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Studies investigating the effects of spirulina on inflammation and oxidative stress status are controversial. Therefore, the current systematic review and meta-analysis aimed to evaluate the impacts of spirulina supplementation on oxidative stress indicators and inflammatory markers. PubMed-Medline, SCOPUS, Web of Science, Embase databases and Google Scholar were searched up to 1 October 2020. Random-effect analysis was applied to perform meta-analysis. Subgroup analyses and multivariate meta-regression were performed to find heterogeneity sources. Quality assessment was conducted using Cochrane Collaboration's tool. A total of 11 studies that enrolled 465 subjects were included in our meta-analysis. Pooled results demonstrated a significant increase in interleukin-2 (IL-2) concentrations [Standardized mean difference (SMD = 2.69 pg/mL; 95% CI: 0.26, 5.11; P = .03)]; however this result changed to insignificant (SMD = 0.54 pg/mL; 95% CI: -1.29, 2.27; P > .05) when sensitivity analysis performed. A marginal decreasing effect were also found on interleukin-6 (IL-6) (SMD = -0.72 mg/dL; 95% CI: -1.50, 0.07; P = .073) and thiobarbituric acid reactive substances (TBARS) levels (SMD = -0.65; 95% CI: -1.37, 0.08; P = .08). In addition, results of subgroup analysis revealed a significant reduction in IL-6 and TBARS concentrations when the baseline body mass index (BMI) of participants was lower than 25 kg/m2 . Moreover, spirulina had no significant effect on tumour necrosis factor-α (TNF-α) (SMD = -0.07 mg/dL; 95% CI: -0.33, 0.18; P = .56) and malondialdehyde (MDA) concentrations (SMD = -0.42; 95% CI: -0.98, 0.14; P = .14). Spirulina consumption contributed to a significant increase in IL-2 concentrations changing to insignificant after sensitivity analysis and marginal decreasing effects on IL-6 and TBARS levels. No considerable impacts were observed on TNF-α and MDA concentrations.

Introduction: In this study, we aimed to assess the relationship of cardiac and hepatic T2* magnetic resonance imaging (MRI) values as a gold standard for detecting iron overload with serum ferritin level, heart function, and liver enzymes as alternative diagnostic methods. Methods: A total 58 patients with beta-thalassemia major who were all transfusion dependent were evaluated for the study. T2* MRI of heart and liver, echocardiography, serum ferritin level, and liver enzymes measurement were performed. The relationship between T2* MRI findings and other assessments were examined. Cardiac and hepatic T2* findings were categorized as normal, mild, moderate, and severe iron overload. Results: 22% and 11% of the patients were suffering from severe iron overload in heart and liver, respectively. The echocardiographic findings were not significantly different among different iron load categories in heart or liver. ALT level was significantly higher in patient with severe iron overload than those with normal iron load in heart (P=0.005). Also, AST level was significantly lower in normal iron load group than mild, moderate, and severe iron load groups in liver (P

Lutein is considered as a major biologically active carotenoid, with potential benefits for obesity and cardiometabolic health. This double-blind, randomised controlled trial aimed to assess whether the consumption of lutein along with a low-calorie diet (LCD) can influence anthropometric indices, body composition and metabolic parameters in obese middle-aged individuals. After a 2-week run-in period with an LCD, forty-eight participants aged 45–65 years were randomly assigned to consume 20 mg/d lutein or placebo along with the LCD for 10 weeks. Dietary intake, anthropometric indices, body composition, lipid profile, glucose homoeostasis parameters, NEFA and appetite sensations were assessed at the beginning and end of the study. After 10 weeks, body weight and waist circumference significantly decreased in both groups, although between-group differences were not significant. There was more of a decrease in the percentage of body fat in the lutein group v. the placebo group. Moreover, the placebo group experienced a significant reduction in fat-free mass (FFM), whereas the lutein group preserved FFM during calorie restriction, although the between-group difference did not reach statistical significance. Visceral fat and serum levels of total cholesterol (TC) and LDL-cholesterol were significantly decreased only in the lutein group, with a statistically significant difference between the two arms only for TC. No significant changes were observed in the TAG, HDL-cholesterol, glucose homoeostasis parameters, NEFA and appetite sensations. Lutein supplementation in combination with an LCD could improve body composition and lipid profile in obese middle-aged individuals.

