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Transcarotid artery revascularization (TCAR) is an accepted and approved treatment for carotid artery stenosis in high-risk patients, and recently in standard risk patients under the guidelines of the recent CMS National Coverage Determination. However, it's applicability is limited by certain anatomic criteria, such as heavily calcified internal carotid arteries. We retrospectively reviewed two patients at our institution with heavily calcified internal carotid artery plaques who underwent intravascular lithotripsy and TCAR. These two cases demonstrate the feasibility of lithotripsy for modification of heavy, calcified plaque prior to TCAR for patients at high risk for carotid endarterectomy.

Global warming has endangered crop production by reducing water availability and increasing temperature. Kaolin may protect plants against these conditions by reflecting the light and decreasing plant temperature. This study was conducted to evaluate the protective effects of kaolin spraying on kernel yield and quality of four walnut cultivars and genotype. The experiment was conducted as a split-plot factorial design in time factor with four factors including irrigation levels (100% and 50% of regular irrigation), kaolin solution concentrations (0, 2.5, 5 and 7.5%), walnut varieties (‘Chandler’, ‘Franquette’, ‘K72’ and ‘SG’) in two consecutive years (2012–2013). By increasing the kaolin concentration under well-watered irrigation, gas exchange, chlorophyll concentration, leaf potassium content, and kernel quality were improved. Moreover, increasing the kaolin concentration reduced sunburn and leaf temperature under different irrigation regimes. Based on results, genotypes ‘K72’ and ‘SG’ showed more severe sunburn symptoms. Water stress and no kaolin application had negative effect on the kernel color. Leaf temperature increased with reducing the irrigation and concentration of kaolin. Under water stress, ‘Chandler’ had the highest relative water content (58.25%) and ‘Franquette’ had the lowest RWC and therefore considered as the most drought sensitive cultivar. The lowest fruits sunburn in ‘Franquette’, was related to the thickness of its fruits’ husk. In general, the foliar application of kaolin 5% and 7.5% alleviated the negative effect of drought stress and improved the walnut kernels quality under water deficit condition by improving chlorophyll content, RWC, and gas exchange and reducing leaf temperature.

【Abstract】Objective: Trauma is one of the leading causes of mortality and morbidity in adults and a major contributor to health care expenditures. Although spine-related injuries constitute a small proportion of trauma cases, they need special consideration due to poor functional outcomes and substantial burden. Despite relatively extensive previous studies on traumatic spinal injuries, there is still obscurity in some aspects of the issue. The purpose of this study is to establish a regional multicenter traumatic spine fracture/dislocation registry. Methods: This is a prospective case series study, including all patients with acute traumatic spine lesions admitted to a regional multicenter since 2014. Data is extracted based upon a form developed by Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. Novel electronic data entry software is initiated and data will be entered to the software. Information remains confidential and security considerations will be taken based on standards of data entry systems. Results: The results of this study will include age and gender distribution of the patients, causes of injury, location of pain and neurological deficit, the American Spinal Injury Association score and Frankel grade on admission, at discharge, after 6 and 12 months and at the latest annual follow-up, radiologic findings, details of operative procedures and methods of external fixation. Conclusion: This study will identify prognostic factors that influence the ultimate fate of spine fracture patients and determine short and long-term outcome of different treatment methods. It can lead to a considerable improvement in patient care and will have a great national and transnational impact. Key words: Spinal fractures; Registries; Spinal injuries; Prospective studies

【Abstract】Objective: To strengthen the current Injury Surveillance System (IS System) in order to better monitor injury conditions, improve protection ways and promote safety. Methods: At first we carried out a study to evaluate the frameworks of IS System in the developed countries. Then all the available documents from World Health Organization, Eastern Mediterranean Regional Organization, as well as Minister of Health and Medical Education concerning Iran were reviewed. Later a national stakeholder抯 consultation was held to collect opinions and views. A national workshop was also intended for provincial representatives from 41 universities to identify the barriers and limitations of the existing program and further to strengthen injury surveillance. Results: The evaluation of the current IS System revealed many problems, mainly presented as lack of accurate pre- and post-hospital death registry, need of precise injury data registry in outpatient medical centers, incomplete injury data registry in hospitals and lack of accuracy in definition of variables in injury registry. The five main characteristics of current IS System including flexibility, acceptability, simplicity, usefulness and timeliness were evaluated as moderate by experts. Conclusions: Major revisions must be considered in the current IS System in Iran. The following elements should be added to the questionnaire: identifier, manner of arrival to the hospital, situation of the injured patient, consumption of alcohol and opioids, other involved participants in the accident, intention, severity and site of injury, side effects of surgery and medication, as well as one month follow-up results. Data should be collected from 10% of all hospitals in Iran and analyzed every 3 months. Simultaneously data should be online to be retrieved by researches. Key words: Wounds and injuries; Population surveillance; Registries; Iran

【Abstract】Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to de- scribe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through ex- pert panels and semi-structured interviews with trauma spe- cialists and policy makers. Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of pub- lic education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training stan- dards of the front line medical team and continuing educa- tion and evaluation are yet to be addressed. Trauma regis- try has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources), it is not yet established in our system of trauma care. Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system. Key words: Emergency medical services; Trauma centers; Wounds and injuries

【Abstract】Objective: Injury is a major cause of morbidity and mortality in the world. The assessment of patterns and severity of injury in high-risk groups is crucial for planning and service development. On a large scale na-tional household survey, we estimated the annual incidence and the patterns of injury, the demographics of the injured people, as well as the service use for all injuries in Iran. The current study aims at assessing the reliability of the ques-tionnaire before carrying out a national survey. Methods: In a pilot study using cluster random sam-pling approach, 73 people were interviewed. The interview-ers asked the participants to report all injuries occurred in them and the care provided during the previous 12 months, based on “Short Form Injury Questionnaire 7”. About two weeks later, the interview was repeated by another interviewer. Results: In our test-retest reliability, Kappa score was good for three and moderate for four questions. The ques-tion on the injured organ had the highest test-retest reliabil-ity with a Kappa score of 0.84. Conclusions: The reliability of the questionnaire and the procedure of questioning are confirmed. The ques-tionnire is proper for utilization in large national surveies. Key words: Injury severity score; Reproducibility of results; Iran

Objective: This study investigated the association between Coronavirus Disease 2019 mRNA vaccination and stroke in Qatar., Methods: Between December 1, 2020, and April 11, 2023, a matched case-control study was conducted to investigate the association between 3036 acute stroke cases and 3036 controls drawn from the entire population of Qatar., Results: The adjusted odds ratio (aOR) for vaccination among cases compared to controls was 0.87 (95% CI: 0.75-1.00). The aOR was 0.74 (95% CI: 0.45-1.23) for a single vaccine dose, 0.87 (95% CI: 0.73-1.04) for primary-series vaccination (two doses), and 0.91 (95% CI: 0.66-1.25) for booster vaccination (three or more doses). The aOR was 0.87 (95% CI: 0.72-1.04) for BNT162b2 and 0.86 (95% CI: 0.67-1.11) for mRNA-1273. Subgroup analyses, considering different durations since vaccination, also demonstrated no association. Subgroup analyses based on nationality, age, number of coexisting conditions, or prior infection status yielded similar results. Subgroup analysis, stratified by stroke type, suggested an association between vaccination and cerebral venous sinus thrombosis (aOR of 2.50 [95% CI: 0.97-6.44]), but it did not reach statistical significance., Conclusion: There was no evidence of an increased risk of stroke following vaccination, both in the short term and in the long term, extending beyond a year after receiving the vaccine., Competing Interests: Declarations of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Dr. Butt has received institutional grant funding from Gilead Sciences unrelated to the work presented in this paper. Otherwise, we declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

