Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.

METHODS

We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.

FINDINGS

Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.

INTERPRETATION

As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed.

FUNDING

Bill & Melinda Gates Foundation.

Evaluation of the effect of mitoquinone on functional parameters, DNA structure, and genes expression related to the apoptotic and antioxidants of human sperm after freezing-thawing

OBJECTIVE

Sperm freezing is considered as an effective way in assisted reproductive technology (ART) programs, it has detrimental effects on sperm function, due to the production of reactive oxygen species (ROS). This study aimed to investigate the potential of Mitoquinone (MitoQ) in inhibiting the production of mitochondrial ROS during sperm freezing.

METHODS

A total of 20 human normozoosperm samples were collected for this study. The samples were divided into four groups, each containing different concentrations of MitoQ (0, 0.2, 2, and 20 nM), and then subjected to the freezing process. After thawing, the sperm suspensions were evaluated for parameters including motility, morphology, acrosome integrity, adenosine triphosphate (ATP) level, intracellular ROS, viability, chromatin packaging, DNA denaturation, DNA fragmentation, as well as the expression of antioxidants (GPX, SOD) and apoptotic (Bax, Bcl2) genes.

RESULTS

The results showed that total and progressive mobility of sperms significantly increased in the 2 nM group, while significantly decreased in the 20 nM group (p ≤ 0.05). Sperm morphology did not significantly improve across all the tested concentrations (p ≥ 0.05). Intracellular ROS levels showed a significant decrease and increase in the concentrations of 2 and 20 nM, respectively (p ≤ 0.05). Furthermore, a significant increase was observed in viability, ATP, acrosome integrity, chromatin packaging, and non-denatured and non-fragmented DNA after treatment with 2 nM of MitoQ, compared with the control group (p ≤ 0.05). Regarding gene expressions, the relative expressions of oxidative stress genes were increased in the 2 nM group and decreased in the 20 nM group (p ≤ 0.05), while no significant difference was observed in the expressions of apoptotic genes compared with the control group (p ≥ 0.05). All the comparisons were made with respect to the control group.

CONCLUSION

Adding the optimal concentration of MitoQ (2 nM) to the sperm freezing medium not only improves sperm functional parameters and reduces DNA damages, but also stimulates the expression of antioxidant genes, leading to even greater benefits for sperm cryopreservation.

A Study of Emotion Regulation Difficulties, Repetitive Negative Thinking, and Experiential Avoidance in Adults with Stuttering: A Comparative Study

Objective: Stuttering is a type of communication and fluency disorder that hurts mental and emotional health. It is also associated with a significant increase in both trait and social anxiety. Studies on stuttering in adults have indicated the nature and impact of this phenomenon. In addition, some psychological aspects of this phenomenon remain vague and need further investigation. Therefore, the present study aimed to compare emotion regulation difficulties, repetitive negative thinking, and experiential avoidance between people who stutter and healthy individuals. Method : In this study, 101 people who stutter (43 females and 58 males, with a mean age of 29.55 ± 187 years), as well as 110 healthy individuals (74 females and 36 males, with a mean age of 25.57 ± 489 years) as participants were chosen using the convenience sampling method among those who referred to the speech therapy clinics of Tehran, Iran. Research instruments including the repetitive negative thinking inventory, Difficulties in Emotion Regulation Scale, and Acceptance and Action Questionnaire (AAQ-I) were used for data collection. Data were analyzed using multivariate ANOVA test and Multiple Regression Analysis. Results: The mean age of the participants was 29.55 years in the people who stutter and 25.57 years in the healthy individuals (P < 0.01). The present results indicated that the mean score of experiential avoidance was higher in the people who stutter (M ± SD: 35.74 ± 9.24) compared to the healthy individuals (M ± SD: 8.89 ± 31.11). Additionally, the mean score of emotion regulation difficulties was higher in the people who stutter (M ± SD: 88.75 ± 20.59) compared to the healthy individuals (M ± SD: 64.14 ± 94.94) (P < 0.001). However, there was no significant difference in the mean score of repetitive negative thinking between the people who stutter (M ± SD: 98.45 ± 25.85) and healthy individuals (M ± SD: 93.71 ± 25.24) groups (P > 0.05). There was a significant correlation between experiential avoidance and emotion regulation difficulties in people who stutter (P < 0.01). Experiential avoidance and repetitive negative thinking can significantly predict emotion regulation difficulties in people who stutter (R = 0.65, P < 0.01). Conclusion: People who stutter obtained higher emotion regulation difficulties and experiential avoidance scores than those without stuttering and A significant correlation between experiential avoidance and emotion regulation difficulties was found. Future studies should consider the role of emotion regulation difficulties and experiential avoidance in people who stutter.

Sleep Problems, Social Anxiety and Stuttering Severity in Adults Who Do and Adults Who Do Not Stutter

