Publications by authors named "Abbas Keshtkar"

48 Publications

Transitional immature regulatory B cells and regulatory cytokines can discriminate chronic antibody-mediated rejection from stable graft function.

Int Immunopharmacol 2020 Sep 8;86:106750. Epub 2020 Jul 8.

Department of Immunology, School of Medicine, Tehran University of Medical Science, Tehran, Iran. Electronic address:

Background: The balance between inflammatory and anti-inflammatory responses of the immune system has been demonstrated to determine the fate of transplanted allografts. Here we analyzed CD19CD24CD38 immature transitional regulatory B (TRB) cells, as well as the gene and protein levels of interleukin (IL)-10 and transforming growth factor (TGF)-β in the three separate groups, include of stable transplanted subjects, chronic antibody-mediated rejection (cAMR) patients, and healthy individuals.

Method: Peripheral blood mononuclear cells (PBMCs) from stable subjects (n = 36), cAMR patients (n = 36) and healthy controls (n = 18) were isolated. Flowcytometry was performed for CD19, CD24, and CD38 surface markers. ELISA and quantitative real-time PCR were performed for IL-10 and TGF-β cytokines.

Result: The percentages of immature TRB cells were significantly decrease in cAMR patients (0.98%) versus stable recipients (2.81%) and healthy subjects (4.03%) (P = 0.001 and P < 0.001, respectively). Total lymphocytes, circulating B cells, memory and mature subsets of B cells did not show any significant difference between the groups. TGF-β mRNA was 3-fold upregulated in the cAMR group compared to stable patients (P < 0.001.), but without significant alteration at the protein level. Also, long-term survival renal transplant recipients had a higher protein but not mRNA levels of IL-10 than short-term survival renal transplant recipients.

Conclusion: It seems that immature TRB cell subpopulation might be a crucial regulator of immune system response and plays an important role in determining the transplantation outcome. Furthermore, immunosuppressive IL-10 and TGF-β cytokines might act as a double sword and can exhibit either pathogenic or protective effects against allograft.
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http://dx.doi.org/10.1016/j.intimp.2020.106750DOI Listing
September 2020

Safety and effectiveness of MRE in comparison with CTE in diagnosis of adult Crohn's disease.

Med J Islam Repub Iran 2019 11;33:132. Epub 2019 Dec 11.

Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract that is characterized by recurrent attacks and frequent recovery. The lifelong course of this disease requires frequent assessment of the disease activity. The aim of this study was to compare the effectiveness and safety of computed tomography enterography (CTE) to magnetic resonance enterography (MRE) in adults with CD. A systematic review of the literatures was performed to evaluate the effectiveness and safety of CTE in comparison with MRE. PubMed, Cochrane Library, Scopus, Web of Science, and Embase were searched. Effectiveness outcomes included were sensitivity, specificity, diagnosis difference, diagnostic odds ratio, and positive and negative likelihood. Quality assessment of the studies was conducted using the QADAS score. Meta-analysis was done by RevMan 5.3 for selected outcomes. Five studies had eligibility for analyzing effectiveness. The meta-analysis results showed that diagnosis difference of MRE and CTE, for diagnosing active CD (0.03 CI 95% -0.07-0.13), fistula (-0.01 CI 95% -0.09-0.07), and cramping (-0.02 CI 95% -0.1- 0.06) were not statistically significant. Six studies were finally selected for safety assessment. The results showed that people who are examined with CTE frequently are at increased risk of developing cancer significantly, as they receive more than 50 msv of radiation per year. There was no significant difference between MRE and CTE in diagnosis of Crohn's activity, detection of bowel obstruction, and detection of fistula and stenosis of the alimentary canal. However, the assessment of the safety profile of MRE and CTE showed that MRE is meaningfully safer than CTE for evaluating the recurrence of CD.
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http://dx.doi.org/10.34171/mjiri.33.132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137873PMC
December 2019

Prevalence of Malnutrition Among Elderly People in Iran: Protocol for a Systematic Review and Meta-Analysis.

JMIR Res Protoc 2019 Nov 12;8(11):e15334. Epub 2019 Nov 12.

Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

Background: Malnutrition occurs following a decrease or an imbalance in the absorption of energy, protein, vitamins, and minerals because of numerous factors. Thus, it has serious and life-threatening consequences. To plan for this issue, we need information on the burden of this problem.

Objective: The aim of this study is to determine the prevalence of malnutrition among elderly people in Iran.

Methods: For the purpose of this study, papers, including original articles, theses, and conference proceedings on the prevalence of malnutrition among people aged 60 years and above, and have been published in national and international journals until September 2018 will be included without any language limitation. The following keywords along with their synonyms in Persian will be used in the literature search: malnutrition, elderly, and Iran. At first, the screening process will be conducted based on our inclusion and exclusion criteria. Then, the full text of the remaining articles will be read carefully, and eligible articles will be selected according to the objectives of the study. Next, the methodological quality of the selected papers will be reviewed, and the required information will be extracted from those with acceptable quality. Finally, a meta-analysis will be performed using the Stata software (version 14) when optimum criteria are met. It should be noted that all stages of screening, selection, quality assessment of primary studies, and data extraction will be performed by two reviewers independently.

Results: This review is ongoing and will be completed at the end of 2019.

Conclusions: This review aims to provide comprehensive evidence about the prevalence of malnutrition among elderly people in Iran. This can help Iranian health managers and policy makers make informed decisions for preventing malnutrition and promoting the health status of elderly people.

Trial Registration: PROSPERO CRD42018115358; https://tinyurl.com/y28su47m.

International Registered Report Identifier (irrid): DERR1-10.2196/15334.
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http://dx.doi.org/10.2196/15334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880236PMC
November 2019

Pharmacological prophylaxis versus pancreatic duct stenting plus pharmacological prophylaxis for prevention of post-ERCP pancreatitis in high risk patients: a randomized trial.

Endoscopy 2019 10 27;51(10):915-921. Epub 2019 Aug 27.

Liver and Pancreaticobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this noninferiority study was to evaluate the effectiveness of pancreatic duct (PD) stenting plus pharmacological prophylaxis vs. pharmacological prophylaxis alone in the prevention of post-ERCP pancreatitis (PEP) in high risk patients.

Methods: In this randomized, controlled, double-blind, noninferiority trial, patients at high risk of developing PEP were randomly allocated to pharmacological prophylaxis (rectal indomethacin, sublingual isosorbide dinitrate, and intravenous hydration with Ringer's lactate) plus PD stenting (group A) or pharmacological prophylaxis alone (group B). The rate and severity of PEP, serum amylase levels, and length of hospital stay after ERCP were assessed.