An effective approach to producing sophisticated miniaturized and nanoscale materials involves arranging nanomaterials into layered hierarchical frameworks. Nanostructured layered materials are constructed to possess isolated propagation assets, massive surface areas, and envisioned amenities, making them suitable for a variety of established and novel applications. The utilization of various techniques to create nanostructures adorned with metal nanoparticles provides a secure alternative or reinforcement for the existing physicochemical methods. Supported metal nanoparticles are preferred due to their ease of recovery and usage. Researchers have extensively studied the catalytic properties of noble metal nanoparticles using various selective oxidation and hydrogenation procedures. Despite the numerous advantages of metal-based nanoparticles (NPs), their catalytic potential remains incompletely explored. This article examines metal-based nanomaterials that are supported by layers, and provides an analysis of their manufacturing, procedures, and synthesis. This study incorporates both 2D and 3D layered nanomaterials because of their distinctive layered architectures. This review focuses on the most common metal-supported nanocomposites and methodologies used for photocatalytic degradation of organic dyes employing layered nanomaterials. The comprehensive examination of biological and ecological cleaning and treatment techniques discussed in this article has paved the way for the exploration of cutting-edge technologies that can contribute to the establishment of a sustainable future., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

In this research, a sitagliptin-lignin biopolymer (SL) containing zinc selenide quantum dots (ZnSe QDs) and doxorubicin (doxo) was synthesized. The fabricated polymeric drug delivery system was characterized via FTIR, XRD, SEM, TGA, IR, and DSC. SLQD-Doxo exhibited an irregular surface with a 32 nm diameter and well-defined surface chemistry. Drug loading efficiency was assessed at different concentrations, pH levels, time intervals, and temperatures, and drug kinetics were calculated. Maximum drug release was observed at 6 μmol concentration after 24 h, pH of 6.5 and 45 °C. The maximum drug encapsulation efficiency was 81.75 %. SLQD-Doxo demonstrated 24.4 ± 1.04 % anti-inflammatory activity, and the maximum lipoxygenase inhibition in a concentration-dependent manner was 71.45 ± 2.02 %, compared to indomethacin, a standard anticancer drug. The designed system was applied to breast cancer MCF-7 cells to evaluate anticancer activity. Cytotoxicity of SLQD-Doxo resulted in 24.48 ± 1.64 dead cells and 74.39 ± 4.12 viable cells. Lignin's polyphenolic nature resulted in good antioxidant activity of LLQD-Doxo. The combination of SLQD-Doxo was appropriate for drug delivery at high temperatures and acidic pH of tumor cells compared to healthy cells., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: The infrageniculate popliteal artery is a potential source for inflow in lower extremity bypass surgery in patients with isolated tibial artery disease. The objective of our study was to assess the short- and long-term outcomes of popliteal-distal bypasses using data from the Vascular Quality Initiative (VQI)., Methods: The VQI registry was queried between 2003 and 2021 for patients undergoing surgical revascularizations with the below-knee popliteal artery serving as inflow. Demographics, comorbidities, intraoperative characteristics, and postoperative complications were analyzed. Kaplan-Meier models were used to estimate amputation-free survival, survival, and freedom from amputation. Cox regression analysis was conducted to determine factors associated with major amputation or death., Results: A total of 1884 procedures were analyzed. The mean age of the included patients was 67.7 years. The most frequently observed preoperative comorbidities included insulin-dependent diabetes (52.3%), coronary disease (32.4%), and end-stage renal disease (14.4%). Of all the patients, 670 (35.6%) had a history of ipsilateral endovascular intervention. The procedures were performed for a variety of indications, including tissue loss (84.3%), rest pain (10.9%), and claudication (4.8%). Intraoperatively, the outflow targets were the dorsalis pedis (31.4%), the posterior tibial (24.4%), and the anterior tibial arteries (15.6%). Vein conduit was used in 92.1% of cases. The rate of perioperative myocardial infarction (MI) was 2.4%, and the 30-day mortality was 1.9%. The median length of follow up was 371 days. Amputation-free survival was found to be 85.6% (95% confidence interval [CI], 84.0%-87.2%) at 6 months and 78.6% (95% CI, 76.6%-80.4%) at 12 months. Survival was found to be 93.4% (95% CI, 92.2%-94.5%) at 6 months and 88.6% (95% CI, 87.1%-90.0%) at 12 months. Freedom from amputation was found to be 92.0% (95% CI, 90.7%-93.3%) at 6 months and 89.0% (95% CI, 87.3%-90.4%) at 12 months. Cox regression analysis demonstrated that age greater than 65 years, congestive heart failure, coronary artery disease, and end-stage renal disease were associated with a higher risk of major amputation or death (P < .05)., Conclusions: Below-knee popliteal-distal bypass is a safe and effective approach to treat severe tibial vessel occlusive disease in this challenging patient cohort. Patients exhibited low perioperative complication rates and good amputation-free survival at 1 year., Competing Interests: Disclosures None., (Copyright © 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Both the environment and human health have suffered as a result of excessive and irrational pesticide use. The human body is vulnerable to a wide range of illnesses brought on by prolonged exposure to or intake of food contaminated with pesticide residues, including immunological and hormonal abnormalities and the development of certain tumors. Sensors based on nanoparticles stand out from more conventional spectrophotometry analytical methods due to their low detection limits, high sensitivity, and ease of use; that is why the demand for simple, fast, and less expensive sensing methods increases daily and presents myriad uses. Such demands are fulfilled by employing paper-based analytical devices having intrinsic properties. The presented work reports an on-site, easy-to-handle, and disposable paper-based sensing device for performing fast screening along with readout from a smartphone. The fabricated device utilizes luminescent silica quantum dots, immobilized into a paper cellulose matrix, and the resonance energy transfer phenomenon is employed. The silica quantum dots probes were fabricated from citric acid and, by undergoing physical adsorption, were confined on the nitrocellulose substrate in small wax-traced spots. The silica quantum dots were excited by smartphone ultraviolet LED, acting as an energy source and for capturing the image. The obtained LOD is 0.054 μM, and the coefficient of variation is less than 6.1%, comparable to the result obtained by UV-Visible and fluorometric analysis under similar experimental conditions. In addition, high reproducibility (≥9.8%) and high recovery ≥90% were obtained in spiked blood samples. The fabricated sensor sensitively detected pesticides giving a LOD of 2.5 ppm along with the development of yellow color within a short period of 5 min. The sensor functions well when sophisticated instrumentation is not accessible. The presented work shows the potential of the paper strip for the on-site detection of pesticides in biological and environmental samples., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Thoracic endovascular aortic repair (TEVAR) has emerged as a viable option of treatment for uncomplicated type B aortic dissection (UTBAD) due to the potential for inducing favorable aortic remodeling. The aim of this study is to compare outcomes of UTBAD treated medically or with TEVAR in either the acute (1 to 14 days) or subacute period (2 weeks to 3 months)., Methods: Patients with UTBAD between 2007 and 2019 were identified using the TriNetX Network. The cohort was stratified by treatment type (medical management; TEVAR during the acute period; TEVAR during the subacute period). Outcomes including mortality, endovascular reintervention, and rupture were analyzed after propensity matching., Results: Among 20,376 patients with UTBAD, 18,840 were medically managed (92.5%), 1099 patients were in the acute TEVAR group (5.4%), and 437 patients were in the subacute TEVAR group (2.1%). The acute TEVAR group had higher rates of 30-day and 3-year rupture (4.1% vs 1.5%; P < .001; 9.9% vs 3.6%; P < .001) and 3-year endovascular reintervention (7.6% vs 1.6%; P < .001), similar 30-day mortality (4.4% vs 2.9%; P < .068), and lower 3-year survival compared with medical management (86.6% vs 83.3%; P = .041). The subacute TEVAR group had similar rates of 30-day mortality (2.3% vs 2.3%; P = 1), 3-year survival (87.0% vs 88.8%; P = .377) and 30-day and 3-year rupture (2.3% vs 2.3%; P = 1; 4.6% vs 3.4%; P = .388), with significantly higher rates of 3-year endovascular reintervention (12.6% vs 7.8%; P = .019) compared with medical management. The acute TEVAR group had similar rates of 30-day mortality (4.2% vs 2.5%; P = .171), rupture (3.0% vs 2.5%; P = .666), significantly higher rates of 3-year rupture (8.7% vs 3.5%; P = .002), and similar rates of 3-year endovascular reintervention (12.6% vs 10.6%; P = .380) compared with the subacute TEVAR group. There was significantly higher 3-year survival (88.5% vs 84.0%; P = .039) in the subacute TEVAR group compared with the acute TEVAR group., Conclusions: Our results found lower 3-year survival in the acute TEVAR group compared with the medical management group. There was no 3-year survival benefit found in patients with UTBAD who underwent subacute TEVAR compared with medical management. This suggests the need for further studies looking at the necessity for TEVAR when compared with medical management for UTBAD as it is non-inferior to medical management. Higher rates of 3-year survival and lower rates of 3-year rupture in the subacute TEVAR group compared with the acute TEVAR group suggest superiority of subacute TEVAR. Further investigations are needed to determine the long-term benefit and optimal timing of TEVAR for acute UTBAD., (Copyright © 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: We aimed to elucidate current national multiarterial coronary bypass grafting practice patterns and assess perioperative outcomes., Methods: Isolated primary nonemergent/nonsalvage coronary artery bypass grafting patients with at least 1 internal thoracic artery and 2 or more grafts in The Society of Thoracic Surgery Adult Cardiac Surgery Database (2018-2019) were divided into 3 cohorts: single-arterial, bilateral internal thoracic artery (BITA), and radial artery multiarterial grafting. Observed-to-expected ratios based on 2017 Society of Thoracic Surgery risk models were derived for 30-day perioperative mortality, composite major morbidity and mortality, and deep sternal wound infections for each grafting group overall and as a function of institutional multiarterial case volumes per study period: low (<10), intermediate (11-30), and high (>30)., Results: A total of 281,515 patients (BITA, 15,663 [5.6%]; radial, 23,905 [8.5%]) at 1013 centers showed distinct geographic grafting patterns: BITA and radial multiarterial grafting rates were lowest in the South (4% and 6%, respectively) and highest in the Northeast (9% and 11%, respectively). The median institutional number of BITA and radial cases per study period was 4 and 7, with only 14% and 21% of institutions performing >30 BITA and radial multiarterial cases per study period, respectively. The observed-to-expected mortality for single-arterial bypass grafting was similar to multiarterial: single-arterial, 1.00 (95% CI, 0.98-1.03); BITA, 0.98 (95% CI, 0.84-1.13; P = .711); and radial, 0.96 (95% CI, 0.86-1.07; P = .818). Observed-to-expected mortality and composite major morbidity and mortality were lower at high vs low multiarterial case-volume centers: 0.91 (95% CI, 0.75-1.08) vs 1.30 (95% CI, 0.89-1.79; P = .048) and 1.06 (95% CI, 0.99-1.13) vs 1.51 (95% CI, 1.32-1.71; P < .001), respectively, for BITA, and 0.82 (95% CI, 0.87-1.30) vs 1.67 (95% CI, 1.21-2.21; P < .001) and 0.91 (95% CI, 0.93-1.08) vs 1.42 (95% CI, 1.24-1.61; P < .001), respectively, for radial., Conclusions: Multiarterial bypass grafting remains underused and limited to select centers. Worse outcomes at low-volume BITA and radial institutions document a case-volume outcomes effect. Additional studies are warranted to improve multiarterial outcomes at low-volume institutions., (Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: Many researchers have suggested that bismuth composite shields (BCS) reduce breast dose remarkably; however, the level of this reduction and its impact on image quality has not been assessed. This study aimed to evaluate the efficiency of nano- and micro- BCS in reducing the dose and image quality during chest computed tomography (CT) scans., Materials and Methods: Bismuth shields composed of 15 weighting percentage (wt%) and 20 wt% bismuth oxide (Bi 2 O 3 ) nano- and micro-particles mixed in silicon rubber polymer were constructed in 1 and 1.5 mm thicknesses. The physical properties of nanoparticles were assessed using a scanning electron microscope (SEM), X-ray diffraction (XRD), and energy-dispersive X-ray (EDX). Breast radiation doses were measured experimentally during chest CT using PMMA standard dosimetry phantom (body phantom, 76-419-4150, Fluke Biomedical) in the presence of the shields. The image quality was assessed by calculating signal and noise values in different regions., Results: The SEM images showed that the average size of Bi 2 O 3 nano- and micro-particles was about 70 nm and 150 μm, respectively. The breast doses were reduced by increasing the shield thickness/bismuth weight percentage. The maximum dose reduction was related to the 20% weight of Bi 2 O 3 nano-particles and a thickness of 1.5 mm. The minimum dose reduction was related to the 15% weight of Bi 2 O 3 micro-particles with a thickness of 1 mm. The mean noise was higher in nano-particle bismuth shields than in micro-particles., Conclusion: Composite shields containing bismuth nano- and micro-particles can reduce the breast dose during chest CT examinations while negatively impacting diagnostic image quality. Several critical factors, such as bismuth concentration, particle size, and shield thickness, directly affect the efficiency., (Copyright © 2022. Published by Elsevier Inc.)

