Tissue-restricted control of established central nervous system autoimmunity by TNF receptor 2-expressing Treg cells.

CD4+Foxp3+ regulatory T (Treg) cells are central modulators of autoimmune diseases. However, the timing and location of Treg cell-mediated suppression of tissue-specific autoimmunity remain undefined. Here, we addressed these questions by investigating the role of tumor necrosis factor (TNF) receptor 2 (TNFR2) signaling in Treg cells during experimental autoimmune encephalomyelitis (EAE), a model of multiple sclerosis. We found that TNFR2-expressing Treg cells were critical to suppress EAE at peak disease in the central nervous system but had no impact on T cell priming in lymphoid tissues at disease onset. Mechanistically, TNFR2 signaling maintained functional Treg cells with sustained expression of CTLA-4 and Blimp-1, allowing active suppression of pathogenic T cells in the inflamed central nervous system. This late effect of Treg cells was further confirmed by treating mice with TNF and TNFR2 agonists and antagonists. Our findings show that endogenous Treg cells specifically suppress an autoimmune disease by acting in the target tissue during overt inflammation. Moreover, they bring a mechanistic insight to some of the adverse effects of anti-TNF therapy in patients.

Proteinase 3 promotes formation of multinucleated giant cells and granuloma-like structures in patients with granulomatosis with polyangiitis.

OBJECTIVES: Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are autoimmune vasculitides associated with antineutrophil cytoplasm antibodies that target proteinase 3 (PR3) or myeloperoxidase (MPO) found within neutrophils and monocytes. Granulomas are exclusively found in GPA and form around multinucleated giant cells (MGCs), at sites of microabscesses, containing apoptotic and necrotic neutrophils. Since patients with GPA have augmented neutrophil PR3 expression, and PR3-expressing apoptotic cells frustrate macrophage phagocytosis and cellular clearance, we investigated the role of PR3 in stimulating giant cell and granuloma formation. METHODS: We stimulated purified monocytes and whole peripheral blood mononuclear cells (PBMCs) from patients with GPA, patients with MPA or healthy controls with PR3 or MPO and visualised MGC and granuloma-like structure formation using light, confocal and electron microscopy, as well as measuring the cell cytokine production. We investigated the expression of PR3 binding partners on monocytes and tested the impact of their inhibition. Finally, we injected zebrafish with PR3 and characterised granuloma formation in a novel animal model. RESULTS: In vitro, PR3 promoted monocyte-derived MGC formation using cells from patients with GPA but not from patients with MPA, and this was dependent on soluble interleukin 6 (IL-6), as well as monocyte MAC-1 and protease-activated receptor-2, found to be overexpressed in the cells of patients with GPA. PBMCs stimulated by PR3 formed granuloma-like structures with central MGC surrounded by T cells. This effect of PR3 was confirmed in vivo using zebrafish and was inhibited by niclosamide, a IL-6-STAT3 pathway inhibitor. CONCLUSIONS: These data provide a mechanistic basis for granuloma formation in GPA and a rationale for novel therapeutic approaches.

The effect of propolis supplementation on cardiovascular risk factors in women with rheumatoid arthritis: A double-blind, placebo, controlled randomized clinical trial.

Propolis has gained popularity in recent years because of its beneficial properties, which make it a possible preventative and therapeutic agent as well as a valuable food and cosmetic ingredient. The objective of this study was to evaluate the effects of propolis supplementation on cardiovascular risk factors in women with rheumatoid arthritis. This randomized, double-blind, placebo-controlled clinical trial was performed among 48 patients diagnosed with rheumatoid arthritis. Subjects were randomly assigned to placebo and intervention groups, supplemented with 1000 mg/day of propolis for 12 weeks. Cardiovascular risk factors including, high-sensitivity C-reactive protein (hs-CRP), monocyte chemoattractant protein (MCP-1), Nitric oxide, blood pressure, and lipid profile were assessed pre-and post-intervention. The atherogenic index of plasma value, as well as total cholesterol/high-density lipoprotein cholesterol (HDL-C), triglyceride/HDL-C, and non-HDL-C/HDL-C ratios, were significantly reduced in the intervention group, compared with the placebo group post-intervention (p < 0.05). Moreover, there was a significant reduction in the serum level of hs-CRP in the intervention group when compared with the placebo group (p = 0.001). Furthermore, propolis supplementation could marginally reduce MCP-1 (p = 0.051). These data indicate that propolis supplementation may be a promising treatment strategy for cardiovascular complications among rheumatoid arthritis patients.