Results: During 21 months, a total of 414 patients (mean age 55.5 ± 17.0 years; 60.2 % female) were enrolled (207 in each group). PEP occurred in 59 patients (14.3 %, 95 % confidence interval [CI] 11.1 % - 17.9 %: 26 patients [12.6 %, 95 %CI 8.6 % - 17.6 %] in group A and 33 [15.9 %, 95 %CI 11.4 % - 21.4 %] in group B). There was no significant difference between the two groups in PEP severity ( = 0.59), amylase levels after 2 hours ( = 0.31) or 24 hours ( = 0.08), and length of hospital stay ( = 0.07).

Conclusions: The study failed to demonstrate noninferiority or inferiority of pharmacological prophylaxis alone compared with PD stenting plus pharmacological prophylaxis in the prevention of PEP in high risk patients.
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http://dx.doi.org/10.1055/a-0977-3119DOI Listing
October 2019

Effect of probiotic and synbiotic supplementation on inflammatory markers in health and disease status: A systematic review and meta-analysis of clinical trials.

Clin Nutr 2020 03 17;39(3):789-819. Epub 2019 Apr 17.

Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

The current systematic review and meta-analysis investigated the effect of probiotic/synbiotic on a wide range of inflammatory and anti-inflammatory markers in healthy and various disease conditions. PubMed, SCOPUS and Web of Science databases were searched. All clinical trials which investigated the effect of oral administration of probiotic or synbiotic on inflammatory markers (C-reactive protein (CRP), interleukin (IL) 1β, IL-4, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor (TNF) α, interferon (IFN) γ and transforming growth factor (TGF) β) for more than one week with concurrent control groups were included. One-hundred sixty seven publications was analysed. Results were as follows: CRP decreased in healthy, metabolic disorders, inflammatory bowel disease (IBD), arthritis and critically ill condition but not in renal failure. IL-1B: no change in healthy subjects and arthritis. TNF-α: decreased in healthy, fatty liver, IBD and hepatic cirrhosis, no change in diabetes, metabolic syndrome (MS) + PCOS (polycystic ovary syndrome) and arthritis. IL-6: no change in healthy, metabolic disorders and arthritis, increased in cirrhosis and renal failure, decreased in PCOS + MS. IL-10: no change in healthy, IBD and metabolic disorders, increased in arthritis. IL-4, IL-8, IL-12, IFN-g and TGF-b: no change in healthy subjects. In conclusion, probiotic/synbiotic decreased some of the inflammatory markers. The intervention was most effective in CRP and TNF-α reduction in healthy or disease state. Moreover, the intervention decreased inflammation most effectively in the following disease conditions, respectively: IBD, arthritis, fatty liver. PROSPERO REGISTRATION NUMBER: CRD42018088688.
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http://dx.doi.org/10.1016/j.clnu.2019.04.004DOI Listing
March 2020

The Effect of Vitamin D Supplements on Clinical and Para-Clinical Outcomes in Patients With Multiple Sclerosis: Protocol for a Systematic Review.

JMIR Res Protoc 2019 Apr 22;8(4):e12045. Epub 2019 Apr 22.

Bristol-Myers Squibb, Uxbridge, United Kingdom.

Background: Multiple sclerosis (MS) is an inflammatory disease, which has a wide range of effects on patients. There are controversies regarding the role of vitamin D in clinical and laboratory improvements in MS patients.

Objective: The aim of this systematic review protocol is to evaluate the efficacy of vitamin D supplements on relapse rate, gadolinium-enhancing lesions of magnetic resonance imaging (MRI), and cytokine profiles.

Methods: We will search PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, ProQuest, American College of Physicians Journal Club database, Health Technology Assessment Database (The Cochrane Collaboration), and National Health System Economic Evaluation Database (The Cochrane Collaboration) and gray literature including reference of included studies and conference abstracts. Clinical trials reporting the effect of any doses of vitamin D on relapse rate, gadolinium-enhancing lesions of MRI, and cytokine profiles will be included. In total, 2 independent researchers will independently assess the studies, extract data, and evaluate the quality of primary studies.

Results: This systematic review was started in September 2017 and the process is continuing. The included articles are evaluated and researchers are going to extract the data.

Conclusions: To our knowledge, this will be the first comprehensive systematic review aiming to assess the effect of vitamin D supplements on clinical and para-clinical outcomes in patients with multiple sclerosis.

International Registered Report Identifier (irrid): DERR1-10.2196/12045.
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http://dx.doi.org/10.2196/12045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658286PMC
April 2019

Defining loneliness in older adults: protocol for a systematic review.

Syst Rev 2019 01 17;8(1):26. Epub 2019 Jan 17.

Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.

Background: Socialization is an important part of the healthy aging process, but natural changes in the lifestyle and health of older people increased risk of loneliness. However, loneliness is not well defined and might differ in different cultures and settings. The main objective of this systematic review is to summarize literature on the topic and propose a definition that might help aging research and practice in the future.

Methods: Eight databases including PubMed, Scopus, CINAHL, Web of Science, EMBASE, PsycINFO, Proquest, and Age Line bibliographic will be run individually to retrieve relevant literature on loneliness among elderly population using subject headings and appropriate MeSH terms. Inclusion and exclusion criteria will be developed and refined by the research team. Two reviewers will participate in each search stage including abstract/title and full text screening, data extraction, and appraisal. We will restrict our search to articles published in the English language biomedical journal between 2000 and 2017. The protocol adheres to the standards recommended by the PRISMA-P.

Discussion: The results of this systematic review can present a more accurate definition of loneliness for researchers who aim at conducting new primary and secondary studies on this subject.

Systematic Review Registration: CRD42017058729.
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http://dx.doi.org/10.1186/s13643-018-0935-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335854PMC
January 2019

Quadriceps architecture in individuals with patellofemoral pain: a systematic review protocol.

JBI Database System Rev Implement Rep 2019 07;17(7):1277-1282

Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

Objective: The objective of this review is to identify differences in quadriceps architectural parameters between healthy individuals and those with patellofemoral pain (PFP).

Introduction: Patellofemoral pain is one of the most common causes of knee pain among physically active populations. Muscular imbalance may play an important role in patellar malalignment or patellar maltracking. A systematic review will clarify the possible architectural changes of quadriceps muscles in persons with PFP.

Inclusion Criteria: Eligible observational studies will include individuals younger than 50 years who have been diagnosed with unilateral or bilateral PFP. The comparator will be the contralateral, asymptomatic limb of the individual with PFP or a healthy matched subject. Studies that include measurement of quadriceps muscle size as the primary outcome will be considered. Studies in which participants had coexisting pathology, a history of lower limb surgery or injury, or pain originating from other joints will be excluded.

Methods: PubMed/MEDLINE (NLM), Scopus, Embase, Physiotherapy Evidence Database, Web of Science and CINAHL databases and multiple gray literature sources will be searched. Studies published since 1 January 1990 will be considered; there will be no language restriction. Retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. If possible, meta-analyses will be performed, and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented.
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http://dx.doi.org/10.11124/JBISRIR-2017-003689DOI Listing
July 2019

Self-Monitoring by Traffic Light Color Coding Versus Usual Care on Outcomes of Patients With Heart Failure Reduced Ejection Fraction: Protocol for a Randomized Controlled Trial.

