A randomized, placebo-controlled, double-blinded mechanistic clinical trial using endotoxin to evaluate the relationship between insomnia, inflammation, and affective disturbance on pain in older adults: A protocol for the sleep and Healthy Aging Research for pain (SHARE-P) study

Chronic pain is prevalent in older adults. Treatment, especially with opioids, is often ineffective and poses considerable negative consequences in this population. To improve treatment, it is important to understand why older adults are at a heightened risk for developing chronic pain. Insomnia is a major modifiable risk factor for chronic pain that is ubiquitous among older adults. Insomnia can also lead to heightened systemic inflammation and affective disturbance, both of which may further exacerbate pain conditions in older adults. Endotoxin exposure can be used as an experimental model of systemic inflammation and affective disturbance. The current study aims to understand how insomnia status and endotoxin-induced changes in inflammation and affect (increased negative affect and decreased positive affect) may interact to impact pain facilitatory and inhibitory processes in older adults. Longitudinal data will also assess how pain processing, affective, and inflammatory responses to endotoxin may predict the development of pain and/or depressive symptoms. The current study is a randomized, double-blinded, placebo-controlled, mechanistic clinical trial in men and women, with and without insomnia, aged 50 years and older. Participants were randomized to either 0.8ng/kg endotoxin injection or saline placebo injection. Daily diaries were used to collect variables related to sleep, mood, and pain at two-week intervals during baseline and 3-, 6-, 9-, and 12-months post-injection. Primary outcomes during the experimental phase include conditioned pain modulation, temporal summation, and affective pain modulation ∼5.5 hours after injection. Primary outcomes for longitudinal assessments are self-reported pain intensity and depressive symptoms. The current study uses endotoxin as an experimental model for pain. In doing so, it aims to extend the current literature by: (1) including older adults, (2) investigating insomnia as a potential risk factor for chronic pain, (3) evaluating the role of endotoxin-induced affective disturbances on pain sensitivity, and (4) assessing sex differences in endotoxin-induced hyperalgesia.

Clinicaltrialsgov

NCT03256760.

Trial sponsor

NIH R01AG057750-01.

Sleep and Healthy Aging Research on Depression (SHARE-D) randomized controlled trial: Protocol overview of an experimental model of depression with insomnia, inflammation, and affect mechanisms in older adults

Depression, one of the most common diseases in older adults, carries significant risk for morbidity and mortality. Because of the burgeoning population of older adults, the enormous burden of late-life depression, and the limited efficacy of current antidepressants in older adults, biologically plausible models that translate into selective depression prevention strategies are needed. Insomnia predicts depression recurrence and is a modifiable target to prevent incident and recurrent depression in older adults. Yet, it is not known how insomnia gets converted into biological- and affective risk for depression, which is critical for identification of molecular targets for pharmacologic interventions, and for refinement of insomnia treatments that target affective responding to improve efficacy. Sleep disturbance activates inflammatory signaling and primes immune responses to subsequent inflammatory challenge. In turn, inflammatory challenge induces depressive symptoms, which correlate with activation of brain regions implicated in depression. This study hypothesizes that insomnia serves as a vulnerability factor for inflammation-related depression; older adults with insomnia will show heightened inflammatory- and affective responding to inflammatory challenge as compared to those without insomnia. To test this hypothesis, this protocol paper describes a placebo-controlled, randomized, double-blind study of low dose endotoxin in older adults (n = 160; 60-80 y) with insomnia vs. comparison controls without insomnia. The aims of this study are to examine differences in depressive symptoms, measures of negative affective responding, and measures of positive affective responding as a function of insomnia and inflammatory challenge. If the hypotheses are confirmed, older adults with two "hits", insomnia and inflammatory activation, would represent a high risk group to be prioritized for monitoring and for depression prevention efforts using treatments that target insomnia or inflammation. Moreover, this study will inform the development of mechanism-based treatments that target affect responses in addition to sleep behaviors, and which might also be coupled with efforts to reduce inflammation to optimize efficacy of depression prevention.

Costs associated with treatment of insomnia in Alzheimer’s disease caregivers: a comparison of mindfulness meditation and cognitive behavioral therapy for insomnia

Background

Among the over 5 million informal caregivers for patients with Alzheimer’s disease (AD) in the United States (US), over 60% experience insomnia. Research on insomnia treatment efficacy in AD caregivers is limited. An ongoing randomized non-inferiority clinical trial, the Caregiver Sleep Research study, is evaluating whether mindfulness meditation is non-inferior to cognitive behavioral therapy for insomnia (CBT-I) in the treatment of insomnia in AD caregivers. The present report examines estimated intervention costs in this ongoing trial.

Methods

Micro-costing was used to itemize and abstract costs of the two interventions: a mindfulness-based intervention known as mindful awareness practices for insomnia (MAP-I); and CBT-I. This approach involves collecting detailed data on resources utilized and the unit costs of those resources, thereby revealing actual resource use and economic costs for each treatment arm. Personnel time, patient time, and supplies were inventoried, and unit costs were applied. Caregiver time costs, including travel, were based on US Labor Bureau home-health aide national mean hourly wages; instructor/staff costs were based on hourly wages. Per-participant and program costs were calculated assuming individual- and group-delivery to reflect real-world implementation. Sensitivity analyses evaluated robustness of estimates.

