Birth Size Outcomes in Relation to Maternal Blood Levels of Some Essential and Toxic Elements.

Exposures to toxic trace elements and deficiencies of essential trace elements during pregnancy may impact fetal growth. This study was conducted to determine the association between maternal blood levels of essential elements including manganese (Mn), copper (Cu), and zinc (Zn) and toxic elements including arsenic (As), cadmium (Cd), and lead (Pb) at the first trimester with neonatal anthropometric parameters. This cross-sectional study was conducted in 2019-2020 in Isfahan, Iran. Overall, 263 mother-infant pairs were recruited in the first trimester of pregnancy. Maternal whole blood was collected, and essential and toxic elements were determined by mass spectrometry (ICP-MS)-based method. Birth size measurements were performed according to standardized protocols. Geometric means and standard deviations of maternal blood concentrations of Mn, Cu, Zn, As, Cd, and Pb were 3.94 ± 0.82, 5.22 ± 0.57, 7.67 ± 0.58, 2.21 ± 0.77, - 0.59 ± 0.98, and 3.23 ± 0.72 µg/l, respectively. Mean age of mothers was 29.94 ± 5.22 years. Thirty-one (12.1%) neonates were preterm. Maternal blood Pb levels were negatively correlated with birth weight (ß = - 0.22 (CI 95%: - 0.38, - 0.05) p = 0.010) and marginally with birth head circumference (ß = - 0.14(CI 95%: - 0.29, 0.02), P = 0.094) after adjustment for potential confounder variables. There was no significant association between Mn, Cu, Zn, As, Cd, and birth size measurements. Reverse association was found between maternal blood Pb levels and birth weight and birth head circumference. There is limited evidence related to the association between essential and toxic elements during pregnancy with birth size measurements and pregnancy disorders. More studies are suggested to assess of the effect of the trace elements and birth outcomes.

Growth Hormone Response to L-Arginine Alone and Combined with Different Doses of Growth Hormone-Releasing Hormone: A Systematic Review and Meta-Analysis.

Background: Arginine (ARG) can modulate growth hormone (GH) release by suppressing its endogenous inhibitory regulator, somatostatin. ARG also induces the release of the GH-releasing hormone (GHRH). This study aims to review the effects of L-arginine supplementation alone and combined with GHRH in different doses on GH secretion. Methods: In this systematic review and meta-analysis, an electronic literature search was conducted on Medline database (PubMed), Scopus, and Web of Science databases. All eligible studies were randomized clinical trials that reported the effects of ARG supplementation alone or with GHRH on GH levels. Mean difference (MD) and 95% confidence intervals (CI) were computed as the effect size. Results: Meta-analyses showed significant effects of ARG alone on GH release (MD = 10.07, 95% CI: 7.87, 12.28). Moreover, the response of GH was greater with ARG in combination with GHRH (MD = 24.96, 95% CI: 17.51, 32.42). There was no significant difference between the patients and healthy individuals and between oral and injection use of ARG. The systematic review revealed the important role of ARG in combination with other amino acids on GH secretion in patients with GH deficiency. Conclusion: This study revealed that in GH-deficient individuals, high doses of ARG supplementation in combination with GHRH and/or other amino acids might have potential therapeutic effects on increasing GH concentrations. These findings propose that ARG supplementation can be considered as a potential stimulator in management of GH deficiency.

Latent Class Analysis of knowledge, Attitude, and Practice of a Population-Based Sample of Iranian Pregnant Women toward COVID-19.

Background: The aim of the study is to identify latent class (LC)-derived patterns of women's knowledge, attitude, and practice (KAP) toward coronavirus disease 2019 (COVID-19) in Iran. Materials and Methods: This cross-sectional survey of 2029 women, who participated in the PERSIAN Birth Cohort, was conducted in Isfahan, Iran. KAP was assessed by shortened and validated form of a recently used questionnaire in Iran. LC analysis was used to discover underlying response patterns of KAP toward COVID-19 using Mplus 8.0 software. Results: Three classes were identified: Class 1 (n = 514, 25.33%) "Low knowledge and poor practice, Class 2 (n = 423, 22.08%) "Moderate knowledge and proper practice," and Class 3 (n = 1092, 53.82%) "Low knowledge and proper practice." The lowest rate of positive attitude was seen in Class 3. Women living in rural areas, as well as those with lower education, were more likely to member classes with improper practice. Conclusion: The findings suggest that the LCA approach can provide important information reflecting different levels of adoption of protection toward COVID-19 infection. The results may be useful to conducting health-care programs during the outbreaks.

