Which insulin resistance-based definition of metabolic syndrome has superior diagnostic value in detection of poor health-related quality of life? Cross-sectional findings from Tehran Lipid and Glucose Study.

BACKGROUND: The superiority of the diagnostic power of different definitions of metabolic syndrome (MetS) in detecting objective and subjective cardiovascular outcomes is under debate. We sought to compare diagnostic values of different insulin resistance (IR)-based definitions of MetS in detecting poor health-related quality of life (HRQoL) in a large sample of Tehranian adults. METHODS: This cross-sectional study conducted within the framework of the Tehran Lipid and Glucose Study on a total sample of 742 individuals, aged ≥ 20 years. Metabolic syndrome was defined according to the World Health Organization (WHO), the European Group for the study of Insulin Resistance (EGIR), and the American Association of Clinical Endocrinology (AACE). Health-related quality of life was assessed using the Short Form Health Survey (SF-36). Logistic regression analysis and Receiver Operating Characteristic (ROC) curve were used to investigate the impact of the three IR-based definitions of MetS on HRQoL and compare their discriminative powers in predicting poor HRQoL. RESULTS: Compared with other definitions, the WHO definition identified more participants with MetS (41.8 %). Although the AACE definition had higher adjusted odds ratios for reporting poor physical HRQoL (OR: 1.95; CI: 0.84-4.53 and OR: 1.01; CI: 0.55-1.85 in men and women respectively) and mental HRQoL (OR: 0.97; CI: 0.41-2.28 and OR: 1.00; CI: 0.56-1.79 in men and women respectively), none of the three studied definitions were significantly associated with poor physical or mental HRQoL in either gender; nor did ROC curves show any significant difference in the discriminative powers of IR-based definitions in detecting poor HRQoL in either gender. CONCLUSIONS: None of the three studied IR-based definitions of MetS could significantly detect poor HRQoL in the physical or mental domains, indicating no significant superior diagnostic value for any of these definitions.

Serum-free cryopreservation of human amniotic epithelial cells before and after isolation from their natural scaffold.

Amniotic epithelial cells are a promising source for stem cell-based therapy through their potential capacity to differentiate into the cell lineages of all three germ layers. Long-term preservation is necessary to have a ready-to-use source of stem cells, when required. Reduced differentiation capability, decrease of viability and use of fetal bovine serum (FBS) are three drawbacks of clinical application of cryopreserved stem cells. In this study, we used human amniotic fluid instead of animal serum, and evaluated viability and multipotency of amniotic epithelial cells after cryopreservation in suspension and compared with those cryopreserved on their natural scaffold (in situ cryopreservation). There was no significant difference in viability of the cells cryopreserved in amniotic fluid and FBS. Also, the same results were achieved for expression of pluripotency marker OCT-4 when FBS was replaced by amniotic fluid in the samples with the same cryoprotectant. The cells cryopreserved in presence of scaffold had a higher level of viability compared to the cells cryopreserved in suspension. Although, the number of the cells expressed OCT-4 significantly decreased within cryopreservation in suspension, no decrease in expression of OCT-4 was observed when the cells cryopreserved with their natural scaffold. Upon culturing of post-thawed cells in specific lineage differentiating mediums, the markers of neuronal, hepatic, cardiomyocytic and pancreatic were found in differentiated cells. These results show that replacement of FBS by amniotic fluid and in situ cryopreservation of amniotic epithelial cells is an effective approach to overcome limitations related to long-term preservation including differentiation during cryopreservation and decrease of viability.

The effects of preservation procedures on amniotic membrane's ability to serve as a substrate for cultivation of endothelial cells.

Amniotic membrane (AM) has been used as a scaffold for the ex vivo expansion of different types of cells and a cell delivery matrix in regenerative medicine. Since the preservation procedures can influence the AM properties for experimental and clinical purposes, this study was established to investigate the feasibility of using the AM after different preservation methods to serve as substrates for endothelial cell expansion ex vivo. The effects of cryopreservation and lyophilization were evaluated on mechanical and histological characteristics of the AM, and the results were compared with the fresh AM. The ECM components of the basement membrane were well conserved in all groups. Although lyophilization resulted in more histological changes and lower level of physical variables including thickness, F(max), elongation at break and suture retention than the fresh and cryopreserved AM, endothelial cells grown on the lyophilized AM were better attached to the basement membrane. Cytotoxicity assay by MTT showed that the lyophilized AM is a compatible substrate for endothelial cells cultivation. The findings of this study suggest that the lyophilized AM is a suitable matrix for cultivation of endothelial cells due to this fact that lyophilization led to exposure of basement membrane of the AM.

Colonic Mucosal Infiltration of IgG4 Plasma Cells and Ulcerative Colitis: Determinant of Presence, Activity, Extension, and Duration of Disease.

