Mapping catquest scores onto EQ-5D utility values in patients with cataract disease

Background: Mapping from non-performance-based measures onto generic performance-based measures provides an appropriate solution to derive utilities to be used in economic evaluations. Objectives: This study aimed to create a model through which EQ-5D utilities for cataracts can be obtained from scores on the disease-specific Catquest measure. Patients and Methods: One hundred ninety-nine observations from 103 patients who self-administered the EQ-5D, the Catquest and questions on demographic and clinical characteristics were included in the analysis. Data was divided into estimation and validation datasets. To predict EQ-5D utilities, multiple regression analysis, using the Ordinary Least Square (OLS) and the censored least absolute deviation (CLAD), was performed. Catquest scores, age, gender, and performing surgery were included as explanatory variables. An estimation dataset was used to derive the coefficients, and these coefficients were then validated using a validation dataset. Based on the explanatory power, the consistency, the simplicity, the mean absolute error (MAE) and the correlations between observed and fitted utilities, the most appropriate model was selected. Results: The mean EQ-5D and Catquest scores of the total sample were 0.631 and 15.8, respectively. Age and surgery showed no significant effect for either method. Removing age and surgery, model II was built and given an R2of 0.697, an MAE of 0.1176 for the OLS and an R2of 0.614, and an MAE of 0.1153 for the CLAD method. In the validation stage, the CLAD revealed better prediction ability, with an MAE of 0.198 versus an MAE of 0.209 for the OLS. ICC and Bland-Altman analysis put the CLAD as a preferred method with the following equation: Utilities (EQ-5D) = 0.988 - 0.0281 × Catquest (PD) + 0.102 × gender (male = 1). Conclusions: Based on these results, a mapping function was obtained which appears to be valuable in predicting EQ-5D utilities from Catquest scores. This function gives an appropriate solution to estimate utilities when primary EQ-5D data is not available. Although the model represents good consistency and predictive ability, further examination of obtained function is required with large samples. © 2016, Iranian Red Crescent Medical Journal

Supplementation of freezing and thawing media with brain-derived neurotrophic factor protects human sperm from freeze-thaw-induced damage

Objective To investigate the effects of brain-derived neurotrophic factor (BDNF) supplementation to freezing and thawing media on frozen-thawed human sperm parameters. Design Laboratory study. Setting University hospital. Patient(s) Semen samples from 21 healthy fertile men. Intervention(s) We measured reactive oxygen species (ROS) by flow cytometry using the probes dichlorofluorescin diacetate for intracellular hydrogen peroxide (H2O2) and dihydroethidium for intracellular superoxide anion (O2��), sperm plasma membrane integrity by flow cytometry, caspase-3 activity using ELISA, and AKT phosphorylation status using Western blot in sperm that was cryopreserved and thawed in media either supplemented with BDNF or without BDNF supplementation (control). Main Outcome Measure(s) Sperm motility, viability, ROS levels, caspase-3 activity and AKT phosphorylation. Result(s) The percentage of motile and viable sperm cells was significantly higher in BDNF-supplemented groups as compared with the nonsupplemented (control) group. There was a significant difference in AKT phosphorylation status between BDNF-supplemented groups and the control group. Moreover, the levels of intracellular H2O2 and caspase-3 activity were significantly lower in the sperm cells that were frozen and thawed in media supplemented with BDNF compared with in the control group. Conclusion(s) BDNF supplementation to sperm freezing or thawing media has protective effects against oxidative stress and apoptosis in frozen-thawed human spermatozoa and could improve sperm function, probably through the activation of AKT. © 2016 American Society for Reproductive Medicin

Comparison of SF-6D and EQ-5D scores in patients with breast cancer

Background: Utility values are a key component of a cost-utility analysis. The EQ-5D and SF-6D are two commonly used measures for deriving utilities. Of particular importance is assessing the performance of these instruments in terms of validity. Objectives: This study aimed to compare the performance of the EQ-5D and the SF-6D in different states of breast cancer. Patients and Methods: This was a cross-sectional study of 163 patients with breast cancer who attended the breast cancer subspecialty clinic affiliated with the breast cancer research center (BCRC) at ACECR, in Tehran, Iran, and were consecutively recruited. Patients completed several questionnaires, including the EQ-5D, SF-36, and general questions regarding their demographic characteristics. Utility values for different states of breast cancer were obtained using predetermined algorithms for the EQ-5D and SF-6D. The distribution of the utility values and the differences between the different states for both instruments were statistically assessed. Furthermore, the agreement between the two instruments was evaluated using intra-class correlation coefficients and Bland-Altman plots. Results: The mean and median EQ-5D utility scores for the total sample were 0.685 and 0.761, respectively. The mean SF-6D utility score for the total sample was 0.653, and the median utility score was 0.640. The mean utility values of the EQ-5D for “state P,” “state R,” “state S,” and “state M” were estimated as 0.674, 0.718, 0.730, and 0.552, respectively. The SF-6D provided mean utility values of 0.638, 0.677, 0.681, and 0.587 for those states. Both instruments assigned statistically significant (P &lt; 0.01) scores for different states. The intra-class correlation for the two measures was 0.677 (95% confidence interval (CI): 0.558 - 0.764). The Bland-Altman plot indicated a better agreement on the higher values and that at higher values, the EQ-5D yields a higher score than the SF-6D; this relationship was reversed at lower values. Conclusions: Although the two instruments were able to discriminate between various states, the values derived from these instruments were quite different. This distinction could have influenced the conclusions of an economic evaluation. Further research is required to determine which instrument should be used in economic evaluations.</p

