Medical management of painful achalasia: a patient-driven systematic review.

Achalasia is a rare esophageal disorder characterized by abnormal esophageal motility and swallowing difficulties. Pain and/or spasms often persist or recur despite effective relief of the obstruction. A survey by UK charity 'Achalasia Action' highlighted treatments for achalasia pain/spasms as a key research priority. In this patient-requested systematic review, we assessed the existing literature on pharmacological therapies for painful achalasia. A systematic review of the literature using Medline, Embase and Cochrane databases was performed to identify studies evaluating pharmacological therapies for achalasia. Methodological quality of included randomized controlled trials was assessed using the Cochrane Risk of Bias tool. In total, 70% (40/57) of survey respondents reported experiencing pain/spasms. A range of management strategies were reported. Thirteen studies were included in the review. Seven were randomized controlled trials. Most studies were >30 years old, had limited follow-up, and focussed on esophageal manometry as the key endpoint. Generally, studies found improvements in lower esophageal pressures with medications. Only one study evaluated pain/spasm specifically, precluding meta-analysis. Overall risk of bias was high. The achalasia patient survey identified that pain/spasms are common and difficult to treat. This patient-requested review identified a gap in the literature regarding pharmacological treatments for these symptoms. We provide an algorithm for investigating achalasia-related pain/spasms. Calcium channel blockers or nitrates may be helpful when esophageal obstruction and reflux have been excluded. We advocate for registry-based clinical trials to expand the evidence base for these patients.

Epigenome-wide association study of body mass index, and the adverse outcomes of adiposity.

Approximately 1.5 billion people worldwide are overweight or affected by obesity, and are at risk of developing type 2 diabetes, cardiovascular disease and related metabolic and inflammatory disturbances. Although the mechanisms linking adiposity to associated clinical conditions are poorly understood, recent studies suggest that adiposity may influence DNA methylation, a key regulator of gene expression and molecular phenotype. Here we use epigenome-wide association to show that body mass index (BMI; a key measure of adiposity) is associated with widespread changes in DNA methylation (187 genetic loci with P < 1 × 10-7, range P = 9.2 × 10-8 to 6.0 × 10-46; n = 10,261 samples). Genetic association analyses demonstrate that the alterations in DNA methylation are predominantly the consequence of adiposity, rather than the cause. We find that methylation loci are enriched for functional genomic features in multiple tissues (P < 0.05), and show that sentinel methylation markers identify gene expression signatures at 38 loci (P < 9.0 × 10-6, range P = 5.5 × 10-6 to 6.1 × 10-35, n = 1,785 samples). The methylation loci identify genes involved in lipid and lipoprotein metabolism, substrate transport and inflammatory pathways. Finally, we show that the disturbances in DNA methylation predict future development of type 2 diabetes (relative risk per 1 standard deviation increase in methylation risk score: 2.3 (2.07-2.56); P = 1.1 × 10-54). Our results provide new insights into the biologic pathways influenced by adiposity, and may enable development of new strategies for prediction and prevention of type 2 diabetes and other adverse clinical consequences of obesity.

Mapping the experiences of people with achalasia from initial symptoms to long-term management.

BACKGROUND: Achalasia is a rare motility disorder affecting the oesophagus, which is associated with a range of symptoms and different treatment strategies. Currently, little is known about people's experiences with achalasia and its management. This study aimed to understand the experiences of people living with achalasia, from the initial onset of symptoms to long-term management. METHOD: This qualitative study explored the journey of people living with achalasia and outlined the care pathway using a process map. Ten female and five male participants living with achalasia (age range: 40-73) took part, and all aspects of their diagnosis, treatment and management were discussed. A process map showing people's experiences by separating the management of their condition into a series of steps was developed to present the pathway in the participants' journey. The analysis involved discussing the process map within the research team. RESULTS: The process map comprised of 10 steps, which occurred before and after diagnosis. The developed map indicates that most participants managed their on-going symptoms through stress management techniques and dietary changes. Key issues that participants highlighted about their journey managing achalasia were misdiagnosis, delay in diagnosis and lack of support in the long-term management of achalasia. CONCLUSIONS: This research was a novel study exploring patients' experiences and management of achalasia and mapping their journey. Two distinct phases to their journeys were identified: before and after diagnosis. Areas highlighted by this study can provide a basis for future research, in particular behaviour change to support the long-term management of achalasia.

