Cost effectiveness analysis of Avonex and CinnoVex in Relapsing Remitting MS

INTRODUCTION: Multiple sclerosis is a chronic and degenerative neurological disease characterized by loss of myelin sheath of some neurons in brain and spinal cord. It is associated with high economic burden due to premature deaths and high occurrence of disabilities. The aim of the current study was to determine cost effectiveness of two major products of interferon 1a in patients with relapsing-remitting multiple sclerosis. METHOD AND MATERIALS: Altogether, 140 patients who have consumed Avonex and CinnoVex in Relapsing Remitting MS for at least two years were randomly selected (70 patients in each group). Health-related quality of life (HRQoL) was assessed using the adopted MSQoL-54 instrument. Costs were measured and valued from Ministry of Health and Medical Education (MOHME) perspective. Two-way sensitivity analysis was used to check robustness of the results. RESULTS: Patients in CinnoVex group reported significantly higher scores in both physical (69.5 vs. 50.9, P<0.001) and mental (63.3 vs. 56.6, P=0.03) aspects of HRQoL than Avonex group. On the other hand, annual cost of CinnoVex and Avonex were 2410 US and 4515US per patient, respectively (P<0.001). CONCLUSIONS: The results showed that CinnoVex was dominant option over the study period. It is suggested that results of the current study should be considered in allocating resources to MS treatments in Iran. Of course, our findings should be interpreted with caution duo to short term horizon and lack of HRQoL scores at baseline (before the intervention)

Persistent Homology of Weighted Visibility Graph from Fractional Gaussian Noise

In this paper, we utilize persistent homology technique to examine the topological properties of the visibility graph constructed from fractional Gaussian noise (fGn). We develop the weighted natural visibility graph algorithm and the standard network in addition to the global properties in the context of topology, will be examined. Our results demonstrate that the distribution of {\it eigenvector} and {\it betweenness centralities} behave as power-law decay. The scaling exponent of {\it eigenvector centrality} and the moment of {\it eigenvalue} distribution, $M_{n}$, for $n\ge1$ reveal the dependency on the Hurst exponent, $H$, containing the sample size effect. We also focus on persistent homology of $k$-dimensional topological holes incorporating the filtration of simplicial complexes of associated graph. The dimension of homology group represented by {\it Betti numbers} demonstrates a strong dependency on the Hurst exponent. More precisely, the scaling exponent of the number of $k$-dimensional topological \textit{holes} appearing and disappearing at a given threshold, depends on $H$ which is almost not affected by finite sample size. We show that the distribution function of \textit{lifetime} for $k$-dimensional topological holes decay exponentially and corresponding slope is an increasing function versus $H$ and more interestingly, the sample size effect is completely disappeared in this quantity. The persistence entropy logarithmically grows with the size of visibility graph of system with almost $H$-dependent prefactors.Comment: 17 pages, 13 figures, Comments Welcom

The role of melatonin on doxorubicin-induced cardiotoxicity: A systematic review

Purpose: Doxorubicin, as an effective chemotherapeutic drug, is commonly used for combating various solid and hematological tumors. However, doxorubicin-induced cardiotoxicity is considered as a serious adverse effect, and it limits the clinical use of this chemotherapeutic drug. The use of melatonin can lead to a decrease in the cardiotoxic effect induced by doxorubicin. The aim of this review was to evaluate the potential role of melatonin in the prevention of doxorubicin-induced cardiotoxicity. Methods: This review was conducted by a full systematic search strategy based on PRISMA guidelines for the identification of relevant literature in the electronic databases of PubMed, Web of Science, Embase, and Scopus up to January 2019 using search terms in the titles and abstracts. 286 articles were screened in accordance with our inclusion and exclusion criteria. Finally, 28 articles were selected in this systematic review. Results: The findings demonstrated that doxorubicin-treated groups had increased mortality, decreased body weight and heart weight, and increased ascites compared to the control groups; the co-administration of melatonin revealed an opposite pattern compared to the doxorubicin-treated groups. Also, this chemotherapeutic agent can lead to biochemical and histopathological changes; as for most of the cases, these alterations were reversed near to normal levels (control groups) by melatonin co-administration. Melatonin exerts these protection effects through mechanisms of anti-oxidant, anti-apoptosis, anti-inflammatory, and mitochondrial function. Conclusion: The results of this systematic review indicated that co-administration of melatonin ameliorates the doxorubicin-induced cardiotoxicity. © 2019 Elsevier Inc