JMIR Res Protoc 2018 Nov 14;7(11):e184. Epub 2018 Nov 14.

Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Islamic Republic Of Iran.

Background: Patients with heart failure (HF) reduced ejection fraction (HFrEF) have symptoms that are more severe and experience a higher rate of hospitalization compared with HF preserved ejection fraction (HFpEF) patients. However, symptom recognition cannot be made by patients based on current approaches. This problem is a barrier to effective self-care that needs to be improved by new self-monitoring instruments and strategies.

Objective: This study describes a protocol for the self-monitoring daily diaries of weight and shortness of breath (SOB) based on the traffic light system (TLS). The primary objective is to compare the self-care between the intervention and control group. Comparison of HF knowledge, HF quality of life (HFQOL), and all-cause hospitalization between the 2 groups are the secondary objectives.

Methods: A single-blind randomized controlled trial is being conducted at the HF clinic at Tehran Heart Center (Tehran, Iran). Sixty-eight adult patients of both genders will be enrolled during admission to HF clinic. Eligible subjects will be assigned to either the intervention or control group by a block balanced randomization method. Baseline surveys will be conducted before random allocation. Participants in the intervention group will receive an integrated package consisting of (1) HF self-care education by an Australian Heart Foundation booklet on HF, (2) regular home self-monitoring of weight and SOB, and (3) scheduled call follow-ups for 3 months. Patients in the control group will receive no intervention and they only complete monthly surveys.

Results: This study is ongoing and is expected to be completed by the end of 2018.

Conclusions: This is the first trial with new self-monitoring instruments in Iran as a low and middle-income country. If the findings show a positive effect, the package will be applied in different regions with the same health care status.

Trial Registration: Iranian Registry of Clinical Trials IRCT2017021032476N1; https://en.irct.ir/trial/25296?revision=25296 (Archived by WebCite at http://www.webcitation.org/73DLICQL8).

International Registered Report Identifier (irrid): PRR1-10.2196/9209.
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http://dx.doi.org/10.2196/resprot.9209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262204PMC
November 2018

Prediction of postnatal abnormal coiling of the umbilical cord in gestational diabetes mellitus: a diagnostic accuracy study.

J Matern Fetal Neonatal Med 2020 Apr 19;33(7):1107-1113. Epub 2018 Sep 19.

Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran.

To investigate whether evaluations of antenatal umbilical coiling index (aUCI) could predict postnatal umbilical coiling index (UCI) (pUCI) in people with gestational diabetes mellitus (GDM) compared with normal pregnancy independent of maternal demographic and reproductive characteristics. In this prospective study, 105 women with normal pregnancy, and 117 women with pregnancy complicated by GDM were recruited. Ultrasound scan of umbilical cord was performed at 18-23 and 37-41 weeks of gestation (WG). Evaluation of pUCI, as the reference standard, was performed within 24 hours after delivery. There was no significant relationship between aUCI and maternal demographic and reproductive characteristics. The mean for pUCI was 0.21 ± 0.12 in the GDM group, and 0.21 ± 0.09 in the normal pregnancy ( = .61). In the GDM group, a significant association was found between aUCI and pUCI categories ( = .004). The area under curve (AUC) was less than 0.5 for hypocoiling in both groups. For hypercoiling it was 0.84 ± 0.04 in the GDM group and 0.75 ± 0.06 in the normal pregnancy group (18-23 WG). In the GDM group the cutoff points that predict hypercoiling were 0.28 (18-23WG), and 0.21 (37-41WG). These were 0.35 (18-23WG), and 0.33 (37-41WG) in the normal pregnancy group. Diagnostic accuracy analysis revealed that in the GDM group, the sensitivity and specificity of hypercoiling for prediction of pUCI were 0.94 and 0.70 respectively at 18-23 WG. Antenatal hypercoiling at the second trimester of pregnancy strongly predict postnatal hypercoiling in pregnancies complicated by GDM.
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http://dx.doi.org/10.1080/14767058.2018.1514596DOI Listing
April 2020

Physical activity equivalent labeling vs. calorie labeling: a systematic review and meta-analysis.

Int J Behav Nutr Phys Act 2018 09 14;15(1):88. Epub 2018 Sep 14.

MD, MPH, Professor and Chair, Department of Community and Family Medicine, Duke University, Durham, NC, USA.

Background: Many countries are trying to identify strategies to control obesity. Nutrition labeling is a policy that could lead to healthy food choices by providing information to consumers. Calorie labeling, for example, could lead to consumers choosing lower calorie foods. However, its effectiveness has been limited. Recently, physical activity equivalent labeling (i.e., displaying calories in terms of estimated amount of physical activity to burn calories) has been proposed as an alternative to the calorie-only label. The aim of this review was to identify and evaluate the published literature comparing effects on health behavior between physical activity equivalent labeling and calorie-only labeling.

Method: We searched the following databases: Pubmed/medline, Scopus, Web of science, Agris, Cochrane library, Google Scholar. We also searched along with reference lists of included articles. Articles that were published between 1 January 2000 and 31 October 2016 were eligible for inclusion provided they reported on studies that examined the effects of both types of labeling and included at least one outcome of interest. Mean and standard deviations of the included results were combined using a fixed-effect model. The difference in calories purchased between people exposed to physical activity labeling and calorie-only labeling was calculated as weighted mean difference by using a fixed-effect model.

Result: The difference of calories ordered between physical activity label and calorie label groups was not statistically significant (SMD: -0.03; 95% CI: -0.13, 0.07). The difference of calories ordered between physical activity label and calorie label according to real vs unreal (e.g. web-based) condition was 65 Kcal fewer in real-world settings.

Conclusion: Physical activity calorie equivalent labeling in minutes does not significantly reduce calories ordered compared to calorie-only labeling.
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http://dx.doi.org/10.1186/s12966-018-0720-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137736PMC
September 2018

Antenatal umbilical coiling index in gestational diabetes mellitus and non-gestational diabetes pregnancy.

Taiwan J Obstet Gynecol 2018 Aug;57(4):487-492

Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, 15937-16615 Iran. Electronic address:

Objective: Umbilical cord abnormalities increase fetal morbidity and mortality. This study was designed to compare antenatal umbilical coiling index (aUCI) in gestational diabetes mellitus (GDM) and non-gestational diabetes mellitus (non-GDM) pregnancy, considering uncertainties about the best time to perform antenatal ultrasonography scan.

Materials And Methods: In this prospective study, 246 parturients were included, 123 with GDM and 123 with non-GDM pregnancy. Gestational diabetes was confirmed at 24-28 weeks of gestation (WG) using one-step strategy. An anatomical ultrasound survey of placenta and umbilical cord was performed at 18-23 as well as 37-41 weeks of gestational age.

