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BACKGROUND Studies have indicated that branched amino acids play a crucial role in gene expression, protein metabolism, apoptosis, and restoration of hepatocytes and insulin resistance. This study aimed to compare the plasma levels of branched-chain amino acids in patients with esophageal cancer and normal individuals. METHODS Plasma levels of leucine and isoleucine of 37 patients with esophageal cancer and 37 healthy adults were investigated by high-pressure liquid chromatography. Data analysis was performed using SPSS (version 16) software, and t test was used to compare the plasma levels of branched-chain amino acids in the two groups. RESULTS In the patients group, the mean age ± SD was 63 ± 13.64 years, and 21 (56.8%) individuals were male. In the control group, the mean age ± SD was 64.24 ± 13.08 years, and 21 (54.1%) individuals were male. Plasma levels of leucine (37.68 ± 105) and isoleucine (22.43 ± 59.1) in patients with esophageal cancer were significantly reduced (p value of isoleucine:0.007, and leucine: 0.0001). CONCLUSION In the present study, the plasma levels of branched-chain amino acids in patients with esophageal cancer had changed. Evidence suggests that branched-chain amino acids are essential nutrients for cancer growth and are used by tumors in various biosynthetic pathways as energy sources. Thus, studies in this field can be useful in providing appropriate therapeutic approaches. [ABSTRACT FROM AUTHOR]

BACKGROUND Achalasia, as an incurable disease is defined by the lack of normal esophageal peristalsis and loss of lower esophageal sphincter relaxation due to impaired myenteric neural plexus. The exact cause of myenteric neural cells degeneration in achalasia is still unknown. One hypothesis is that certain neurotropic viruses and autoimmune factors cause the inflammatory response in myenteric network, which consequently destroy neural cells. This study was designed to find the evidence of viral causes of achalasia. METHODS In this case-control study, 52 patients with achalasia and 50 controls referred to Shariati Hospital, were evaluated for the genome of neurotropic viruses, HPV, and adenovirus by polymerase chain reaction (PCR) and reverse transcription (RT) PCR techniques. RESULTS Genome assessment of neurotropic DNA viruses turned out negative in the patients, however, the genome of HSV-1 (Herpes simplex virus) was found in tissues of six controls. No neurotropic RNA viruses were observed in the tissue samples and whole blood of both the patients and controls. Among non-neurotropic viruses, adenovirus genome was positive in tissues of two out of 52 patients and three out of 50 controls. In addition, one out of 52 patients and two out of 50 controls were positive for HPV infection in tissues. CONCLUSION We could not detect any significant relationship between achalasia and HPV, adenovirus, and neurotropic viruses in the cases. Nevertheless, it does not exclude the hypothesis of either an alternate viral species or resolved viral infection as the etiology of achalasia. [ABSTRACT FROM AUTHOR]

Esophageal squamous cell carcinoma (ESCC) is an aggressive tumor that is typically diagnosed only when the tumor has gained remarkable size, extended to peripheral tissues, and led to dysphagia. Five-year survival of advanced cancer is still very poor (19%), even with improved surgical techniques and adjuvant chemoradiation therapy. Therefore, early detection and prevention are the most important strategies to reduce the burden of ESCC. Our review will focus on the studies conducted in Golestan province, an area with a high prevalence of ESCC in northern Iran. We review three aspects of the research literature on ESCC: epidemiological features, environmental factors (including substance abuse, environmental contaminants, dietary factors, and human papilloma virus [HPV]), and molecular factors (including oncogenes, tumor suppressor genes, cell cycle regulatory proteins, and other relevant biomarkers). Epidemiological and experimental data suggest that some chemicals and lifestyle factors, including polycyclic aromatic hydrocarbons (PAHs), cigarette smoking, opium use, and hot tea drinking are associated with the development of ESCC in Golestan. HPV infects the esophageal epithelium, but so far, no firm evidence of its involvement in esophageal carcinogenesis has been provided. Some of these factors, notably hot tea drinking, may render the esophageal mucosa more susceptible to injury by other carcinogens. There are few studies at molecular level on ESCC in Golestan. Increasing awareness about the known risk factors of ESCC could potentially reduce the burden of ESCC in the region. Further studies on risk factors, identifying high risk populations, and early detection are needed. [ABSTRACT FROM AUTHOR]