Validity of a modified food and nutrition literacy questionnaire in primary school children in Iran.

The present study aimed to assess the relative validity and reliability of a modified Food and Nutrition Literacy (M-FNLIT) questionnaire in primary school children in the city of Mashhad. The study was conducted in four phases. In the first step, the content and face validity of the questionnaire were evaluated by Delphi consensus as well as interviewing the students. Then, construct validity was examined using Confirmatory Factor Analysis (CFA). The internal consistency and reliability of the questionnaire were also assessed using Cronbach α and Intraclass Correlation Coefficient (ICC), respectively. Finally, a receiver operating characteristic analysis was performed to detect the cut-off scores of the M-FNLIT scale. Findings of two rounds of Delphi showed satisfactory levels of Content Validity Ratio: 0·72 and 0·92, Content Validity Index (CVI): 0·92 and 0·98, respectively. The results of CFA for domains and subscales of the M-FNLIT questionnaire including cognitive domain (understanding food and nutrition information and nutritional health knowledge) and skill domain (functional, food choice, interactive, and critical skills) indicated acceptable fit indices. M-FNLIT subscale-specific Cronbach α values ranged between 0·68 and 0·8 and ICC was 0·95 (95 % CI 0·93, 96). The final questionnaire included forty items (thirty-six Likert-type and four true-false items). FNLIT scores were categorized as low (≤ 58), medium (> 58­< 81), and high (≥ 81). The M-FNLIT questionnaire has a good level of validity and reliability to measure food and nutrition literacy in primary school children. The questionnaire can be applied in the evaluation of nutritional interventions in this age group.

Differentiation of multipotent stem cells to insulin-producing cells for treatment of diabetes mellitus: bone marrow- and adipose tissue-derived cells comparison.

BACKGROUND: Mesenchymal stem cells (MSCs) from human adipose tissue and bone marrow have a great potential for use in cell therapy due to their ease of isolation, expansion, and differentiation. Our intention was to isolate and promote in vitro expansion and differentiation of MSCs from human adipose and bone marrow tissue into cells with a pancreatic endocrine phenotype and to compare the potency of these cells together. METHODS AND RESULTS: MSCs were pre-induced with nicotinamide, mercaptoethanol, B-27 and b-FGF in L-DMEM for 2 days and re-induced again in supplemented H-DMEM for another 3 days. Expression of five genes in differentiated beta cells was evaluated by Real-time PCR and western blotting and the potency of insulin release in response to glucose stimulation was evaluated by insulin and C-peptide ELISA kit. The differentiated cells were evaluated by immunocytochemistry staining for Insulin and PDX-1. Quantitative RT-PCR results showed up-regulation of four genes in differentiated beta-islet cells (Insulin, Ngn-3, Pax-4 and Pdx-1) compared with the control. Western blot analysis showed that MSCs cells mainly produced proinsulin and insulin after differentiation but nestin was more expressed in pre-differentiated stem cells. Glucose and insulin secretion assay showed that insulin levels and C-peptide secretion were significantly increased in response to 10 mM glucose. CONCLUSIONS: Our study showed that both adipose and bone marrow stem cells could differentiate into functional beta-islet cells but it seems that adipose stem cells could be a better choice for treatment of diabetes mellitus according to their higher potency.

Anticonvulsant activity of oxaprozin in a rat model of pentylenetetrazole-induced seizure by targeting oxidative stress and SIRT1/PGC1α signaling.