TGF-β in radiotherapy: Mechanisms of tumor resistance and normal tissues injury

Emerging evidences show that changes in tumor stroma can adapt cancer cells to radiotherapy, thereby leading to a reduction in tumor response to treatment. On the other hand, radiotherapy is associated with severe reactions in normal tissues which limit the amount radiation dose received by tumor. These challenges open a window in radiobiology and radiation oncology to explore mechanisms for improving tumor response and also alleviate side effects of radiotherapy. Transforming growth factor beta (TGF-β) is a well-known and multitasking cytokine that regulates a wide range of reactions and interactions within tumor and normal tissues. Within tumor microenvironment (TME), TGF-β is the most potent suppressor of immune system activity against cancer cells. This effect is mediated through stimulation of CD4+ which differentiates to T regulatory cells (Tregs), infiltration of fibroblasts and differentiation into cancer associated fibroblasts (CAFs), and also polarization of macrophages to M2 cells. These changes lead to suppression of cytotoxic CD8 + T lymphocytes (CTLs) and natural killer (NK) cells to kill cancer cells. TGF-β also plays a key role in the angiogenesis, invasion and DNA damage responses (DDR) in cancer cells. In normal tissues, TGF-β triggers the expression of a wide range of pro-oxidant and pro-fibrosis genes, leading to fibrosis, genomic instability and some other side effects. These properties of TGF-β make it a potential target to preserve normal tissues and sensitize tumor via its inhibition. In the current review, we aim to explain the mechanisms of upregulation of TGF-β and its consequences in both tumor and normal tissues. © 2020 Elsevier Lt

Gender-based difference in early mortality among patients with ST-segment elevation myocardial infarction: insights from Kermanshah STEMI Registry.

Introduction: This study aimed to evaluate the in-hospital mortality of patients with ST-segment elevation myocardial infarction (STEMI), according to gender and other likely risk factors. Methods: This study reports on data relating to 1,484 consecutive patients with STEMI registered from June 2016 to May 2018 in the Western Iran STEMI Registry. Data were collected using a standardized case report developed by the European Observational Registry Program (EORP). The relationship between in-hospital mortality and potential predicting variables was assessed multivariable logistic regression. Differences between groups in mortality rates were compared using chi-square tests and independent t-tests. Results: Out of the 1484 patients, 311(21%) were female. Women were different from men in terms of age (65.8 vs. 59), prevalence of hypertension (HTN) (63.7% vs. 35.4%), diabetes mellitus (DM) (37.7% vs. 16.2%), hypercholesterolemia (36.7% vs. 18.5%) and the history of previous congestive heart failure (CHF) (6.6% vs. 3.0%). Smoking was more prevalent among men (55.9% vs. 13.2%). Although the in-hospital mortality rate was higher in women (11.6% vs. 5.5%), after adjusting for other risk factors, female sex was not an independent predictor for in-hospital mortality. Multivariable analysis identified that age and higher Killip class (≥II) were significantly associated with in-hospital mortality rate. Conclusion: In-hospital mortality after STEMI in women was higher than men. However, the role of sex as an independent predictor of mortality disappeared in regression analysis. The gender based difference in in-hospital mortality after STEMI may be related to the poorer cardiovascular disease (CVD) risk factor profile of the women