BACKGROUND In the Golestan Cohort Study that was launched to investigate the causes of esophageal cancer, a complete biospecimen bank was established for storage of collected blood, urine, hair, and nail samples. The objective of this study was to evaluate the feasibility of nail samples as a biomarker of selected trace elements status. METHODS Thirty toenail samples were selected randomly from the participants of Golestan Cohort Study (GCS). The samples were cleaned and analyzed for selenium, mercury, chromium, iron, zinc, and scandium by instrumental neutron activation analysis at the University of Missouri Research Reactor Center. Pearson correlation coefficients were computed for selected trace elements concentration versus scandium concentration to assess terrestrial contamination. RESULTS The selenium, zinc, and mercury were not correlated with scandium, suggesting they were free from substantial contamination. The high correlations of scandium with iron and chromium suggest that the iron and chromium levels may be compromised by terrestrial contamination. The coefficients of variation for duplicate samples for selenium and zinc were 2.6% and 7.2%, respectively. CONCLUSION The nail samples from Golestan Cohort Study appears to be useable as a biomarker of selenium, zinc, and mercury and could be considered for use in future studies. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with nonalcoholic steatohepatitis or elevated liver enzymes have increased cardiovascular mortality but are often excluded from prevention trials. We investigated the effectiveness of fixed-dose combination therapy in prevention of major cardiovascular events (MCVE) among individuals with and without presumed nonalcoholic steatohepatitis (pNASH). Methods: 2400 Participants over 50 were randomized into intervention and control. Consent was taken post randomization. Participants in the intervention group were given a combination pill containing aspirin, atorvastatin, hydrochlorothiazide, and valsartan (Polypill). Participants were followed for 5 years. pNASH was diagnosed by ultrasonography and elevated liver enzymes. The primary outcome was MCVE. Clinical Trials. gov ID: NCT01245608. Results: 892 participants did not consent or meet enrollment criteria and 1508 entered the study. During 5-years of follow-up, 63/787 (8. 0%) intervention group participants and 86/721 (11. 9%) controls had MCVE (adjusted RR 0. 61, 95%CI 0. 44 to 0. 83). Although the adjusted relative risk of MCVE in participants with pNASH (0. 35, 95%CI 0. 17 to 0. 74) was under half that for participants without pNASH (0. 73, 95%CI 0. 49 to 1. 00), the difference did not reach statistical significance. Outcomes were also evaluated for the pre-consent population. 138/1249 in the intervention group (11. 0%) and 137/1017 controls (13. 5%) had MCVE during the 5-year follow-up (unadjusted RR 0. 83, 95%CI 0. 66-1. 03). Participants with pNASH in the intervention group had a significant decrease in liver enzyme levels after 60 months of follow-up (intragroup -12. 0 IU/L, 95%CI -14. 2 to -9. 6). Conclusion: Fixed-dose combination therapy is safe and effective for prevention of MCVE even among participants with fatty liver and increased liver enzymes. [ABSTRACT FROM AUTHOR]

BACKGROUND Only a few studies in Western countries have investigated the association between gastroesophageal reflux disease (GERD) and mortality at the general population level and they have shown mixed results. This study investigated the association between GERD symptoms and overall and cause-specific mortality in a large prospective population-based study in Golestan Province, Iran. METHODS Baseline data on frequency, onset time, and patient-perceived severity of GERD symptoms were available for 50001 participants in the Golestan Cohort Study (GCS). We identified 3107 deaths (including 1146 circulatory and 470 cancer-related) with an average follow-up of 6.4 years and calculated hazard ratios (HR) and 95% confidence intervals (CI) adjusted for multiple potential confounders. RESULTS Severe daily symptoms (defined as symptoms interfering with daily work or causing nighttime awakenings on a daily bases, reported by 4.3% of participants) were associated with cancer mortality (HR 1.48, 95% CI: 1.04-2.05). This increase was too small to noticeably affect overall mortality. Mortality was not associated with onset time or frequency of GERD and was not increased with mild to moderate symptoms. CONCLUSION We have observed an association with GERD and increased cancer mortality in a small group of individuals that had severe symptoms. Most patients with mild to moderate GERD can be re-assured that their symptoms are not associated with increased mortality. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis B is considered the most prevalent cause of cirrhosis in Iran, and the prevalence of patients with both hepatitis B and non-alcoholic fatty liver disease (NAFLD) is growing as well. The role of NAFLD in liver status of hepatitis B patients has not been well investigated; therefore, present study aims to compare fibrosis status of different combinations of NAFLD and hepatitis B in a large population of Iranians who had previously participated in Golestan Cohort Study (GCS). Methods: In current study, data of two nested studies within GCS were extracted and analyzed. Study population consisted of Iranians aged 50-75 years old residing in Golestan province. Liver status of participants were assessed using transient elastography. Participants were categorized into four groups of “controls”, “only NAFLD”, “only hepatitis B” and “both” (hepatitis B plus NAFLD). The degree of fibrosis and effect of NAFLD in hepatitis B was investigated using multiple logistic regressions. Moreover, the associations of viral load and presence of NAFLD with LSM and ALT were investigated in overall hepatitis cases using Kruskal-wallis. P-value < 0.05 was considered significant. Results: Current study consisted of 2,089 individuals (53.1% male) with mean age of 58.9 years. Median Liver Stiffness Measurement (LSM) score was 4.7 kPa in total population. “NAFLD”, “hepatitis B” and “both” were all associated with significant fibrosis (LSM > 8), and observed association remained significant after controlling the confounders (“NAFLD” adjusted OR = 2.5, “hepatitis B” adjusted OR = 4.9 and “both” adjusted OR = 5.9). Presence of NAFLD or high viral load were not associated with LSM (p-value = 0.118), while being significantly associated with higher levels of ALT (p-value < 0.001). Conclusion: We were able to show that hepatitis B and NAFLD have a synergistic effect in development of advanced fibrosis. Therefore, when faced with concomitant hepatitis B and NAFLD, higher risks of progression into cirrhosis and hepatocellular carcinoma should be anticipated. [ABSTRACT FROM AUTHOR]