The effect of oxaprozin (OXP) on an experimental model of seizures in rats was investigated in this study. Seizures in Wistar rats (200-250 g) were induced by pentylenetetrazole (PTZ, 60 mg/kg). The anticonvulsant effect of OXP (100, 200, and 400 mg/kg, intraperitoneally) was evaluated in a seizure model. After behavioral tests, the animals underwent deep anesthesia and were put down painlessly. Animal serum was isolated for antioxidant assays (nitric oxide (NO) and glutathione (GSH)). The animals' brains were also isolated to gauge the relative expression of genes in the oxidative stress pathway (sirtuin 1 (Sirt1) and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (Pgc1α)). Intraperitoneal injection of OXP increased the mean latency of myoclonic jerks and generalized tonic-clonic seizure (GTCS) and decreased the number of myoclonic jerks and GTCS duration compared with the PTZ group. Biochemical tests showed that pretreatment with OXP was able to restore GSH serum levels and reverse the augmented NO serum levels caused by PTZ induction to the normal level. The quantitative polymerase chain reaction results also revealed that OXP counteracts the negative effects of PTZ by affecting the expression of the Sirt1 and Pgc1α genes. Overall, this study suggests the potential neuroprotective effects of the nonsteroidal, anti-inflammatory OXP drug in a model of neural impairment caused by seizures via the mechanism of inhibition of the oxidative stress pathway.

Biological and pharmacological effects and nutritional impact of phytosterols: A comprehensive review.

Phytosterols (PSs), classified into plant sterols and stanols, are bioactive compounds found in foods of plant origin. PSs have been proposed to exert a wide number of pharmacological properties, including the potential to reduce total and low-density lipoprotein (LDL) cholesterol levels and thereby decreasing the risk of cardiovascular diseases. Other health-promoting effects of PSs include anti-obesity, anti-diabetic, anti-microbial, anti-inflammatory, and immunomodulatory effects. Also, anticancer effects have been strongly suggested, as phytosterol-rich diets may reduce the risk of cancer by 20%. The aim of this review is to provide a general overview of the available evidence regarding the beneficial physiological and pharmacological activities of PSs, with special emphasis on their therapeutic potential for human health and safety. Also, we will explore the factors that influence the physiologic response to PSs.

The Effect of Shock Wave and Phonophoresis in the Improvement of the Clinical Symptoms and Function of Patients with Mild to Moderate Carpal Tunnel Syndrome: A Clinical Trial.

Background: Carpal tunnel syndrome is a common condition that causes pain, sensory and motor symptoms in the hands, especially in the thumb, index, and middle fingers due to the compression of the median nerve in the carpal tunnel. The purpose of this research was to investigate the effect of the shock wave and phonophoresis in the improvement of clinical symptoms and function of patients with mild to moderate carpal tunnel syndrome. Methods: The present research has employed a double-blind randomized clinical trial on 60 patients in Isfahan, Iran. Patients were randomly divided into 3 treatment groups of shock, phonophoresis, and control, and all patients received conservative treatments. Wrist thermoplastic splint, vitamin B1, and celecoxib were prescribed for all patients. The shock group received their intervention in four sessions of shock once a week for 4 weeks. Patients in the phonophoresis group received phonophoresis (pulse 1:4) 15 minutes every other day for 2 weeks. Pain scores were assessed based on the visual analog pain scale, and the Boston questionnaire severity scale was completed for each patient before, 1 and 2 months after the intervention. The used analytic tests included Fisher's exact tests, 1-way analysis of variance, and repeated measures analysis. Results: Shock wave and phonophoresis showed a significant decrease in pain, symptom severity index (p<0.001), and functional status (p<0.001). This reduction was more persistent in the phonophoresis group. Conclusion: The use of noninvasive shock wave and phonophoresis methods were good alternatives in the treatment of carpal tunnel syndrome.

The relationship between dietary patterns and depression mediated by serum levels of Folate and vitamin B12.