Parental Occupational Exposure and Neurodevelopmental Disorders in Offspring: a Systematic Review and Meta-analysis.

PURPOSE OF REVIEW: Parental occupational exposures might be associated with neurodevelopmental disorders (NDDs) in offspring. We aimed to conduct a systematic review and meta-analysis to summarize and synthesize the current literature and to estimate the pooled magnitude of the underlying association(s) between parental occupational exposures and subsequent risk of NDDs. RECENT FINDINGS: In the meta-analysis of 20 included studies, significant associations were found between parental occupational exposure to pesticides or solvents and the risk of attention deficit hyperactivity disorder in offspring. Prenatal occupational exposure to pesticides was significantly associated with motor development or cognition disorders in children. Furthermore, some evidence showed that metals might have a role in the development of autism spectrum disorders. Further studies need to identify the level of parental occupational exposures that can be significantly associated with NDDs. Moreover, utilizing standardized outcome and exposure scales is recommended to incorporate paternal, maternal, and parental as well as both prenatal and postnatal exposure in future studies.

Knowledge, Attitudes, and Practices toward COVID-19 among Persian Birth Cohort Participants.

BACKGROUND: Knowledge, attitudes, and practices (KAP) toward COVID-19 play an important role in controlling the outbreak. The present study aimed to investigate the KAP of a group of women toward COVID-19 during the second wave of the outbreak in Iran. METHOD AND MATERIAL: A cross-sectional survey of 2862 women was conducted in May and June 2020 in two centers of Persian birth cohort. The survey instrument was a self-reported questionnaire Multivariable linear regression analysis to identify factors associated with knowledge and practice. toward COVID-19 and multinomial logistic regression analyses to identify factors associated with attitudes. Unstandardized regression coefficients (ß) and odds ratios and their 95% confidence intervals were used to quantify the associations between variables and KAP. RESULT: Good knowledge and optimistic attitudes toward the successful control of COVID-19 was seen among participants. Overall, about 57.3% (1640), 41.1% (1176), and 1.6% (46) of respondents were categorized as low (score <50%), moderate (score: 50%-80%), and high (score > 80%) proper practice, respectively. Eighty-five individuals with COVID-19 experience (3.0%) had lower knowledge score (79.91 ± 17.93 vs. 83.81 ± 13.88, P < 0.001) and lower proper practice score (40.22 ± 16.57 vs. 47.96 ± 16.15, respectively, P < 0.001) compared to those who were not infected. A higher level of knowledge was associated with appropriate practice in both groups of positive attitudes (χ2 = 32.23, P < 0.001) and negative attitudes (χ2 = 31.49, P < 0.001). CONCLUSION: This survey recorded good knowledge and relatively good attitudes among women. Special health policies plan should be taken for target populations among women during the COVID-19 pandemic.

Prenatal and perinatal factors associated with developing multiple sclerosis later in life: A systematic review and meta-analysis.