Background Saffron is a traditional herbal medicine that has been used to treat various ailments such as depressive mood. However, the findings of several meta-analyses regarding anti-depressive properties of saffron (Crocus sativus L.) are controversial. The current umbrella meta-analysis was carried out to determine the magnitude and direction of saffron administration on depression. Methods Relevant studies were searched in international databases including PubMed, Scopus, EMBASE, Web of Science, and Cochrane Central Library up to June 2021. Meta-analysis studies investigating the effects of saffron on depression were considered to include in the study. Random-effects model was used to perform the meta-analysis. Additional analyses including subgroup and sensitivity analyses were carried out. Results Overall, 7 meta-analyses were included in the study. The results demonstrated that the consumption of saffron resulted in a significant reduction in BDI scores (ES: −3.87; 95% CI: −5.27, −2.46). However, saffron did not change the HAMD scores (ES: −2.10; 95% CI: −5.05, 0.86, p = 0.164) and mixed scores (HAM-D/BDI/DASS) (ES: 0.02; 95% CI: −0.39, 0.43,p = 0.941). Conclusion Present umbrella meta-analysis demonstrated that saffron intake might contribute to alleviation of depression disorder, however, it cannot be considered as a single therapeutic approach to treat depression.

Inositol is a sugar-alcohol and recognized as a key component of cell membrane phospholipids. It has crucial role in the cell signaling pathways and contribute to improving glycemic responses. Although some earlier studies have revealed the effect of inositol mediating glucose uptake by improving insulin sensitivity, the benefit of inositol supplementation in patients with overweight and obesity is not completely understood. This study aimed to assess the impact of inositol supplementation on body mass index (BMI) through a systematic review and meta-analysis of controlled clinical trials.A systematic search was performed to August 2021 in the following databases: PubMed-Medline, Embase, Web of Science and Scopus. Fifteen controlled clinical trials investigating the effect of inositol on adult's BMI were finally included in the study. A random-effects model was employed to estimate the effect size. Subgroup analysis was performed by dose, duration, age, type of inositol. Meta-regression was used to investigate presence of any linear relationship. Begg's and Egger's tests were carried out to detect small study effect.The results of pooled analysis showed that inositol supplementation significantly decreased BMI scores (WMD = -0.41 kg/mThe meta-analysis suggests that oral inositol supplementation has positive effect on BMI reduction. Inositol supplementation could be considered as an adjunct treatment to improve body mass index.

Lutein is an essential carotenoid commonly consumed in the diet; however, its dietary intake does not usually reach the minimum recommended intake to decrease the incidence of chronic diseases. Experimental and epidemiological evidence suggests an anti-atherosclerotic effect for lutein-rich foods or lutein supplementation. This systematic review aimed to assess the mechanistic pathways of lutein in the prevention of atherosclerosis. Electronic databases, including PubMed, SCOPUS, ProQuest, Embase, and Google Scholar were searched to May 2019. Original studies published in English-language journals that investigated the effects of lutein on atherosclerosis and related risk factors, including lipid profile, hemodynamic, glycemic and inflammatory measurements, and endothelial function indices, were considered. Two reviewers independently extracted data on study characteristics, methods and outcomes. The review protocol has been registered at PROSPERO database of Systematic Reviews (registration number: CRD42019121381). A total of 5818 articles were found in the first phase of the search; from these, 19 met the inclusion criteria: 3 in vitro, 1 ex vivo, 11 animal, and 4 human studies. Nine of ten studies showed positive effects of lutein on endothelial function by reducing blood pressure, arterial thickness, monocyte migration, and vascular smooth muscle cell migration. Twelve studies examined the anti-inflammatory properties of lutein and found a significant decrease in proinflammatory cytokines. Although few studies investigated the anti-hyperlipidemic effects of lutein, three animal studies and one clinical trial found a beneficial effect of lutein on lipid profile. Evidence supports positive effects of lutein on atherosclerosis development and some common risk factors of atherosclerosis, including inflammation and endothelial dysfunction. Further studies focused on the effects of lutein on hyperglycemia, lipid profile, blood pressure and coagulation are required.