Background: While there is sufficient evidence that children and adolescents who stutter reported more impaired sleep compared to children and adolescents who did not stutter, findings among adults who stutter (AWS) were scarce. Furthermore, stuttering is associated with issues related to verbal communication in a social context. As such, it was conceivable that AWS reported higher scores for social anxiety, compared to adults who do not stutter (AWNS). In the present study, we tested whether AWS reported higher sleep complaints compared to AWNS. We further tested whether scores for social anxiety and stuttering independently predicted sleep disturbances. Methods: A total of 110 AWS (mean age; 28.25 years, 27.30% females) and 162 AWNS (mean age; 29.40 years, 51.20% females) completed a series of self-rating questionnaires covering sociodemographic information, sleep disturbances and social anxiety. Adults with stuttering further completed a questionnaire on stuttering. Results: Compared to AWNS, AWS reported a shorter sleep duration, a lower sleep efficiency, higher scores for drug use in terms of sleep-promoting medications (significant p-values and medium effect sizes), and an overall higher PSQI score (significant p-values and large effect size), when controlling for age and social anxiety. Next, while p-values were always significant for subjective sleep quality, sleep disturbances, and daytime functioning, when controlling for age and social anxiety, their effect sizes were trivial or small. For sleep latency, the p-value was not significant and the effect size was trivial. Among AWS, higher scores for stuttering and older age, but not social anxiety, predicted higher sleep disturbances. The association between higher sleep disturbances and higher stuttering severity was greatest among those AWS with highest scores for social anxiety. Conclusions: When compared to AWNS, AWS self-reported higher sleep disturbances, which were associated with older age, and higher scores for stuttering severity, but not with social anxiety. Adults who stutter might be routinely asked for their sleep quality.

Anomalous photoluminescence of InAs surface quantum dots: intensity enhancement and strain control by underlying quantum dots

Strain control and photoluminescence (PL) enhancement of InAs surface quantum dots (SQDs), exposed to ambient conditions, have been achieved by introducing underlying buried quantum dots (BQDs). The PL wavelength has been tuned from 1270 to as long as 1780 nm, redshifted as the size of the SQDs is reduced. This is in strong contrast to standard QDs, in which blueshift is observed from smaller QDs following basic quantum mechanics. Here, smaller SQDs, both in height and base area, as observed by atomic force microscopy, were obtained with wider GaAs spacer thickness between the SQDs and BQDs. The result strongly suggests that strain and related effects dominate the electronic properties of the SQDs rather than their size, and that a change in the complex strain field occurs through the spacer. The underlying BQDs also serve as effective carrier reservoirs. A PL intensity enhancement of 17 fold was observed as the GaAs spacer thickness was reduced from 150 to 10 nm. A large portion of the photoexcited carriers is initially captured and stored in the BQDs. When sufficient carriers are transferred to fill non-radiative surface states, the excess may be transferred to the SQDs enhancing the luminescence.

Genome-wide association study and genomic heritabilities for blood protein levels in Lori-Bakhtiari sheep

Serum protein levels are related to physiological and pathological status of animals and could be affected by both genetic and environmental factors. This study aimed to evaluate genetic variation of serum protein profile in sheep. Blood samples were randomly collected from 96 Lori-Bakhtiari ewes, a heavy meat-type breed. Total protein, albumin, globulin, α1, α2, β and γ globulins and IgG levels were measured in blood serum. The samples were genotyped using the Illumina OvineSNP50 BeadChip. The studied traits adjusted for age, birth type, birth season and estimate of breeding value for body weight were considered as pseudo-phenotypes in genome-wide association analysis. In the GWAS model, the first five principal components were fitted as covariates to correct the biases due to possible population stratification. The Plink, R and GCTA software were used for genome-wide association analysis, construction of Q-Q and Manhattan plots and estimation of genetic variances, respectively. Noticeable genomic heritabilities ± SE were estimated for total and γ globulins (0.868 ± 0.262 and 0.831 ± 0.364, respectively), but other protein fractions had zero or close to zero estimates. Based on the Bonferroni adjusted p values, four QTLs located on 181.7 Mbp of OAR3, 107.7 Mbp of OAR4, 86.3 Mbp of OAR7 and 83.0 Mbp of OAR8 were significantly associated with α1, β, β and γ globulins, respectively. The results showed that the PKP2, IGF2R, SLC22A1 and SLC22A2 genes could be considered as candidate genes for blood serum proteins. The present study showed significant genetic variations of some blood protein fractions.

Sleep Spindle Characteristics in Obstructive Sleep Apnea Syndrome (OSAS)

Background: We compared the density and duration of sleep spindles topographically in stage 2 and 3 of non-rapid eye movement sleep (N2 and N3) among adults diagnosed with Obstructive Sleep Apnea Syndrome (OSAS) and healthy controls.

Materials and Methods: Thirty-one individuals with OSAS (mean age: 48.50 years) and 23 healthy controls took part in the study. All participants underwent a whole night polysomnography. Additionally, those with OSAS were divided into mild, moderate and severe cases of OSAS.

Results: For N2, sleep spindle density did not significantly differ between participants with and without OSAS, or among those with mild, moderate and severe OSAS. For N3, post-hoc analyses revealed significantly higher spindle densities in healthy controls and individuals with mild OSAS than in those with moderate or severe OSAS. Last, in N2 a higher AHI was associated with a shorter sleep spindle duration.

Conclusion: OSAS is associated with a significantly lower spindle density in N3 and a shorter spindle duration in N2. Our results also revealed that, in contrast to moderate and severe OSAS, the sleep spindle characteristics of individuals with mild OSAS were very similar to those of healthy controls.

TET2, DNMT3A, IDH1, and JAK2 Mutation in Myeloproliferative Neoplasms in southern Iran

BACKGROUND

Five epigenetic regulator mutations are considered in myeloproliferative neoplasms (MPN) that have prognostic and therapeutic values.

OBJECTIVE

We aimed to evaluate these mutations in MPNs among the Iranian population.

METHODS

We selected 5 mutations in 4 epigenetic regulatory genes [TET2, DNMT3A, IDH1 (rs147001633&rs121913499), and JAK2)] and evaluated 130 patients with MPNs including 78 Philadelphia chromosome negative (49 ETs, 20 PVs, and 9 PMFs) and 52 Philadelphia chromosome-positive patients as well as 51 healthy controls.