Results: At 18-23 WG, the frequency distribution (10th, 90th percentiles, mean ± SD) of the aUCI in the GDM and non-GDM groups were (0.13,0.66,0.32 ± 0.19) and (0.18,0.74, 0.4 ± 0.31) respectively. These values were (0.12,0.4, 0.25 ± 0.11) in the GDM group at 37-41 WG and (0.17,0.43, 0.29 ± 0.11) in the non-GDM group. A significant relationship was detected between UCI value and GDM/non-GDM groups at both antenatal evaluations (18-23 WG; P = 0.002, 37-41WG; P < 0.001). A significant association at 18-23 WG was found between GDM/non-GDM groups and aUCI categorization (hypocoiling <10th, normocoiling 10th-90th and hypercoiling >90th) (P = 0.001). However, hypocoiling were significantly more frequent in GDM than non-GDM in both antenatal evaluations (P < 0.001, P = 0.006).

Conclusion: Antenatal UCI in pregnancy complicated by GDM were lower in comparison with non-GDM pregnancy. The most abnormal pattern of coiling in gestational diabetes was hypocoiling in both trimesters. In addition, 18-23 WG is the best time to perform ultrasound scan to detect aUCI and umbilical cord pattern.
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http://dx.doi.org/10.1016/j.tjog.2018.04.033DOI Listing
August 2018

Association between low bone mass and the serum RANKL and OPG in patients with nephrolithiasis.

BMC Nephrol 2018 07 11;19(1):172. Epub 2018 Jul 11.

Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Nephrolithiasis is a risk factor for Osteopenia and osteoporosis. Receptor activator of nuclear factor kappaB ligand (RANKL) and osteoprotegerin (OPG) regulate bone remodeling and osteoclastogenesis. This study aimed to evaluate the relation between serum OPG, RANKL concentration, and bone mineral density (BMD) in patients with kidney stone disease.

Methods: Forty-four nephrolithiasis patients with either low bone mass or normal BMD (considered control group) were enrolled in this study. BMD was measured at lumbar spine (L1-L4) and femoral neck by dual-energy X-ray absorptiometry (DEXA). The serum OPG and RANKL were determined using the ELISA method.

Results: The median levels of serum OPG were significantly higher in nephrolithiasis patients with low bone mass compared to the nephrolithiasis patients with normal BMD (3.9 pmol/l versus 3.1 pmol/l; P = 0.03), respectively. Negative correlation was detected between bone densities of femoral neck and OPG in patients with nephrolithiasis (r = -.0344, P = 0.02).

Conclusion: The present study showed that high serum fasting OPG levels may be indicative of femoral neck BMD in patients with nephrolithiasis.
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http://dx.doi.org/10.1186/s12882-018-0960-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042206PMC
July 2018

Efficacy of whole-cell pneumococcal vaccine in mice: A systematic review and meta-analysis.

Microb Pathog 2018 Sep 14;122:122-129. Epub 2018 Jun 14.

Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pediatric Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Despite the fact that pneumococcal conjugate vaccines (PCVs) have significantly reduced the rate of invasive pneumococcal diseases through the use of vaccine serotypes, infection with Streptococcus pneumoniae remains a major public health hazard. Serotype-independent vaccines that are economically viable species of common protein antigens such as whole-cell vaccines (WCVs) are needed. Considering the ongoing debate about the effectiveness of WCVs, a systematic literature review and meta-analysis was carried out to determine the efficacy of WCVs against colonization in mice.

Material And Methods: A systematic review was undertaken of published studies on the protection (colonized/uncolonized) of whole cell pneumococcal vaccine in mice. The search terms used were "whole cell vaccine" and "Streptococcus pneumoniae" in PubMed, Google Scholar, Embase, Web of Science and Scopus engines. Data was extracted from original publications and a meta-analysis was performed on studies divided into sub-groups by the number of inoculations, type of sample, type of adjuvant, time of sampling, design of study and quality of study.

Results: Ten eligible articles published from 2000 to 2016 were included in this review. The meta-analysis was performed on eight out of 10 studies and demonstrated that the estimated pooled risk ratios (RRs) for comparison of colonization between the vaccinated and unvaccinated mice for outcomes 1 and 2 were 0.18 and 0.24, respectively. Lower RRs were observed in sub-groups that were inoculated with vaccines three times, those using cholera toxin (CT) adjuvants and those obtained as tracheal specimens from the mice.

Conclusions: The best protocol for use of a WCV is its application with CT adjuvant administered intranasally in three inoculations at doses of 10⁸ CFU. Further studies performed under similar conditions to obtain accurate results on the effectiveness of this vaccine are recommended.
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http://dx.doi.org/10.1016/j.micpath.2018.06.026DOI Listing
September 2018

Appendicular Skeletal Muscle Mass Reference Values and the Peak Muscle Mass to Identify Sarcopenia among Iranian Healthy Population.

Int J Prev Med 2018 9;9:25. Epub 2018 Mar 9.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Sacopenia is a common problem in elderly with the adverse outcomes. The objective of this study was to estimate the peak appendicular skeletal muscle mass (ASM) and age of its attainment by sex among the Iranian population.

Methods: A total of 691 men and women aged 18-94 years participated in this cross-sectional, population-based study in Bushehr, Iran. ASM was measured by dual X-ray absorptiometry. Cutoff points for men and women were established considering two standard deviations (SDs) below the mean values of the skeletal muscle index (SMI) for young reference groups. The relationship between ASM and age was described by the second-degree regression models. Two SDs below the mean SMIs of reference groups were as cutoff values of low muscle mass in Iranian population.

Results: The peak ASM values were 21.35 ± 0.12 Kg and 13.68 ± 0.10 Kg, and the age at peak ASM were 26 (24-28) years and 34 (33-35) years for men and women, respectively. Mean and SD of SMI in those ages were 7.01 ± 0.02 Kg/m and 5.44 ± 0.02 Kg/m among men and women, respectively. Calculated cutoff values of low muscle mass among the Iranian population were 7.0 Kg/m and 5.4 Kg/m among men and women, respectively.

Conclusions: Iranian reference values of SMI for both genders were similar to Asia Working Group for Sarcopenia recommendation and lower than the United States and European values. Further studies from different nations and the Middle East countries are needed to obtain reference values for populations, enabling the researchers for comparison and also more valid reports on sarcopenia prevalence.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_295_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869961PMC
March 2018

Effect of spinal orthoses and postural taping on balance, gait and quality of life in older people with thoracic hyperkyphosis: protocol for a systematic review and meta-analysis.

BMJ Open 2018 01 31;8(1):e015813. Epub 2018 Jan 31.

Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Thoracic hyperkyphosis is one of the most common spinal disorders in older people, creating impairment, postural instability, gait disorders and a reduced quality of life. The use of spinal orthoses and/or postural taping may be feasible conservative interventions, but their efficacy is uncertain. The aim of this review is therefore to investigate the effectiveness of spinal orthoses and taping on the balance and gait of older people with hyperkyphosis.

Methods And Analysis: We will include randomised controlled trials and clinical trial studies which assess the efficacy of spinal orthoses and taping using the WHO International Classification of Functioning, Disability and Health (ICF) outcome measures in older people with hyperkyphosis of the thoracic spine. A search will be performed in PubMed, SCOPUS, ISI Web of Knowledge, CENTRAL, EMBASE, CINAHL, AMED, PEDro, REHAB DATA and RECAL databases with no restriction of language. Two independent reviewers will perform the study selection and data extraction. Quality assessment will be implemented using modified Down and Black checklists. Publication bias and data synthesis will be assessed by funnel plots, Begg's and Egger's tests, and plots using STATA software V.12.1 version.

Ethics And Dissemination: No ethical issues are predicted. These findings will be published in a peer reviewed journal and presented at national and international conferences.

Prospero Registration Number: CRD42016045880.
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http://dx.doi.org/10.1136/bmjopen-2016-015813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5829855PMC
January 2018

Safety and efficacy of hematopoietic and mesanchymal stem cell therapy for treatment of T1DM: a systematic review and meta-analysis protocol.

Syst Rev 2018 01 26;7(1):23. Epub 2018 Jan 26.

Endocrinology and Metabolism Research Institute, Tehran University of Medical Science, Tehran, Iran.

Introduction: Insulin standard treatment of T1DM cannot cure the patients as different chronic complications occurred subsequently. Investigations on a curative treatment in T1DM propose cell replacement or maintenance instead of exogenous insulin therapy, but different dimensions of this novel treatment are not clarified.

Methods And Analysis: We will include all clinical trials which have evaluated the efficacy MSC or HSC transplantation in T1DM treatment; electronically search bibliographic databases, country registration data banks, and gray literatures; and hand-search two key journals, two experts' article, and references of the included articles with no language restriction. Primary outcome is the extent of reduction in insulin requirement and secondary outcomes are safety of MSC and HSC therapy, effect of this therapy on diabetic parameters, effect of the rout of transplantation and origin of the MSC or HSC on efficacy of treatment, studies heterogeneity and potential reasons of it. Heterogeneity and its severity will be calculated with Q Cochrane test, P value, and I index. STATA software version 12 will be used for meta-analysis. PROSPERO Registration number: CRD42016047176.

Ethics And Dissemination: We will publish the systematic review in a peer review journal; as it presents an analysis of published literature, the study does not require ethical approval.

Strengths And Limitations Of This Study: This systematic review and meta-analysis will investigate the efficacy of MSC and HSC transplantation in T1DM treatment with no language restriction. Also we will evaluate gray literatures after hand searching. This protocol is prepared according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Two reviewers will evaluate screened full texts, extract data, and asses risk of bias of eligible primary studies independently. As there is the possibility that we miss some unpublished primary studies due to negative results, we will use funnel plot to detect this and correct it with fill and trim method.
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http://dx.doi.org/10.1186/s13643-017-0662-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787264PMC
January 2018

The Effectiveness of Exercise Therapy on Scapular Position and Motion in Individuals With Scapular Dyskinesis: Systematic Review Protocol.

JMIR Res Protoc 2017 Dec 13;6(12):e240. Epub 2017 Dec 13.

Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic Of Iran.

Background: Scapular dyskinesis is an alteration in normal scapular position and motion. Some researchers believe that altered kinematics of the scapula subsequent to dysfunction or weakness of scapular stabilizing muscles contributes to impingement syndrome. Scapular muscle exercises are included in the rehabilitation of patients with subacromial impingement syndrome and scapular dyskinesis because the muscular system is one of the major contributors of scapular positioning both at rest and during shoulder movement, but there is considerable uncertainty relating to the relative effectiveness of such approaches on changing scapular position and motion.

Objective: The aim of this systematic review protocol is to evaluate the effectiveness of exercise therapy on scapular position and motion in individuals with scapular dyskinesis.

Methods: A systematic review will be conducted using PubMed, Scopus, Web of Science, Elsevier, Ovid, ProQuest, Physiotherapy Evidence Database, and Cochrane Library. The reference lists of articles, other reviews, gray literature, and key journals will be searched for relevant articles. Clinical trials reporting the effect of therapeutic exercises (scapular strengthening exercise, scapular stabilization exercise, scapular muscle stretching) with the aims of changing scapular position and motion in individuals with scapular dyskinesis will be included. Two independent reviewers will select studies, extract data, and assess the quality of primary studies. Any disagreement during the selection of studies will be discussed and decided by the whole team.

Results: This systematic review began in December 2016 and is currently in progress. The findings will be synthesized to determine the effectiveness of recommended therapeutic exercise on scapular position and motion in individuals with scapular dyskinesis.

Conclusions: This is the first systematic review protocol aiming to assess the effectiveness of exercise therapy in individuals with scapular dyskinesis. The systematic review doesn't require ethics approval because all data used will be provided from published documents. The results of this study will be published in a peer-reviewed journal.

Trial Registration: PROSPERO CRD42017053923; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=53923 (Archived by WebCite at http://www.webcitation.org/6uzq32T02).
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http://dx.doi.org/10.2196/resprot.8011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745349PMC
December 2017

Interventions for Prevention of Intimate Partner Violence Against Women in Humanitarian Settings: A Protocol for a Systematic Review.

PLoS Curr 2017 Jul 12;9. Epub 2017 Jul 12.

Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Humanitarian emergencies and the number of people who are adversely affected are increasing. In such emergencies, the vulnerability of women and girls to gender-based violence increases signifi-cantly and they often experience high levels of intimate partner violence (IPV). There are a limited number of interventions to reduce gender-based violence (GBV) and IPV in the contexts of humanitarian emergencies, and there is uncertainty about the effectiveness of these preventive interventions. This is the protocol for a systematic review that will synthesize the evidence on interventions for primary or secondary prevention of IPV in humanitarian settings, and assess the effect of existing types of IPV-related interventions in these settings.

Methods And Design: The PRISMA-P 2015 statement has been used to prepare this report. Studies published from January 2000 to January 2017 will be reviewed with no language limits. Any experimental, quasi-experimental, or controlled trials will be included. A combination of four key concepts, including "IPV" AND "population" AND "humanitarian setting" AND "intervention" will be used in the search and a variety of information sources will be used: (1) bibliographic databases; (2) special databases and grey literature; (3) and the reference lists of eligible studies. Two reviewers will independently screen articles, extract relevant data and assess study quality. Discrepancies will be resolved through consensus. Risk of bias will be assessed using the Cochrane Risk of Bias tool and the quality of evidence will be assessed using the CONSORT checklist. A narrative synthesis will be provided. If a sufficient number of studies are found, their results will be pooled using a random-effects meta-analysis. For dichotomous outcomes, summaries of intervention effects for each study will be provided by calculating risk ratios with 95% confidence interval. Standardized mean differences will be used for continuous outcomes.