Coherent Hydrodynamic Coupling for Stochastic Swimmers

A recently developed theory of stochastic swimming is used to study the notion of coherence in active systems that couple via hydrodynamic interactions. It is shown that correlations between various modes of deformation in stochastic systems play the same role as the relative internal phase in deterministic systems. An example is presented where a simple swimmer can use these correlations to hunt a non-swimmer by forming a hydrodynamic bound state of tunable velocity and equilibrium separation. These results highlight the significance of coherence in the collective behavior of nano-scale stochastic swimmers.Comment: 6 pages, 3 figure

The association of emotional intelligence with sport injuries and receiving penalty cards among Iranian professional soccer players

Background: High emotional intelligence (EI) seems to be preventive for unconventional sports behavior within competitions leading prevention of sport injuries and also minimization of giving penalty cards. Objectives: The present study aimed to examine this relationship among Iranian Premier League footballers. Methods: This study was performed on Iranian professional soccer players participating in Premier League in 2014-2015 season. To assess emotional intelligence among athletes, the Schutte Self-Report Emotional Intelligence test (SSEIT) was employed. Sport-related injuries were recorded by the physician of each team. Also, the reports of the number of yellow and red cards for each athlete as well as for all teams in two phases (middle and end of each season) was recorded by the Football League Organization were reviewed and recorded. The chi-square test and t-test were used for comparing the variables. The Pearson�s correlation test and the multivariable regression model were also used for discovering association and relationship, respectively. P values of 0.05 or less were considered statistically significant. Results: Among different subscales of EI, only regulation of emotions was significantly different between injured and non-injured athletes (P = 0.04). Lower ability to regulate emotions was associated with higher risk for sport injuries (OR = 0.88, 95 CI: 0.79-0.98, P = 0.02). None of the subscales of EI was related to receiving yellow card, but utilizing emotions was adversely related to receiving red card. The association between utilizing emotions and receiving red card changed to insignificant after using the multivariable regression modeling. Conclusions: By regulating emotions, sport-related injuries can be preventable in soccer players. However, EI may not be helpful in reducing sport fines. © 2019, Author(s)

Melatonin Attenuates Upregulation of Duox1 and Duox2 and Protects against Lung Injury following Chest Irradiation in Rats

Objective: The Lung is one of the most radiosensitive organs of the body. The infiltration of macrophages and lymphocytes into the lung is mediated via the stimulation of T-helper 2 cytokines such as IL-4 and IL-13, which play a key role in the development of fibrosis. It is likely that these cytokines induce chronic oxidative damage and inflammation through the upregulation of Duox1 and Duox2, which can increase the risk of late effects of ionizing radiation (IR) such as fibrosis and carcinogenesis. In the present study, we aimed to evaluate the possible increase of IL-4 and IL-13 levels, as well as their downstream genes such as IL4ra1, IL13ra2, Duox1, and Duox2. Materials and Methods: In this experimental animal study, male rats were divided into 4 groups: i. Control, ii. Melatonin-treated, iii. Radiation, and iv. Melatonin (100 mg/kg) plus radiation. Rats were irradiated with 15 Gy 60Co gamma rays and then sacrificed after 67 days. The expressions of IL4ra1, IL13ra2, Duox1, and Duox2, as well as the levels of IL-4 and IL-13, were evaluated. The histopathological changes such as the infiltration of inflammatory cells, edema, and fibrosis were also examined. Moreover, the protective effect of melatonin on these parameters was also determined. Results: Results showed a 1.5-fold increase in the level of IL-4, a 5-fold increase in the expression of IL4ra1, and a 3-fold increase in the expressions of Duox1 and Duox2. However, results showed no change for IL-13 and no detectable expression of IL13ra2. This was associated with increased infiltration of macrophages, lymphocytes, and mast cells. Melatonin treatment before irradiation completely reversed these changes. Conclusion: This study has shown the upregulation of IL-4-IL4ra1-Duox2 signaling pathway following lung irradiation. It is possible that melatonin protects against IR-induced lung injury via the downregulation of this pathway and attenuation of inflammatory cells infiltration. © 2019 Royan Institute (ACECR). All rights reserved