Results

From the societal perspective, per-participant MAP-I costs were $1884 for individual and $1377 for group delivery; for CBT-I, these costs were $3978 and $1981, respectively. Compared with CBT-I, MAP-I provided cost savings of $2094 (53%) and $604 (30%) per treated caregiver for individual and group delivery, respectively. From the US healthcare system perspective, MAP-I vs. CBT-I participant savings were $1872 (65%) for individual and $382 (44%) for group interventions, respectively. For MAP-I and CBT-I, instructor in-class time was the highest cost component. Results were most sensitive to combined instructor time costs.

Conclusions

Treatment of insomnia with MAP-I, compared to CBT-I, yields substantial cost savings for society and the healthcare system. With this potential for cost savings, results of the ongoing non-inferiority trial have critical implications for insomnia treatment dissemination and its benefits to AD caregivers and other community populations with insomnia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07619-w.

Prevention of Incident and Recurrent Major Depression in Older Adults With Insomnia: A Randomized Clinical Trial

IMPORTANCE

Older adults with insomnia have a high risk of incident and recurrent depression. Depression prevention is urgently needed, and such efforts have been neglected for older adults.

OBJECTIVE

To examine whether treatment of insomnia disorder with cognitive behavioral therapy for insomnia (CBT-I) compared with an active comparator condition, sleep education therapy (SET), prevents major depressive disorder in older adults.

DESIGN, SETTING, AND PARTICIPANTS

This assessor-blinded, parallel-group, single-site randomized clinical trial assessed a community-based sample of 431 people and enrolled 291 adults 60 years or older with insomnia disorder who had no major depression or major health events in past year. Study recruitment was performed from July 1, 2012, to April 30, 2015. The trial protocol was modified to extend follow-up from 24 to 36 months, with follow-up completion in July 2018. Data analysis was performed from March 1, 2019, to March 30, 2020.

INTERVENTIONS

Participants were randomized to 2 months of CBT-I (n = 156) or SET (n = 135).

MAIN OUTCOMES AND MEASURES

The primary outcome was time to incident major depressive disorder as diagnosed by interview and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria. Secondary outcome was sustained remission of insomnia disorder before depression event or duration of follow-up.

RESULTS

Among 291 randomized participants (mean [SD] age, 70.1 [6.7] years; 168 [57.7%] female; 7 [2.4%] Asian, 32 [11.0%] Black, 3 [1.0%] Pacific Islander, 241 [82.8%] White, 6 [2.1%] multiracial, and 2 [0.7%] unknown), 156 were randomized to CBT-I and 135 to SET. A total of 140 participants (89.7%) completed CBT-I and 130 (96.3%) participants completed SET (χ2 = 4.9, P = .03), with 114 (73.1%) completing 24 months of follow-up in the CBT-I group and 117 (86.7%) in the SET group (χ2 = 8.4, P = .004). After protocol modification, 92 (59.0%) of the CBT-I participants and 86 (63.7%) of the SET participants agreed to extended follow-up (χ2 = 0.7, P = .41), with 81 (51.9%) of the CBT-I participants and 77 (57.0%) of the SET group completing 36 months of follow-up (χ2 = 0.8; P = .39). Incident or recurrent major depression occurred in 19 participants (12.2%) in the CBT-I group and in 35 participants (25.9%) in the SET group, with an overall benefit (hazard ratio, 0.51; 95%, CI 0.29-0.88; P = .02) consistent across subgroups. Remission of insomnia disorder continuously sustained before depression event or during follow-up was more likely in CBT-I participants (41 [26.3%]) compared with the SET participants (26 [19.3%], P = .03). Those in the CBT-I group with sustained remission of insomnia disorder had an 82.6% decreased likelihood of depression (hazard ratio, 0.17; 95%, CI 0.04-0.73; P = .02) compared with those in the SET group without sustained remission of insomnia disorder.

CONCLUSIONS AND RELEVANCE

The findings of this randomized clinical trial indicate that treatment of insomnia with CBT-I has an overall benefit in the prevention of incident and recurrent major depression in older adults with insomnia disorder. Community-level screening for insomnia concerns in older adults and wide delivery of CBT-I-based treatment for insomnia could substantially advance public health efforts to treat insomnia and prevent depression in this vulnerable older adult population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01641263.

Alterations in resting-state network dynamics along the Alzheimer's disease continuum

Human brain activity is intrinsically organized into resting-state networks (RSNs) that transiently activate or deactivate at the sub-second timescale. Few neuroimaging studies have addressed how Alzheimer's disease (AD) affects these fast temporal brain dynamics, and how they relate to the cognitive, structural and metabolic abnormalities characterizing AD. We aimed at closing this gap by investigating both brain structure and function using magnetoencephalography (MEG) and hybrid positron emission tomography-magnetic resonance (PET/MR) in 10 healthy elders, 10 patients with subjective cognitive decline (SCD), 10 patients with amnestic mild cognitive impairment (aMCI) and 10 patients with typical Alzheimer's disease with dementia (AD). The fast activation/deactivation state dynamics of RSNs were assessed using hidden Markov modeling (HMM) of power envelope fluctuations at rest measured with MEG. Correlations were sought between temporal properties of HMM states and participants' cognitive test scores, whole hippocampal grey matter volume and regional brain glucose metabolism. The posterior default-mode network (DMN) was less often activated and for shorter durations in AD patients than matched healthy elders. No significant difference was found in patients with SCD or aMCI. The time spent by participants in the activated posterior DMN state did not correlate significantly with cognitive scores, nor with the whole hippocampal volume. However, it correlated positively with the regional glucose consumption in the right dorsolateral prefrontal cortex (DLPFC). AD patients present alterations of posterior DMN power activation dynamics at rest that identify an additional electrophysiological correlate of AD-related synaptic and neural dysfunction. The right DLPFC may play a causal role in the activation of the posterior DMN, possibly linked to the occurrence of mind wandering episodes. As such, these data might suggest a neural correlate of the decrease in mind wandering episodes reported in pathological aging.