Discussion: The review will be useful for IPV management policy and related planning. It will help researchers, policymakers and guideline developers with an interest in reducing violence against women among refugees, internally displaced persons (IDPs), and conflict-affected population.
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http://dx.doi.org/10.1371/currents.dis.f41d45fbdca13babe4ae5be0f9732e75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553713PMC
July 2017

Ambient temperature and cardiovascular mortality: a systematic review and meta-analysis.

PeerJ 2017 4;5:e3574. Epub 2017 Aug 4.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Our study aims at identifying and quantifying the relationship between the cold and heat exposure and the risk of cardiovascular mortality through a systematic review and meta-analysis.

Material And Methods: A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Peer-reviewed studies about the temperature and cardiovascular mortality were retrieved in the MEDLINE, Web of Science, and Scopus databases from January 2000 up to the end of 2015. The pooled effect sizes of short-term effect were calculated for the heat exposure and cold exposure separately. Also, we assessed the dose-response relationship of temperature-cardiovascular mortality by a change in units of latitudes, longitude, lag days and annual mean temperature by meta-regression.

Result: After screening the titles, abstracts and full texts, a total of 26 articles were included in the meta-analysis. The risk of cardiovascular mortality increased by 5% (RR, 1.055; 95% CI [1.050-1.060]) for the cold exposure and 1.3% (RR, 1.013; 95% CI [1.011-1.015]) for the heat exposure. The short-term effects of cold and heat exposure on the risk of cardiovascular mortality in males were 3.8% (RR, 1.038; 95% CI [1.034-1.043]) and 1.1%( RR, 1.011; 95% CI [1.009-1.013]) respectively. Moreover, the effects of cold and heat exposure on risk of cardiovascular mortality in females were 4.1% (RR, 1.041; 95% CI [1.037-1.045]) and 1.4% (RR, 1.014; 95% CI [1.011-1.017]) respectively. In the elderly, it was at an 8.1% increase and a 6% increase in the heat and cold exposure, respectively. The greatest risk of cardiovascular mortality in cold temperature was in the 14 lag days (RR, 1.09; 95% CI [1.07-1.010]) and in hot temperatures in the seven lag days (RR, 1.14; 95% CI [1.09-1.17]). The significant dose-response relationship of latitude and longitude in cold exposure with cardiovascular mortality was found. The results showed that the risk of cardiovascular mortality increased with each degree increased significantly in latitude and longitude in cold exposure (0.2%, 95% CI [0.006-0.035]) and (0.07%, 95% CI [0.0003-0.014]) respectively. The risk of cardiovascular mortality increased with each degree increase in latitude in heat exposure (0.07%, 95% CI [0.0008-0.124]).

Conclusion: Our findings indicate that the increase and decrease in ambient temperature had a relationship with the cardiovascular mortality. To prevent the temperature- related mortality, persons with cardiovascular disease and the elderly should be targeted. The review has been registered with PROSPERO (registration number CRD42016037673).
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http://dx.doi.org/10.7717/peerj.3574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546177PMC
August 2017

Release behavior and signaling effect of vitamin D3 in layered double hydroxides-hydroxyapatite/gelatin bone tissue engineering scaffold: An in vitro evaluation.

Colloids Surf B Biointerfaces 2017 Oct 3;158:697-708. Epub 2017 Jul 3.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Incorporating the controlled release of vitamin D3 (VD3) into biodegradable porous scaffolds is a new approach to equipping multifunctional therapeutics for osteoporosis. The current investigation involves the encapsulation of VD3 into gelatin through the one-step desolvation method. The layered double hydroxides-hydroxyapatite nanocomposite (LDH-HAp) and pure LDH were combined with the gelatin-VD3 complex to reinforce the porous biodegradable structure and enhance the biological response. Afterwards, glutaraldehyde was used to form crosslinks within the gelatin chains. The encapsulation efficiency and loading capacity showed approximately 40% and 50% reduction after crosslinking, respectively. The particle size, zeta potential, contact angle, Young's modulus and porosity were measured to find the effect of VD3 on the scaffolds' physiochemical properties. To explore the bioactivity and degradation behavior, the scaffolds were immersed in simulated body fluid. The VD3 release kinetics followed the Korsmeyer-Peppas model and non-Fickian release pattern. The greater osteblastic expression was observed in VD3-containing scaffolds due to the higher alkaline phosphatase activity which was excited more by HAp (P<0.05). Alizarin red staining illustrated that VD3 induced more calcium deposition, which indicates the signaling role of VD3 on osteoconductivity and biomineralization. The findings provide new insights on the VD3 encapsulation within hydrophilic matrices to protect VD3 and enable the signaling ability for bone tissue engineering scaffolds, which could improve the bone healing efficiency.
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http://dx.doi.org/10.1016/j.colsurfb.2017.07.004DOI Listing
October 2017

Novel layered double hydroxides-hydroxyapatite/gelatin bone tissue engineering scaffolds: Fabrication, characterization, and in vivo study.

Mater Sci Eng C Mater Biol Appl 2017 Jul 18;76:701-714. Epub 2017 Mar 18.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Developing porous biodegradable scaffolds through simple methods is one of the main approaches of bone tissue engineering (BTE). In this work, a novel BTE composite containing layered double hydroxides (LDH), hydroxyapatite (HA) and gelatin (GEL) was fabricated using co-precipitation and solvent-casting methods. Physiochemical characterizations showed that the chemical composition and microstructure of the scaffolds were similar to the natural spongy bone. Interconnected macropores ranging over 100 to 600μm were observed for both scaffolds while the porosity of 90±0.12% and 92.11±0.15%, as well as, Young's modulus of 19.8±0.41 and 12.5±0.35GPa were reported for LDH/GEL and LDH-HA/GEL scaffolds, respectively. The scaffolds were degraded in deionized water after a month. The SEM images revealed that between two scaffolds, the LDH-HA/GEL with needle-like secondary HA crystals showed better bioactivity. According to the alkaline phosphatase activity and Alizarin red staining results, LDH-HA/GEL scaffolds demonstrated better bone-specific activities comparing to LDH/Gel scaffold as well as control sample (P<0.05). The rabbit adipose stem cells (ASCs) were extracted and cultured, then seeded on the LDH-HA/GEL scaffolds after confluence. Three groups of six adult rabbits were prepared: the scaffold+ASCs group, the empty scaffold group and the control group. The critical defects were made on the left radius and the scaffolds with or without ASCs were implanted there while the control group was left without any treatment. All animals were sacrificed after 12weeks. Histomorphometric results showed that the regeneration of defects was accelerated by scaffold implantation but ASC-seeding significantly improved the quality of new bone formation (P<0.05). The results confirmed the good performance of LDH-HA/GEL scaffold to induce bone regeneration.
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http://dx.doi.org/10.1016/j.msec.2017.02.172DOI Listing
July 2017

Predictive value of miR-210 as a novel biomarker for pre-eclampsia: a systematic review protocol.