RESULTS

Eight patients (6.5%) carried the DNMT3A mutation, 35 (27%) were positive for TET2 mutation and 64 (49.3%) had the JAK2V617F mutation. In the healthy controls, 16 (31.4%) cases had the TET2 mutation (15 Heterozygote + 1 Homozygote) and one had heterozygote JAK2 mutation. There was no statistically significant difference between patient groups for any of these mutations, except for JAK2. The JAK2 mutation rate was 18 (90%), 25 (51%), 7 (77.8%), 14 (26.9%) in polycythemia vera, essential thrombocythemia, primary myelofibrosis, and chronic myelocytic leukemia, respectively. Patients aged 60 and older were more likely to carry the TET2 mutation (23% vs. 39% in younger and older than 60 years old individuals, p=0.025). IDH1 was not detected at all and PV had the highest TET2 mutation 7(35%). Two PMF patients had a history of bone marrow transplantation that were negative for IDH1and DNMT3A and one was positive for TET2 mutation.

CONCLUSION

In the normal Iranian population, the heterozygote form of TET2 mutation is significant, especially in the elderly. No association was found between JAK2 and TET2 mutations. Both of them are more prevalent in the age group of 60 years and older. DNMT3A mutation has a low prevalence and occurs in both positive and negative MPNs.

Numerical analysis of hip fracture due to a sideways fall

The primary purpose of this paper is to outline a methodology for evaluating the likelihood of cortical bone fracture in the proximal femur in the event of a sideways fall. The approach includes conducting finite element (FE) analysis in which the cortical bone is treated as an anisotropic material, and the admissibility of the stress field is validated both in tension and compression regime. In assessing the onset of fracture, two methodologies are used, namely the Critical Plane approach and the Microstructure Tensor approach. The former is employed in the tension regime, while the latter governs the conditions at failure in compression. The propagation of localized damage is modeled using a constitutive law with embedded discontinuity (CLED). In this approach, the localized deformation is described by a homogenization procedure in which the average properties of cortical tissue intercepted by a macrocrack are established. The key material properties governing the conditions at failure are specified from a series of independent material tests conducted on cortical bone samples tested at different orientations relative to the loading direction. The numerical analysis deals with simulations of experiments involving the sideways fall, and the results are compared with the experimental data. This includes both the evolution of fracture pattern and the local load-displacement characteristics. The proposed approach is numerically efficient, and the results do not display a pathological mesh-dependency. Also, in contrast to the XFEM approach, the analysis does not require any extra degrees of freedom.

A Novel Method for Sleep-Stage Classification Based on Sonification of Sleep Electroencephalogram Signals Using Wavelet Transform and Recurrent Neural Network

INTRODUCTION

Visual sleep-stage scoring is a time-consuming technique that cannot extract the nonlinear characteristics of electroencephalogram (EEG). This article presents a novel method for sleep-stage differentiation based on sonification of sleep-EEG signals using wavelet transform and recurrent neural network (RNN).

METHODS

Two RNNs were designed and trained separately based on a database of classical guitar pieces and Kurdish tanbur Makams using a long short-term memory model. Moreover, discrete wavelet transform and wavelet packet decomposition were used to determine the association between the EEG signals and musical pitches. Continuous wavelet transform was applied to extract musical beat-based features from the EEG. Then, the pretrained RNN was used to generate music. To test the proposed model, 11 sleep EEGs were mapped onto the guitar and tanbur frequency intervals and presented to the pretrained RNN. Next, the generated music was randomly presented to 2 neurologists.

RESULTS

The proposed model classified the sleep stages with an accuracy of >81% for tanbur and more than 93% for guitar musical pieces. The inter-rater reliability measured by Cohen's kappa coefficient (κ) revealed good reliability for both tanbur (κ = 0.64, p < 0.001) and guitar musical pieces (κ = 0.85, p < 0.001).

CONCLUSION

The present EEG sonification method leads to valid sleep staging by clinicians. The method could be used on various EEG databases for classification, differentiation, diagnosis, and treatment purposes. Real-time EEG sonification can be used as a feedback tool for replanning of neurophysiological functions for the management of many neurological and psychiatric disorders in the future.

Exposure to heavy metals and the risk of osteopenia or osteoporosis: a systematic review and meta-analysis

The relationship between heavy metal exposure and risk of osteopenia or osteoporosis has biological plausibility, yet it remains inconclusive; therefore, we conducted a systematic review and meta-analysis to evaluate the associations between exposure to heavy metals (i.e., cadmium, lead, and mercury) and the risk of osteopenia or osteoporosis. Databases of MEDLINE, Embase, Scopus, and Web of Science were searched through November 2019, to identify studies that evaluated the relationship between exposure to cadmium, lead, and mercury and risk of osteopenia or osteoporosis in adults. Fourteen eligible studies were included. Effect sizes expressed as pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using weighted random-effect models. Exposure to cadmium (OR = 1.35; 95% CI: 1.17 to 1.56; P ≤ 0.001) and lead (OR = 1.15; 95% CI: 1.00 to 1.32; P = 0.05) was associated with an increased risk of osteopenia or osteoporosis, unlike mercury. Subgroup analyses showed cadmium exposure increased the risk of osteopenia or osteoporosis in older (> 65 yrs.; OR = 1.43; 95%CI: 1.08 to 1.88, P = 0.01) compared with younger (18-65 yrs.; OR = 1.24; 95% CI: 1.02 to 1.52, P = 0.03) adults. Also, lead exposure increased the risk in men (OR = 1.55; 95% CI: 1.15 to 2.09, P = 0.007) unlike in women. By contrast to urinary levels, blood (OR = 1.26; 95% CI: 1.08 to 1.47, P = 0.003) and dietary (OR = 1.46; 95% CI: 1.28 to 1.67, P < 0.001) levels of cadmium were associated with an increased risk of osteopenia or osteoporosis. Exposure to cadmium and lead may be associated with an increased risk of osteopenia or osteoporosis, although high heterogeneity was detected.