Dose assessment for emergency workers in early phase of Fukushima Daiichi nuclear power plant accident

In the case of Fukushima Daiichi nuclear power plant (FNP) accident, the radioactive material was released from reactor units 1–3 and transported to short and long distances due to the atmospheric pathways-motions. Power sources for monitoring posts were lost due to earthquake and tsunami. Based on air dose rates and other data measured by monitoring cars, the amount of radioactive material released to the atmosphere from the power station was obtained. The atmospheric dispersion and the transport model used in the RASCAL code, estimate the radionuclide concentrations downwind, both in the air and on the ground due to deposition. The calculated concentrations are then used to estimate the projected doses for workers in vicinity of the accident area in the first minutes of accident time. For dose modeling, we assumed that each worker was 15 min in vicinity of FNP in accident situation, once without and once with protective clothes or respirator. According to Tokyo Electric Power Company (TEPCO) report six workers had received doses over 250 mSv (309 to 678 mSv) apparently due to inhaling Iodine-131 fume. In this paper the calculated dose results using RASCAL code shows that, if emergency workers who work in early phase of accident had not used protective equipment, for 15 min, inhalation doses from iodine in their thyroid gland up to 12 March afternoon would have been 520 mSv. A comparison between calculation results and TEPCO report shows that dose calculated virtually is nearly equal to TEPCO measurement results.

[Contribution of temozolomide chemotherapy for intramedullary grade II spinal cord astrocytomas in adults: Our experience]

INTRODUCTION

Grade II intramedullary astrocytomas are rare tumors. Despite a well-defined role of adjuvant temozolomide chemotherapy for brain gliomas, the contribution of this therapy for intramedullary gliomas is not yet clearly defined.

METHOD

We retrospectively analyzed the data of 5 adult patients treated with temozolomide between 2008 and 2015 for a grade II intramedullary astrocytoma with progression after surgery.

RESULTS

Five patients from 19 to 70 years of age (median, 37years) underwent a second surgery for the progression of a grade II intramedullary astrocytoma (median progression-free survival 26months [8-90]). All tumors remained grade II. Due to a second clinical or/and radiological tumor progression, the patients were treated with temozolomide after a 37months median progression-free survival (5-66). All patients received at minimum 12 cycles (mean 14 ± 5; range 12-24) of temozolomide (150-200mg/m²/day, 5days/28days). All patients were alive after a 10-year median follow-up after diagnosis (6-13). All patients were able to walk except one, who was previously in McCormick autonomy grade IV before chemotherapy. The McCormick autonomy rating after temozolomide was stable for 4 patients and improved for 1 patient. The treatment was delayed once for hematological toxicity.

CONCLUSION

Temozolomide stabilized all 5 patients without any major toxicity. Based on this experience that needs to be confirmed, we consider that temozolomide should be envisaged within the therapeutic arsenal for progressive intramedullary grade II astrocytomas.

Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial

Purpose Cognitive behavioral therapy for insomnia (CBT-I) and Tai Chi Chih (TCC), a movement meditation, improve insomnia symptoms. Here, we evaluated whether TCC is noninferior to CBT-I for the treatment of insomnia in survivors of breast cancer. Patients and Methods This was a randomized, partially blinded, noninferiority trial that involved survivors of breast cancer with insomnia who were recruited from the Los Angeles community from April 2008 to July 2012. After a 2-month phase-in period with repeated baseline assessment, participants were randomly assigned to 3 months of CBT-I or TCC and evaluated at months 2, 3 (post-treatment), 6, and 15 (follow-up). Primary outcome was insomnia treatment response-that is, marked clinical improvement of symptoms by the Pittsburgh Sleep Quality Index-at 15 months. Secondary outcomes were clinician-assessed remission of insomnia; sleep quality; total sleep time, sleep onset latency, sleep efficiency, and awake after sleep onset, derived from sleep diaries; polysomnography; and symptoms of fatigue, sleepiness, and depression. Results Of 145 participants who were screened, 90 were randomly assigned (CBT-I: n = 45; TCC: n = 45). The proportion of participants who showed insomnia treatment response at 15 months was 43.7% and 46.7% in CBT-I and TCC, respectively. Tests of noninferiority showed that TCC was noninferior to CBT-I at 15 months ( P = .02) and at months 3 ( P = .02) and 6 ( P < .01). For secondary outcomes, insomnia remission was 46.2% and 37.9% in CBT-I and TCC, respectively. CBT-I and TCC groups showed robust improvements in sleep quality, sleep diary measures, and related symptoms (all P < .01), but not polysomnography, with similar improvements in both groups. Conclusion CBT-I and TCC produce clinically meaningful improvements in insomnia. TCC, a mindful movement meditation, was found to be statistically noninferior to CBT-I, the gold standard for behavioral treatment of insomnia.