Association of exposure to Bisphenol A with obesity and cardiometabolic risk factors in children and adolescents.

In this study, the association of exposure to Bisphenol A (BPA) with obesity and cardiometabolic risk factors was investigated on 132 children and adolescents aged 6-18 years living in Isfahan, Iran. Potential contributors to BPA exposure were assessed by a questionnaire. Total BPA was detected in urine samples of all participants without significant difference in boys and girls. The mean body mass index (BMI) and waist circumference (WC) increased significantly across the BPA tertiles (p for trend = < 0.001). Similar trend was documented for systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as fasting blood sugar. The risk of obesity was 12.48 times higher in participants in the third tertile of BPA than in others (95% CI: 3.36-46.39, p < 0.001). The current study showed significant association between BPA exposure with obesity and some cardiometabolic risk factors in children and adolescents, however, further longitudinal studies are necessary to evaluate the clinical effects of this finding. Abbreviations: BMI: Body Mass Index; BPA: Bisphenol A; BSTFA: N, O-Bistrifluoroacetamide; CDC: Centers for Disease Control and Prevention; CI: Circumference Interval; DBP: Diastolic Blood Pressure; DLLME: Dispersive liquid-liquid microextraction method; FBS: Fasting Blood Glucose; HDL: high-density lipoprotein cholesterol were; LDL: low-density lipoprotein cholesterol; OR: Odd Ratio; PA: Physical Activity; SBP: Systolic Blood Pressure; TC: total cholesterol; TG: triglycerides; WC: Waist Circumference.

Seroprevalence and risk factors associated with bovine viral diarrhea virus and bovine herpes virus-1 in Zanjan Province, Iran.

Bovine viral diarrhea virus (BVDV) and bovine herpes virus-1 (BHV-1) remain as the major pathogens with heavy economic consequences in Iran. The prevalence of antibodies against BVDV and BHV-1, the rate of BVDV persistently infected (PI) animals, and associated risk factors were evaluated in a cross-sectional study carried out in Zanjan Province, Northwest Iran, in December 2011. A total number of 562 cattle in 10 herds and five cities were randomly selected, and their serum samples were tested to detect antibodies to these viruses and also BVDV antigen-positive (PI) animals. The data were analyzed with Pearson's correlation coefficient, chi-square, and logistic regression test. In total, nine and eight of the selected herds were seropositive to BVDV and BHV-1, respectively. The overall seroprevalence of these infections were estimated at 28.6 and 10.7% for BVDV and BHV-1, respectively, and 0.53% of the samples were detected as persistently infected. Statistical analysis revealed that sex, age, and farming system are risk factors for both infections (P < 0.05), while breed was determined as a strong risk factor only for BVDV (P < 0.001). In addition, the present study certainly identifies that infection with BVDV is associated with infection to BHV-1 (OR = 4.52, 95% CI: 2.60-7.80; P Ë‚ 0.001). The results add our knowledge about the prevalence and associated risk factors of BVDV and BHV-1 in Iran and imply that the prophylactic and surveillance strategies need to be implemented to reduce the risk of spread of these viruses.

Heavy metal concentrations in bovine tissues (muscle, liver and kidney) and their relationship with heavy metal contents in consumed feed.

Toxic (lead, cadmium and mercury) and essential trace (copper and zinc) metals were measured in muscle, liver and kidney samples of bovine and their relationships with heavy metal concentrations in consumed feed were studied. A total of 216 tissue samples from 72 cows and 216 feed samples from 18 farms were collected during four seasons and analyzed for heavy metals by inductively coupled plasma-optical emission spectrometry after wet digestion. The arithmetic mean concentrations (mg/Kg wet weight) of lead (Pb), cadmium (Cd) and mercury were respectively, 0.221, 0.028 and 0.003 in muscle, 0.273, 0.047 and 0.002 in liver and 0.244, 0.114 and 0.003 in kidney. All measured concentrations (with the exception of Pb in muscle) were below the European Union maximum residual limits (MRL). The Cd contents of the kidney were significantly higher than which observed in other tissues. Although, copper (Cu) and zinc (Zn) levels in all of samples were below MRL, but results showed that many cattles may be suffering from Cu and/or Zn deficiency. Significant and positive correlations between Pb (p < 0.05, r = 0.163) and Cd (p < 0.01, r = 0.303) concentrations in feed and studied organs were observed. As a considerable amount of metals above MRL were noticed in our study, continuous monitoring of these metals is recommended to avoid hazardous transfer to human through the food of animal origin.