Backgrounds & aims Spexin (SPX) as a novel polypeptide hormone plays a role in carbohydrate & lipid metabolism, energy balance, and calorie intake and it has a potential role in pathology of diabetes mellitus. Current study aimed to investigate the relationship between serum spexin levels and metabolic syndrome components in obese and normal weight people with or without diabetes. Methods Eighty-six men and eighty-two women were recruited in this study as obese and normal weight people with or without diabetes. Insulin, HbA1c, FBS, TG, TC, HDL-C, and LDL-C levels, serum SPX, weight, height, body mass index, waist and hip circumference, as well as blood pressure were measured by standard methods. Results There was a significant inverse relationship between serum levels of SPX and waist circumference (r = −0.37, P = 0.016) and triglyceride (r = −0.34, P = 0.028) in healthy people with normal weight. Moreover, a considerable relationship was observed between levels of SPX and FBS in healthy obese people (r = −0.42, P = 0.006). Conclusions There was an inverse relationship between serum SPX and three components of metabolic syndrome, including FBS levels, waist circumference values, and serum TG concentrations in people without diabetes, highlighting SPX as a potential marker of metabolic syndrome in healthy people without diabetes.

Background N-acetyl cystatin (NAC) potentially can contribute to weight changes due to its antioxidant activities. Aim of the review we carried out a systematic review and meta-analysis of randomized clinical trials in order to examine whether NAC consumption can result in any changes in anthropometric indices. Methods Using appropriate keywords, we searched online databases of PubMed-Medline, SCOPUS, Web of Science, Embase databases and Google Scholar, published for relevant articles up to Nov 2019. Random-effect model was employed to report weighted mean differences. Sensitivity and subgroup analyses were carried out. Results A number of 7 eligible studies were identified. The results indicated no significant effect of NAC on BMI, weight and WC [(SMD=-0.08 Kg/m2 ; CI: -0.25, 0.08; P = 0.335, I2 = 0.0 %, P = 0.967), (SMD= -0.38 Kg; 95 % CI: -2.11, 2.87; P = 0.766, I2 = 0.0 %, P = 0.691) and (SMD= -0.22 Cm; 95 % CI: 0.52, 0.08; p = 0.153, I2 = 0.0 %, P = 0.826), respectively. No effect of sensitivity and subgroup analyses were observed. Conclusion There was no significant effect of NAC supplementation on obesity indices. As far as we assessed anthropometric factors mainly as the secondary outcome in these studies rather than the main outcome, more specific trials are suggested to assess this relationship precisely.

Background Paclitaxel induced peripheral neuropathy (PIPN) is a major debilitating side effect of paclitaxel in patients with breast cancer with no fully known mechanisms. The aim of the study was to find out the possible risk factors for PIPN. Methods Eligible patients with node positive breast cancer undergoing chemotherapy with paclitaxel were assessed. They belonged to an initial randomized controlled trial in which the effectiveness of omega-3 fatty acids in preventing and reducing severity of PIPN was evaluated (protocol ID: NCT01049295). Reduced total neuropathy score (r-TNS) was used for measuring PIPN. All analyses were performed adjusting for intervention effect. The association between age, BMI, BSA, pathological grade, molecular biomarkers and PIPN was evaluated. Results Fifty-seven patients with breast cancer were investigated. Age was significantly associated with risk of PIPN (RR:1.50, P value = .024). Body mass index and BSA had significant association with severity of PIPN (B:1.28, P = .025; and B: 3.88, P = .010 respectively). Also, BSA showed a significant association with the risk of PIPN (RR: 2.28, P = .035; B: 3.88, P = .035). Incidence and severity of PIPN were much more pronounced in progesterone receptor positive (PR+) patients (RR:1.88, P = .015 and B:1.54, P = .012). Multivariate analysis showed that age and the status of PR+ were independent risk factor for incidence and the status of PR+ was the only independent risk factor for severity of PIPN. Conclusion Age, BSA and the status of PR+, should be considered as the risk factors for PIPN before commencement of chemotherapy with paclitaxel in patients with breast cancer. Older patients, those with greater BSA and PR+ patients may need closer follow up and more medical attention due to greater incidence and severity of PIPN.