Aims: The association between asthma and obesity has been shown but its accurate mechanism is unknown. In the current study, we sought to investigate the gene expression levels of IL-17/TRAF6/MAPK/USP25 axis and pro-inflammatory cytokine level (IL-6, IL-1β, and TNF-α) in obese Ovalbumin (OVA)-sensitized female and male Wistar rats lung tissue., Main Methods: Animals in both males and females were divided into eight groups (four groups in each sex) based on diet and OVA-sensitization: normal diet, a normal diet with OVA-sensitization, high-fat diet (HFD), and OVA-sensitization with an HFD., Key Findings: In both sexes, obese OVA-sensitized rats, the methacholine concentration-response curve shifted to the left and EC 50 methacholine decreased. Increased pro-inflammatory cytokines as well as elevated IL-17/TRAF6/MAPK axis genes and decreased USP25 gene expression were identified in obese OVA-sensitized groups., Significance: The results indicate that in obese OVA-sensitized rats, the IL-17 axis were involved in the pathogenesis of the disease and can be considered as a therapeutic target in subjects with obesity-related asthma., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Atypical protein kinase-c (aPKC) isoforms are important regulators of polarity and stem cell differentiation. There are three isoforms of aPKC: aPKC-ι, aPKC-ζ, and PKM-ζ. Recently, aPKC-ι was shown to regulate human trophoblast stem cell (TSC) differentiation. Compensation by remaining isoforms when a single aPKC isoform is lost can occur, but the expression pattern of aPKC-ζ in placenta is unknown. Here we show that aPKC-ι, aPKC-ζ and a new isoform, aPKC-ζ III, are expressed in trophoblasts. Therefore, studies examining the role of aPKC isoforms that control for potential compensation between aPKC isoforms are necessary to understand aPKC-mediated regulation of TSC differentiation., (Copyright © 2022. Published by Elsevier Ltd.)