Body Contouring Surgery and the Maintenance of Weight-Loss Following Roux-En-Y Gastric Bypass: A Retrospective Study.

BACKGROUND: Bariatric surgery leads to significant weight loss with reduced morbidity and mortality. However, excess skin as a consequence of weight loss represents a major problem, impacting upon patient's functionality with potential negative effects on weight loss. OBJECTIVES: We evaluated the effect of body-contouring surgery on weight-loss maintenance following bariatric surgery. METHODS: We undertook a retrospective analysis of patients undergoing Roux-en-Y gastric bypass (RYGB) +/- body-contouring surgery (BC). The control group (n = 61) received RYGB, the test group (n = 30) received RYGB+BC 12 to 18 months after bariatric surgery. Each RYGB+BC patient was matched to two control patients for age, sex, glycaemic status, and weight on day of surgery. Per cent weight loss (%WL) was calculated at 3, 6, 12, 24, 36, 48, and 60 months post-RYGB for both groups. RESULTS: The %WL was similar at 3, 6, and 12 months post-RYGB. At 24 months, %WL was 35.6% in the RYGB+BC group and 30.0% in the RYGB group (P < 0.05). At 36 months, the RYGB+BC group maintained their weight loss (%WL 33.0%), in contrast, the RYGB gained weight (%WL = 27.3%, P < 0.05). This trend continued (RYGB+BC vs RYGB) at 48 months (%WL 30.8% vs 27.0%) and at 60 months (%WL 32.2% vs 22.7%, P < 0.05). CONCLUSIONS: Our results suggest patients who undergo body contouring after bariatric surgery are able to lose significantly more weight and maintain weight loss at five years of follow up compared to those undergoing bariatric surgery alone.

Early Effect of Bariatric Surgery on Urogenital Function in Morbidly Obese Men.

INTRODUCTION: Obesity is an independent risk factor for erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). Bariatric surgery has been shown to improve erectile function and urinary symptoms in medium- to long-term studies (3- to 12-month postoperative follow-up). AIM: To investigate the early effect (1 month postoperatively) of bariatric surgery on ED and LUTS, which has not previously been investigated. METHODS: Morbidly obese men (body mass index > 35 kg/m2) undergoing bariatric surgery were asked to complete the International Index of Erectile Function (IIEF) and International Prostate Symptom Score (IPSS) questionnaires before surgery and 1, 3, and 6 months after surgery. MAIN OUTCOME MEASURE: The influence of bariatric surgery on urogenital function, body mass index, fasting blood glucose, and glycated hemoglobin were analyzed using parametric and non-parametric tests for paired samples. RESULTS: Of 30 patients who completed the study, 18 reported ED (IIEF score < 25) and 14 reported moderate or severe LUTS (IPSS ≥ 8) before the operation. Twelve patients had ED and moderate or severe LUTS. IIEF score, IPSS, body mass index, percentage of weight loss, fasting blood glucose, and glycated hemoglobin showed significant and rapid improvement after bariatric surgery starting at the 1-month postoperative time point and improvement continued throughout the study in all patients with ED or moderate to severe LUTS. CONCLUSION: This is the first study showing improvement in erectile and urinary function within 1 month after bariatric surgery, an effect that was parallel to glycemic improvement and weight loss.

Reported appetite, taste and smell changes following Roux-en-Y gastric bypass and sleeve gastrectomy: Effect of gender, type 2 diabetes and relationship to post-operative weight loss.