Population based MRI and DTI templates of the adult ferret brain and tools for voxelwise analysis

Non-invasive imaging has the potential to play a crucial role in the characterization and translation of experimental animal models to investigate human brain development and disorders, especially when employed to study animal models that more accurately represent features of human neuroanatomy. The purpose of this study was to build and make available MRI and DTI templates and analysis tools for the ferret brain as the ferret is a well-suited species for pre-clinical MRI studies with folded cortical surface, relatively high white matter volume and body dimensions that allow imaging with pre-clinical MRI scanners. Four ferret brain templates were built in this study – in-vivo MRI and DTI and ex-vivo MRI and DTI – using brain images across many ferrets and region of interest (ROI) masks corresponding to established ferret neuroanatomy were generated by semi-automatic and manual segmentation. The templates and ROI masks were used to create a web-based ferret brain viewing software for browsing the MRI and DTI volumes with annotations based on the ROI masks. A second objective of this study was to provide a careful description of the imaging methods used for acquisition, processing, registration and template building and to demonstrate several voxelwise analysis methods including Jacobian analysis of morphometry differences between the female and male brain and bias-free identification of DTI abnormalities in an injured ferret brain. The templates, tools and methodological optimization presented in this study are intended to advance non-invasive imaging approaches for human-similar animal species that will enable the use of pre-clinical MRI studies for understanding and treating brain disorders.

Application of buccal fat pad-derived stem cells in combination with autogenous iliac bone graft in the treatment of maxillomandibular atrophy: a preliminary human study

Stem cell therapy for the treatment of bone defects is an alternative or adjunct to autologous bone grafting. This study assessed the efficacy of buccal fat pad-derived stem cells (BFPSCs) with iliac bone block grafting for the treatment of extensive human alveolar ridge defects. Eight patients with extensive jaw atrophy were selected for this study. The jaws were reconstructed with non-vascularized anterior iliac crest bone blocks. Gaps between the blocks were filled with freeze-dried bone granules and covered with a collagen membrane. In the test group (n=4), these granules were seeded with BFPSCs. Cone beam computed tomography scans were used to assess the amount of new bone formed at six sites in each patient. Trephine biopsies of 2-mm were also taken from the graft site during implant placement for histomorphometric analysis. The mean bone width change at the graft site was greater in the test group than in the control group (3.94±1.62mm vs. 3.01±0.89mm). New bone formation was 65.32% in the test group versus 49.21% in the control group. The application of BFPSCs in conjunction with iliac bone block grafts may increase the amount of new bone formation and decrease secondary bone resorption in extensively atrophic jaws.

Cognitive behavioral therapy and tai chi reverse cellular and genomic markers of inflammation in late-life insomnia: a randomized controlled trial

BACKGROUND

Sleep disturbance is associated with activation of systemic and cellular inflammation, as well as proinflammatory transcriptional profiles in circulating leukocytes. Whether treatments that target insomnia-related complaints might reverse these markers of inflammation in older adults with insomnia is not known.

METHODS

In this randomized trial, 123 older adults with insomnia were randomly assigned to cognitive-behavioral therapy for insomnia (CBT-I), tai chi chih (TCC), or sleep seminar education active control condition for 2-hour sessions weekly over 4 months with follow-up at 7 and 16 months. We measured C-reactive protein (CRP) at baseline and months 4 and 16; toll-like receptor-4 activated monocyte production of proinflammatory cytokines at baseline and months 2, 4, 7, and 16; and genome-wide transcriptional profiling at baseline and month 4.

RESULTS

As compared with sleep seminar education active control condition, CBT-I reduced levels of CRP (months 4 and 16, ps < .05), monocyte production of proinflammatory cytokines (month 2 only, p < .05), and proinflammatory gene expression (month 4, p < .01). TCC marginally reduced CRP (month 4, p = .06) and significantly reduced monocyte production of proinflammatory cytokines (months 2, 4, 7, and 16; all ps < .05) and proinflammatory gene expression (month 4, p < .001). In CBT-I and TCC, TELiS promoter-based bioinformatics analyses indicated reduced activity of nuclear factor-κB and AP-1.

CONCLUSIONS

Among older adults with insomnia, CBT-I reduced systemic inflammation, TCC reduced cellular inflammatory responses, and both treatments reduced expression of genes encoding proinflammatory mediators. The findings provide an evidence-based molecular framework to understand the potential salutary effects of insomnia treatment on inflammation, with implications for inflammatory disease risk.

Tai chi, cellular inflammation, and transcriptome dynamics in breast cancer survivors with insomnia: a randomized controlled trial

BACKGROUND

Mind-body therapies such as Tai Chi are widely used by breast cancer survivors, yet effects on inflammation are not known. This study hypothesized that Tai Chi Chih (TCC) would reduce systemic, cellular, and genomic markers of inflammation as compared with cognitive behavioral therapy for insomnia (CBT-I).

METHODS

In this randomized trial for the treatment of insomnia, 90 breast cancer survivors with insomnia were assigned to TCC or CBT-I for 2-hour sessions weekly for 3 months. At baseline and postintervention, blood samples were obtained for measurement of C-reactive protein and toll-like receptor-4-activated monocyte production of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF), with a random subsample (n = 48) analyzed by genome-wide transcriptional profiling.

RESULTS

Levels of C-reactive protein did not change in the TCC and CBT-I groups. Levels of toll-like receptor-4-activated monocyte production of IL-6 and TNF combined showed an overall reduction in TCC versus CBT-I (P < .02), with similar effects for IL-6 (P = .07) and TNF (P < .05) alone. For genome-wide transcriptional profiling of circulating peripheral blood mononuclear cells, expression of genes encoding proinflammatory mediators showed an overall reduction in TCC versus CBT-I (P = .001). TELiS promoter-based bioinformatics analyses implicated a reduction of activity of the proinflammatory transcription factor, nuclear factor-κB, in structuring these differences.