Because spermatogonia transmit genetic information across generations, their DNA must be protected from environmental damages, including exposure to zinc oxide nanoparticles (ZnO NPs), which are frequently used in modern technology. Here, we used an in vitro system enriched for spermatogonia and exposed them to 10 and 20 μg/ml ZnO NPs for one/seven days. We did not detect any significant cell death, chromosomal instability, or DNA fragmentation in the spermatogonia treated with the ZnO NPs following one-day treatment with 10 or 20 μg/ml ZnO NPs. However, ZnO NPs (both 10 and 20 μg/ml) induced chromosomal instability in the spermatogonia after seven days of treatment. Moreover, one-day exposure to these NPs induced reactive oxygen species (ROS) generation and upregulation of apoptotic pathway-related genes p53, Caspase3 and Il6, as an inflammatory factor. Taken together, our study provides preliminary evidence for possible damages induced by low concentrations of ZnO NPs in spermatogonia. We should pay increased attention when using these NPs because of the silent damages in spermatogonia that can be transmitted to the next generation and cause severe effects. However, more data and validation of these results are required to determine the extent of this concern., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Electrochemical sensing methods monitor biomolecules because of their specificity, rapid response, lower cost, and automation. Hemoglobin is an abundant protein in the human body and is correlated with various physiological processes. Levels of hemoglobin in blood are associated with anemia in pregnant women. In this research, a non-enzymatic sensor based on NiTe nanorods is developed for the detection and quantification of hemoglobin (Hb) from anemic pregnant patients. NiTe nanorods are synthesized by the single-step method. After characterizing the material, sensing parameters such as the effect of scan rate, pH, concentration, and interferences are optimized using standard hemoglobin samples. Linearity, the limit of detection (LOD), and the limit of quantification (LOQ) for NiTe nanorods are 0.99698, 0.012 nM, and 0.04 nM, respectively. Stability is measured by cyclic chronoamperometry (12 h) and voltammetry (100 cycles). Recovery of hemoglobin from blood samples is in the range of 63-90%. NiTe nanorods quantitatively determine hemoglobin from the blood samples of anemic pregnant women., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Search and rescue (SAR) is vital for visitor safety in US national parks, which are popular destinations for tourists. Previous studies have described SAR and seasonal visitation patterns, but not in the context of overall visitation. In addition, studies on the association between SAR and developed park areas remain limited. Concurrently, social media can be valuable for sharing information about conservation awareness and the joy of being outdoors. However, social media can potentially be an avenue for users to share risky and dangerous behaviors performed during attempts to obtain photos and videos. The associations between SAR and social media have not been discussed in existing literature., Methods: Variables included recreational visits, developed site stay visits, backcountry visits, SAR incidents, and tweets. Data from 2017 were obtained from National Park Service visitor use statistics, the SAR incident dashboard, and the University of California, Irvine, Cloudberry application. Correlation analysis was performed using nonparametric Kendall rank correlation coefficients., Results: Recreational visits were correlated with SAR incidents (r τ =0.415, P<0.001). Developed site stays were similarly correlated with SAR incidents (r τ =0.447, P<0.001), as were backcountry visits (r τ =0.428, P<0.001). Backcountry visits had a stronger correlation with fatalities (r τ =0.380, P<0.001) compared to developed site stays (r τ =0.304, P<0.001). Tweets were correlated with SAR incidents (r τ =0.468, P<0.001), recreational visits (r τ =0.403, P<0.001), and fatalities (r τ =0.367, P<0.001)., Conclusions: Our findings demonstrate associations between national park visitation, SAR incidents, fatalities, and Twitter use and provides a concept framework for future prospective studies to further investigate the relationships between visitation, SAR, and social media., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Creatinine is an indicator of hindrance in urination and renal insufficiency. Creatinine levels are the marker of the late stages of prostate cancer. Early and sensitive detection of creatinine can reduce deaths associated with prostate cancer. In this work, nitrogen-doped porous carbon antimony (Sb/NPC) nanoparticles are fabricated to be employed as a non-enzymatic biosensor. Sb/NPC has promising redox activity and is synthesized by a two-step reaction using low-cost precursors. Electrochemical sensing by Sb/NPC is conducted for standard creatinine solutions on a three-electrodes system. Cyclic voltammetry, amperometry, and electrochemical impedance spectroscopy are used to sense creatinine. LOD and LOQ of the Sb/NPC modified electrode are 0.74 µM and 2.4 µM, respectively. This electrode system analyzes creatinine in the serum of prostate cancer patients who have elevated PSA levels. More than 90% creatinine is recovered from a spiked serum sample of a prostate cancer patient. A direct relation is observed between PSA levels and creatinine levels in prostate cancer. The developed cyclic voltammetric setup detects trace concentrations of creatinine in serum., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: Endovascular therapies are increasingly used in patients with complex multilevel disease and chronic limb-threatening ischemia (CLTI). Infrageniculate bypass with autologous vein conduit is considered the gold standard in these patients. However, many patients often lack optimal saphenous vein, leading to the use of nonautologous prosthetic conduit. We compared limb salvage and survival rates for patients with CLTI undergoing first time revascularization with either open nonautologous conduit or endovascular intervention., Methods: We retrospectively reviewed consecutive patients undergoing first time endovascular or open surgical revascularization at our institution between 2009 and 2016. Patients were divided into endovascular intervention or open bypass with nonautologous conduit (NAC) cohorts. Primary endpoints were amputation-free survival (AFS), freedom from reintervention, primary patency, and overall survival. Propensity scoring was used to construct matched cohorts. Outcomes were evaluated using Kaplan-Meier and Cox Proportional Hazards models., Results: A total of 125 revascularizations were identified. There were 65 endovascular interventions and 60 NAC bypasses. In unmatched analysis, there was an elevated risk of perioperative MI (7% vs. 0%, P = 0.05) and amputation (10% vs. 2%, P = 0.04) for the NAC groups compared to the endovascular group. In matched analysis, endovascular patients had a lower incidence of 30-day amputation (1.5% vs. 10% P = 0.04) and length of stay (median days, 1 vs. 9, P < 0.01) compared to the open cohort. While not statistically significant, the endovascular group trended towards increased rates of two-year AFS (76% vs. 65%, P = 0.07) compared to the NAC group. There was no significant difference in overall survival when the endovascular cohort was compared to NAC (85% vs. 77%, P = 0.29) patients. In matched Cox analysis, nonautologous conduit use was associated with an increased risk of limb loss (HR 2.03, 95% CI 0.94-4.38, P = 0.07) compared to endovascular revascularization., Conclusions: An "endovascular first" approach offers favorable perioperative outcomes and comparable AFS compared to NAC and may be preferable when autologous conduit is unavailable., (Copyright © 2021. Published by Elsevier Inc.)

Today's world needs to control the industrial pollution through smarter ways. Presently, we observed the capacity of soil borne fungi to digest Synozol Red HF-6BN and Synozol Black B. Initially, 86 fungal strains were isolated from soil samples randomly collected from industrial sites. Among these, 31 isolates were capable of dye decolorization on solid media, with SN12f and SN13a isolates showed the highest decolorization capacity. The dye decolorization by both strains was higher (80-95%), when incubated for 120 h under optimized conditions of pH, concentration, nutrient source and temperature. The dye (Synozol red HF-6BN and Synozol black B) decolorization by SN12f isolate was maximum (˃90%) at pH7, whereas the SN13a decolorized 90% of Synozol red HF-6BN and 89% of Synozol black B at pH3. The SN13a and SN12f isolates at 40 mg/L showed de-colorization of 94.71%, 81.4% (for Synozol red HF-6BN) and 90.5%, 84.4% (Synozol black B), respectively. Our isolates also mitigated the toxic effect of azo dyes on the growth of phosphate solubilizing soil bacteria. In fact, the untreated effluent showed toxic effects on the growth of beneficial bacterial by developing zone of inhibition (16.5 mm around Aeromonas spp., 14.5 mm around Sallmonella while 14.25 mm around Citrobacter spp). However, the fungal treated dye was unable to develop zone of inhibition. Laccase activity was positive for both of fungal isolates after incubation on Bassnell Hass Medium (0.0733 U/mL for SN12f and 0.0439 U/mL SN13a). Using molecular approaches (ITS region), SN12f was identified as Aspergillus nidulans, while SN13a as Aspergillus fumigatus. The current study showed that local fungal flora can reclaim the contaminated soils and support the agro-friendly micro-flora., (Copyright © 2020 Elsevier Inc. All rights reserved.)