Introduction: In the northwest of Iran, gastric cancer is the first and third common form of malignancy in men and women, respectively. Homeobox protein CDX2, was proposed as a prognostic biomarker in gastric cancer. Objectives: This study aimed to assess the association of CDX2 expression overall survival as well as clinicopathologic variables in patients with gastric cancer. Materials and Methods: CDX2 expression was examined by the immunohistochemistry method in the formalin-fixed paraffin-embedded surgical specimens of gastric cancer. The association between CDX2 expression and overall survival, stage of the disease, metastasis status, pathology type of the tumor, and serum levels of tumor markers serum levels of tumor markers carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125), cancer antigen 19-9 (CA 19-9) was then evaluated. Results: Ninety-two patients with primary gastric cancer were recruited. CDX2 expression was positive in 72 (78%) of the subjects. Overall survival was not significantly different between two groups of patients (CDX2 positive versus negative). However, the risk of death was 21% lower in CDX2 positive patients, after adjusting for age and gender (P=0.565). Disease stage and metastasis rate were significantly lower in CDX2 positive patients (P=0.027, and P=0.021, respectively). Additionally, 71% of the CDX2 positive subjects had intestinal pathology type of the disease (P=0.025). Accordingly, a significant lower level of CA19-9 was found in CDX2 positive patients as well (P=0.002). Conclusion: There was not any significant association between CDX2 expression and overall survival in patients with gastric cancer, although the risk of death was lower in CDX2 positive subjects. However, there was a less invasive pattern of gastric carcinoma in this group of patients.

Cancer-related malnutrition causes morbidity and reduced survival. The aim of this study was to evaluate the nutritional and inflammatory status of patients with acute leukemia in association with duration of neutropenic fever (DNF) and length of hospital stay (LHS) during induction chemotherapy. Fifty-five patients with acute lymphoblastic leukemia (ALL) (n = 28) and acute myeloid leukemia (AML) (n = 27) completed the study. There were significant differences between the two groups according to LHS and DNF (p = 0.022 and p = 0.012, respectively): both had a longer period in patients with AML. The patients were statistically different according to body mass index (BMI), pre-albumin, high-sensitivity C-reactive protein (hs-CRP) and patient-generated subjective global assessment (PG-SGA) score (p = 0.049, p = 0.028, p < 0.001, p = 0.030). In patients with ALL, serum albumin and pre-albumin levels were associated with LHS and DNF, respectively. Moreover, PG-SGA score was associated with DNF. In patients with AML, BMI and second pre-albumin level < 10 mg/dL were associated with DNF. Pre-albumin was the common indicator for chemotherapy-related complications in patients with both ALL and AML. Early nutritional assessment can help to find patients with acute leukemia who need nutritional support, and it may contribute to better outcome and less toxicity.