Reduced energy intake drives weight loss following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures. Post-operative changes in subjective appetite, taste, and smell and food preferences are reported and suggested to contribute to reduced energy intake. We aimed to investigate the prevalence of these changes following RYGB and SG and to evaluate their relationship with weight loss. 98 patients post-RYGB and 155 post-SG from a single bariatric centre were recruited to a cross-sectional study. Participants completed a questionnaire, previously utilised in post-operative bariatric patients, to assess the prevalence of post-operative food aversions and subjective changes in appetite, taste and smell. Anthropometric data were collected and percentage weight loss (%WL) was calculated. The relationship between food aversions, changes in appetite, taste and smell and %WL was assessed. The influence of time post-surgery, gender and type 2 diabetes (T2D) were evaluated. Following RYGB and SG the majority of patients reported food aversions (RYGB = 62%, SG = 59%), appetite changes (RYGB = 91%, SG = 91%) and taste changes (RYGB = 64%, SG = 59%). Smell changes were more common post-RYGB than post-SG (RYGB = 41%, SG = 28%, p = 0.039). No temporal effect was observed post-RYGB. In contrast, the prevalence of appetite changes decreased significantly with time following SG. Post-operative appetite changes associated with and predicted higher %WL post-SG but not post-RYGB. Taste changes associated with and predicted higher %WL following RYGB but not post-SG. There was no gender effect post-RYGB. Post-SG taste changes were less common in males (female = 65%, males = 40%, p = 0.008). T2D status in females did not influence post-operative subjective changes. However, in males with T2D, taste changes were less common post-SG than post-RYGB together with lower %WL (RYGB = 27.5 ± 2.7, SG = 14.6 ± 2.1, p = 0.003). Further research is warranted to define the biology underlying these differences and to individualise treatments.

Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass.

BACKGROUND: Previous studies show that 'poor responders' to Roux-en-Y gastric bypass (RYGBP) may be identified on the basis of early postoperative weight loss. Early identification of poor responders could allow earlier provision of postoperative behavioural and/or intensive lifestyle interventions and enhance their maximal weight loss. Our aim was to investigate whether early postoperative weight loss predicts the maximal weight loss response after RYGBP and sleeve gastrectomy (SG). METHODS: We undertook a retrospective cross-sectional study of 1,456 adults who underwent either RYGBP (n = 918) or SG (n = 538) as a primary procedure in one of two European centres. Postoperative weight loss was expressed as weight loss velocity (WLV) and percentage weight loss. Linear regression analyses were performed to determine the association of early postoperative weight loss with maximal %WL, including adjustment for baseline variables. RESULTS: There was marked variability in maximal %WL following both RYGBP (mean 32.9 %, range 4.1-60.9 %) and SG (mean 26.2 %, range 1.1-58.3 %). WLV 3-6 months postoperatively was more strongly associated with maximal %WL (r (2) = 0.32 for RYGBP and r (2) = 0.26 for SG, P < 0.001 for both) than either WLV 0-6 weeks or 6 weeks to 3 months postoperatively (r (2) = 0.14 and 0.10 for RYGBP, respectively; r (2) = 0.18 and 0.21 for SG, respectively; P < 0.001 for all). Multiple linear regression analysis, including baseline variables of age, sex, preoperative BMI, type 2 diabetes, ethnicity, and bariatric centre, revealed that 3-6 month WLV was an independent predictor of maximal %WL in both SG and RYGBP groups (standardised ß-coefficients 0.51 and 0.52, respectively; P < 0.001 for both). CONCLUSIONS: There is a marked variability in weight loss response following RYGBP and SG. Early postoperative weight loss can be used to identify patients whose predicted weight loss trajectories are suboptimal. Early targeting of poor responders with more intensive postoperative lifestyle and behavioural support could potentially enhance their weight loss response.

Co-designing an intervention using the COM-B model to change an eating behaviour in people living with achalasia.