BACKGROUND: Major depressive disorder is among main worldwide causes of disability. The low medication compliance rates in depressed patients as well as the high recurrence rate of the disease can bring up the nutrition-related factors as a potential preventive or treatment agent for depression. The aim of this study was to investigate the association between dietary patterns and depression via the intermediary role of the serum folate and vitamin B12, total homocysteine, tryptophan, and tryptophan/competing amino acids ratio. METHODS: This was an individually matched case-control study in which 110 patients with depression and 220 healthy individuals, who completed a semi-quantitative food frequency questionnaire were recruited. We selected the depressed patients from three districts in Tehran through non-probable convenience sampling from which healthy individuals were selected, as well. The samples selection and data collection were performed during October 2012 to June 2013. In addition, to measure the serum biomarkers 43 patients with depression and 43 healthy people were randomly selected from the study population. To diagnose depression the criteria of Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were utilized. RESULTS: The findings suggest that the healthy dietary pattern was significantly associated with a reduced odds of depression (OR: 0.75; 95% CI: 0.61-0.93) whereas the unhealthy dietary pattern increased it (OR: 1.382, CI: 1.116-1.71). The mediation analysis showed that the healthy dietary pattern was associated with a reduced risk of depression via increased serum levels of the folate and vitamin B12; however, the unhealthy dietary pattern was associated with increased risk of depression via decreased serum levels of folate and vitamin B12, based on tree adjusted logistic regression models. CONCLUSION: Dietary patterns may be associated with depression by changing the serum levels of folate and vitamin B12. Further studies are required to confirm the mechanism.

Vitamin D deficiency mediates the relationship between dietary patterns and depression: a case-control study.

BACKGROUND: Depression is a major contributor to disability-adjusted life years (DALY) lost in the world. Dietary patterns are widely used to investigate diet-disease relations. In the current study, the relationship between dietary patterns and depression was investigated. Besides, the role of serum vitamin D, zinc, magnesium, and total antioxidant capacity as potential mediatory variables was studied. METHODS: It was an individually matched case-control study in which 330 depressed and healthy subjects were recruited for the extraction of dietary patterns; psychiatrists diagnosed major depressive disorder, using the criteria of the Diagnostic and Statistical Manual of Mental Disorders. Serum vitamin D and aforementioned biomarkers were measured for a number of randomly selected depressed and healthy individuals. We conducted mediatory analysis by regression models. RESULTS: Healthy and unhealthy dietary patterns were associated with the lower and higher odds of depression (OR 0.39, CI 0.17-0.92 and OR 2.6, CI 1.04-6.08), respectively. A significant relationship between serum vitamin D with depression after adjusting for potential confounders was observed as well (OR 0.93, CI 0.87-0.99). According to the mediatory analysis the unhealthy dietary patterns were related to depression via altering the serum vitamin D concentration. CONCLUSION: This study showed that vitamin D deficiency mediates the relationship between unhealthy dietary patterns and depression. However, to get a clearer result further prospective studies are required.

Erythrocytes polyunsaturated fatty acids mediate relationship between dietary patterns and depression.

Background: This study aimed to examine the association between depression and dietary patterns via the intermediary role of erythrocytes polyunsaturated fatty acids (PUFA). Methods: In this individually matched case-control study, the dietary patterns were extracted for 330 individuals using factor analysis. Furthermore, erythrocyte PUFAs including n-3 and n-6 were assessed using a GC-Mass spectrometry analytical method for 84 people. Depression was diagnosed using the criteria mentioned in the Diagnostic and Statistical Manual of Mental Disorders. The dietary patterns were also extracted using a valid and reliable semi-quantitative food frequency questionnaire. Results: The findings showed that healthy dietary patterns were related to the risk of depression (P = 0.01, odds ratio (OR) = 0.31, 95% confidence interval (CI): 0.14-0.68) by the increase of ratio n-3 /n-6 PUFA (p ≤ 0.03) and decrease of ratio n-6 /n-3 PUFA (p ≤ 0.005). Moreover, the unhealthy dietary patterns were associated with the risk of depression (P = 0.02, OR = 2.7, 95%CI: 1.25-5.9) by the decrease of ratio n-3/n-6 PUFA (p ≤ 0.03) and increase of ratio n-6/n-3 PUFA (p ≤ 0.001). Conclusion: Based on the results, the type of dietary pattern is related to the risk of depression considering the changes in n-3 and n-6 PUFA as well as the ratio of n-3 to n-6 as the mediator variables. Of course, further studies are required in this area.