CONCLUSIONS

Among breast cancer survivors with insomnia, 3 months of TCC reduced cellular inflammatory responses, and reduced expression of genes encoding proinflammatory mediators. Given the link between inflammation and cancer, these findings provide an evidence-based molecular framework to understand the potential salutary effects of TCC on cancer survivorship.

[Supraorbital approach to treat a fronto-orbital fracture with pneumocephaly, a minimal invasive technique]

We describe a supraorbital approach through an upper eyebrow skin incision to treat a fronto-orbital fracture with pneumocephaly in a 84-year-old cardiac patient. The clinical and cosmetic results are excellent. This case is illustrated by pre- and postoperative CT-scan and MRI as well as pictures showing the minimal invasive technique.

Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial

STUDY OBJECTIVES

To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia.

DESIGN

Randomized controlled, comparative efficacy trial.

SETTING

Los Angeles community.

PATIENTS

123 older adults with chronic and primary insomnia.

INTERVENTIONS

Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months.

MEASUREMENTS

Insomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels.

RESULTS

CBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [95% CI, 0.07-0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change.

CONCLUSIONS

Treatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys.

Hyperoside and anthocyanin content of ten different pomegranate cultivars

Pomegranate (Punica granatum L.) is native to the Mediterranean region and has been used extensively as a medicine in many counties. Hyperoside is known as an important flavonoid with antioxidant activity and anti hypertension effect. Anthocyanins are the active component in several herbal medicines, thus accurate measurement of hyperoside and anthocyanins, along with their degradation indices, is very useful to food technologists and horticulturists. The aim of the current study was to determine the antioxidant capacity as hyperoside and anthocyanin content of ten different Iranian pomegranate cultivars. Spectroscopic analyses of the pomegranate showed Black peel cultivar had the highest hyperoside content (25.93 +/- 2.87, 620.41 +/- 30.32 mg/100 g) in its pulp and peel, respectively. Based on this study, the amounts of anthocyanin in pulp ranged between 1.56 +/- 0.05 and 3.89 +/- 0.07 mg g(-1) which related to Sweet white peel and Sweet alac cultivars, respectively. More over the highest and also the lowest peel anthocyanin contents related to these cultivars. The results revealed that the hyperoside and also anthocyanin peel content of each variety is higher than its pulp content. In addition the potency of black peel (Medicinal pomegranate) and Sweet alac cultivars for prevention of coronary heart disease and hypertension were presented.

Age of menarche as a risk factor for gynecological cancer in Iranian women and review of the literature

BACKGROUND

This study analyzed the age of menarche in different regions of Iran with a review of previous studies and examined the changes of menarche age over the past years.

MATERIALS AND METHODS

A descriptive and cross-sectional study which was conducted in 11 different provinces of Iran with a sample size of 26,831. The year of birth and age of menarche in the population obtained through health records which were available in the health centers collected and also questioning the subjects under investigation.

RESULTS

The highest average age of 14.6 years obtained from Kermanshah province and the lowest was from Kerman with 12.98 years. The lowest average was observed with age group under 30 (13.22) and the highest age of menarche (13.53) belonged to the 30 to 40 year age group. The average age of menarche in this study was 13.24 years.

DISCUSSION

A declining trend of about two to four months for each ten years has been observed in girls born in 1920s to 1940s and then an upward trend of about nine months for ten years in subjects born in 1950s and 1960s. The stressful condition of war and poor economic and social conditions of Iranian people can justify this upward leap. However in women under 30 years of age, the menarche age showed a rapid declining trend to 13.22 years.

CONCLUSION

Obtaining accurate information and knowing all the factors affecting this issue can be very useful in planning the public health in women and health educational programs.

Antibacterial activity and composition of essential oils from Pelargonium graveolens L'Her and Vitex agnus-castus L

BACKGROUND AND OBJECTIVES

Essential oils are volatile compounds that have been used since Middle Ages as antimicrobial, anti-inflammatory, sedative, local anesthetic and food flavoring agents. In the current study, essential oils of Pelargonium graveolens L'Her and Vitex agnus-castus L. were analyzed for their antibacterial activities.

MATERIALS AND METHODS

The chemical compositions of essential oils were characterized by GC-MS. Disc diffusion method was used to study antimicrobial activity.

RESULTS AND CONCLUSION

Inhibition zones showed that the essential oils of the two plants were active against all of the studied bacteria (except Listeria monocytogenes). The susceptibility of the strains changed with the dilution of essential oils in DMSO. The pure essential oils showed the most extensive inhibition zones and they were very effective antimicrobial compounds compared to chloramphenicol and amoxicillin. The most susceptible strain against these two essential oils was Staphylococcus aureus. It seems that β-citronellol is a prominent part of P. graveolens volatile oil and caryophyllene oxide is a famous and important part of V. agnus-castus volatile oil and their probable synergistic effect with other constituents are responsible for the antibacterial effects of these oils. However further studies must be performed to confirm the safety of these oils for use as antimicrobial agents and natural preservatives in different products.

