Nonsteroidal anti-inflammatory drug use reduces risk of adenocarcinomas of the esophagus and esophagogastric junction in a pooled analysis.

BACKGROUND & AIMS: Regular use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) has been reported to reduce risks of esophageal adenocarcinoma (EAC) and esophagogastric junctional adenocarcinoma (EGJA). However, individual studies have been too small to accurately assess the effects of medication type, frequency, or duration of use. We performed a pooled analysis to investigate these associations. METHODS: We performed a pooled analysis of 6 population-based studies within the Barrett's and Esophageal Adenocarcinoma Consortium to evaluate the association between NSAID use and the risk of EAC and EGJA, using uniform exposure definitions. We collected information from 6 studies (5 case-control and 1 cohort), with a total of 1226 EAC and 1140 EGJA cases, on aspirin and/or NSAID use. Study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariate adjusted logistic regression models and then pooled using a random effects meta-analysis model. RESULTS: Compared with nonusers, individuals who have used NSAIDs had a statistically significant reduced risk of EAC (OR, 0.68; 95% CI, 0.56-0.83); they also appeared to have a reduced risk of EGJA (OR, 0.83; 95% CI, 0.66-1.03). Similar reductions in risk were observed among individuals who took aspirin or nonaspirin NSAIDs. The highest levels of frequency (daily or more frequently) and duration (≥10 years) of NSAID use were associated with an approximately 40% reduction in risk of EAC, with ORs of 0.56 (95% CI, 0.43-0.73; P(trend) < .001) and 0.63 (95% CI, 0.45-0.90; P(trend) = .04), respectively. CONCLUSIONS: Although reverse causation could, in part, explain the inverse association observed between NSAID use and EAC risk, our pooled analysis suggests a possible role for NSAIDs in prevention of adenocarcinomas of the esophagus and esophagogastric junction.

Relationship Between Achievement Motivation, Mental Health and Academic Success in University Students.

Students of medical sciences are under intense mental stress induced by medical training system and are more likely to develop psychological and mental disorders. These psychological disorders may influence their performance in different aspects of life including their study. The aim of the present study is to assess the possible relationships between mental health, achievement motivation, and academic achievement and to study the effect of background factors on mentioned variables. The sample group consists of students of Kurdistan University of medical sciences. 430 students at Kurdistan University of Medical Sciences were selected randomly to participate in the present cross-sectional study in 2016. We used General Health Questionnaire (GHQ) and Achievement motivation test (AMT) as the measures of our study. Our findings indicated that mental health is significantly correlated with achievement motivation (p < .001), but has no correlation with educational success (p = .37). Also, a significant relationship was observed between achievement motivation and academic achievement (p = .025). GHQ was not correlated with demographic factors, while academic achievement and achievement motivation are associated with the field of study and marital status respectively. Conclusively, students who are more motivated to achieve their educational and academic goals, will be more likely to be successful in their education and have stronger academic performance. Also, students with more appropriate mental health status will have higher level of motivation in their education and studies. These findings reflect the importance of maintaining the medical field students' motivation and its role in their academic success.

Comparing the Effect of Ondansetron-dexamethasone and Metoclopramide-dexamethasone on Postoperative Nausea and Vomiting after Gynecological Laparoscopy: A Randomized Double-blind Clinical Trial.

Background: Nausea and vomiting is a common complication after gynecological surgeries, especially laparoscopy, which can lead to discomfort and restlessness in the patients. The aim of the study was to compare the effect of ondansetron-dexamethasone and metoclopramide-dexamethasone on postoperative nausea and vomiting following gynecological laparoscopy. Materials and Methods: In this double-blind clinical trial, 68 females scheduled for gynecological laparoscopy and age range of 18-40 years were randomly divided into two groups. Group OD received ondansetron 4 mg plus dexamethasone 8 mg and group MD received metoclopramide 10 mg plus dexamethasone 8 mg, 15 min before the end of surgery. The incidence of nausea and vomiting and need for rescue medication was assessed during the recovery period, as well as at 2, 4, 6, 12, and 24 h after surgery. The data were analyzed using STATA software version 12 and a significance level of <0.05 was considered in this research. Results: The incidence of nausea in ondansetron and metoclopramide groups was 23.3% and 33.3%, respectively, and the frequency of vomiting was 10% and 16.6%, respectively, which showed no significant difference (P > 0.05). The highest incidence of nausea and vomiting in patients belonged to the metoclopramide group inside 4-6 h after surgery. Conclusion: Our study showed that no significant difference was observed in the incidence of nausea and vomiting between ondansetron-dexamethasone and metoclopramide-dexamethasone groups following laparoscopic gynecological surgery; however, the number of patients with nausea and vomiting was lower in the ondansetron-dexamethasone group.