Identification of potential genomic regions for egg weight by a haplotype-based genome-wide association study using Bayesian methods

1. Theoretically, haplotype blocks might be a more suitable alternative to SNP genotypes as they are usually better at capturing multi-allelic QTL effects, compared to individual SNP genotypes in genome-wide association studies. The objectives of this study were to identify genomic regions related to egg weight traits by Bayesian methods (BayesA, BayesB, and BayesN) that fit fixed-length haplotypes using GenSel software. 2. Genotypes at 294,705 SNPs, that were common on a 600K Affymetrix chip, were phased for an egg-laying hen population of 1,063 birds. Recorded traits included first egg weight (FEW) and average egg weight at 28, 36, 56, 66, 72 and 80 weeks of age. 2. Fitting 1Mb haplotypes from BayesB resulted in the highest proportion of genetic variance explained for the egg weight traits. Based on the trait, the genetic variance explained by each marker ranged from 27% to 76%. 3. Different haplotype windows associated with egg weight traits only explained a small percentage of the genetic variance. 4. The top one 1-Mb window on GGA1 explained approximately 4.05% of total genetic variance for the FEW. Candidate genes, including PRKAR2B, HMGA2, LEMD3, GRIP1, EHBP1, MAP3K7, and MYH were identified for egg weight traits. 5. Several genomic regions, potentially associated with egg weight traits, were identified, some of which overlapped with known genes and previously reported QTL regions for egg production traits.

Changes in performance, egg quality and blood parameters of laying hens fed selenium and oregano oil

Context Organic and herbal additives in feed may lead to more healthy animal products. For this study, we hypothesised that an organic form of selenium and/or a herbal additive (oregano, Origanum vulgare L.) may improve performance of laying hens. Aims The study was designed to determine the effects of selenium source (SS, sodium selenite; or selenium yeast, SY), oregano essential oil (OEO) and a combination of Se and OEO on performance, egg quality and blood parameters of laying hens. Methods In total, 216 Lohmann LSL-Lite laying hens, 66 weeks of age, were assigned to feed on one of six diets: control group, receiving basal diet (BD); BD + 0.3 mg SS/kg; BD + 0.3 mg SY/kg; BD + 250 mg OEO/kg; BD + 250 mg OEO + 0.3 mg SS/kg; BD + 250 mg OEO + 0.3 mg SY/kg. For each treatment, there were six replicates of six hens each for 12 weeks. Key results Feed conversion ratio was higher (P &lt; 0.05) with the OEO diet than in the control. The SY diet decreased egg production and the OEO diet decreased egg mass (P &lt; 0.05), although this effect was reversed with the SY + OEO diet. This would illustrate a synergistic effect of OEO with SY. Highest and lowest yolk colour values were found with the SY and SS diets, respectively (P &lt; 0.05). Serum uric acid was lower with diets containing Se than the control diet (P &lt; 0.05). Glutathione peroxidase activity was highest with SY and SY + OEO diets and lowest with the OEO diet (P &lt; 0.05). Birds fed the SS + OEO diet showed the highest total antioxidant capacity and those fed SY showed the lowest total antioxidant capacity (P &lt; 0.05). Conclusions Based on the results of the current study, it can be concluded that SY diet have increasing effect on egg weight in laying hens. In addition, novel synergistic effects between OEO and SY diets on improving egg production, egg mass and feed conversion ratio have been found. In terms of oxidative status, the detected synergistic effects between OEO and SS diets on total antioxidant capacity and between OEO and SY diets on glutathione peroxidase (GPx) have not been reported before, that appreciate more clarifying investigations in future. Although, dietary supplemental SY individually and also with OEO increased GPx, adding SS to diet together with OEO showed more improving effect on GPx compared to the separate usage. Implications Dietary supplemental SY can improve egg weight in laying hens. In addition, adding SY to diet of laying hens individually and with OEO have beneficial effects on oxidative status of bird in terms of GPs activity, which in turn can ameliorate the unfavourable impressions of probable environmentally oxidative stress on productive performance.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study

Importance

Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.

Objective

To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Evidence Review

We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.

Findings

In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).

Conclusions and Relevance

The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.

Alpha-wave Characteristics in Psychophysiological Insomnia

Individuals with psychophysiological insomnia (Psych-Insomnia) would show raised cortical arousal through their initiating sleep. Frequent changes in the alpha activity can be indicative of visual cortical activation, even without visual stimulation or retinal input. Therefore, we aimed to investigate alpha-wave characteristics in Psych-Insomnia before and after sleep onset. In a case–control study, 11 individuals with Psych-Insomnia (age: 44.00 ± 13.27) and 11 age-, sex-, and body mass index-matched healthy individuals (age: 41.64 ± 15.89) were recruited for this study. An overnight polysomnography monitoring was performed. Alpha characteristics were calculated from wake before sleep onsets (WBSOs), wake after sleep onset, rapid eye movement, and nonrapid eye movement in the both groups. They include the alpha power and alpha frequency and their variability in the central region. In the WBSO, alpha activity and variability were higher in the Psych-Insomnia individuals compared to healthy individuals. In both groups, alpha frequency variability was observed at approximately 1 Hz. Alpha-wave synchronization in Psych-Insomnia individuals was higher than the group with normal sleep. Individuals with Psych-Insomnia have a lot of imagination in the wake before sleep, which can be caused by stress, everyday concerns, and daily concerns.