Assessment of welders exposure to carcinogen metals from manual metal arc welding in gas transmission pipelines, iran

BACKGROUND

Welding can produce dangerous fumes containing various metals especially carcinogenic ones. Occupational exposure to welding fumes is associated with lung cancer. Therefore, welders in Gas Transmission Pipelines are known as a high-risk group. This study was designed to determinate the amounts of metals Cr, Ni, and Cd in breathing zone and urine of welders and to assess the possibility of introducing urinary metals as a biomarker due to occupational exposure.

METHODS

In this cross sectional study, 94 individuals from Gas Transmission Pipelines welders, Iran, Borujen in 2011 were selected and classified into 3 groups including Welders, Back Welders and Assistances. The sampling procedures were performed according to NIOSH 7300 for total chromium, nickel, and cadmium and NIOSH 7600 for Cr+6. For all participants urine samples were collected during the entire work shift and metals in urine were determined according to NIOSH 8310.

RESULTS

Back Welders and Assistances groups had maximum and minimum exposure to total fume and its elements, respectively. In addition, results showed that there are significant differences (P<0.05) between Welders and Back Welders with Assistances group in exposure with total fume and elements except Ni. Urinary concentrations of three metals including Cr, Cd and Ni among all welders were about 4.5, 12 and 14-fold greater than those detected in controls, respectively. Weak correlations were found between airborne and urinary metals concentrations (R2: Cr=0.45, Cd=0.298, Ni=0.362).

CONCLUSION

Urinary metals concentrations could not be considerate as a biomarker for welders' exposure assessment.

Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis

STUDY OBJECTIVES

Disturbances of sleep are hypothesized to contribute to pain. However, experimental data are limited to healthy pain-free individuals. This study evaluated the effect of sleep loss during part of the night on daytime mood symptoms and pain perceptions in patients with rheumatoid arthritis in comparison with control subjects.

DESIGN

A between-groups laboratory study with assessment of mood symptoms and pain perception before and after partial night sleep deprivation (PSD; awake 23:00 hr to 03:00 hr).

SETTING

General clinical research center.

PARTICIPANTS

Patients with rheumatoid arthritis (n = 27) and volunteer comparison control subjects (n = 27).

MEASUREMENTS

Subjective reports of sleep, mood symptoms and pain, polysomnographic assessment of sleep continuity, and subjective and objective assessment of rheumatoid arthritis-specific joint pain.

RESULTS

PSD induced differential increases in self-reported fatigue (P < 0.09), depression (P < 0.04), anxiety (P < 0.04), and pain (P < 0.01) in patients with rheumatoid arthritis compared with responses in control subjects, in whom differential increases of self-reported pain were independent of changes in mood symptoms, subjective sleep quality, and objective measures of sleep fragmentation. In the patients with rheumatoid arthritis, PSD also induced increases in disease-specific activity as indexed by self-reported pain severity (P < 0.01) and number of painful joints (P < 0.02) as well as clinician-rated joint counts (P < 0.03).

CONCLUSION

This study provides the first evidence of an exaggerated increase in symptoms of mood and pain in patients with rheumatoid arthritis after sleep loss, along with an activation of rheumatoid arthritis-related joint pain. Given the reciprocal relationship between sleep disturbances and pain, clinical management of pain in patients with rheumatoid arthritis should include an increased focus on the prevention and treatment of sleep disturbance in this clinical population.

Rate of use of contraceptive methods and risk factors in Tehran, the capital of Iran, in 2010 compared to other cities and regions

BACKGROUND

Unwanted pregnancies and deaths from abortion cost the lives of 500 women daily. This study was designed to determine the rate of use of contraceptive methods and the risks.

MATERIAL AND METHODS

This cross-sectional study was conducted in 2010 in Tehran, Iran. Total sample size was 304 participants who all filled out a questionnaire which had two parts. Data were analyzed by SPSS.

FINDINGS

The results showed that age (p = 0.003), employment status (p = 0.001), number of children (p = 0.001), and marriage (p = 0.01), had a significant relation with type of contraceptive method while, education did not correlate with contraceptive methods.

DISCUSSION

New and often younger couples with no experience about different contraceptive methods may tend to use natural methods because of their lack of knowledge of other techniques. Use of modern contraceptives early in marriage or even before marriage could be a good strategy.

Chronic recurrent multifocal osteomyelitis: a case report

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disease. It is a diagnosis of exclusion based on the clinical, radiological and pathological criteria. The awareness of the corresponding feature can help avoid of unnecessary diagnostic procedures and prolonged antibiotic therapy. We present a case of 4.5 year old girl, diagnosed with CRMO who were followed for 6 months as a case of chronic bacterial osteomyelitis and received long course of antibiotic therapy.

New results regarding trends in Iranian women's health and a comparison with WHO data

Half of the world's population consists of women, who play important roles in cultural formation and education, maintain and promote households and their health, and consequently affect the community. In a general sense, women's health may be an important cornerstone for the formation of a healthy community. In developing countries, 67% of women work in the agriculture sector and produce 55% of the food products throughout the world. In East Asian countries, which have the highest level of cloth and furniture export, 74% of workers are women. Due to these considerations, we assessed women's health indicators in Iran. We reviewed health information from national health reports, including two national health surveys conducted in 1991 and 2009 with a sample size of 1/1,000 of the Iranian population, the 2000 Iran Demographic and Health Survey, and all published indices that were calculated in 2006 or later. The most important finding was that the maternal mortality rate decreased from 54 per 100,000 live births in 1991 to 37.4 per 100,000 live births in 1997. It decreased further to 24.7 per 100,000 live births in 2006. The Millennium Development Goal is 18-22 per 100,000 live births in 2015.