Esophageal adenocarcinoma incidence in individuals with gastroesophageal reflux: synthesis and estimates from population studies.

OBJECTIVES: Recent advances in the management of Barrett's esophagus may kindle enthusiasm for screening for esophageal adenocarcinoma (EAC). Symptoms of gastroesophageal reflux disease (GERD) are recognized as relative risks for EAC. However, the absolute incidence of EAC in specific populations with GERD is unknown. We aimed to estimate the symptom-, age-, and sex-specific incidences of EAC, and place these incidences in the perspective of other cancers for which screening is endorsed. METHODS: A Markov computer model utilizing published and publicly available data was created to estimate the age- and sex-specific incidences of EAC in American white non-Hispanics with GERD symptoms. RESULTS: The incidence of EAC in men younger than 50 years with GERD symptoms is very low (for instance, at the age of 35 years, incidence=1.0/100,000), and their incidence of colorectal cancer is relatively much higher (for instance, at the age of 35 years, incidence of colorectal cancer is 6.7-fold greater). The incidence of EAC in older men with weekly GERD symptoms is substantial (for instance, at the age of 70 years, incidence=60.8/100,000 person-years), but their incidence of colorectal cancer is at least threefold greater. The incidence of EAC in women with GERD is extremely low, and similar to that of breast cancer in men (for instance, 3.9/100,000 person-years at the age of 60 years). CONCLUSIONS: Screening for EAC should not be performed in men younger than 50 years or in women because of very low incidences of cancer, regardless of the frequency of GERD symptoms. In white men with weekly GERD over the age of 60 years, the incidence of EAC is substantial, and might warrant screening if that practice is particularly accurate, safe, effective, and inexpensive.

Synthesis of modified ZnO nanorods and investigation of its application for removal of phthalate from landfill leachate: A case study in Aradkouh landfill site.

In this study, zinc oxide nanorods, co-doped with iron and silver, were synthesized in a co-precipitation method. Its properties were determined using X-ray diffraction (XRD), Transmission electron microscopy (TEM), Field Emission Scanning Electron Microscopy (FE-SEM), Brunauer-Emmett-Teller (BET), Dynamic light scattering (DLS) and X-ray photoelectron spectroscopy (XPS) analysis. The results of FE-SEM and TEM showed that zinc oxide nanoparticles synthesized and co-doped with iron and silver were formed as separate nanorods. Also, the average values of DBP and DEHP amount of phthalates in the leachate from the landfill site of Aradkouh were obtained 52.5 and 94.69 mg/L, respectively. The highest removal efficiency in real samples for phthalates was found to be 52%. The highest removal efficiency of TOC were was 61%. The synthesized nanostructure could have proper efficiency in removal of phthalates from water sources under the visible light of LED lamp.

Comparison of the Effectiveness of Ultrasound-Guided Prolotherapy in Supraspinatus Tendon with Ultrasound-Guided Corticosteroid Injection of Subacromial Subdeltoid Bursa in Rotator Cuff-Related Shoulder Pain: A Clinical Trial Study.