A selective and cost-effective biosensor based on catalase immobilized antimonene quantum dots modified glassy carbon electrode (Cat@AMQDs-GCE) is designed for the first time to determine hydrogen peroxide (H 2 O 2 ). Antimonene quantum dots (AMQDs) are synthesized by a single step method, characterized by various analytical techniques and applied to the electrochemical sensing of hydrogen peroxide. Catalase enzyme specific for H 2 O 2 reduction is immobilized onto AMQDs to facilitate its detection by cyclic voltammetry and amperometry. Concentration, scan rate, pH, stability and selectivity are optimized. Linearity of Cat@AMQDs-GCE is determined as 0.989 with limit of detection as 4.4 μM. Amperometric measurements show recovery of 95 to 103.4% for H 2 O 2 from human serum samples. Cat@AMQDs-GCE is electrochemically stable up to 30 cycles, reducing the cost of analysis. Cat@AMQDs-GCE shows good selectivity in presence of ascorbic acid, dopamine, leucine and glucose. Prepared electrode is also applied for the quantitative determination of H 2 O 2 from ovarian cancer serum. CA 125 concentration is previously determined by Elecsys CA 125 II Assay. Results demonstrate that concentration of H 2 O 2 increases with increasing levels of CA125 in serum., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

In this work, the potential of chia seed mucilage (CSM) as a new source of carbohydrate for encapsulation of green cardamonmum Essential oils (GCEOs) was evaluated. 1 H NMR spectrum, FTIR spectrum and, SEM image has confirmed the existence of the GCEOs in the nanofibers. The nanofibers of CSM and polyvinyl alcohol have not antibacterial property, while nanofibers containing GCEOs show antibacterial activity against E. coli and S. aureus. Incorporating GCEOs in CSM nanofibers improved the antioxidant of the generated nanofibers. The amount of radical scavenging for the nanofibers containing 16 (mg/ml) of GCEOs was 18% and increasing the GCEOs concentration up to 64 (mg/ml) leads to grow the activity up to 41%. Thus, our studies indicate that nanofiber can be used as a novel antioxidant and antibacterial agent in the food and pharmaceutical industry., Competing Interests: Declaration of competing interest The authors declared that they have no conflict of interest., (Copyright © 2020. Published by Elsevier B.V.)