OBJECTIVE: Both genetic and environmental factors play roles in Multiple Sclerosis (MS) etiopathogenesis. The relationship between prenatal/perinatal factors/exposures and future MS occurrence in the offspring remains controversial. Here, we aimed to review the available evidence on prenatal/perinatal factors associated with later MS occurrence. METHOD: We performed systematic search of PubMed, Web of Science, and Scopus from inception to October 2020. We included original observational studies conducted on human participants addressing the association between prenatal/perinatal factors and MS occurrence. Data were extracted according to the PRISMA guideline. The adjusted odds ratio (OR) with 95% confidence interval (CI) was considered as the desired effect size. The heterogeneity was evaluated by Cochran's Q and I2 and the publication bias was assessed. We excluded gestational/neonatal vitamin D level, season of birth, and latitude because of recently published systematic reviews/meta-analyses on these subjects. RESULTS: Overall, 2306 records were identified in the primary search. After excluding irrelevant studies, we evaluated 34 studies with contributing data on 100 prenatal/perinatal factors associated with an increased or decreased risk of MS occurrence. In the meta-analyses, we found no statistically significant associations between later MS occurrence in offspring and prenatal smoking exposure (OR = 1.01, 95% CI = 0.77-1.34), mode of delivery (OR = 0.90, 95% CI = 0.52-1.56), birth order (OR = 0.85, 95% CI = 0.72-1.00), and maternal age (OR = 1.34, 95% CI = 0.88-2.04). Paternal age and parents' marital status at the time of childbirth, maternal preeclampsia/ toxemia, forceps use, birth weight, plurality, and preterm birth were the other most studied factors, and none reported to affect MS risk. CONCLUSION: We found that prenatal smoking exposure, mode of delivery, birth order, and maternal age do not affect risk of future MS development. Moreover, most of the other investigated factors were reported not to affect MS risk in the offspring.

Intergenerational influence of paternal physical activity on the offspring's brain: A systematic review and meta-analysis.

BACKGROUND: It is well established that parents can influence their offspring's neurodevelopment. It is shown that paternal environment and lifestyle is beneficial for the progeny's fitness and might affect their metabolic mechanisms; however, the effects of paternal exercise on brain in the offspring have not been explored in detail. OBJECTIVE: This study aims to review the impact of paternal physical exercise on memory and learning, neuroplasticity, as well as DNA methylation levels in the offspring's hippocampus. STUDY DESIGN: In this systematic review and meta-analysis, electronic literature search was conducted in databases including PubMed, Scopus, and Web of Science. Eligible studies were those with an experimental design, including an exercise intervention arm, with assessment of any type of memory function, learning ability, or any type of brain plasticity as the outcome measures. Standardized mean difference (SMD) and 95% confidence intervals (CI) were computed as effect size. RESULTS: The systematic review revealed the important role of environmental enrichment in the behavioral development of next generation. Also, offspring of exercised fathers displayed higher levels of memory ability, and lower level of brain-derived neurotrophic factor. A significant effect of paternal exercise on the hippocampal volume was also reported in the few available studies. CONCLUSION: These results suggest an intergenerational effect of paternal physical activity on cognitive benefit, which may be associated with hippocampal epigenetic programming in offspring. However, the biological mechanisms of this modulation remain to be determined.

Investigation of HER-2 Expression an Its Correlation with Clinicopathological Parameters and Overall Survival of Esophageal Squamous Cell Carcinoma Patients.

BACKGROUND & OBJECTIVE: Human epidermal growth factor receptor 2 (HER-2) exhibits a vast range of expression in esophageal squamous cell carcinoma (ESCC) patients as a biomarker. This paper aimed to investigate HER-2 expression and clinicopathological parameters of esophageal SCC. METHODS: HER-2 expression was assessed in 102 ESCC patients by immunohistochemistry. The HER-2 staining intensity , according to the Gastric HER2 Biomarker1.0.0.1 version of the college of American pathologists (CAP) protocol for gastric and gastroesophageal junction cancers, was graded as 0 (no reactivity in any of the cancer cells' membranes); 1+ (pale or hardly noticeable reactivity in the membrane of cancer cells' cluster [≥ 5 neoplastic cells] regardless of the positive cancer cells' percentage); 2+ (weak-to-moderate complete, basolateral, or lateral membranous reactivity regardless of the positive cancer cells' percentage); and 3+ ( strong complete, basolateral, or lateral reactivity in the membrane of the cancer cell cluster regardless of the positive cancer cells' percentage).In this regard, 3+ scored samples were considered as positive. If HER-2 expression was scored 2+, an additional fluorescence in situ hybridization (FISH) was performed. Fisher's exact test was employed for investigating the correlation of HER-2 expression status with patients' clinicopathological characteristics (including age, gender, tumor location, stage, grade, infiltration level, venous invasion, lymphatic invasion, and tumor recurrence). Kaplan-Meier analysis was done for the patients' survival assessments. RESULTS: Five patients (~5%) were HER-2 positive and no significant association was observed between HER-2 expression and clinicopathological properties. In addition, HER-2 expression status exhibited no significant association with the patients' overall survival (P=0.9299). CONCLUSION: HER-2 is not a suitable prognostic biomarker for Iranian ESCC patients.