Mesenchymal Stem Cells Upregulate the Expression of PD-L1 But Not VDR in Dendritic Cells.

OBJECTIVE: Mesenchymal stem cells (MSCs) show immunomodulatory functions. But the exact mechanism underlying these activities of MSCs is still not completely understood. There have been a few studies which have assessed the effects of these cells on dendritic cells (DCs) function. Given the importance of programmed cell death receptor-1 (PD-L1) and vitamin D receptor (VDR) expression in induction of tolerance in DCs, we were encouraged to investigate if one of the immunomodulatory functions of MSCs could be inducing upregulation of PD-L1 and VDR on DCs or not. METHODS: DCs were co-cultured with MSCs or treated with them in transwell plates in the presence or absence of Lipopolysaccharide (LPS). Expression of PD-L1 and VDR mRNA and proteins in treated DCs were assessed by Real-time PCR and Western blot techniques. Furthermore, treated DCs were co-cultured with allogeneic T-cells, and T-cell proliferation and cytokine secretions in co-culture supernatants were assessed. RESULTS: The results showed that PD-L1 but not VDR expression is significantly upregulated in the DCs co-cultured with MSCs. Furthermore, cell-to-cell contact and also presence of maturation inducers like LPS is necessary for this function. Moreover, our results indicated that MSCs could induce tolerogenic DCs (TolDCs) which could decrease the secretion of IL-2 by T-cells and inhibit T-cell proliferation as well as increase secretion of IL-10. CONCLUSIONS: Overall, our results show that MSCs may have several suppressive effects on immune responses by induction of TolDCs expressing more PD-L1 immunomodulatory molecule and change the cytokines profile of DCs and T-cells.

Effective treatment with rituximab for the maintenance of remission in frequently relapsing minimal change disease.

AIM: Treatment of frequently relapsing or steroid-dependent minimal change disease (MCD) in children and adults remains challenging. Glucocorticoids and/or other immunosuppressive agents are the mainstay of treatment, but patients often experience toxicity from prolonged exposure and may either become treatment dependent and/or resistant. Increasing evidence suggests that rituximab (RTX) can be a useful alternative to standard immunosuppression and allow withdrawal of maintenance immunosuppressants; however, data on optimal treatment regimens, long-term efficacy and safety are still limited. METHODS: We undertook a prospective study of RTX to allow immunosuppression minimization in 15 young adults with frequently relapsing or steroid-dependent, biopsy-proven MCD. All patients were in remission at the start of treatment and on a calcineurin inhibitor. Two doses of RTX (1 gr) were given 6 months apart. A subset of patients also received an additional dose 12 months later, in order to examine the benefit of re-treatment. Biochemical and clinical parameters were monitored over an extended follow-up period of up to 43 months. RESULTS: Median steroid-free survival after RTX was 25 months (range 4-34). Mean relapse frequency decreased from 2.60 ± 0.28 to 0.4 ± 0.19 (P < 0.001) after RTX. Seven relapses occurred, five of which (71%) when CD19 counts were greater than 100 µ. Immunoglobulin levels remained unchanged, and no major side effects were observed throughout the follow-up period. CONCLUSIONS: Rituximab therapy is effective at maintaining prolonged steroid-free remission and reducing relapse frequency in this group of patients. Our study lends further support for the role of RTX in the treatment of patients with frequently relapsing or steroid-dependent MCD.

The long-term complications of the inherited tubulopathies: an adult perspective.

The inherited tubulopathies are lifelong disorders and their clinical features and complications may present quite different challenges in adulthood from those in childhood. In this review we outline the pathophysiology and documented complications (including the late and unusual) of the monogenic tubulopathies from the perspective of the adult nephrologist.