BACKGROUND: Shoulder pain is the third most common type of musculoskeletal disorder and rotator cuff (RC) tendinopathy is the most frequent diagnosis. Ultrasound is the most preferable guidance tool for diagnostic and interventional purposes. The aim of this study is to compare the effectiveness of the prolotherapy injection with corticosteroid injection in patients with RC dysfunction. MATERIALS AND METHODS: Thirty to sixty-five-year-old patients with chronic RC disease were divided into two groups. Ultrasound-guided dextrose prolotherapy of supraspinatus tendon was done for one group and ultrasound-guided corticosteroid injection in the subacromial bursa was done for the other groups. Visual analog scale (VAS) and Shoulder Pain and Disability Index (SPADI) were evaluated for both groups at baseline, 3 and 12 weeks after injections. RESULTS: Thirty-three patients were included in the result. Both the groups showed significant improvement in VAS and SPADI scores in 3 and 12 weeks after injections compared with preinjection times with no difference between two groups neither in 3 weeks nor in 12 weeks after injections. CONCLUSION: Both ultrasound-guided dextrose prolotherapy and CS injections are effective in the management of RC-related shoulder pain in both short-term and long-term with neither being superior to the other. Therefore, prolotherapy may be a safe alternative therapy instead of corticosteroid injection due to lack of its side effects.

Modified wheat straw-derived graphene for the removal of Eriochrome Black T: characterization, isotherm, and kinetic studies.

A cost-effective and environment-benign adsorbent was prepared from an abundant agro-waste material. Wheat straw was reduced to graphene and then modified by crosslinking to epichlorohydrin. During the conversion process of wheat straw to graphene, the specific surface area increased more than 100 times (from 4 to 415 m2 g-1). The adsorption efficiency of raw wheat straw, graphene nanosheets, and modified graphene against Eriochrome Black T (EBT) were 8.0, 34.7, and 74.4%, respectively. The modified graphene was further investigated for the effect of environmental condition, i.e., pH (3 to 11), EBT concentration (25-100 mg L-1), adsorbent dosage (0.25-0.75 g L-1), contact time (5-60 min), and solution temperature (30-60 °C). The dye removal remained at a high level under a wide range of pH from 3 to 9. The EBT removal decreased from 87.3 to 54.5 by increasing dye concentration and increased from 38.2 to 85.4% by increasing adsorbent dose in the studied ranges. Dye removal also increased by mixing time from 5 to 30 min, whereas a slight drop was observed by continuing agitation up to 60 min. Conducting experiments at various temperatures revealed an endothermic process. Pseudo-first-order and pseudo-second-order models were adequate to represent the adsorption kinetics. Isotherm models suggest a multilayer adsorption of EBT molecules on heterogeneous modified graphene surface with a maximum adsorption capacity of 146.2 mg g-1. The present work demonstrated that the modified graphene obtained from available and low-cost agro-wastes could be used effectively as adsorbent against EBT from aqueous media.

Polymorphisms in MGMT and DNA repair genes and the risk of esophageal adenocarcinoma.

Rates of adenocarcinoma of the esophagus (EAC) and esophago-gastric junction (EGJAC) have increased rapidly in recent decades. The primary risk factors, gastro-esophageal acid reflux and smoking, are potentially genotoxic through the generation of N-nitroso compounds. The DNA repair protein O(6)-methylguanine-DNA methyltransferase (MGMT) is the major cellular defense against alkylating DNA damage. We compared patients with EAC (n = 263) or EGJAC (n = 303) with matched population controls (n = 1,337) for the frequency of 5 MGMT single nucleotide polymorphisms (SNPs) (rs12269324, rs12268840, L84F, I143V, K178R), as well as SNPs in DNA repair genes ERCC1 (N118N), XRCC1 (Q399R) and XPD (K751Q). Relative risks were estimated using multivariable logistic regression. Potential biological interaction was assessed through the synergy index S. Each MGMT SNP conferred increased risks of EAC but not EGJAC; strongest associations were found for the 2 variant MGMT alleles rs12268840 and I143V (p = 0.005 and p < 0.001, respectively). Homozygous carriers of MGMT rs12268840 with frequent acid reflux had significantly higher risks of EAC (OR 15.5, 95% CI 5.8-42) than expected under an additive model, consistent with biological interaction (S = 3.3, 95% CI 1.1-10). Modest, nonsignificant interactions with smoking were also observed. Homozygous variant ERCC1 genotype was associated with reduced risks of EAC (OR 0.6, 95% CI 0.4-1.1), while the homozygous variant XRCC1 genotype conferred higher risks of EGJAC (OR 1.6, 95% CI 1.1-2.4). No associations with EAC or EGJAC were observed with XPD (rs13181). In summary, MGMT SNPs are associated with increased risks of EAC. Exposure to acid reflux, and possibly smoking, confer markedly higher risks among homozygous variant genotype carriers.