BACKGROUND Infiltration of IgG4 positive plasma cells has been detected in the colonic mucosa of patients with ulcerative colitis (UC). The aim of the study was to investigate the association between colonic mucosal infiltration of IgG4 plasma cells and the presence, activity, extension, and duration of UC. METHODS In this case-control study (2009-2014), 102 subjects (84 with UC/18 controls) were enrolled. Clinical records and rectosigmoid biopsies of UC patients were selected, and biopsies were stained with IgG4 monoclonal antibodies. IgG4 positive plasma cells were counted by a single pathologist. RESULTS Amongst 84 patients with UC, 73.8% had UC without primary sclerosing cholangitis (PSC), and 26.2% had UC with PSC. IgG4 plasma cells were seen in 35 (41.7%) patients with UC and 0% of controls (p = 0.001). The mean amount of IgG4 containing plasma cells was significantly different between active and inactive patients with UC, although it was not significantly different between UC patients with and without PSC. The presence of IgG4 infiltration was significantly associated with the extension and duration of the disease. Furthermore, IgG4 count had a sensitivity/specificity of 78.6%/83.3% for the diagnosis of UC. CONCLUSION Our study revealed the diagnostic role of IgG4 plasma cells in the colonic mucosa of patients with UC and its association with activity, extension, and duration of disease.

Facial hyperpigmentation: Any link to cancer?

INTRODUCTION: Ectopic adrenocorticotropic hormone (ACTH) syndrome is recognized by edema, proximal muscle weakness, hypertension, diabetes and skin hyperpigmentation. This syndrome is mainly associated with malignancies. CASE PRESENTATION: A 43-year-old woman came to our hospital with a history of new-onset diabetes, hypertension, edema and facial hyperpigmentation from four months before. Upon admission, she had alkalosis, hypokalemia, mild hypertension and low-grade fever. Due to abdominal pain, an abdominal ultrasound was performed, which revealed common bile duct (CBD) and pancreatic duct dilation. The abdominopelvic computed tomography (CT) scan showed a poorly-enhancing mass in the periampullary region. CONCLUSION: The patient's facial hyperpigmentation and hypokalemia appear to have been due to ACTH ectopic syndrome as a result of periampullary cancer.

Different Light Transmittance of Placental and Reflected Regions of Human Amniotic Membrane That Could Be Crucial for Corneal Tissue Engineering.

PURPOSE: Because of long-term incorporation of amniotic membrane (AM) into corneal stroma after transplantation as a scaffold for stem cell delivery, the variation in haziness is a major factor that influences visual quality. The aim of this study was to evaluate probable sources of transparency variation in fresh and freeze-dried AM and compare the obtained results with transparency of rabbit corneas. METHODS: Amnions were extracted from placental and reflected regions of placentas from elective Cesarean sections. The effects of removing epithelial cells and spongy layer on transparency and thickness of fresh and freeze-dried AMs and rabbit cornea were evaluated. The epithelial surface of AMs was evaluated with histological analysis and scanning electron microscopy. RESULTS: The reflected region of intact AM was thinner and more transparent than the placental region. From histological analysis, the main source of difference between placental and reflected regions of amnion is related to epithelial cells. The process of acellularization improved light transmission of the AM in both placental and reflected regions and also omitted variation between transparency of reflected and placental regions of AM. Freeze-drying of intact AM did not improve transparency because of scattering of light by cellular debris; however, removing the epithelial layer before freeze-drying resulted in optimized light transmission similar to transparency of rabbit cornea. CONCLUSIONS: The amniotic epithelial cells play a major role as a source of variation in light transmission properties of amnion. From the results, epithelial-denuded freeze-dried AM was found to be a suitable scaffold to be applied in corneal tissue engineering.

Association between Metabolic Syndrome and Health-related Quality of Life among Individuals with Normal and Impaired Glucose Regulation: Findings from Tehran Lipid and Glucose Study.

BACKGROUND: Recent studies have shown that metabolic syndrome is associated with poor health-related quality of life (HRQoL). Moreover, it is shown that the prevalence of MetS and impaired glucose regulation, which are shown to have negative impact on HRQoL, overlap. This study aimed to investigate the association between HRQoL and metabolic syndrome (MetS) considering glucose regulation status in a sample of non-diabetic Tehranian adults. METHODS: This was a cross-sectional study conducted within the framework of the Tehran Lipid and Glucose Study (TLGS).Logistic regression analysis was used to estimate the odds ratio (OR) with 95% confidence interval (CIs) in normal and impaired glucose regulation. Cochran's Mantel-Haenszel test was used to test the homogeneity of the odds ratios for reporting poor HRQoL in those with MetS in two groups of normal and impaired glucose regulation. RESULTS: Totally, 946 participants were studied. After adjustment for age and educational level in women, MetS showed a significant negative impact on physical functioning and bodily pain in those with impaired glucose regulation and physical role limitation in normal glucose regulation group. In impaired glucose regulation group, women with MetS were more likely to report poor physical functioning (OR: 2.86, CI: 1.02-2.79), and bodily pain (OR: 2.96 CI: 1.09-8.04). In women with normal glucose regulation, poor physical role limitation was significantly associated with MetS. This association was not seen in men in either group. Based on the test of homogeneity of odds ratio, the association between MetS and HRQoL in those with normal and impaired glucose regulation was different in role physical subscale. CONCLUSIONS: The current study showed that in both normal and impaired glucose regulation groups, MetS was associated with poor physical HRQoL in women but not men.