Background: Achalasia is a rare motility disorder affecting the oesophagus, leading to difficulties with eating and drinking. Participants in previous studies reported that they needed more social, clinical and behavioural support in the long-term management of achalasia. This study, therefore aimed to 1) identify the most challenging eating behaviour for people living with achalasia and 2) co-design a behaviour change intervention to help address the challenges they experience. Methods: This study used a qualitative approach involving online focus groups. The COM-B model was the theoretical framework, with behaviour change techniques (BCTs) as the active ingredients that target a mixture of capability, opportunity and/or motivation. Three focus groups were undertaken to obtain a range of input from different people living with achalasia. Participants in this study identified the target behaviour, prioritised the different BCTs which most resonated with them to design an intervention and decided on the mode of delivery. The research team analysed the techniques that helped participants with their eating behaviour using the COM-B model as a framework to create the intervention. Results: The 24 participants in this study identified "eating in a social setting" as the target behaviour for the intervention. A workbook that can be personalised by the individual was the most suitable intervention. The workbook structure aligns with the constructs of the COM-B model. It includes reflection, activities and goal-setting sections based on what was indicated to be useful for the majority of the participants. Key techniques to overcome the challenges with eating in a social setting included social support, regulation to reduce negative emotions, goals and planning. Conclusion: Using a focus group approach with the COM-B model as the theoretical framework, the participants in this study developed an intervention to support people living with achalasia. In order to achieve long-term behaviour change, engagement with a personalised workbook could facilitate eating in a social setting. Future work will need to pilot the workbook to ensure it can support people to improve their quality of life and complement the ongoing care they receive from health services.

Facile and green synthesis of recyclable, environmentally friendly, chemically stable, and cost-effective magnetic nanohybrid adsorbent for tetracycline adsorption.

Antibiotic contamination of water sources, particularly tetracycline (TC) contamination, has emerged as one of the global issues that needs action. In this research, ZnCoFe2O4@Chitosan (Ch) as a magnetic nanohybrid adsorbent was synthesized using the microwave-assisted co-precipitation method, and their efficiency for the TC adsorption process was investigated. FESEM (Field Emission Scanning Electron Microscope), EDX (Energy Dispersive X-ray), Mapping and line Scan, XRD (X-Ray Diffraction), FTIR (Fourier Transform Infrared Spectrometer), VSM (Vibrating Sample Magnetometer), Thermogravimetric analysis (TGA) and BET (Brunauer Emmett Teller) techniques were used to check and verify its physical and chemical properties. The removal of TC via the adsorption process from synthetic and real wastewater samples was investigated. The factors determining the TC adsorption process, comprising tetracycline concentration (5-30 mg/L), adsorbent dosage (0.7-2 g/L), contact time (2-45 min), and pH (3-11), were evaluated. The removal effectiveness for the synthetic sample and the real wastewater sample was 93 % and 80 %, respectively, under the ideal TC adsorption process parameters of pH 3, adsorbent dosage 1 g/L, TC initial concentration 5 mg/L, and contact time 30 min. According to kinetic and equilibrium studies, the adsorption of TC by ZnCoFe2O4@Ch follows pseudo-second-order kinetics and the Freundlich isotherm. Additionally, it was determined through the analysis of thermodynamic data that the process of exothermic adsorption is spontaneous and is followed by a decrease in disorder (ΔH = -15.16 kJ/mol, ΔS = -28.69 kJ/mol, and ΔG = -6.62 kJ/mol). After five cycles of recovery and regeneration, the ZnCoFe2O4@Ch magnetic nanocomposite was able to remove 65 % of the TC pollutant and had good chemical stability. The results showed that the magnetic nano-adsorbent ZnCoFe2O4@Ch is a novel magnetic nano-adsorbent with high adsorption capacity that can be utilized to eliminate pharmaceutical contaminants from aqueous solutions.

Advances in three-dimensional electrochemical degradation: A comprehensive review on pharmaceutical pollutants removal from aqueous solution.