Aspirin, nonsteroidal anti-inflammatory drugs, and the risks of cancers of the esophagus.

BACKGROUND: Frequent consumption of aspirin and nonsteroidal anti-inflammatory drugs (NSAID) has been associated with reduced occurrence of cancers of the esophagus, although potential modifying effects of other causal factors remain relatively unexplored. METHODS: We compared nationwide samples of Australian patients with adenocarcinomas of the esophagus (EAC; n = 367) or esophagogastric junction (EGJAC; n = 426) or esophageal squamous cell carcinoma (ESCC; n = 309) with control participants sampled from a population register (n = 1,580). Intakes of aspirin, other NSAIDs, and acetaminophen (paracetamol) were assessed from self-reports. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) using multivariable logistic regression. RESULTS: Compared with never-users of aspirin, those who used aspirin at least weekly had significantly lower risks of EAC (OR, 0.48; 95% CI, 0.32-0.72), EGJAC (OR, 0.71; 95% CI, 0.49-1.01), and ESCC (OR, 0.63; 95% CI, 0.40-0.98). At least weekly use of other NSAIDs was also associated with reduced risks of EAC (OR, 0.74; 95% CI, 0.51-1.08), EGJAC (OR, 0.53; 95% CI, 0.37-0.77), and ESCC (OR, 0.46; 95% CI, 0.30-0.73). No association was observed between frequent use of acetaminophen and esophageal cancer. Risk reductions for EAC among users of aspirin and NSAIDs were greater among those who experienced at least weekly symptoms of reflux (OR, 0.26; 95% CI, 0.12-0.55 and OR, 0.41; 95% CI, 0.21-0.77, respectively) than those who did not experience reflux (OR, 0.96; 95% CI, 0.46-2.00 and OR, 0.78; 95% CI, 0.35-1.72, respectively). Recent use of NSAIDs in the past 5 years was associated with greater risk reductions. CONCLUSIONS: Frequent use of aspirin and NSAIDs is associated with reduced occurrence of esophageal cancers, particularly among those with frequent symptoms of gastroesophageal reflux.

Obesity and the risk of epithelial ovarian cancer: a systematic review and meta-analysis.

Obesity is a risk factor for several hormone-related cancers but evidence for an effect on risk of epithelial ovarian cancer remains inconclusive. Many studies evaluating this association have had insufficient statistical power to detect modest effects, particularly for histological subtypes of ovarian cancer. We have therefore assembled the published evidence on obesity and ovarian cancer in a systematic literature review and meta-analysis. We identified eligible studies using Medline and manual review of retrieved references, and included all population-based studies that assessed the association between overweight, body mass index (BMI25-29.9) and obesity (BMI30) and histologically confirmed ovarian cancer. Meta-analysis was restricted to those studies that expressed effect as an odds ratio (OR), risk ratio, or standardised incidence ratio and 95% confidence interval (CI). We identified 28 eligible studies, of which 16 on adult obesity and 9 on obesity in early adulthood were suitable for meta-analysis. Overall, 24 of 28 studies reported a positive association between obesity and ovarian cancer, and in 10 this reached statistical significance. The pooled effect estimate for adult obesity was 1.3 (95%CI1.1-1.5) with a smaller increased risk for overweight (OR1.2;95%CI1.0-1.3). The pooled OR was stronger among case-control studies (OR=1.5) than cohort studies (OR=1.1). Overweight/obesity in early adulthood was also associated with an increased risk of ovarian cancer. There was no evidence that the association varied for the different histological subtypes of ovarian cancer. Ovarian cancer should be added to the list of cancers likely to be related to obesity.