Background Malnutrition is common in patients with gastric cancer. Early identification of malnourished patients results in improving quality of life. We aimed to assess the nutritional status of patients with inoperable gastric adenocarcinoma (IGA) and finding a precise malnutrition screening score for these patients before the onset of chemotherapy. Methods Nutritional status was assessed using patient generated subjective global assessment (PG-SGA), visceral proteins, and high-sensitivity C reactive protein. Tumor markers of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA-125) and CA 19-9 and their association with nutritional status were assessed. Then a new score for malnutrition screening was defined. Results Seventy-one patients with IGA completed the study. Malnourished and well-nourished patients (based on PG-SGA) were statistically different regarding albumin, prealbumin and CA-125. The best cut-off value for prealbumin for prediction of malnutrition was determined at 0.20 mg/dl and using known cut-off values for albumin (3.5 g/dl) and CA-125 (35 U/ml), a new score was defined for malnutrition screening named MS-score. According to MS-score, 92% of the patients had malnutrition and it could predict malnutrition with 96.8% sensitivity, 50% specificity and accuracy of 91.4%. Conclusion MS-score has been suggested as an available and easy-to-use tool for malnutrition screening in patients with IGA.

Background.There is a considerable dissimilarity in the survival duration of the patients with gastric cancer. We aimed to assess the systemic inflammatory response (SIR) and nutritional status of these patients before the commencement of chemotherapy to find the appropriate prognostic factors and define a new score for predicting metastasis.Methods.SIR was assessed using Glasgow Prognostic Score (GPS). Then a score was defined as prealbumin/CRP based prognostic score (PCPS) to be compared with GPS for predicting metastasis and nutritional status.Results.71 patients with gastric cancer were recruited in the study. 87% of patients had malnutrition. There was a statistical difference between those with metastatic (n=43) and those with nonmetastatic (n=28) gastric cancer according to levels of prealbumin and CRP; however they were not different regarding patient generated subjective global assessment (PG-SGA) and GPS. The best cut-off value for prealbumin was determined at 0.20 mg/dL and PCPS could predict metastasis with 76.5% sensitivity, 63.6% specificity, and 71.4% accuracy. Metastatic and nonmetastatic gastric cancer patients were different in terms of PCPS (P=0.005).Conclusion.PCPS has been suggested for predicting metastasis in patients with gastric cancer. Future studies with larger sample size have been warranted.

Aim: This study was conducted to investigate the effect of oral vitamin E on mucositis and neutropenia in patients with leukemia. Methods: This was a randomized double-blind placebo controlled clinical trial of 60 patients with leukemia (acute lymphoblastic, acute myelogenous leukemia and chronic myelogenous leukemia) who were consecutive recipients of allogenic bone marrow transplantation (BMT), randomly assigned to receive 400 mg vitamin E twice daily (supplemented group) or placebo (control). The incidence and severity of mucositis and the mean duration of neutropenia were compared. Results: The mean duration of neutropenia and the incidence of the mucositis between the two groups was the same (P = 1.0). The difference between the placebo group and mucositis grade 1 (P = 0.31), grade 2 (P = 0.25), grade 3 (P = 0.93) and grade 4 (P = 0.32) was not statistically significant. Moreover the variables of age, sex, BMI and underlying disease had no effect. Conclusion: In this study supplementation with oral vitamin E had no effect on mucositis and neutropenia in patients with leukemia who were recipients of allogenic BMT. More interventional trials are warranted.

e15095Background: Colorectal cancer (CRC) has a progressive incidence throughout the world and peripheral neuropathy is the major dose-limiting side effect of oxaliplatin, a chemotherapeutic agent ...

e12031Background: Peripheral neuropathy is the main dose-limiting complication of paclitaxel. In this study, the association between clinical characteristics of the patients with breast cancer, dis...

e14504 Background: Oxaliplatin induced peripheral neuropathy (OXIPN) is the major dose-limiting side effect of oxaliplatin. N-3 PUFAs have known neuroprotective property. This study was a randomize...