Water pollution, stemming from various contaminants including organic and pharmaceutical pollutants, poses a significant global challenge. Amidst the array of methods available for pollutant mitigation, the three-dimensional electrochemical approach emerges as a standout solution due to its environmental compatibility, cost-effectiveness, and rapid efficiency. This study delves into the efficacy of three-dimensional electrochemical processes in purging organic and pharmaceutical pollutants from aqueous media. Existing research indicates that the three-dimensional electrochemical process, particularly when employing particle electrodes, exhibits notable success in degrading organic and pharmaceutical pollutants. This achievement is largely attributed to the ample specific surface area of particle electrodes and the shortened mass transfer distance, which collectively enhance efficiency in comparison to traditional two-dimensional electrochemical methods. Moreover, this approach is lauded for its environmental friendliness and cost-effectiveness. However, it is imperative to note that the efficacy of the process is subject to various factors including temperature, pH levels, and current intensity. While the addition of oxidants can augment process efficiency, it also carries the risk of generating intermediate compounds that impede the reaction. In conclusion, the three-dimensional electrochemical method proves to be a viable and practical approach, provided that process conditions are meticulously considered and adhered to. Offering advantages from both environmental and economic perspectives, this method presents a promising alternative to conventional water and wastewater treatment techniques.

Removal of arsenic as a potentially toxic element from drinking water by filtration: A mini review of nanofiltration and reverse osmosis techniques.

Arsenic is a priority contaminant that enters drinking water through both natural and man-made processes, posing a risk to human health and leading to the development of a variety of illnesses. Since millions of people are exposed to drinking water with a concentration of this pollution that is higher than allowed levels, its removal has become a crucial issue, and this removal is accomplished using a variety of techniques. In this study, the removal of arsenic using two membrane processes-nanofiltration (NF) and reverse osmosis (RO) has been specially investigated in light of the outstanding removal efficiency of arsenic through membrane processes. Arsenic in drinking water must be removed using the right techniques to comply with world health organization (WHO) guidelines. According to the findings of several studies, NF membranes can remove significant amounts of heavy metals, such as arsenic, at low pressures while still producing high-quality water, which lowers operating costs. RO membranes are regarded as yet another efficient membrane technology for eliminating both types of arsenic throughout a wide pH and pressure range. Although the likelihood of membrane clogging can be considered as a restriction in these processes, given the possibility of its modification through the use of proper pre-treatment and also taking into consideration benefits such as the lack of need for chemicals, the absence of sludge production, removal effectiveness up to the WHO standard limit, and the removal of a wide variety of contaminants, they are preferred compared to other techniques in as much as they have the potential to become the most effective method of removal.

Demographic and anthropometric characteristics and their effect on the concentration of heavy metals (arsenic, lead, chromium, zinc) in children and adolescents.

Background: Biomonitoring is a well-established method for assessing people's exposure to contaminants in the environment. Many non-communicable diseases can be prevented or aggravated by physiologically monitoring heavy metals in biological matrices such as urine, evaluating their association with non-communicable diseases, and attempting to limit exposure to them. The focus of this research was to determine the association between potentially toxic elements (PTE) such as arsenic (As), lead (Pb), chromium (Cr), and zinc (Zn) urine concentrations and anthropometric indices and demographic data in children and adolescents aged 6-18 years in Kerman, Iran. Methods: 106 children and adolescents aged 6-18 years in Kerman were randomly selected. A questionnaire was used to acquire demographic information from the participants' parents. Height, weight, and waist circumference (WC) were all assessed, as well as body mass index (BMI) and BMI Z-score. Induced Coupled Plasma Mass Spectrometry (ICP/MS) was used to quantify As, Pb, Cr, and Zn concentrations in participants' urine. Results: The geometric mean concentrations were As (38.72 ± 39.30), Pb (19.58 ± 22.91), Cr (1.06 ± 0.28), and Zn (344.72 ± 288.16) µg/creatinine. Boys aged 12-18 years old had higher mean concentration of As than boys aged 6-11 years old (p = 0.019) according to two measurement standards, µg/L, and µg/creatinine, whereas girls had no significant difference. In general, there was a strong association between parental education and metal concentrations of As, Pb, and Cr. As, Pb, and Zn (µg/creatinine) had a significant positive association with BMI z-score and BMI. As, Pb, and Zn metals were shown to have a substantial positive association (p < 0.001). There was no evidence of an association between the metals evaluated and WC. Conclusions: The findings of this study generally showed that there was a significant association between demographic characteristics and exposure to these metals in children and adolescents, indicating that these people were exposed to these metals, which can harm their health. As a result, the pathways of exposure to metals must be limited.