Extensive application of zinc oxide (ZnO) nanoparticles (NPs) in everyday life results in increased exposure to these NPs. Spermatogonial stem cells (SSCs) guarantee sperm production throughout the male reproductive life by providing a balance between self-renewal and differentiation. We used an in vitro platform to investigate the ZnO NPs effects on SSCs. We successfully synthesized ZnO NPs. In order to investigate these NPs, we isolated SSCs from mouse testes and cultured them in vitro. Our results confirmed the uptake of ZnO NPs by the cultured SSCs. We observed a dose- and time-dependent decrease in SSC viability. Both spherical and nanosheet ZnO NPs had the same cytotoxic effects on the SSCs, irrespective of their shapes. Moreover, we have shown that short time (one day) exposure of SSCs to a low concentration of ZnO NPs (10 μg/mL) promoted expressions of specific genes (Plzf, Gfr α1 and Bcl6b) for SSC self-renewal and differentiation genes (Vasa, Dazl, C-kit and Sycp3) expressed by spermatogonia during spermatogenesis. Our study provides the first insight into ZnO NPs function in SSCs and suggests a new function for ZnO NPs in the male reproductive system. We demonstrated that ZnO NPs might promote spermatogenesis via upregulation of gene expression related to SSC self-renewal and differentiation at low concentrations. Additional research should clarify the possible effect of ZnO NPs on the SSC genome and its effects on human SSCs., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: With increased focus on the opioid crisis, it was our goal to describe rates and risk factors for postoperative use of opioids in patients undergoing abdominal aortic aneurysm (AAA) repair as well as identify pain modalities that are underutilized., Methods: We retrospectively analyzed perioperative analgesic prescriptions for endovascular (EVAR) and open AAA repair between January 1, 2010 and January 1, 2018. Patients' baseline opioid use, demographics, and medical comorbidities were obtained. The EVAR group was further subdivided into percutaneous (pEVAR) and cutdown (cEVAR) groups. Primary outcomes were postoperative and discharge pain medication prescriptions. Relative rates of opioid prescribing were obtained through the electronic medical record and normalized into morphine milligram equivalents (MMEs)., Results: Of the 128 patients analyzed in the entire cohort, 21.8% (n = 28) underwent open repair and 78.12% (n = 100) underwent EVAR (46 pEVAR, 54 cEVAR). As expected, open repair had increased postoperative pain reported compared to EVAR (2.67 ± 0.75 vs. 0.96 ± 0.19, P < 0.01). Adjunctive epidural reduced postoperative pain for open repair (0.77 ± 0.48 vs. 3.50 ± 0.96, P < 0.01). EVAR had less postoperative opioid prescriptions compared to open repair (35.0% vs. 77.3%, P < 0.01). In the endovascular group, there was no difference between postoperative opioid prescription based on access, pEVAR versus cEVAR (65.8% vs. 80.1%, P = 0.11). When stratifying patients by number of cutdowns, patients with bilateral cutdown as opposed to a single cutdown received more opioid prescriptions than pEVAR patients (84.44% vs. 65.8%, P = 0.036). Of those receiving opioids, the average MME for open repair was 320.94 mg compared to 28.82 mg for EVAR (P < 0.01). Those undergoing percutaneous repair had significantly less MME use during hospitalization compared to femoral cutdown (17 ± 3.52 vs. 31.90 ± 5.43 mg, P < 0.01). Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and ketorolac, were rarely used in the postoperative period for open or EVAR (8.3% vs 1.1%). Percutaneous EVAR patients reported less pain at discharge compared to cEVAR patients (0.18 ± 0.12 vs. 0.88 ± 0.29, P = 0.036). Open and EVAR had comparable low rates of NSAID and acetaminophen prescriptions at discharge. Open patients had longer postoperative length of stay compared to EVAR patients (9.82 ± 1.27 vs. 3.86 ± 0.47, P < 0.01). pEVAR had a shorter length of postoperative course compared to cEVAR (3.2 ± 0.26 vs. 4.12 ± 0.30, P < 0.01). Patients undergoing EVAR with use of pain medications amounting to <20 MME had a significantly shorter length of stay., Conclusions: This single institutional retrospective study evaluated pain prescription patterns for patients undergoing AAA repair. AAA patients are predominantly treated with opioid pain medications with few adjunctive therapies. Intraoperative epidural and pEVAR may aid in decreasing the total MME used; however, the total number of opioids prescribed is similar for pEVAR and cEVAR despite the difference in approach. Clinicians must consider alternative nonopioid based pain management strategies., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Myofascial neck and back pain is an increasingly common chief symptom in the emergency department. Currently, there are no widely accepted conventional therapies, and there is little evidence on the efficacy of interventions such as trigger point injections (TPIs)., Objective: This study evaluates whether TPIs with 1% lidocaine can improve myofascial back and neck pain compared with conventional therapies. Secondary outcomes include changes in length of stay and number of opioid prescriptions on discharge., Methods: This single-center, prospective, randomized, pragmatic trial was carried out in patients clinically determined to have myofascial back or neck pain. Patients were randomized into the experimental arm (TPI with 1% lidocaine) or the control arm (standard conventional approach). Numeric Rating Scores (NRS) for pain and additional surveys were obtained prior to and 20 min after the intervention., Results: The NRS for pain was lower in the TPI group compared with the control group after adjustment for initial pain (median difference -3.01; 95% confidence interval -4.20 to -1.83; p < 0.001). Median length of stay was 2.61 h for the TPI group and 4.63 h for the control group (p < 0.001). More patients in the control group (47.4%) were discharged home with an opioid compared with the TPI group (2.9%) (p < 0.001)., Conclusions: TPI is an effective method for managing myofascial pain in the emergency department. This study indicates it may improve pain compared with conventional methods, reduce length of stay in the emergency department, and reduce opioid prescriptions on discharge., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Self-harm-related death is one of the most unfortunate, tragic, and regrettable types of death owing to injuries with a variety of socio-economic and cultural causes. The study aimed to determine the trend in the mortality of self-harm by sex and age at national and provincial levels in Iran over a period of 26 years., Methods: The Iran Death Registration System (DRS), cemetery databanks in Tehran and Esfahan, and the national population and housing censuses of Iran were used for this study. Using a growth model, the population was estimated in the age groups. Incompleteness, misalignment, and misclassification in the DRS were all considered and addressed accordingly. We used a spatio-temporal and Gaussian process regression model to estimate mortality rates in children and adults., Results: Over the study period, 67,670 deaths were estimated owing to self-harm across the country. The overall age-standardized mortality rate decreased from 4.32 per 100,000 (95% unit interface (UI): 3.25-5.75) to 2.78 (2.15-3.59) per 100,000 between 1990 and 2015, a reduction of approximately 35.65%. The M/F ratio was 2.03:1 with an annual percent change of -2.38% and -1.37% for women and men, respectively. The annual self-harm mortality rate was higher among individuals aged 15-24 years, as well as it was more in men during the study period., Conclusion: Mortality from self-harm has declined over the study period in Iran. Higher rates in men and in population aged 15-24 years, with considerable variation by province, were the distinguishing features of self-harm. Iran needs to improve monitoring through a comprehensive multisectoral strategy; and most importantly, provide timely, effective and low-cost preventive interventions., (Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The outbreak of COVID-19 has caused concerns globally. On 30 January WHO has declared it as a global health emergency. The easy spread of this virus made people to wear a mask as precautionary route, use gloves and hand sanitizer on a daily basis that resulted in generation of a massive amount of medical wastes in the environment. Millions of people have been put on lockdown in order to reduce the transmission of the virus. This epidemic has also changed the people's life style; caused extensive job losses and threatened the sustenance of millions of people, as businesses have shut down to control the spread of virus. All over the world, flights have been canceled and transport systems have been closed. Overall, the economic activities have been stopped and stock markets dropped along with the falling carbon emission. However, the lock down of the COVID-19 pandemic caused the air quality in many cities across the globe to improve and drop in water pollutions in some parts of the world., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The aim of this study is to evaluate the performance and predictors of failure of paclitaxel drug-eluting stents and paclitaxel-coated balloons in the treatment of long-segment femoropopliteal disease. We report a retrospective cohort analysis of patients treated with paclitaxel-eluting stents and paclitaxel-coated balloons in lesions >100 mm, which were not included in any of the pivotal trials., Methods: Ninety-seven patients with peripheral vascular disease (Rutherford III-VI) underwent long-segment (≥100 mm) femoropopliteal drug-eluting stent (DES) implantation or angioplasty with drug-coated balloons (DCB). Patients were followed after their initial procedure for target lesion restenosis, defined as a reduction in lumen diameter by greater than 50% as measured by duplex ultrasonography (ratio >2)., Results: The median length of the affected arterial segments was 110 mm (interquartile range [IQR] 100-150, absolute range 100-260) using up to 4 overlapping stents. During the median 13-month follow-up (IQR 7-16), no early thrombotic occlusions occurred within 30 days, but 28 (29%) patients developed a target lesion restenosis after 1 year. Cumulative primary patency at 6 and 12 months was 87% and 71% overall, respectively. The cumulative patency during the same follow-up periods varied between patients treated with different paclitaxel modalities with 88% and 80% primary patency in patients treated with DES (n = 63) versus 81% and 49% in patients treated with DCB (n = 21) (adjusted hazard ratio 2.46, P = 0.03). Lesion length, concurrent tibial intervention, and recurrent target lesions were not associated with restenosis., Conclusions: Short-term outcomes in patients treated with paclitaxel-eluting stents and paclitaxel-coated balloons in long lesions, mirror results from the clinical trials. The primary patency observed in patients treated with DES was significantly higher than in patients treated with DCB., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Study Objective: To evaluate the Essentials in Minimally Invasive Gynecology (EMIG)- Fundamentals of Laparoscopic Surgery Laparoscopic Simulation System and the EMIG Hysteroscopy Simulation System for face validity and functionality in a pilot testing environment., Design: A prospective controlled pilot study., Setting: Three teaching institutions in the US Southwest., Subjects: Twenty-seven residents and gynecologists, with 22 fitting who fit 1 of 4 categories of exposure to hysteroscopic and laparoscopic surgery and surgical simulation. Eleven were postgraduate year 1 and 5 postgraduate year 3, 1 was American Board of Obstetrics & Gynecology certified, and 5 were either fellows in-training or had completed a fellowship in minimally invasive gynecologic surgery., Interventions: After completing a screening survey, each subject was exposed to a structured orientation to the 2 simulation systems and then tested with proctor supervision on the 5 laparoscopic and 2 hysteroscopic exercises. A short 5-point Likert questionnaire designed to determine face validation and question clarity was administered to each subject at sites 2 and 3., Measurements and Main Results: Face validity was high for each of the 7 exercises (means ranged from 4.8 to 4.9 of 5), and subjects considered instructions to be clear (means from 4.7 to 4.9). The recorded exercise times generally reduced with increasing levels of training, although the sample sizes were not designed to determine significance given the pilot design. Similarly, exercise errors were generally less frequent with increasing experience. The systems, including the devices and recording mechanisms, performed well, and proctor evaluation and training were satisfactory., Conclusion: The EMIG laparoscopic and hysteroscopic simulations systems were considered to have good face validity and appear to be suitable for a construct validation trial to confirm their utility in distinguishing among trainees and practitioners with a wide spectrum of endoscopic surgical experience. The recording and specimen storage mechanisms will allow for multiple proctors to rate a candidate's performance, thereby enhancing evaluation consistency and quality., (Copyright © 2019. Published by Elsevier Inc.)