Serum testosterone/cortisol ratio in people with obstructive sleep apnea

Objectives

Obstructive sleep apnea (OSA) is a major health problem that has been associated with endocrine dysfunction in the hypothalamic‐pituitary‐gonadal (HPG) and hypothalamic‐pituitary‐adrenal (HPA) axes. This study investigated cortisol, testosterone, and the testosterone/cortisol ratio in patients with OSA compared to normal sleepers.

Methods

Thirty‐nine OSA patients diagnosed by overnight polysomnography (PSG) were divided into three groups, including ten mild OSA patients, 16 patients with moderate OSA, and 13 patients with severe OSA according to the apnea‐hypopnea index (AHI). In addition, 13 normal sleepers with normal PSG findings were recruited as the control group. Serum levels of cortisol, testosterone, and sex hormone‐binding globulin (SHBG) were measured using enzyme‐linked immunosorbent assay (ELISA).

Results

There were no significant differences between the normal sleepers and the three subtypes of OSA in terms of total and free testosterone levels (P > .1). The results showed significantly higher levels of cortisol in the severe OSA group compared to the normal sleepers and the two other subtypes of OSA (P < .01). In addition, the testosterone/cortisol (T/C) ratio was significantly lower among the severe OSA compared to the moderate OSA patients (P = .01). A significant correlation was observed between minimal SpO2 and AHI (r=−0.69, P < .01), cortisol and AHI (r = .47, P < .01) and cortisol and minimal SpO2 (r = −.26, P = .06).

Conclusion

According to the findings, OSA is linked to HPA axis activity in severe OSA patients but not among the mild and moderate subtypes of the disorder.

Physico-chemical properties and fatty acid composition of

Chrozophora tinctoria L., usually known as dyer’s Croton, Turnsole or Giradol, has been used in various medicinal and food products for many years. However, no comprehensive research has been undertaken to assess its potential as a new seed oil crop. Therefore, the current study examined the fatty acid composition, physico-chemical properties and antioxidant activity of C. tinctoria seeds, grown in the southwest of Iran. The seed oil content was found to be 26.40%. The extracted oil was analyzed for fatty acid composition using gas chromatography (GC). The results showed that unsaturated fatty acids accounted for almost 91% of the total fatty acids. Linoleic acid was the dominant fatty acid (76.68%), followed by oleic acid (13.99%) and palmitic acid (5.32%). δ-tocopherol was the major tocopherol in the oil, representing 70 mg/100 g oil. The total phenolic content (151.70 mg GAE per 100 g oil) and total flavonoid content (1.17 mg QE oil) were also determined in the extracted oil. The antioxidant activity was measured by a DPPH assay and expressed as 45% of the seed oil. Due to its high oil yield and high unsaturated fatty acid content, C. tinctoria could be regarded as a new source of edible oil.

Psychometric properties of the Kurdish version of Pittsburgh Sleep Quality Index

BACKGROUND

The Pittsburgh Sleep Quality Index (PSQI) is a standardized questionnaire that used for subjective assessment of sleep quality. It has been translated into several languages and is widely used in clinical research settings. Since there is no sleep-related scale standardized in the Kurdish language, the present study aimed to translate and validate the PSQI into Kurdish.

METHODS

First, the PSQI was successfully translated into Kurdish then back-translated into English by independent professional bilingual translators. The translated version of PSQI was tested with 230 participants, 150 healthy subjects, 40 subjects with insomnia, and 40 subjects with physical symptoms. Internal consistency was calculated by the Cronbach Alpha method using SPSS-20 software. Spearman correlation via a test-retest process was used for reliability. The General Health Questionnaire (GHQ28) was used to analyze criterion validity. The construct validity of the scale was tested by exploratory factor analysis (EFA). Factor weight was checked by confirmatory factor analysis (CFA) using LISREL software version 8.8.

RESULTS

The internal consistency and reliability for PSQI global score was acceptable (Cronbach's alpha = 0.70). The result showed a strong correlation between test and retest after six weeks (r = 0.83). Correlations between the global score and components of the PSQI with the GHQ28 were all statistically significant (r = 0.23-0.72, p < 0.05). Exploratory factor analysis revealed three factors with a significant correlation between the PSQI global score and these factors. All factor weights were above 0.40.

CONCLUSION

The results of this study support the PSQI's validity and reliability. This study offers a foundation for further studies in Kurdish populations.

Cerebral laterality as assessed by hand preference measures and developmental stuttering

The causes of developmental stuttering, a neurodevelopmental communicative disorder, have not been elucidated to date. Neuroimaging studies suggest that atypical cerebral laterality could be one of such causal factors. Moreover, handedness, a behavioural index for cerebral laterality, has been linked to stuttering and recovery from it. However, findings are conflicting, possibly due to sample selection procedures, which typically rely on self-reported stuttering, and to the fact that handedness is typically assessed with regards to its direction rather than degree. We investigated the possible relationship between handedness and stuttering. This is the first study where children who stutter (CWS) were selected using clinical criteria as well as speech samples and where a non-Western population was studied. Findings from 83 CWS aged 3-9 years (mean = 6.43, SD = 1.84) and 90 age- and sex-matched children who do not stutter (mean = 6.45, SD = 1.71) revealed no differences in their hand preference scores as evaluated by parent-completed Edinburgh Handedness Inventory, for both direction and degree. The severity of stuttering was not found to correlate with the degree of handedness. We suggest that parents and professionals not treat left- or mixed-hand preference as a reason for concern with regards to stuttering.