Factors Affecting Gender Differences in the Association between Health-Related Quality of Life and Metabolic Syndrome Components: Tehran Lipid and Glucose Study.

OBJECTIVE: Using structural equation modeling, this study is one of the first efforts aimed at assessing influential factors causing gender differences in the association between health-related quality of life (HRQoL) and metabolic syndrome. METHODS: A sample of 950 adults, from Tehran Lipid and Glucose Study were recruited for this cross sectional study in 2005-2007. Health-related quality of life was assessed using the Iranian version of SF-36. Metabolic syndrome components (MetSCs) and physical and mental HRQoL were considered as continuous latent constructs explaining the variances of their observed components. Structural equation modeling was performed to examine the association between the constructs of MetSCs and the physical and mental HRQoL within the two gender groups. RESULTS: Based on the primary hypothesis, MetSCs and HRQoL were fitted in a model. The negative effect of MetSCs on HRQoL was found to be significant only in the physical domain and only in women. The proportion of all the cardio-metabolic risk factors as well as subscales of physical HRQoL that have been explained via the two constructs of MetSCs and HRQoL, respectively, were significantly higher in women. Physical activity in both men (ß = 3.19, p<0.05) and women (ß = 3.94, p<0.05), age (ß = -3.28, p<0.05), education (ß = 2.63, p<0.05) only in women and smoking (ß = 2.28, p<0.05) just in men, directly affected physical HRQoL. Regarding the mental domain, physical activity (ß = 3.37, p<0.05) and marital status (ß = 3.44, p<0.05) in women and age (ß = 2.01, p<0.05) in men were direct effective factors. Age and education in women as well as smoking in men indirectly affected physical HRQoL via MetSCs. CONCLUSION: Gender differences in the association between MetSCs and physical HRQoL could mostly be attributed to the different structures of both MetSCs and physical HRQoL constructs in men and women. Age and smoking are the most important socio-behavioral factors which could affect this gender-specific association in the mental domain.

Metabolic syndrome and health-related quality of life in reproductive age and post-menopausal women: Tehran Lipid and Glucose Study.

BACKGROUND: Given the lack of data clarifying the manner in which women with metabolic syndrome (MetS) in different eras of their life perceive their health-related quality of life (HRQoL), this study aimed at investigating the association between MetS and HRQoL in reproductive age and post menopausal women. METHODS: This was a cross-sectional study conducted within the framework of Tehran Lipid and Glucose Study (TLGS). Metabolic syndrome was defined according to the Joint Interim Statement (JIS) and HRQoL was assessed using the Short Form Health Survey (SF-36). Logistic regression analysis was used to estimate the odds ratio (OR) of poor HRQoL with 95% confidence intervals (CIs) for reproductive age and post-menopausal women separately and adjusted for confounding variables. RESULTS: All 603 participants with (n = 340) and without (n = 263) MetS were studied. Overall, in both physical and mental domains, those without MetS had higher scores in all subscales of SF-36 except for vitality, role emotional and mental component summary. Unadjusted odds ratios (95% CI) for poor physical HRQoL were 2.8 (1.7-4.6); (P < 0.001) and 1.5 (0.7-3.4) for the reproductive age and post-menopausal groups, respectively. Compared to the post-menopausal group, the odds ratio of reporting poor HRQoL for reproductive age women was significantly higher, even after adjusting for age (OR: 1.7, 95% CI: 1.0-3.0, P < 0.05). CONCLUSION: The results indicate that MetS is associated with poor HRQoL in reproductive age, but not in post-menopausal women, and the association is observed mainly in relation to physical rather than mental health.

Permanent expression of midbrain dopaminergic neurons traits in differentiated amniotic epithelial cells.

Amniotic epithelial cells (AECs) have been the subject of interest due to their stem cells characteristics. Pluripotency, lack of teratoma formation, low immunogenicity and no ethical issues make them an alternative source of stem cells for generation of dopaminergic neurons in vitro. AECs may differentiate into midbrain dopaminergic neurons in the presence of induction factors which trigger pathway naturally occurring in the mesencephalon during embryogenesis. In this study, we examined whether FGF8 and Sonic hedgehog (Shh) can induce AECs to express permanently midbrain dopaminergic neurons traits. We found that fresh isolated AECs temporarily expressed some neural markers which decreased 7 days after culture. Co-treatment of cells with FGF8 and Shh had synergistic effect on expression of TH, DAT, Pax2, Lmx1b and En1. Shh ceased differentiation in dopaminergic state and decreased DßH. HPLC analysis revealed that dopamine was released into the medium upon depolarization, indicating that functional dopaminergic neurons were present in the culture. These results demonstrate that AECs have capability to differentiate into dopaminergic neurons and can be a candidate for cell replacement therapy of Parkinson's disease.