In recent times, incorporation of Halloysite Nanotubes (HNTs) with various antimicrobial agents as interfacial materials between these nanotubes and pathogenic microorganisms, for the development of antimicrobial nanocomposites with enhanced antimicrobial activities has gained researcher's interest. The main benefits given by HNT to these nanocomposites include enhanced thermal and mechanical stability of the antimicrobial nanocomposites and also prolong durability and release of the antimicrobial agents in a sustained manner. The exceptional structure of these aluminosilicate minerals based nanotubes (hollow tubular lumen with huge surface area) and oppositely charged surface molecules assist in attaching various molecules on both, the internal surface as well as on the outer surface of these nanotubes. Other advantages of these clay-based minerals are their biocompatibility, non-toxicity, eco-friendly nature and their natural availability with affordable price, which also contribute in selecting them as supporting material for biological applications. Therefore, these clay-based nanotubes have been recently used for developing various antimicrobial nanocomposites. In this review, various antimicrobial nanocomposites developed through incorporation of HNT with myriad antimicrobial agents such as nanoparticles, metal ions, antibiotics, essential oils, biopolymers, phenolic compounds, surfactants and food preservatives as an interface between these nanotubes and microorganisms have been discussed. These antimicrobial nanocomposites could be synthesized in different forms (powder, film, nanocapsule and adhesive) which can be applicable in various fields such as food packaging, water decontamination, waste water management, healing of wounds, antimicrobial agents for surfaces, orthopedics and for the treatment of microbial infections., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: The aim of this study was to evaluate the performance of paclitaxel-eluting stents (PESs) and paclitaxel-coated balloons (PCBs) on amputation-free survival in patients with critical limb ischemia (CLI)., Methods: A retrospective review of all patients with Rutherford stage 5 and 6 limb ischemia undergoing endovascular revascularization with paclitaxel-related technology, both PES and PCB, was carried out over a 4-year period. Clinical grading was determined by Rutherford classification and the Society for Vascular Surgery's Wound, Ischemia, and foot Infection (WIfI) scoring system. Clinical and angiographic follow-up was reviewed based on intention-to-treat analysis. The primary endpoint of this study was amputation-free survival at 12 months. Secondary endpoints included wound healing, freedom from target lesion revascularization, and patency of target vessels at 12 months. Follow-up occurred at 3, 6, and 12 months postoperatively. Target lesion patency was defined as <50% stenosis, based on a duplex velocity ratio of less than or equal to 2. Postoperative ankle-brachial index (ABI) and duplex ultrasound were performed to verify successful treatment. Outcomes were evaluated using Kaplan-Meier and Cox proportional-hazards models., Results: A total of 88 limbs were revascularized in 88 patients. Drug-eluting stent (DES) was used as the sole drug technology in 56 patients (60.7% men, median age 70.5 years) and drug-coated balloon (DCB) was used as the sole drug technology in 32 patients (46.9% men, median age 66 years). Baseline demographics were well matched except for a higher prevalence of occluded target lesions in the DES group (41.1% vs. 12.5%; P = 0.004). Limbs were treated for Rutherford stage 5 CLI in 71.6% and stage 6 CLI in 28.4%. Univariate analysis identified no dependent factors affecting limb salvage, except for the use of DCBs. After 12 months of follow-up, amputation-free survival was significantly higher in the DES group than in the DCB group (88.5% vs. 71.1%; P = 0.0443). Wound healing rates after 1 year were also higher in the DES group (83.9% vs. 59.4%; P = 0.0198). Freedom from target lesion revascularization was no different between patients treated with DESs and patients treated with DCBs (90.6% vs. 85.7%; P = 0.518). Primary patency at 12 months in patients treated with DESs was significantly higher than in patients treated with PCBs (80.4% vs. 58.1%; P = 0.0255)., Conclusions: Overall, drug technology represents a viable option for patients with CLI; a cohort not represented in major randomized trials. In our experience, femoropopliteal lesions treated with DESs have higher primary patency rates than those treated with DCBs. This was found to support higher amputation-free survival rates in patients treated with paclitaxel DESs than those treated with paclitaxel DCB. The use of paclitaxel DESs for CLI was also associated with significantly improved wound healing compared with DCBs. Our data suggest improved outcomes with DESs compared with DCBs; however, these patients represent a nonrandomized, heterogenous group that were treated with the operator's best judgment., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: Comprehensive and up-to-date data on fatal injury trends are critical to identify challenges and plan priority setting. This study provides a comprehensive assessment of poisoning mortality trends across Iran., Study Design: The data were gathered from various resources, including death registration systems, cemetery databases of Tehran and Esfahan, the Demographic and Health Survey of 2000, and three rounds of national population and housing censuses., Methods: After addressing incompleteness for child and adult death data separately and using a spatio-temporal model and Gaussian process regression, the level and trend of child and adult mortality were estimated. For estimating cause-specific mortality, the cause fraction was calculated and applied to the level and trend of death., Results: From 1990 to 2015, 40,586 deaths due to poisoning were estimated across the country. The poisoning-related age-standardized death rate per 100,000 was estimated to have changed from 3.08 (95% uncertainty interval [UI]: 2.32-4.11) in 1990 to 0.96 (95% UI: 0.73-1.25) in 2015, and the male/female ratio was 1.35 during 25 years of study with an annual percentage change of -5.4% and -4.0% for women and men, respectively. The annual mortality rate was higher among children younger than 5 years and the elderly population (≥70 years) in the study period., Conclusions: This study showed that mortality from poisoning declined in Iran over the period from 1990 to 2015 and varied by province. Understanding the reasons for the differences of poisoning mortality by province will help in developing and implementing measures to reduce this burden in Iran., (Copyright © 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Liver ischemia/reperfusion (I/R) injury is a major complication of hepatic surgery and transplantation. It is one of the leading causes of morbidity and mortality because of post-surgery hepatic dysfunction. Several studies have suggested different mechanisms are involved in the pathogenesis of I/R injury in the liver that includes oxidative stress, inflammation, mitochondria dysfunction, liver Kupffer cells (KCs) activation, vascular cell adhesion molecule overexpression, and facilitation of polymorphonuclear neutrophil injury. Curcumin is a natural product extracted from Curcuma longa that is known to suppress these pathways and as a result reduces liver ischemia-reperfusion injury. This paper gives an overview of the protective effects of curcumin against I/R injury in the liver and discusses the studies that have linked biological functions of curcumin with liver I/R injury improvement., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Burn injuries are a major cause of preventable mortality worldwide. To implement preventive strategies, a detailed understanding of the rate and trend of fatal burn injuries is needed. The aim of this study was to determine the rate and trend of burn mortality at national and province level in Iran from 1990 to 2015., Materials and Methods: The data were retrieved from various sources: the Death Registration System, cemetery databases, the Demographic and Health Survey and three national population and housing censuses. ICD-10 codes were converted to Global Burden of Disease (GBD) codes for comparability. After addressing the incompleteness of death data, statistical methods such as spatio-temporal modelling and Gaussian Process Regression (GPR) were applied to estimate the levels and trend of death and cause specific mortality., Results: The number of deaths due to burning across Iran was 80,625, with a male to female ratio of 0.88, 0.94 and 1.14 in 1990, 1995 and 2015, respectively. The annual percentage change of age-standardized death rate from 1990 to 2015 was -5.42% and -4.22% in women and men, respectively. The burn-related age-standardized mortality rate decreased considerably from 5.97 in 1990 to 1.74 per 100,000 in 2015. The mortality rate due to burns was highest among those aged more than 85 years, especially in Ilam province., Conclusion: This study showed a decline in burn mortality in Iran from 1990 to 2015. Continued efforts to reduce the burden of burns are needed to accelerate this progress and prevent injuries., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Background: Extracorporeal membrane oxygenation (ECMO) is an important life-saving modality for patients with cardiopulmonary failure. Vascular complications, including clinically significant limb ischemia, may occur as a result of femoral artery cannulation for venoarterial (VA) ECMO. This study examines our institutional experience with femoral VA ECMO and the development of ipsilateral limb ischemia., Methods: We performed a retrospective review of all consecutive patients undergoing femoral VA ECMO between 2011 and 2016. The primary endpoint was clinical evidence of limb-threatening ischemia. Multivariate logistic regression analysis was used to identify predictors for limb ischemia after cannulation., Results: Between March 2011 and September 2016, 154 patients underwent femoral cannulation for VA ECMO. Overall in-hospital mortality was 59.7%. Clinically significant ipsilateral limb ischemia occurred in 34 (22%) patients; 7 required four-compartment fasciotomy, and 3 of these patients required amputation. On univariate analysis, a history of pulmonary disease, peripheral arterial disease, and stroke or transient ischemic attack was significantly associated with clinical limb ischemia. On multivariate analysis, younger age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93-0.99), diabetes (OR, 2.77; 95% CI, 1.08-7.12), pulmonary disease (OR, 3.86; 95% CI, 1.38-10.78), and peripheral arterial disease (OR, 13.68; CI, 2.75-68.01) were associated with limb ischemia. Lack of prophylactic distal perfusion catheter and arterial cannula size were not independently associated with limb ischemia., Conclusions: Femoral ECMO cannulation can be associated with significant limb ischemia necessitating surgical intervention. Younger patients, as well as those with a history of diabetes, pulmonary disease, and peripheral arterial disease, may be at increased risk for this complication., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: The unplanned 30-day readmission rate is a marker of quality of patient care across many disciplines. Data regarding risk factors for unplanned readmission after major lower extremity amputation (LEA) are limited. We evaluated predictors of readmission at our institution after major LEA., Methods: We conducted a retrospective review of all patients undergoing above-knee amputation (AKA) or below-knee amputation (BKA) between November 2009 and November 2014. Patient demographic variables were collected. Predictors of unplanned 30-day readmission and stump complications were determined by multivariable logistic regression., Results: A total of 811 patients were identified (AKA, 325; BKA, 486). Of these, 739 patients were included in the final analysis after excluding 30-day decedents without readmission. The overall 30-day readmission rate was 28.8% (AKA 27.9%; BKA 29.4%; P = .730). Stump complications accounted for 28.6% of readmissions (16.5% of AKA; 35.8% of BKA; P = .004). Other common diagnoses included nonsurgical site infection (33.8%), exacerbation of congestive heart failure (7.0%), and diabetes-related complications (6.1%). Surgical intervention was performed on 61% of stump complications (35.9% of AKA readmitted with stump complications; 68.7% of BKA readmitted with stump complications). BKA stump complications were converted to AKAs in 34.1% of cases (3.2% of the total BKA). None of the AKA stump complications required a higher level of amputation (ie, hip disarticulation). Independent predictors of all 30-day readmission included coronary artery disease and end-stage renal disease. American Society of Anesthesiologists class 3 as compared with class 4 was protective. Independent predictors of 30-day readmission for stump complications included rest pain and BKA. Patients who underwent BKA, rest pain as an indication for amputation, and having an occluded bypass graft were predictors of having a stump complication requiring surgery., Conclusions: The 30-day readmission rate after major LEA is high, with wound infections accounting for a significant proportion of these readmissions. There was no difference in readmission rates based on level of amputation. Those undergoing BKA were more likely to present with stump complications requiring a surgical intervention, and often a higher level of amputation. Identification of high-risk patients may play a role in reducing postoperative readmissions and stump complications., (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Above-knee amputations (AKAs) and below-knee amputations (BKAs) are associated with high postoperative mortality rates. In this study, we examined factors associated with 30-day, 90-day, and 1-year mortality in patients who underwent a major lower extremity amputation., Methods: We queried a prospectively collected institutional database for all patients who underwent AKA or BKA with primary or secondary closure, during a 5-year period, between November 2009 and November 2014. Predictors of 30- and 90-day mortality were determined by multivariable logistic regression, and risk indexes for 1-year mortality were determined with Cox proportional hazards model., Results: We identified 811 patients who underwent AKA (n = 325) or BKA (n = 486). The 30-day mortality was 8.4% (AKA, 13.5%; BKA, 4.9%; P < .001) and 90-day mortality was 15.4% (AKA, 24.3%; BKA, 9.45%; P < .001). Predictors of 30-day mortality included AKA (odds ratio [OR], 3.09; 95% confidence interval [CI], 1.76-5.53), emergency operation (OR, 2.86; 95% CI, 1.56-5.14), chronic obstructive pulmonary disease (OR, 3.09; 95% CI, 1.07-7.81), end-stage renal disease (ESRD) on hemodialysis (HD; OR, 2.35; 95% CI, 1.24-4.33), and chronic kidney disease stages 3 (OR, 1.84; 95% CI, 1.00-3.37) and 4 (OR, 2.33; 95% CI, 1.01-4.98). Predictors of 90-day mortality included age (OR, 1.02; 95% CI, 1.00-1.04), ESRD on HD (OR, 2.56; 95% CI, 1.55-4.22), AKA (OR, 2.61; 95% CI, 1.70-4.05), history of coronary artery bypass grafting (OR, 2.04; 95% CI, 1.06-3.87), and medium-intensity or high-intensity statin (OR, 0.46; 95% CI, 0.29-0.73). One-year survival for the overall cohort was 73.7% (95% CI, 70.8%-76.8%). Predictors of 1-year mortality included AKA (hazard ratio [HR], 2.07; 95% CI, 1.54-2.77), coronary artery bypass grafting (HR, 1.57; 95% CI, 1.07-2.32), age >70 years (HR, 1.39; 95% CI, 1.02-1.88), gangrene (HR, 1.44; 95% CI, 1.07-1.94), ESRD on HD (HR, 1.96; 95% CI, 1.42-2.70), chronic obstructive pulmonary disease (HR, 2.54; 95% CI, 1.52-4.25), Caucasian race (HR, 1.62; 95% CI, 1.18-2.22), history of open lower extremity revascularization (HR, 0.71; 95% CI, 0.51-1.00) and undergoing bilateral amputations (HR, 2.10; 95% CI, 1.06-4.15). In the year after amputation, medium-intensity statin (HR, 0.64; 95% CI, 0.47-0.87) and high-intensity statin (HR, 0.56; 95% CI, 0.33-0.95) conferred a mortality benefit. Low-intensity statins did not confer protection from mortality. At 1 year after amputation, only 44.7% of patients were receiving appropriate statin therapy., Conclusions: AKA and BKA have historically been associated with high mortality rates. Medium-intensity and high-intensity statin therapies were associated with a mortality benefit at 1 year. We have identified initiation of statin therapy in this high-risk population as a gap in patient care., (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