It appears that delayed hemolytic transfusion reactions may occur several days after the administration of donor red cells is true even though they have been shown to be compatible in cross match tests by the antiglobulin technique. A specific case was observed in our center, which confirms the fact. The patient was a 37-year-old male suffering from intermediate β-thalassemia. He had a history of two previous transfusions, with unknown transfusion reaction. In the last transfusion, laboratory data showed: Hb 7.8 g/dL and Hematocrit (Hct) 24.2%. The patient received two units of cross matched, compatible concentrated red blood cells (RBCs). After eight days a severe reaction was observed with clinical evidence of tachycardia, fatigue, fever, back pain, chest discomfort, jaundice, nausea and anorexia. Accordingly delayed hemolytic transfusion reaction was suspected, and anti-RBC antibodies were tested. Laboratory tests revealed the presence of three alloantibodies: Anti-N, anti-S, anti-K, and a monospecific autoanti-JK(b).

1039 Background: Axonal sensoryperipheral neuropathy is the major dose-limiting side effect of paclitaxel. Omega-3 fatty acids have beneficial effects on neurological disorders from their effects o...

Background Oxaliplatin induced peripheral neurotoxicity (OXIPN) is the major dose-limiting and long-lasting side effect of oxaliplatin. N-3 PUFAs have neuroprotective property via their effects on voltage-gated ion channels and by reducing the production of proinflammatory cytokines that causes neuropathy. This study was a randomized double blind placebo controlled trial to find the possible advantages of n-3 PUFAs for preventing and reducing the severity of OXIPN in patients with colon cancer. Methods Eligible patients with colon cancer randomly allocated to take n-3 PUFAs pearls, 640 mg t.i.d during chemotherapy with oxaliplatin and one month after the cessation of the treatment or placebo. All patients were evaluated for incidence and severity of OXIPN based on “reduced Total Neuropathy Score” in which clinical and electrophysiological assessments were included. Results Seventeen patients (47 %) of the n-3 PUFA supplemented group (n = 36) did not develop PN while it was 11 %(4 patients) in the placebo group (n = 35). There was a significant difference in PN incidence (OR = 0.14, .95 % CI = (0.04 to 0.49), p = 0.002). The difference of OXIPN severity was significant between the two study groups (B = −1.61, 0.95 % CI = (−2.59 to −0.62), p = 0.001). Conclusions N-3 PUFAs may have neuroprotective effect for reducing the incidence and severity of OXIPN. Finding an effective prophylactic or symptomatic therapy for OXIPN would significantly improve the patients’ quality of life. Trial registration IRCT201112158397N2

Background Axonal sensory peripheral neuropathy is the major dose-limiting side effect of paclitaxel.Omega-3 fatty acids have beneficial effects on neurological disorders from their effects on neurons cells and inhibition of the formation of proinflammatory cytokines involved in peripheral neuropathy. Methods This study was a randomized double blind placebo controlled trial to investigate the efficacy of omega-3 fatty acids in reducing incidence and severity of paclitaxel-induced peripheral neuropathy (PIPN). Eligible patients with breast cancer randomly assigned to take omega-3 fatty acid pearls, 640 mg t.i.d during chemotherapy with paclitaxel and one month after the end of the treatment or placebo. Clinical and electrophysiological studies were performed before the onset of chemotherapy and one month after cessation of therapy to evaluate PIPN based on "reduced Total Neuropathy Score". Results Twenty one patients (70%) of the group taking omega-3 fatty acid supplement (n = 30) did not develop PN while it was 40.7%( 11 patients) in the placebo group(n = 27). A significant difference was seen in PN incidence (OR = 0.3, .95% CI = (0.10-0.88), p = 0.029). There was a non-significant trend for differences of PIPN severity between the two study groups but the frequencies of PN in all scoring categories were higher in the placebo group (0.95% CI = (−2.06 -0.02), p = 0.054). Conclusions Omega-3 fatty acids may be an efficient neuroprotective agent for prophylaxis against PIPN. Patients with breast cancer have a longer disease free survival rate with the aid of therapeutical agents. Finding a way to solve the disabling effects of PIPN would significantly improve the patients’ quality of life. Trial registration This trial was registered at ClinicalTrials.gov (NCT01049295)