Sexual Dysfunction in Breast Cancer: A Case-Control Study

Background: Sexual dysfunction in breast cancer patients is considered as a common and distressing problem. Considering the increasing number of breast cancer survivors living for longer periods of time with the disease and the importance of their quality of life, we conducted the present study to compare the sexual functioning in breast cancer patients with their healthy counterparts. Methods: In this case-control study, breast cancer patients who completed their treatment protocol and were followed up for at least six months were included. The controls were healthy women with normal clinical breast examinations. All subjects filled-in the Persian version of Female Sexual Function Index questionnaire. Results: A total of 165 subjects including 71 breast cancer patients and 94 healthy women were studied. The frequency of sexual dysfunction in cases and controls was 52.6% and 47.4%, respectively (P = 0.09). There were no significant differences between the two groups regarding domain scores, except for vaginal lubrication (P = 0.045). Logistic regression analysis indicated that significant determinants of sexual dysfunction in breast cancer group was patients' age (OR = 4.0, 95%CI: 1.3 – 11.5, P = 0.01) and age of the spouse (OR= 9.8, 95% CI: 1.8-51.9, P= 0.007), while in controls, only emotional relationship with the husband was the significant predictive factor (OR = 6.3, 95%CI: 1.9 – 20.5, P = 0.002). Conclusions: Our findings indicated that sexual dysfunction is prevalent in Iranian women regardless of their physical health status. The frequency of vaginal dryness in breast cancer patients was significantly higher than controls. Age of the patient and the spouse (>40) were the only significant predictors of sexual dysfunction among women with breast cancer. Preventive strategies, sexual education and access to effective treatment should be planned in supportive care of breast cancer patients

Comparison of Clinicopathological Characteristics and Outcome of Inflammatory and Non-inflammatory Locally Advanced Breast Cancer: A Study in Iran

Background: Inflammatory breast cancer (IBC), a subgroup of locally advanced breast cancer (LABC), is diagnosed based on clinical findings, and seems to be different from other types of LABC. The purpose of this study was to compare clinicopathological characteristics and outcomes between inflammatory and non-inflammatory LABC patients at Breast Cancer Research Center (BCRC), Tehran, Iran. Methods: The medical records of all patients who were diagnosed as LABC in BCRC  since  1997  to  2011  were  extracted  from  the database. Then,  clinical  and pathological characteristics and overall survival of IBC patients were compared with non-inflammatory LABC (NI-LABC). Results: A total number of 340 patients were identified as LABC from which 17 patients (5%) were diagnosed as IBC. Menopausal status, body mass index (BMI), family history of breast cancer, nodal status, and Her2/neu and PR positivity were not statistically different between IBC and NI-LABC groups. The difference in estrogen receptor (ER) between the two groups was significant (P = 0.028). Median duration of follow-up was 26.50 months. Patients with IBC had overall survival of 27.9 months (95% CI: 22.7–33.1) which was lower than patients in the NI-LABC group with a survival of 118.9 months (95% CI: 107.3–130.6) (P = 0.015). The difference between the disease-free survivals of the two groups were also statistically significant (P < 0.001). Conclusions: Compared to NI-LABC, IBC is more frequently ER negative and more commonly associated with lower survival rate. These findings reinforce the idea that IBC has a more aggressive biology and more unfavorable outcome than NI-LABC and needs close follow-up

Altered FoxO3 expression and apoptosis in granulosa cells of women with polycystic ovary syndrome