BMJ Open 2016 Sep 28;6(9):e011920. Epub 2016 Sep 28.

Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Pre-eclampsia (PE) is a serious condition affecting 3-5% of all pregnancies worldwide. However, underlying molecular pathogenesis of this disease has largely remained unknown. Recently, several studies have indicated the possibility role of microRNAs, especially miR-210, in the aetiology of PE. The aim of this systematic review is to assess the possible role of miR-210 as a novel biomarker for the prediction of PE.

Methods And Analysis: Using a combination of mesh terms 'preeclampsia', 'microRNA' and their equivalents, an electronic search will be performed for all observational studies (cross sectional, case-control and cohort) in PubMed, Web of Science, Scopus, Embase, Cochrane, LILACS and OvidSP MEDLINE from January 2005 to December 2015. Furthermore, other sources are searched, including grey literature, reference lists of relevant primary studies as well as key journals. Study selection, data extraction and quality assessment of studies will be performed independently by 2 reviewers, and any disagreement will be resolved by consensus. If sufficient data are available, it will be combined by either fixed or random effects models. We will investigate the source)s(and degree of heterogeneity using 'Heterogeneity χ' and I. Heterogeneity would be investigated through either subgroup analysis or metaregression. Stata V.11.1 will be used for data analysis.

Ethics And Dissemination: The results of this study are disseminated in peer-reviewed journal articles and academic presentations. Formal ethical approval is not required, since the secondary data will be collected.

Trial Registration Number: CRD42015032345.
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http://dx.doi.org/10.1136/bmjopen-2016-011920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051509PMC
September 2016

Motor control exercise for symptomatic lumbar disc herniation: protocol for a systematic review and meta-analysis.

BMJ Open 2016 Sep 27;6(9):e012426. Epub 2016 Sep 27.

Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences and Health Services, Tehran, Iran.

Introduction: Lumbar disc herniation (LDH) is a common condition in adults and can impose a heavy burden on both the individual and society. It is defined as displacement of disc components beyond the intervertebral disc space. Various conservative treatments have been recommended for the treatment of LDH and physical therapy plays a major role in the management of patients. Therapeutic exercise is effective for relieving pain and improving function in individuals with symptomatic LDH. The aim of this systematic review is to evaluate the effectiveness of motor control exercise (MCE) for symptomatic LDH.

Methods And Analysis: We will include all clinical trial studies with a concurrent control group which evaluated the effect of MCEs in patients with symptomatic LDH. We will search PubMed, SCOPUS, PEDro, SPORTDiscus, CINAHL, CENTRAL and EMBASE with no restriction of language. Primary outcomes of this systematic review are pain intensity and functional disability and secondary outcomes are functional tests, muscle thickness, quality of life, return to work, muscle endurance and adverse events. Study selection and data extraction will be performed by two independent reviewers. The assessment of risk of bias will be implemented using the PEDro scale. Publication bias will be assessed by funnel plots, Begg's and Egger's tests. Heterogeneity will be evaluated using the I statistic and the χ test. In addition, subgroup analyses will be conducted for population and the secondary outcomes. All meta-analyses will be performed using Stata V.12 software.

Ethics And Dissemination: No ethical concerns are predicted. The systematic review findings will be published in a peer-reviewed journal and will also be presented at national/international academic and clinical conferences.

Trial Registration Number: CRD42016038166.
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http://dx.doi.org/10.1136/bmjopen-2016-012426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051468PMC
September 2016

Type 2 Diabetes: Model of Factors Associated with Glycemic Control.

Can J Diabetes 2016 Oct 9;40(5):424-430. Epub 2016 Jun 9.

Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

Objectives: The purpose of this study was to evaluate the related factors and their intercorrelated impacts on glycemic control in people with type 2 diabetes mellitus.

Methods: Patients with type 2 diabetes were recruited for this study during their regular clinic visits at a major medical centre in Iran. Glycated hemoglobin (A1C) levels were used as the indicator of glycemic control. Regression analysis was used to determine the relationships between glycemic control and demographics, self-care behaviours, resources and affective variables. Moreover, the associations between diabetes-related distress and measured variables were tested.

Results: Three hundred eighty people with type 2 diabetes completed the study. The mean duration of diabetes was 8.94±6.57 years, and the mean A1C levels were 7.78%±1.7%. Diabetes-related distress was significantly associated with A1C levels, controlling for all other variables (p=0.01). On the other hand, depression (p<0.001), self-management (p<0.001), anxiety (p<0.001) and patient-physician relationship (p=0.023) were significantly associated with diabetes-related distress.

Conclusions: Diabetes-related distress was found to be associated with glycemic control in people with type 2 diabetes, whereas age, depression, anxiety, self-management and family and social support may affect glycemic control indirectly through diabetes-related distress. Thus, it is important to assess and, if appropriate, treat people with diabetes for diabetes-related distress in order to identify and help them overcome barriers to optimal glycemic control.
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http://dx.doi.org/10.1016/j.jcjd.2016.02.014DOI Listing
October 2016

Prevalence of celiac disease among the Iranian population: A systematic review and meta-analysis of observational studies.

Turk J Gastroenterol 2016 Mar;27(2):122-8

Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background/aims: The current systematic review and meta-analysis study assessed the prevalence of celiac disease (CD) in Iran.

Materials And Methods: Electronic databases, including MEDLINE, SCOPUS, Web of Science, Cochrane library Collaboration, and Iranian scientific databases, were searched from 1993 to 2013 for English and Persian articles. The following terms were used, alone or combined, "celiac (MeSH)," "ceoliac," "prevalence (MeSH)," and "Iran*." Heterogeneity was assessed using the I2 statistic with a cut-off value of 50%, and the Chi-square test was used to define a statically significant degree of heterogeneity with a p value of <0.10. The publication bias of literatures was assessed by visual examination of the funnel plot and Begger's funnel plot.

Results: Meta-analysis was conducted on seven publications with 9,720 subjects. Overall, the pooled prevalence of CD among the Iranian population was 0.72% [95% confidence interval (CI): 0.62%-0.98%]. There was no significant heterogeneity among the studies (I2=4%, p=0.396). The pooled prevalence of CD on the basis of IgA-anti tissue transglutaminase (tTGA) and tTGA and duodenal biopsy positivity was 0.83% (95% CI: 0.69%-1.14%) and 0.79% (95% CI: 0.66%-1.09%), respectively. No significant publication bias was observed using the funnel plot and Begger's funnel plot.