Hypothalamic-Pituitary-Gonadal Activity in Paradoxical and Psychophysiological Insomnia

Background:

Although insomnia is a sex-dimorphic disorder, there is limited knowledge about the association between sex hormones and insomnia. In the present study, the level of hypothalamus–pituitary–gonadal (HPG) axis activity was investigated in patients with insomnia by measuring serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), 17α-Hydroxyprogesterone, testosterone, progesterone, estradiol, dehydroepiandrosterone sulfate, and sex hormone-binding globulin.

Methods:

Numbers of 19 patients; including 13 females (68.40%) with paradox insomnia (32–53 years; 43.20 ± 6.40) and 17 patients; including 8 females (47.05%) with psychophysiological insomnia (14–62 years; 38.40 ± 16.30) were recruited. Seventeen aged-matched normal sleeper consisted of 13 males (26–59 years; 40.70 ± 10) consisted of 13 males (76.50%) were also recruited as control group. Insomnia was diagnosed by a sleep clinician according to the International Classification of Sleep Disorders-Second Edition criteria and an overnight polysomnography (PSG). A volume of 5 ml of venous blood samples were collected, prepared, and stored at 8 AM under standard condition. Serum levels of hormones were measured using enzyme-linked immunosorbent assay kits. Data were analyzed by Chi-square and ANCOVA. The associations between PSG and biochemical parameters were evaluated using multiple linear regression analysis.

Results:

There were no significant differences in all biochemical analyses between two insomnia subgroups (paradoxical and psychophysiological insomnia) and normal sleepers. Testosterone was positively related to maximum pulse transit time (PTT). Moreover, both LH and FSH were positively related to wake index and diastolic blood pressure.

Conclusion:

Although there were no significant differences in all HPG's hormones between groups, both LH and FSH were associated with wake index and diastolic blood pressure. Moreover, testosterone was positively related to PTT.

Relationship between serum homovanillic acid, DRD2 C957T (rs6277), and hDAT A559V (rs28364997) polymorphisms and developmental stuttering

The involvement of the brain dopamine system in the pathophysiology of developmental stuttering has been previously suggested. In the present study, we aimed to investigate the relationship between developmental stuttering in children and the levels of serum homovanillic acid (HVA), dopamine D2 receptor (DRD2) C957T (rs6277), and solute carrier family 6 member 3 (SLC6A3) human dopamine transporter (hDAT) A559V (rs28364997) single-nucleotide polymorphisms. In a case-control study, serum level of HVA, DRD2 C957T, and DAT A559V were compared between 85 children who stuttered (CWS) and 85 age- and sex-matched children who did not stutter (CWNS). Although serum level of HVA was higher among the CWS (median = 25.50 ng/mL) than that in the CWNS (median = 17.40 ng/mL), the difference between the two groups was not significant (p = 0.43). No significant correlation was observed between age and the level of HVA among all the participants (r = -0.15, p = 0.06), nor was there any correlation among the CWS (r = -0.19, p = 0.14) or among the CWNS (r = -0.13, p = 0.27) according to the Spearman correlation coefficient. On the other hand, there was a significant negative correlation between age from stuttering onset and the serum level of HVA among the CWS group (r = -0.32, p = 0.01). The Spearman correlation coefficient did not indicate any significant correlation between stuttering severity and HVA in CWS (r = -0.06, p = 0.59). The mutant allele of hDAT A559V was observed neither in the CWS nor in the controls. The allele frequencies of DRD2 C957T were not significantly different between the CWS and the CWNS; however, the frequency of the TT genotype was significantly higher among the CWS (p = 0.02), which was associated with 2.25-fold susceptibility to stuttering (OR = 2.25, 95% CI = 1.03 to 4.90, p = 0.04). Our findings suggest that the serum level of HVA might be a biomarker for dopaminergic involvement in the pathogenesis of stuttering. Moreover, the present study indicates that the DRD2 C957T polymorphism might be a risk factor for the development of stuttering among Iranian Kurdish population.

Sleep Architecture and Hypothalamic-Pituitary-Adrenal Activity in Paradoxical and Psychophysiological Insomnia

Introduction:

There are controversial reports about association between sleep and Hypothalamic-Pituitary-Adrenal (HPA) activity. Studies have reported the influence of insomnia on HPA hormones. However, they usually ignored the heterogeneity of insomnia symptoms, so subtypes of the disorder have not been considered in the reports. The present study aimed to investigate the final and intermediate products of HPA system among a group of psychophysiological and paradoxical insomniac patients in comparison to a group of normal sleepers.

Methods:

We investigated the awakening serum level of Adrenocorticotropic Hormone (ACTH) and cortisol after one night Polysomnography (PSG) in 17 subjects with psychophysiological insomnia, 19 subjects with paradoxical insomnia and 17 subjects with normal sleep profile. Groups were matched for age and Body Mass Index (BMI). Serum levels of ACTH and cortisol were measured by Enzyme-Linked Immunosorbent Assay (ELISA) method.

Results:

Although, a tendency toward elevation of both ACTH and cortisol was observed among patients with paradoxical insomnia compared to both control and psychophysiological insomnia, the differences were not significant comparing three groups. According to regression analysis, higher Non-Rapid Eye Movement sleep (NREM) arousal and Pulse Transit Time (PTT) significantly predicted higher level of ACTH.

Conclusion:

These findings could suggest the personality traits hypothesis for paradoxical insomnia. Both cortical and subcortical arousal could lead to more HPA activity and higher ACTH level. Further studies are recommended to confirm the hypothesis.