Androgen Receptor Expression and Its Correlation with Clinicopathological Parameters in Iranian Patients with Triple Negative Breast Cancer.

BACKGROUND & OBJECTIVE: Our knowledge about correlation of androgen receptor expression and clinicopathological properties of triple-negative breast cancer (TNBC) patients is inadequate, particularly in the Iranian population. The main aim of the present study was to assess the AR expression in TNBC Iranian patients and evaluate its correlation with their clinicopathological parameters. METHODS: Herein, 76 TNBC patients were evaluated for the AR expression by immunohistochemistry. The slides' staining intensity was investigated according to the average degree of nuclear staining and sub-classified into negative (0), weak (1), moderate (2), or strong (3). Subsequently, the positive cells percentage for each slide was assessed and sub-classified into <25% (1), 25-50% (2), 50-75% (3), and >75% (4). The aggregation of these two scores was used as the final score ranging from 0 to 7. While 4-7 scores were selected as positive, the others were included in the AR-negative expression group. Fisher's exact test was used to analyze the AR expression correlation with the clinicopathological parameters. RESULTS: Positive immunoreactivity for AR was observed in 8 out of 76 (11%) specimens. No-correlation (P>0.05) was observed between the AR expression and grade, stage, lymph node status, and Ki-67 level. The AR-positive patients exhibited older age at the time of diagnosis (P=0.0339) and larger tumor size (P=0.0224) in comparison with the AR-negative patients. Low percentage of TNBC patients expressed AR and no significant correlation was observed between its expression and most of the clinicopathological parameters. CONCLUSION: AR may not be a suitable biomarker and treatment target for the Iranian patients with TNBC.

Association of serum uric acid concentration with components of pediatric metabolic syndrome: A systematic review and meta-analysis.

BACKGROUND: Hyperuricemia is implicated in the pathogenesis of inflammatory diseases and metabolic disorders. Metabolic syndrome (MetS) in childhood is one of the most important causes of different noncommunicable diseases in adulthood. This study aimed to systematically review the association between serum uric acid (UA) concentration and components of pediatric MetS. MATERIALS AND METHODS: In this meta-analysis and systematic review, related articles were gathered by searching English databases including PubMed, Web of Science, Scopus, and Google Scholar. We used the following keywords: uric acid, metabolic syndrome, hypertension, fasting blood sugar (FBS), hyperglycemia; the search was limited to English language and included observational and cohort studies performed among children or adolescents. Pooled relative risks (odds ratio [OR]) and corresponding 95% confidence interval (95% CI) were extracted. A random-effect model was used. RESULTS: On the basis of 34 eligible studies, the pooled correlation between UA with metabolic components including FBS (r = 0.24, 95% CI = 0.09-0.40), fasting insulin (r = 0.26, 95% CI = 0.15-0.37), and hyperglycemia (r for triglyceride and UA = 0.23, 95% CI = 0.19-0.38) (r for high-density lipoprotein and UA = -0.28, 95% CI = -0.37 to -0.20) was statistically significant. The association of both diastolic blood pressure (DBP) and systolic blood pressure (SBP) was statistically significant with UA (r for SBP and UA = 0.34, 95% CI = 0.24-0.43; r for DBP and UA = 0.18, 95% CI = 0.11-0.25). The OR between risk of abdominal obesity with UA was statistically significant (OR = 2.62, 95% CI = 1.41-3.84). CONCLUSION: Serum UA concentration is associated with major components of the pediatric MetS. Its measurement and control should be underscored in at-risk children and adolescents.

Association of CD49d expression with clinicopathological features of chronic lymphocytic leukemia patients in the Iranian population.