Occurrence and ecological risks of microplastics and phthalate esters in organic solid wastes: In a landfill located nearby the Persian Gulf.

Landfill sites are the main source of plastic waste. Thus, municipal solid waste (MSW) in landfills may act as a reservior of microplastics (MPs) and related pollutants such as phthalate esters (PAEs) into surrounding environment. However, there is limited information on MPs and PAEs in landfill sites. Levels of MPs and PAEs in organic solid waste disposed in a landfill of Bushehr port were investigated for the first time in this study. The mean MPs and PAEs levels in organic MSW samples were 12.3 items/g and 7.99 µg/g, respectively, and the mean PAEs concentration in MPs was 87.5 µg/g. The highest number of MPs was related to the size classes of >1000 µm and <25 µm. The highest dominant type, color, and shape of MPs in organic MSW were nylon, white/transparent, and fragments, respectively. Di (2-ethylhexyl) phthalate (DEHP) and diisobutyl phthalate (DiBP) were the dominant compounds of PAEs in organic MSW. Based on the finding of present study, MPs showed a high hazard index (HI). DEHP, dioctyl phthalate (DOP), and DiBP demonstrated high-level hazards for sensitive organisms in water. This work illustrated considerable MPs and PAEs levels from an uncontrolled landfill without adequate protection, possibly contributing to their release into the environment. The sites of landfill located near marine environments, such as Bushehr port landfill adjacent to the Persian Gulf, may indicate critical threats to marine organisms and the food chain. Continuous landfills control and monitoring, especially the ones near the coastal area, is highly recommended to prevent further environmental pollution.

Integrative genomic analyses in adipocytes implicate DNA methylation in human obesity and diabetes.

DNA methylation variations are prevalent in human obesity but evidence of a causative role in disease pathogenesis is limited. Here, we combine epigenome-wide association and integrative genomics to investigate the impact of adipocyte DNA methylation variations in human obesity. We discover extensive DNA methylation changes that are robustly associated with obesity (N = 190 samples, 691 loci in subcutaneous and 173 loci in visceral adipocytes, P < 1 × 10-7). We connect obesity-associated methylation variations to transcriptomic changes at >500 target genes, and identify putative methylation-transcription factor interactions. Through Mendelian Randomisation, we infer causal effects of methylation on obesity and obesity-induced metabolic disturbances at 59 independent loci. Targeted methylation sequencing, CRISPR-activation and gene silencing in adipocytes, further identifies regional methylation variations, underlying regulatory elements and novel cellular metabolic effects. Our results indicate DNA methylation is an important determinant of human obesity and its metabolic complications, and reveal mechanisms through which altered methylation may impact adipocyte functions.

Gastroesophageal reflux and voice changes: objective assessment of voice quality and impact of antireflux therapy.

BACKGROUND AND AIM: Voice-related complaints are the most common extraesophageal manifestation of gastroesophageal reflux disease (GERD). The aim of this study was to compare objectively measured voice parameters in normal subjects and patients with GERD and to assess the impact of antireflux surgery on these parameters in patients with reflux disease. METHODS: Normal subjects and patients with reflux symptoms were asked to read a standardized, phonetically balanced text while the impedance across vocal cords was recorded using electroglottography. Irregularity in the voice frequency (CFx) and amplitude (CAx) as well as irregularity of the closed phase ratio of vocal cords (CQx) were calculated. These 3 voice parameters were compared between the normal subjects and patients with gastroesophageal reflux. In a subgroup of GERD patients who underwent antireflux surgery, electroglottography was repeated 3 months or later after surgery and the voice parameters were compared with preoperative values. RESULTS: There were 55 normal subjects and 32 patients with GERD. Compared with normal subjects, GERD patients had a significantly higher irregularity in both voice frequency (P=0.04) and amplitude (P=0.03). The CQx did not differ significantly between the 2 groups (P=0.18). In 16 GERD patients who underwent surgery, a significant improvement in postoperative values was observed for both voice frequency (CFx: 48.4 vs. 30.4, P=0.002) and amplitude (CAx: 25.9 vs. 9.3, P=0.004). CONCLUSIONS: There are measurable alterations in voice quality in patients with GERD when compared with normal subjects. Antireflux surgery improves the irregularity in both amplitude and frequency of voice in patients with reflux disease.