Prevalence of Intestinal Protozoa Infections and Associated Risk Factors among Schoolchildren in Sanandaj City, Iran.

BACKGROUND: Intestinal parasites are still a serious public health problem in the world, especially in developing countries. This study aimed to assess the prevalence of intestinal protozoa infections and associated risk factors among schoolchildren in Sanandaj City, Iran. METHODS: This cross-sectional study involving 400 schoolchildren was carried out in 2015. Each student was selected using systematic random sampling method. Questionnaire and observation were used to identify possible risk factors. Fresh stool samples were observed using formal-ether concentration method. RESULTS: Five species of intestinal protozoa were identified with an overall prevalence of 42.3%. No cases of helminthes infection were detected. The predominant protozoa were Blastocys hominis (21.3%) and Entamoeba coli (4.5%). Overall, 143 (35.9%) had single infections and 26 (6.4%) were infected with more than one intestinal protozoa, in which 23 (5.9%) had double intestinal protozoa infections and 3 (0.5%) had triple infections. A significant relationship was observed between intestinal protozoa infection with economic status, water resources for drinking uses, and the methods of washing vegetables (P<0.05). CONCLUSION: Education programs on students and their families should be implemented for the prevention and control of protozoa infections in the study area.

A comparative study of hospital admissions for respiratory diseases during normal and dusty days in Iran.

During the last century, most of people around the world moved from communicable to non-communicable diseases, mainly due to air pollution. Air pollutants and dust storm increase risk of morbidity, for cardiovascular and respiratory diseases, and increase the number of deaths. The city of Ahvaz is considered as the focal point of air pollution and dust storm in Iran. The aim of this study was to determine the number of Hospital Admission Respiratory Disease (HARD) including asthma attacks, acute bronchitis and chronic obstructive pulmonary disease attributed to PM10 by a descriptive study during normal and dust event days in Ahvaz during the time period 2010-2012. The hourly PM10 data was collected from the Iranian Environmental Protection Agency and Razi hospital. The annual PM10 mean concentrations reached 282, 288 and 278 µg/m3 in 2010, 2011 and 2012, respectively. The number of HARD attributed to PM10 was 1438, 1945 and 1393 people, respectively, and the highest number of daily admissions was attributed to the highest daily PM10 concentration in Ahvaz. The average number of daily HARD during dusty days was higher than normal days, and a significant positive correlation, between the number of hospital admissions and dusty days, was found. Dust had significant impact on HARD in Ahvaz.

A new approach to estimation of the number of central synapse(s) included in the H-reflex.

BACKGROUND: Among the main clinical applications of the H-reflex are the evaluation of the S1 nerve root conductivity such as radiculopathy and measurement of the excitability of the spinal motoneurons in neurological conditions. An attempt has been made to reduce the pathway over which H-reflex can be obtained in a hope to localize a lesion to the S1 nerve root, so the S1 central loop has been suggested. The main goal of this study is the estimation of the H-reflex number of synapse(s) for better understanding of the physiology of this practical reflex. METHODS: Forty healthy adult volunteers (22 males, 18 females) with the mean age of (37.7 +/- 10.2) years participated in this study. They were positioned comfortably in the prone position, with their feet off the edge of the plinth. Recording electrodes were positioned at the mid point of a line connecting the mid popliteal crease to the proximal flare of the medial malleolus. Stimulation was applied at the tibial nerve in the popliteal fossa and H, F and M waves were recorded. Without any change in the location of the recording electrodes, a monopolar needle was inserted as cathode at a point 1 cm medial to the posterior superior iliac spine, perpendicular to the frontal plane. The anode electrode was placed over the anterior superior iliac spine, and then M and H waves of the central loop were recorded. After processing the data, sacral cord conduction delay was determined by this formula: sacral cord conduction delay = central loop of H-reflex - (delays of the proximal motor and sensory fibers in the central loop). RESULTS: The central loop of H-reflex was (6.77 +/- 0.28) msec and the sacral cord conduction delay was (1.09 +/- 0.06) msec. CONCLUSION: The sacral cord conduction time was estimated to be about 1.09 msec in this study and because at least 1 msec is required to transmit the signal across the synapse between the sensory ending and the motor cell, so this estimated time was sufficient for only one central synapse in this reflex.