Purpose: To determine the level of apoptosis, and alteration of FoxO3 (forkhead box O3 transcription factor) expression and phosphorylation in human granulosa cells amongst polycystic ovary syndrome (PCOS) patients and control group. Methods: We recruited infertile women with PCOS (n = 14) and compared them with infertile women due to tubal blockage or male factor infertility (n = 14, controls). GnRH agonist and gonadotropins were used for ovarian stimulation. Follicular fluids from large follicles (>16 mm) were pooled and granulosa cells (GCs) were isolated using cell strainer methodology. Apoptosis of purified GCs was measured by flow cytometry using Annexin V and propidium iodide. Quantitative real-time PCR and western blotting were performed to assess alteration of FoxO3 expression and phosphorylation in GCs. Results: There were higher percentages of early and late apoptosis in GCs of PCOS patients than in the control group. FoxO3 mRNA level and total FoxO3 protein were significantly higher in PCOS group than in the control group. The ratio of p-FoxO3/total FoxO3 decreased significantly in PCOS than in the control group. It was inferred that unphosphorylated (active form) FoxO3 was higher in GCs of PCOS patients. Apoptosis was significantly and positively correlated with the total FoxO3 and negatively correlated with the p-FoxO3 protein levels in PCOS patients. Conclusions: Activation and overexpression of FoxO3 in granulosa cells of PCOS women correlated with higher apoptosis levels in these cells suggesting that FoxO3 may be a candidate for the higher apoptosis in granulosa cells from women with PCOS. © 2016, Springer-Verlag Berlin Heidelberg

Predictive Role of EGFR, IGF-1R, VEGFR2 and HIF-1? Expression on Survival of Patients with Triple-negative Breast Cancer

Background: Triple-negative breast cancer (TNBC) carries a poor prognosis and therapeutic options are limited to date. The aim of this study was to investigate to what extent the epidermal growth factor receptor (EGFR), vascular endothelial growth factor receptor 2 (VEGFR2), hypoxia inducible factor-1 alpha (HIF-1?) and insulin-like growth factor-1 receptor (IGF-1R) are expressed in TNBC and to determine if these expressions have a predictive role. Methods: Of 923 breast cancer patients who were treated and followed in Academic Center for Education, Culture and Research (ACECR) from 2006-2010, 104 of them had TNBC. Immunohistochemistry analyses were performed on tissue microarray blocks with antibodies for EGFR, VEGFR2, HIF-1? and IGF-1R. Results: We analyzed tumor samples from 104 patients with classic primary invasive ductal carcinoma (IDC). Fifteen patients (14%) were in stage I, 46.6% in stage II, 30.1% in stage III and 5.8% in a metastatic stage (stage IV). The median overall survival (OS) was 48 months. EGFR was expressed in 15 (14%), VEGFR2 in 63 (61%), IGF-1R in 81 (78%) and HIF-1? in 57 (55%) samples. EGFR expression was significantly associated with poor outcome in terms of OS (P = 0.021, OR = 3.9). Conclusions: Among the four investigated tumor markers, only EGFR was significantly associated with survival of patients with TNBC

Gluten sensitive enteropathy in patients with iron deficiency anemia of unknown origin

AIM: To determine the prevalence of gluten sensitive enteropathy (GSE) in a large group of patients with iron deficiency anemia (IDA) of obscure origin

Cerium and Yttrium Oxide Nanoparticles Against Lead-Induced Oxidative Stress and Apoptosis in Rat Hippocampus

Due to numerous industrial applications, lead has caused widespread pollution in the environment; it seems that the central nervous system (CNS) is the main target for lead in the human body. Oxidative stress and programmed cell death in the CNS have been assumed as two mechanisms related to neurotoxicity of lead. Cerium oxide (CeO2) and yttrium oxide (Y2O3) nanoparticles have recently shown antioxidant effects, particularly when used together, through scavenging the amount of reactive oxygen species (ROS) required for cell apoptosis. We looked into the neuroprotective effects of the combinations of these nanoparticles against acute lead-induced neurotoxicity in rat hippocampus. We used five groups in this study: control, lead, CeO2 nanoparticles + lead, Y2O3 nanoparticles + lead, and CeO2 and Y2O3 nanoparticles + lead. Nanoparticles of CeO2 (1000 mg/kg) and Y2O3 (230 mg/kg) were administered intraperitoneally during 2 days prior to intraperitoneal injection of the lead (25 mg/kg for 3 days). At the end of the treatments, oxidative stress markers, antioxidant enzymes activity, and apoptosis indexes were investigated. The results demonstrated that pretreatments with CeO2 and/or Y2O3 nanoparticles recovered lead-caused oxidative stress markers (ROS, lipid peroxidation, and total thiol molecules) and apoptosis indexes (Bax/Bcl-2 and caspase-3 protein expression). Besides, these nanoparticles reduced the activities of lead-induced superoxide dismutase and catalase as well as the ADP/ATP ratio. Interestingly, the best recovery resulted from the compound of these nanoparticles. Based on these outcomes, it appears that this combination may potentially be beneficial for protection against lead-caused acute toxicity in the brain through improving the oxidative stress-mediated programmed cell death pathway. © 2014, Springer Science+Business Media New York