Conclusion: CD prevalence among the Iranian population was approximately similar to that of the American and European populations.
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http://dx.doi.org/10.5152/tjg.2015.150191DOI Listing
March 2016

Accuracy of c-KIT in Lung Cancer Prognosis; a Systematic Review Protocol" instead of c-KIT Expression in Lung Cancer Prognostic Evaluation - a Systematic Review Protocol.

Asian Pac J Cancer Prev 2016 ;17(2):863-6

Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran E-mail :

Background: Extensive efforts have been made to investigate c-KIT expression in lung cancer specimens and its correlation with clinical outcomes, but the issue remains unresolved. Thus, this study will be conducted to clarify the prognostic value of c-KIT expression in lung cancer patients.

Materials And Methods: We will search Pubmed, SCOPUS, and ISI web of sciences with no restriction of language. Studies with any design (except case reports or case series) evaluating correlations of c-KIT expression with survival or outcome in patients with lung cancer will be included. The outcome measures will include all types of survival indexes, including overall survival rate and disease free survival using Kaplan-Meier analysis and hazard ratios. Study selection and data extraction will be performed by two independent researchers. Quality assessment (assessment of risk of bias) and data synthesis will be implemented using Stata software version 11.1.

Results: No ethical issues are predicted. These findings will be published in a peer-reviewed journal and presented at national and international conferences.

Conclusions: This systematic review protocol is registered in the PROSPERO International Prospective Register of Systematic Reviews, registration number = CRD42015023391.
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http://dx.doi.org/10.7314/apjcp.2016.17.2.863DOI Listing
January 2017

Diagnostic and prognostic accuracy of miR-21 in renal cell carcinoma: a systematic review protocol.

BMJ Open 2016 Jan 4;6(1):e009667. Epub 2016 Jan 4.

Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran.

Introduction: Renal cell carcinoma (RCC) is the most common neoplasm in adult kidneys. One of the most important unmet medical needs in RCC is a prognostic biomarker to enable identification of patients at high risk of relapse after nephrectomy. New biomarkers can help improve diagnosis and hence the management of patients with renal cancer. Thus, this systematic review aims to clarify the prognostic and diagnostic accuracy of miR-21 in patients with RCC.

Methods And Analysis: We will include observational studies evaluating the diagnostic and prognostic roles of miR-21 in patients with renal cancer. The index test and reference standards should ideally be performed on all patients. We will search PubMed, SCOPUS and ISI Web of Science with no restriction of language. The outcome will be survival measures in adult patients with RCC. Study selection and data extraction will be performed by two independent reviewers. QUADAS-1 will be used to assess study quality. Publication bias and data synthesis will be assessed by funnel plots and Begg's and Egger's tests using Stata software V.11.1.

Ethics And Dissemination: No ethical issues are predicted. These findings will be published in a peer-reviewed journal and presented at national and international conferences.

Trail Registration Number: This systematic review protocol is registered in the PROSPERO International Prospective Register of Systematic Reviews, registration number CRD42015025001.
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http://dx.doi.org/10.1136/bmjopen-2015-009667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716203PMC
January 2016

Diagnostic yield of EUS-guided FNA for malignant biliary stricture: a systematic review and meta-analysis.

Gastrointest Endosc 2016 Feb 28;83(2):290-8.e1. Epub 2015 Sep 28.

Anniston Digestive Health, Anniston, Alabama, USA.

Background And Aims: EUS-guided FNA (EUS-FNA) is increasingly being used for tissue diagnosis of extrahepatic biliary strictures. The aim of this study was to determine the diagnostic yield of EUS-FNA in malignant biliary strictures.

Methods: A comprehensive literature review was carried out by 2 reviewers for studies evaluating the accuracy of EUS-FNA in biliary stricture. A meta-analysis was performed to determine the pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for EUS-FNA of extrahepatic biliary stricture. A Quality Assessment of Diagnostic Accuracy Studies questionnaire was used to assess the quality of the selected studies. Several sensitivity analyses were performed to assess the effect of the quality of the studies on the accuracy of the final results of the meta-analysis.

Results: Twenty studies involving 957 patients met inclusion criteria and were included in the meta-analysis. The pooled sensitivity and specificity of EUS-FNA for diagnosis of malignant biliary stricture were 80% (95% confidence interval [CI], 74%-86%), and 97% (95% CI, 94%-99%), respectively. The pooled positive likelihood ratio was 12.35 (95% CI, 7.37-20.72), and the negative likelihood ratio was 0.26 (95% CI, 0.18-0.38). The pooled diagnostic odds ratio for diagnosing a malignant biliary stricture was 70.53 (95% CI, 38.62-128.82). The area under the receiver-operating characteristic curve was 0.97. Sensitivity analyses showed that the quality of the included studies did not affect the accuracy of the final results of the meta-analysis.

Conclusion: This meta-analysis demonstrates that EUS-FNA is sensitive and highly specific for diagnosing malignancy in biliary strictures. Further studies are needed to compare EUS--FNA with emerging methods including cholangioscopy-guided biopsy and laser endomicroscopy.
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http://dx.doi.org/10.1016/j.gie.2015.09.024DOI Listing
February 2016

Gallstone disease and obesity: a population-based study on abdominal fat distribution and gender differences.

Ann Hepatol 2015 Sep-Oct;14(5):702-9

Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences. Tehran, Iran.

Background: Existing evidence suggests the visceral fat is more metabolically active than subcutaneous fat. We aimed to investigate the value of subcutaneous (SAT) and visceral adipose tissue thickness (VAT) for prediction of gallstone disease (GSD) in general population by focus on gender differences and comparison with body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR).

Material And Methods: In this cross-sectional survey, 1,494 subjects (51.4 % men), aged above 50, randomly selected from Golestan Cohort Study residing in Gonbad City, Iran, underwent anthropometric measurements and abdominal ultrasonography.

Results: Prevalence of GSD was 17.8% (95% CI 15.9-19.8). Following adjustment for age and then other potential risk factors, all obesity indices, except for SAT, were associated with GSD in women with the highest odds ratio observed in WHtR (OR 1.52, 95% CI 1.22-1.89). In contrast, WHR was the only associated index in men (OR 1.49, 95% CI 1.08-2.06). The trend of increasing obesity measures across the quartiles with the risk of GSD was significant in subgroups of WHtR and BMI in women and WHR in men. No significant association was found between SAT and GSD in men or women.

Conclusions: The best anthropometric indicators of the risk of GSD may differ by gender. In men, WHR might be the only preferred index to estimate risk of GSD. WHtR, WHR, VAT and BMI are associated with GSD risk in women, although WHtR might better explain this risk. SAT is the poor indicator for identifying subjects with GSD in both genders.
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May 2016