Measurement of Urinary Triclocarban and 2,4-Dichlorophenol Concentration and Their Relationship with Obesity and Predictors of Cardiovascular Diseases among Children and Adolescents in Kerman, Iran.

Exposure to Endocrine-Disrupting Chemicals (EDCs) at an early age can lead to chronic diseases. 2,4-Dichlorophenol (2,4-DCP) and Triclocarban (TCC) are among EDCs that disrupt the endocrine system and alter the body's metabolism. In the present study, the hypothesis that exposure to 2,4-DCP and TCC affects obesity and predictors of cardiovascular diseases was investigated. Fasting Blood Sugar (FBS), Total Cholesterol (TC), Triglyceride (TG), Low-Density Lipoprotein (LDL), High-Density Lipoprotein (HDL (tests were performed on 79 children and adolescents. Also, blood pressure, Body Mass Index (BMI), and BMI z-score were measured to examine the hypothesis. Urinary concentrations of TCC and 2,4-DCP were measured by Gas Chromatography-Mass Spectrometry (GC/MS). Mean concentrations of TCC and 2,4-DCP (µg/L) were higher in obese individuals (5.50 ± 2.35, 0.29 ± 0.13, respectively). After adjusting for possible confounding factors, the results showed an increase in TCC concentration among girls and a decrease in 2,4-DCP among boys with increasing age. The 2,4-DCP concentration among girls increased by 0.007 and 0.01 units with a one-unit increase in Diastolic Blood Pressure (DBP) and FBS, respectively. There was a significant relationship between TCC and TG (Odds Ratio (OR) = 1.02, p-value = 0.007), LDL (OR = 1.05, p-value = 0.003), and HDL (OR = 0.88, p-value = 0.002). There was also a significant relationship between 2,4-DCP and TG (OR = 1.02, p-value = 0.002), LDL (OR = 1.12, p-value = 0.007), and HDL (OR = 0.92, p-value = 0.02). Exposure to TCC and 2,4-DCP can increase some heart risk factors and increase the risk of cardiovascular diseases and obesity. However, to confirm the results of the present study, it is necessary to conduct further studies, such as cohort and case-control studies, with a larger sample size to examine the causal relationships.

Association of urinary triclosan, methyl triclosan, triclocarban, and 2,4-dichlorophenol levels with anthropometric and demographic parameters in children and adolescents in 2020 (case study: Kerman, Iran).

Endocrine-disrupting chemicals (EDCs) can be a major risk factor for noncommunicable illnesses, especially when children are exposed to them. The purpose of this study was to assess the urine concentrations of triclosan (TCS), methyl triclosan (MTCS), triclocarban (TCC), and 2,4-dichlorophenol (2,4-DCP) and its association with anthropometric and demographic parameters in children and adolescents aged 6-18 living in Kerman, Iran, in 2020. A GC/MS instrument was used to measure the concentrations of the analytes. TCS, MTCS, TCC, and 2,4-DCP geometric mean concentrations (µg/L) were 4.32 ± 2.08, 1.73 ± 0.88, 4.66 ± 10.25, and 0.19 ± 0.14, respectively. TCS, MTCS, TCC, and 2,4-DCP were shown to have a positive and significant association with BMI z-score and BMI (p-value < 0.01). TCS and MTCS have a positive, strong, and substantial association (p-value < 0.01, r = 0.74). There was no significant association between the waist circumference (WC) and the analytes studied. In addition, there was a close association between analyte concentration and demographic parameters (smoking, education, income, etc.) overall. In Kerman, Iran, the current study was the first to look into the association between TCS, MTCS, TCC, and 2,4-DCP analytes and anthropometric and demographic data. The levels of urinary TCS, MTCS, TCC, 2,4-DCP, and anthropometric parameters in children and adolescents are shown to have a significant association in this study. However, because the current study is cross-sectional and it is uncertain if a single experiment accurately reflects long-term exposure to these analytes, more research is needed to determine the impact of these analyses on the health of children and adolescents.