Effects of age and leg length upon central loop of the gastrocnemius-soleus H-reflex latency.

BACKGROUND: central loop of the gastrocnemius-soleus H-reflex latency (Tc) that looks promising in the diagnosis of S1 radiculopathy; has been investigated in a few studies and only two of them have focused on the constitutional factors affecting it. Although leg length has been shown to contribute to the Tc, the role of age is controversial. More confusing, none of the previously performed studies have used strict criteria to rule out subclinical neuropathy, so the results could be misleading. This study has been performed to determine the influence of leg length and age on Tc among a carefully selected group of healthy volunteers. METHODS: after screening forty six volunteers by taking history, physical examination and a brief electrophysiologic study; forty of them were selected to enroll into the study. Tc was obtained in all the study subjects and leg length and age were recorded for correlational analyses. RESULTS: this group was consisted of 26 males (65%) and 14 females (35%) with the age range of 19-65 years (Mean +/- SD: 37 +/- 10.7) and leg length range of 29.5-43 centimeters (36.4 +/- 3.4). Mean +/- SD for Tc was 6.78 +/- 0.3. We found a significant correlation between Tc and leg length (p value= 0.003, r = 0.49 and confidence interval 95% = 0.59-0.88), no significant correlation was found between age and Tc (p value= 0.48, r = 0.11), also we obtained the regression equation as: Tc = 0.04L + 5.28 CONCLUSIONS: in contrast to leg length, age was not correlated with Tc. Future studies are required to delineate other contributing factors to Tc.

A high prevalence of cumulative trauma disorders in Iranian instrumentalists.

BACKGROUND: Cumulative trauma disorders (CTDs) are common in musicians and their prevalence has been the subject of a number of studies in most western countries. Such studies are scarce in developing countries despite the possibility that CTDs may have a different prevalence in these countries, especially when considering traditional musical instruments and different methods of playing. Although not formally studied before, according to our experience the prevalence of CTDs seemed to be high among Iranian instrumentalists. We proposed this study to determine the prevalence of CTDs in amateur music students playing one of the two traditional Iranian instruments: Daf and Setar. METHODS: In a prospective cross sectional study, we interviewed and examined the students of three music training centers in Iran. Seventy eight instrumentalists, who were playing Daf or Setar and twelve students who had not started playing yet were regarded as case and control groups respectively. Some of them also underwent electrodiagnostic studies. RESULTS: Forty-seven percent (17 of 36) of the Setar players and 57% (24 of 42) of the Daf players and fifty-three percent (41 of 78) of the instrumentalists as a whole had CTDs. None of them had carpal tunnel syndrome. CONCLUSIONS: Our study revealed that the prevalence of CTDs in Iranian instrumentalists was unusually high. In addition to age, other variables may be contributory. This needs to be further studied.

Effect of Posture Training with Weighted Kypho-Orthosis (WKO) on Improving Balance in Women with Osteoporosis.

Objectives. To determine the effect of weighted kypho-orthosis (WKO) on improving balance in women with osteoporosis. In this nonrandomized controlled clinical trial, 31 patients with osteoporosis were included. The patients were assigned to two groups: (1) control group who received 4-week home-based daily exercise program including weight bearing, back strengthening, and balance exercises and (2) intervention group (WKO) who performed aforementioned exercises and wore WKO for one hour twice a day. Patients were assessed using clinical balance tests (timed up and go test, functional reach test, and unilateral balance test) before and 4 weeks after start of treatment. Results. Functional reach and timed up and go test were improved significantly in both groups compared to baseline. The improvement in intervention group was more significant in comparison to control group (P < 0.05). Discussion. Posture training with WKO together with exercise program improved two clinical balance tests in women with osteoporosis. Conclusion. Posture training support (PTS) applied as WKO together with back extension exercises can be prescribed as an intervention in elderly women in order to reduce the risk of falling.