Vitamin B12 supplementation in end stage renal diseases: a systematic review.

BACKGROUND: Hyperhomocysteinemia is a risk factor for cardiovascular disease particularly in patients with end stage renal disease (ESRD). Vitamin B12 supplementation on its own still remains as a controversial issue for clinicians in decreasing the level of homcysteine in this group of patients. METHODS: Using all randomized controlled trials (RCTs), clinical trials and pre-post-trial studies found during January 1999 to March 2014, we conducted a systematic review which assessed the effects of vitamin B12 in decreasing homocysteine levels in patients with ESRD. RESULTS: The findings of this study revealed that, overall, the greatest effect of B12 supplementation on decreasing homocysteine levels in patients with ESRDs occurred when it was combined with folate supplementation. It was also demonstrated that injection treatments might be more beneficial than oral intake treatments. CONCLUSION: More rigorous studies are needed to draw a firm conclusion about B12 therapy and the level of homocyteine in patients with ESRD.

The relationships between dietary patterns and socioeconomic status with anthropometric and body composition indices in Iranian preschool children: A cross-sectional study.

Background: The prevalence of overweight and obesity among Iranian children is on the rise. Dietary patterns (DPs) and socioeconomic status ( socioeconomic status (SES)) may relate to children's excess weight as a predictor of the risk of obesity in adulthood that may vary by geographical regions. Aim: The relationship between DPs and the development of obesity in preschool children has not been adequately evaluated. The present study evaluates this relationship by considering SES. Methods: A total of 320 preschool children (4-6 years) were randomly selected from three different areas of Mashhad based on economic status. Dietary intake was evaluated using a semi-quantitative food frequency questionnaire completed by the children's parents. Anthropometric and body composition variables were measured by means of valid tools and standard methods. socioeconomic status data were collected through a researcher-made questionnaire. Results: Three dominant DPs of 'healthy', 'unhealthy', and 'meat-free' were identified using factor analysis. The prevalence of overweight and obesity among the children who followed meat-free DP was significantly higher than that of other children (p = 0.004). The means and standard deviations of energy intake, body mass index (BMI), waist circumference, fat-free mass, and fat mass were 1187.97 ± 356.87 Kcal/day, 16.23 ± 2.28 kg/m2, 54.28 ± 6.49 cm, 16.24 ± 2.23 kg, and 4.62 ± 2.70 kg respectively. Being in the higher levels of SES was significantly related to height (p = 0.02), energy intake (p < 0.001), BMI (p = 0.003), waist circumference (p = 004), and fat mass (p = 0.002). Conclusions: Adherence to meat-free DP and being in the highest levels of SES may be associated with a greater chance of developing overweight and obesity. Therefore, meat consumption and SES can be used to predict childhood overweight and obesity.

Haemodiafiltration results in similar changes in intracellular water and extracellular water compared to cooled haemodialysis.

BACKGROUND/AIMS: Intradialytic hypotension is the most common complication of modern day haemodialysis (HD). Convective modalities, including haemodiafiltration (HDF) are reported to result in greater cardiovascular stability compared to standard HD, which has been suggested to be due to improved solute transport between compartments. We therefore investigated the effect of treatment on body water by bioimpedance. METHODS: We measured the change in extracellular water (ECW) and intracellular water (ICW) in 263 outpatients attending for HD using cooled dialysate and 134 patients for HDF. RESULTS: Patient cohorts were matched for demographics, dialysate composition, ultrafiltration rate, and session duration. The fall in systolic blood pressure following HD was -11.8 mm Hg (-25.3 to 2.3) and not different from that following HDF -12 mm Hg (-27 to 6). Similarly there were no differences in pretreatment serum sodium and dialysate sodium gradient [HD 1 mmol/l (-1 to 3) vs. HDF 2 mmol/l (1 to 4)], or change in serum sodium posttreatment [HD 0 mmol/l (-2 to 2) vs. HDF 1 mmol/l (-1 to 3)]. There were no differences in ICW or ECW pretreatment, and following treatment the reduction in ICW and ECW did not differ [ICW HD -3.5% (-5.7 to -1.8) vs. -4.1% (-6.0 to -1.7), ECW HD -7.1% (-9.4 to -4.7) vs. HDF -7.1% (-9.7 to -4.9)]. CONCLUSION: We were unable to demonstrate any advantage for HDF over HD using cooled dialysate in terms of changes in blood pressure during a treatment session, or differences in the relative changes in ICW or ECW volumes.