BACKGROUND: Identification of factors affecting prognosis in chronic lymphocytic leukemia (CLL) is important for risk stratification of patients. METHODS: In the present study, CD49d expression was analyzed by multi-color flow cytometry in 98 newly diagnosed and untreated CLL patients at the hematopathology ward. The patients were divided into two subgroups according to CD49d expression (30% cut off) and the association of this marker with the patients' clinicopathological properties were evaluated. RESULTS: In this study, CD49d expression exhibited significant association with the Rai stage of the disease (P<0.0001), CD38 status (P<0.0001), hemoglobin level (P=0.0006), and platelet count (P=0.0016). The CD49d-positive patients presented in higher stages in comparison with CD49d-negative patients. Although only 1% of the CD49d-negative patients were CD38-positive, this proportion for CD49d-positive group was 69%. However, no significant correlation was observed between CD49d expression and patients' age (P=0.2031), gender (P=0.8119), and absolute lymphocytes count (P=0.1073). CONCLUSION: Therefore, CD49d is a grateful biomarker with high association with clinicopathological parameters in CLL patients.

Prolactin receptor expression as a novel prognostic biomarker for triple negative breast cancer patients.

Prolactin receptor (PRLR) is a novel emerging prognostic biomarker in different cancers, especially in breast cancer. However, there is limited information about the association of PRLR expression and triple-negative breast cancers (TNBC) prognosis. In this study, 80 TNBC patients were evaluated for PRLR expression by immunohistochemistry. The correlation of PRLR expression with clinicopathological features, patient recurrence, and survival was investigated. PRLR expression was considered positive if >10% of tumor cells were stained. The Fisher's exact test was used to analyze PRLR expression relation with the clinicopathological parameters. Survival distribution was estimated by the Kaplan-Meier method. Positive immunoreactivity for PRLR was observed in 50 out of 80 (62%) specimens. Although expression of PRLR was associated with TNBC patients' stage, no-correlation was observed between its expression and tumor size, grade, lymph node status, and Ki-67 expression. In addition, patients with positive expression of PRLR exhibited lower recurrence (P = 0.0027) and higher overall survival (P = 0.0285) in comparison with negative expression group. In multivariate analyses, positive expression of PRLR was an independent prognostic marker for lower recurrence (P < 0.001) and higher overall survival (P < 0.001). Therefore, PRLR plays a crucial role in TNBC and has to be considered as an independent prognostic biomarker for TNBC patients.

Undifferentiated Pleomorphic Sarcoma of Pancreas: A Case Report and Review of the Literature for the Last Updates.

The most prevalent type of soft tissue sarcoma is undifferentiated pleomorphic sarcoma (UPS) or previously known as malignant fibrous histiocytoma. It accounts over 20% of all soft tissue sarcomas and occurs most frequently in the extremities, trunk, and retroperitoneum. However, it has been rarely observed in the digestive system. Pancreas sarcoma represents less than 1% of all pancreatic tumors, and primary UPS of the pancreas is even rarer. It exhibits high recurrence and poor prognosis. In this case, a 72-year-old woman with a UPS tumor which was located in the pancreas head and neck without adhesion to the retroperitoneum will be discussed.

Gastric Schwannoma: A Case Report and Review of the Literature for Gastric Submucosal Masses Distinction.

Schwannomas origin from Schwann cells sheath and generally are benign, slow-growing, and asymptomatic neoplasms which frequently appear in the head and neck. Although gastrointestinal schwannoma is really rare, the most affected organ in GI system is the stomach. Gastric schwannoma forms 0.2% of all gastric tumors. This neoplasm is always detected as a submucosal mass, the same as other gastrointestinal stromal tumors. Although these tumors have almost the same presentations, they are completely different at therapeutic options and prognoses. Hence, it is important to distinguish them apart and make an accurate diagnosis to optimize treatment outcomes. Herein, we report a case of 28-year-old woman with frequent vomiting and abdominal pain caused by 5 × 6 cm schwannoma in the antrum of the stomach. This is a rare case of gastric outlet obstruction due to a massive schwannoma. In addition, all other probable submucosal masses will be discussed at different aspects.