Antioxidant properties of peel and pulp hydro extract in ten Persian pomegranate cultivars

This study compares the antioxidant activity of ten different pomegranate cultivars grown in Iran using the ferric reducing power assay (FRAP assay), which is based on the reduction of a ferric-tripyridyl triazine complex to its ferrous, colored form in the presence of antioxidants. Aqueous solutions of known Fe(+2) concentration, in the range of 100-1000 micromol L(-1) were used for calibration. The results showed that among pulp and peel fractions the sour alac and sweet white peel cultivars had more FRAP value respectively. The pomegranate peel extract had markedly higher antioxidant capacity than the pulp extract. The peel extract of sweet white peel cultivar appeared to have more potential as a health supplement rich in natural antioxidants compared to the pulp and peel extracts of other pomegranate cultivars.

Apparent diffusion coefficient and cerebral blood volume in brain gliomas: relation to tumor cell density and tumor microvessel density based on stereotactic biopsies

BACKGROUND AND PURPOSE

MR imaging-based apparent diffusion coefficient (ADC) and regional cerebral blood volume (rCBV) measurements have been related respectively to both cell and microvessel density in brain tumors. However, because of the high degree of heterogeneity in gliomas, a direct correlation between these MR imaging-based measurements and histopathologic features is required. The purpose of this study was to correlate regionally ADC and rCBV values with both cell and microvessel density in gliomas, by using coregistered MR imaging and stereotactic biopsies.

MATERIALS AND METHODS

Eighteen patients (9 men, 9 women; age range, 19-78 years) with gliomas underwent diffusion-weighted and dynamic susceptibility contrast-enhanced MR imaging before biopsy. Eighty-one biopsy samples were obtained and categorized as peritumoral, infiltrated tissue, or bulk tumor, with quantification of cell and microvessel density. ADC and rCBV values were measured at biopsy sites and were normalized to contralateral white matter on corresponding maps coregistered with a 3D MR imaging dataset. ADC and rCBV ratios were compared with quantitative histologic features by using the Spearman correlation test.

RESULTS

The highest correlations were found within bulk tumor samples between rCBV and cell density (r=0.57, P < .001) and rCBV and microvessel density (r=0.46, P < .01). An inverse correlation was found between ADC and microvessel density within bulk tumor (r=-0.36, P < .05), whereas no significant correlation was found between ADC and cell density.

CONCLUSION

rCBV regionally correlates with both cell and microvessel density within gliomas, whereas no regional correlation was found between ADC and cell density.

Sixty-four-row multisection CT angiography for detection and evaluation of ruptured intracranial aneurysms: interobserver and intertechnique reproducibility

BACKGROUND AND PURPOSE

The purpose of this work was to assess intertechnique and interobserver reproducibility of 64-row multisection CT angiography (CTA) used to detect and evaluate intracranial aneurysms.

MATERIALS AND METHODS

From October 2005 to November 2006, 54 consecutive patients with nontraumatic subarachnoid hemorrhage (SAH) underwent both CTA and digital substraction angiography (DSA). Four radiologists independently reviewed CT images, and 2 other radiologists reviewed DSA images. Aneurysm diameter (D), neck width (N), and the presence of a branch arising from the sac were assessed.

RESULTS

DSA revealed 67 aneurysms in 48 patients and no aneurysm in 6 patients. Mean sensitivity and specificity of CTA for the detection of intracranial aneurysms were, respectively, 94% and 90.2%. For aneurysms less than 3 mm, CTA had a mean sensitivity of 70.4%. Intertechnique and interobserver agreements were good for the detection of aneurysms (mean kappa = 0.673 and 0.732, respectively) and for the measurement of their necks (mean kappa = 0.753 and 0.779, respectively). Intertechnique and interobserver agreements were excellent for the measurement of aneurysm diameters (mean kappa = 0.847 and 0.876, respectively). In addition, CTA was accurate in determining the N/D ratio of aneurysms and adjacent arterial branches. However, the N/D ratio was overestimated by all of the readers at CTA.

CONCLUSION

Sixty-four-row multisection CTA is an imaging method with a good interobserver reproducibility and a high sensitivity and specificity for the detection and the morphologic evaluation of ruptured intracranial aneurysms. It may be used as an alternative to DSA as a first-intention imaging technique in patients with SAH.

Immediate intracranial aneurysm occlusion after embolization with detachable coils: a comparison between MR angiography and intra-arterial digital subtraction angiography

BACKGROUND AND PURPOSE

To prospectively compare the effectiveness of time-of-flight (TOF) and contrast-enhanced (CE) MR angiography (MRA) with that of digital subtraction angiography (DSA) to assess immediate intracranial aneurysm occlusion after selective embolization.

METHODS

From August 2006 to March 2007, 33 consecutive patients with 40 aneurysms were included. Thirty aneurysms were treated by endosaccular coils (group 1). Ten aneurysms were treated by stent placement and subsequent endosaccular coils (group 2). All patients underwent MRA within 24 h after treatment. One senior and one fellow radiologist independently reviewed the MR images, and another senior radiologist reviewed the DSA images.