The effects of racial differences on body composition and total body water measured by multifrequency bioelectrical impedance analysis influence delivered Kt/V dialysis dosing.

INTRODUCTION: Haemodialysis dosing is traditionally based on urea clearance (Kt/V). Aiming for the same Kt/V target, some racial groups have better survival. We investigated whether body composition differs with ethnicity and may lead to differences in Kt/V delivered. METHODS: We compared total body water (TBW) measured by multifrequency bioelectrical impedance analysis (MF-BIA) that calculated from standard anthropometric equations. RESULTS: Three hundred and seventy-one adult patients, with a mean age of 58.2 ± 16.6 years, 60.6% of whom were male, 29.1% diabetic, 38.5% Caucasoid, 29.4% African/Afro-Caribbean, 24.8% South Asian and 5.4% East Asian, were studied. TBW measured by MF-BIA differed significantly from that predicted by anthropometric equations. Body fat of women and diabetics was greater, and muscle mass in South Asians was reduced. The difference between the TBW MF-BIA measurement and that of the equation by Watson et al. [11] was associated with % muscle mass (ß -10.8, p < 0.001), age (ß 0.23, p < 0.001), serum albumin (ß -0.24, p < 0.001), body mass index (ß 0.91, p = 0.001) and racial origin (ß -9.86, p = 0.04). CONCLUSIONS: Variation in body composition between ethnic groups potentially leads to over-estimation of delivered dose for some ethnic groups and underestimation for others when using anthropometric equations. MF-BIA assessments of body water should be evaluated as a method for dosing dialysis patients.

Cord sign: cortical venous thrombosis evolving to a ring enhancing lesion.

Cortical venous thrombosis can present with non-specific findings including headaches and seizures. Subsequent cortical infarction has a variety of radiological appearances. The authors describe the diagnostic challenge of a case of cortical venous thrombosis presenting with focal motor seizures where imaging showed a ring enhancing lesion and the 'cord sign' and underwent a stereotactic brain biopsy.

Effect of Extracorporeal Shockwave Therapy on Pain Management of Patients with Post-Stroke Hemiplegic Shoulder Pain: A Prospective Randomized Controlled Trial.

Background: Post-stroke hemiplegic shoulder pain (HSP) is a common complication leading to significant activity limitation. Some approaches have been recommended for the management of HSP, and most of them have various adverse effects, while none were established to be effective. This study aimed to evaluate the effect of minimally invasive extracorporeal shockwave therapy (ESWT) on patients with HSP pain management. Materials and Methods: Using a single-blind, randomized clinical trial, 43 patients with HSP were randomly assigned to complete three focus ESWT sessions once a week and additional five radial ESWT sessions twice a week. Patients in the control arm received zero energy ESWT. Visual analog scale, passive range of motion (ROM), Fugl-Meyer upper extremity assessment (FMA-UE), and shoulder pain and disability scale (SPADI) were measured at baseline, at the end of the interventions, and within four and eight weeks' intervals to evaluate the pain, function, and ROM in the affected shoulder. Result: Both groups showed an improvement in pain scores on the fourth and eighth weeks visits (P-value <0.001). Intervention with ESWT could effectively lead to a less severe pain score compared to the control group (P-value <0.001). In the intervention group, the ROM improved in both passive abduction and forward flexion (P-value <0.05), but no significant change was observed in the control group (P-value >0.05). FMA-UE and SPADI did not differ significantly between groups. Conclusion: Based on the findings of this study, the combination of rESWT and focused ESWT can efficiently improve stroke-induced HSP.