Rheumatologic complications in a cohort of 227 patients with common variable immunodeficiency

Common variable immunodeficiency (CVID) is the most prevalent symptomatic type of human primary immunodeficiency diseases (PID). Clinically, CVID is characterized by increased susceptibility to infections and a wide variety of autoimmune and rheumatologic disorders. All patients with CVID registered in Iranian PID Registry (IPIDR) were enrolled in this retrospective cohort study. We investigated the frequency of rheumatologic diseases and its association with immunological and clinical phenotypes in patients with CVID. A total of 227 patients with CVID were enrolled in this study. The prevalence of rheumatologic disorders was 10.1% with a higher frequency in women than men. Most common rheumatologic manifestations were juvenile idiopathic arthritis (JIA) and adult rheumatoid arthritis (RA) followed by juvenile spondyloarthritis (JSpA) and undifferentiated inflammatory arthritis (UIA). Septic arthritis in patients with CVID with a history of RA and JIA was higher than patients without rheumatologic complication. Patients with CVID with a history of autoimmunity (both rheumatologic and non-rheumatologic autoimmunity) had lower regulatory T cells counts in comparison with patients without autoimmune disorders. There was an association between defect in specific antibody responses and negative serologic test results in patients with rheumatologic manifestations. JIA, RA, JSpA and UIA are the most frequent rheumatologic disorders in patients with CVID. Due to antibody deficiency, serologic tests may be negative in these patients. Therefore, these conditions pose significant diagnostic and therapeutic challenges for immunologists and rheumatologists in charge of the care for these patients.

Sex steroid hormones and sex hormone binding globulin levels, CYP17 MSP AI (-34T:C) and CYP19 codon 39 (Trp:Arg) variants in children with developmental stuttering

Developmental stuttering is known to be a sexually dimorphic and male-biased speech motor control disorder. In the present case-control study, we investigated the relationship between developmental stuttering and steroid hormones. Serum levels of testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), oestradiol, progesterone, cortisol, and sex hormone binding globulin (SHBG), as well as the 2nd/4th digit ratio (2D:4D), an indicator of prenatal testosterone level, were compared between children who stutter (CWS) and children who do not stutter (CWNS). Moreover, two SNPs (CYP17 -34 T:C (MSP AI) and CYP19 T:C (Trp:Arg)) of cytochrome P450, which is involved in steroid metabolism pathways, were analysed between the groups. Our results showed significantly higher levels of testosterone, DHT, and oestradiol in CWS in comparison with CWNS. The severity of stuttering was positively correlated with the serum levels of testosterone, DHEA, and cortisol, whereas no association was seen between the stuttering and digit ratio, progesterone, or SHBG. The CYP17CC genotype was significantly associated with the disorder.

EEG/EOG/EMG data from a cross sectional study on psychophysiological insomnia and normal sleep subjects

The data presented here had been originally collected for a research project entitled ‘Sleep EEG spectral analysis in psychophysiological insomnia and normal sleep subjects’. This article describes the data of 11 subjects, referred to Sleep Disorders Research Center (SDRC) in Kermanshah, Iran. The data includes 14 EEG, 6 EOG, and 3 EMG channels, with a sampling ratio of 256 Hz. It includes power spectral features in segments of 30 s for each channel, and nonlinear analysis parameter. Also, the complete demographic and polysomnography specifications are attached.

Effects of L-carnitine supplementation on biomarkers of oxidative stress, antioxidant capacity and lipid profile, in patients with pemphigus vulgaris: a randomized, double-blind, placebo-controlled trial

BACKGROUND/OBJECTIVES

Pemphigus vulgaris (PV), as an autoimmune disease including mucosa and the skin, is associated with several complications and comorbidities. The present study planned to determine the effect of L-carnitine (LC) supplementation on biomarkers of oxidative stress (OS), antioxidant capacity and lipid profile in PV patients.Subjects/MethodsFifty two control and patients with PV, participated in the current randomized, double-blind, placebo-controlled clinical trial. The patients were allocated randomly to receive 2 g per day LC tartrate subdivided into two equal doses of 1 g before breakfast and dinner (n=26) or placebo (n=26) for 8 weeks. Anthropometric, lipid profile and OS values were determined at baseline and end of intervention period.

RESULTS

LC intake significantly reduced serum levels of triglycerides, total-, LDL- cholesterol and oxidative stress index (OSI; P<0.05). In addition, supplementation with LC resulted to a meaningful increase in levels of total antioxidant capacity (TAC) (P=0.05) and serum carnitine (P<0.001). LC intake revealed non-significant change in serum total oxidant capacity (P=0.15) and HDL- cholesterol (P=0.06) in comparison to the placebo.

CONCLUSIONS

LC consumption may have favorable results on TAC, OSI and lipid profiles in patients with PV. The results were in line with the idea that LC supplementation can be associated with positive effects on metabolic status and OS of patients with PV.European Journal of Clinical Nutrition advance online publication, 23 August 2017; doi:10.1038/ejcn.2017.131.

Approach to the Management of Autoimmunity in Primary Immunodeficiency

Primary immunodeficiency diseases (PIDs) consist of a genetically heterogeneous group of immune disorders that affect distinct elements of the immune system. PID patients are more prone to infections and non-infectious complications, particularly autoimmunity. The concomitance of immunodeficiency and autoimmunity appears to be paradoxical and leads to difficulty in the management of autoimmune complications in PID patients. Therefore, management of autoimmunity in patients with PID requires special considerations because dysregulations and dysfunctions of the immune system along with persistent inflammation impair the process of diagnosis and treatment.

