. The reference growth curves change over time in the pediatric age group, repeated surveys should be conducted to update the age- and gender-specific reference curves in different populations