RESULTS

DSA showed 22 complete occlusions, ten residual necks, and eight residual aneurysms. For residual neck detection, there was no difference between TOF-MRA (sensitivity, 80%-80%; specificity, 93.8%-100%, according to both readers) and CE-MRA (sensitivity, 80%-80%; specificity, 100%). For residual aneurysm detection, there was a significant difference between TOF-MRA (sensitivity, 50%-62.5%; specificity, 100%) and CE-MRA (sensitivity and specificity, 100%, according to both readers). In group 2, a residual aneurysm was missed by both readers with TOF-MRA in the same 3 aneurysms. Moreover, both readers judged CE-MRA better than TOF-MRA to assess parent-artery patency in group 2. Interobserver agreement was excellent for TOF-MRA and CE-MRA (kappa=0.9 and 1, respectively).

CONCLUSIONS

In our study, both TOF-MRA and CE-MRA had high and comparable sensitivity and specificity for the assessment of immediate aneurysm occlusion after selective embolization, except when a stent-assisted technique was used. In such cases, CE-MRA was superior to TOF-MRA to evaluate aneurysm occlusion and parent-artery patency.

Information on heavy equipments and facilities in Belgium: gamma-knife

PURPOSE

To explain the principles and indications of gamma knife radiosurgery and to illustrate the correlated neuroimaging features.

METHODS AND MATERIAL

Between December 1999 and July 2007, 1620 patients were treated by GK for a large variety of indications (metastasis 26%, vascular malformations 7%, trigeminal neuralgia 14%, pituitary adenoma 3%, primary CNS tumour 8%, other tumours 6%, vestibular schwannoma 19%, meningioma 17%, functional disorders <1%). The patients benefited from MRI follow-ups.

RESULTS

MRI is the imaging technique of choice for Gamma knife radiosurgery (GKRS) in almost all indications. Computed Tomography, Digital Subtraction Angiography and Positron Emission Tomography have an additional role in some indications. Significant MRI data is illustrated in most indications. Evaluation of the treatment is mainly performed using MRI follow-up studies. The main features of these MRI follow-ups are described. Stabilisation or shrinking of the lesions volumes was generally observed. T2 relaxation times were also modified in and around the treated target areas, in patients responding to treatment and without any symptomatic complications. Modifications in contrast uptake were also observed in those patients. A few patients presented symptomatic complications associated with T2 signal anomalies. The interpretation of those modifications is discussed.

CONCLUSION

MRI is the method of choice for GKRS planning in most indications. Imaging changes after radiosurgery provide the best quality control available to assess the response to radiosurgical treatment and to identify and monitor potential complications.

Stereotactic comparison among cerebral blood volume, methionine uptake, and histopathology in brain glioma

BACKGROUND AND PURPOSE

Vascularity, metabolism, and histologic grade are related in gliomas but the exact determinants of these relationships are not fully defined. We used image coregistration and stereotactic biopsies to regionally compare cerebral blood volume (CBV) and (11)C-methionine (MET) uptake measurements in brain gliomas and to assess their relationship by histopathologic examination.

MATERIALS AND METHODS

Fourteen patients with brain gliomas underwent MR imaging, including dynamic susceptibility contrast-enhanced MR and positron-emission tomography (PET) using MET acquired in identical stereotactic conditions before biopsy. MR-based CBV maps were calculated and both CBV maps and PET images were coregistered to anatomic images. Sixty-five biopsy samples were obtained on trajectories targeted toward high MET uptake area. The following histopathologic features were semiquantified in each sample: mitotic activity, endothelial proliferation, cellular pleomorphism, and tumor necrosis. CBV and MET uptake values were measured in the biopsy area and normalized to contralateral white matter. CBV ratios were compared with MET uptake ratios, and both measurements were compared with histologic features of each sample.

RESULTS

CBV ratios ranged from 0.08 to 10.24 (median = 1.73), and MET uptake ratios ranged from 0.30 to 4.91 (median = 1.67). There was a positive correlation between CBV ratios and MET uptake ratios (r = 0.65, P < .001). Both CBV and MET uptake ratios were found to be significantly related to endothelial proliferation and mitotic activity (P < .01).

CONCLUSION

Within glial tumors, there is a local relationship between CBV and MET uptake measurements. Both provide indices of focal malignant activity.

[Role of new MRI techniques in neuroradiologic practice]

Magnetic Resonance Imaging (MRI) has been introduced in clinical practice in the mid-eighties. However, MRI is an ever evolving imaging technique with constant new developments allowing broadening of clinical applications. In particular, angio-MRI involves many different acquisition techniques that will guide their clinical use. On the other hand, clinical applications of the following techniques are briefly discussed: diffusion, perfusion, tractography and diffusion tensor imaging, spectroscopy and functional imaging.

[The medical imaging and radiology department]

Technological developments arising from research have affected the whole wide spectrum of medical endeavor and have made a very significant impact on clinical practice and especially on imaging sciences. Ultrasonography brought spectacular advances, but CT and MRI became important landmark techniques. A further important development, which greatly increased the involvement of radiologists in direct patient management, was the growth of interventional and therapeutic techniques, called interventional radiology. Some statistics: approximately 155,000 patients per year including 19,000 CT Scans, 10,000 MRI exams, 21,000 ultrasound examinations and 1,000 therapeutic procedures. Some research activities: CT quantification of pulmonary emphysema, respiratory mechanics, MR and CT angiography, antenatal diagnosis of congenital and genetic diseases of the fetus, quantification of portal haemodynamics, MR imaging of bile and pancreatic ducts, morphologic and functional imaging of the brain, radiology of bone trauma, MR characterization in hepatic lesions.