Egg quality and production performance of laying hens injected with growth hormone and testosterone in the late phase of production

In this study, 160 73-week-old laying hens (HyLine W-36) were used to investigate the changes in production performance and egg quality parameters of aged laying hens after injection of different doses of growth hormone (GH) and a fixed dose of testosterone (Ts). The hens were weighed individually, placed in laying cages and then randomly assigned to four treatments with four replicates of 10 birds each, in a completely randomised design. The experiment was started at the 75th week and lasted until the 82nd week of age. The treatments were: 1: injection of 100 µL distilled water (control group), 2: injection of 500 µg Ts/kg liveweight + 50 µg GH/kg liveweight, 3: injection of 500 µg Ts/kg liveweight + 100 µg GH/kg liveweight and 4: injection of 500 µg Ts/kg liveweight + 150 µg GH/kg liveweight. In this study, ovulation rate (egg production percent), egg mass and feed intake were significantly higher in Treatment 3 than the control group (P < 0.05), and in Treatment 4, feed conversion ratio was significantly higher than for the other experimental groups (P < 0.05). In addition, the birds in Treatment 3 showed greater egg weight, albumen height, eggshell weight, eggshell density and eggshell weight per surface area than the control group (P < 0.05). In Treatment 3, egg length significantly increased compared with Treatments 1 and 4 (P < 0.05), and in Treatments 2 and 4, shell breaking strength was significantly lower than for the control group (P < 0.05). In conclusion, our results showed positive effects of GH and Ts administration on egg quality parameters and production performance in aged laying hens. Taken together, in the present study Treatment 3 was found more effective in improving egg quality and production performance of the old laying hens.

Evaluation of Serum and Urinary Neopterin Levels as a Biomarker for Occupational Exposure to Crystalline Silica

Background:

Crystalline silica is a commonly used mineral in various industries and construction activities, and it is so important introducing potential biomarkers to identify early indicators of biological effects in its high-risk occupational exposures.

Aim:

The present study was aimed to assess the blood and urinary neopterin as an early biomarker of exposure in the workers of an insulator manufacturing plant who are exposed to crystalline silica.

Subjects and Methods:

This analytical descriptive study was done among two groups of exposed workers (n = 55) and unexposed office workers (n = 38) of an insulator manufacturing plant. Statistical software R was used to determine sample size and select the participants by random sampling among nonsmoker workers. Sampling of airborne silica in breathing zone of participants was done based on the National Institute for Occupational Safety and Health method 7601. The urinary and blood samples were collected and prepared for analysis by high-performance liquid chromatography to determine the level of urinary and serum neopterin. All of the statistical analyses were carried out using SPSS 22.

Results:

The airborne silica concentration was significantly different between two exposed and unexposed groups (P < 0.001, 0.27 [0.11] vs. 0.0028 [0.0006] mg/m³, respectively). The urinary neopterin in exposed group is significantly higher than the unexposed one (P < 0.001, 97.67 [30.24] vs. 55.52 [2.18] μmol/mol creatinine, respectively). Neopterin level of serum in exposed group is higher than the unexposed group, and there is a significant difference between them (P < 0.001, 6.90 [2.70] vs. 2.20 [1.20] nmol/l, respectively). The positive significant correlations were found between silica exposure concentration with urinary and serum neopterin (P < 0.001, r = 0.36 and 0.59, respectively).

Conclusions:

Considering the sensitively and easily measurement of neopterin in biological fluid and also the statistically significant positive relationships which were found between the airborne silica concentration and neopterin levels in the present study, the serum and urinary neopterin levels can be considered the potential biomarkers of silica exposure for doing further comprehensive studies in this area.

Modeling of polystyrenic nanoparticles driven β-trans-crystalline efficiency in isotactic polypropylene

Addition of four styrenic soft nano-particles induced relative β-polymorphism as much as 20, 27, 34 and 10% during 10 minutes annealing of iPP at 116 °C. The kinetic and thermodynamic aspects of the phenomenon rationalized by a bi-exponential function

Late Recovery from Stuttering: The Role of Hand Dominancy, Fine Motor and ‎Inhibition Control

OBJECTIVE

There are controversial reports about factors that affect recovery from stuttering. In the ‎present study, the effect of hand dominancy, fine motor and inhibition control on late ‎recovery from stuttering was investigated among a group of Kurdish-Persian children who ‎stuttered in Iran.‎

METHOD

Twenty-two Kurdish-Persian children aged 7-14 years who stuttered were followed for 6 ‎years. Based on the evaluation of three experienced speech therapists and parental judgments, ‎these children were classified into recovered or persistent groups. Data about fine motor ‎control of hand and inhibition control were obtained, using Purdue Pegboard and Victoria ‎Strop Color Word Tests, respectively. Risk factors including sex, age, and family history of ‎stuttering, handedness, inhibitory control and fine motor control of hand were compared ‎between the groups and modeled to predict recovery from stuttering using logistic regression.‎

RESULTS

From the 22 participants, 5 (22.7%) recovered from stuttering. The recovered and persistent ‎groups did not show significant differences in the interference effect. By dividing the scores ‎of the Purdue Pegboard tests to the right and left hand, we created a new Handedness Index ‎‎(HI). HI was significantly higher in the recovered group. The score of right hand was higher ‎than the left in the recovered group, but no difference was found between the two hands in ‎the persistent group. Among the investigated risk factors, only HI could predict the recovery ‎from or persistency of stuttering with 94% sensitivity and 84% specificity.‎

CONCLUSION

Handedness Index can predict the recovery from stuttering significantly among children who ‎stutter.‎.