We report a novel use of Artegraft (North Brunswick, NJ) bovine heterograft for carotid reconstruction after resection of a neck squamous cell carcinoma (SCC). A 65-year-old man presented with a large left neck SCC encasing and invading the cervical internal carotid artery (ICA). Computed tomography angiography revealed an incomplete Circle of Willis, and no viable vein conduit on duplex mapping. The patient underwent en bloc resection including portion of the cervical ICA followed by reconstruction with Artegraft which was well tolerated. This represents the first case report of tumor invasion of the ICA reconstructed using Artegraft as conduit., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Fall-related injuries are considered to be a leading cause of morbidity and disability worldwide. The aim of this study was to investigate the incidence of fall-related injuries and its determinants in Iran., Methods: A cross-sectional household survey of a representative sample of 15-64 years old Iranians was carried out in 2011. A three-stage cluster sampling design was used. Total of 1525 clusters were randomly selected. Six households in each cluster were randomly selected, and one member of each household was interviewed. Data on the demographics and history of fall-related injury were obtained using the previously validated and reliability tested Short Form Injury Questionnaire 7 (SFIQ7). In all, 7886 subjects responded to the survey., Results: The incidence rate of all fall-related injuries was 59 (95%CI: 45-72) per 1000 person-year. The incidence rate of First Aid Fall-Related Injuries (FAFRIs) and Medical Attended Fall-Related Injuries (MAFRIs) were 30±5 and 28±12, respectively. Homes were the most common place of falls (52.5%). For all and MAFRIs, the most common activity leading to fall injury was walking (37.8% and 47.6%, respectively) whereas for FAFRIs was playing (31.9%). For all and FAFRIs, the most common description was as follows: upper limb as the injured organ (52.0% and 61.2%, respectively) and superficial wound as the most prevalent type of injury (39.0% and 61.8%, respectively). However, for MAFRIs, lower limb injuries (52.9%) and fracture (43.6%) were more pronounced. Risk factors for MAFRI were as follows: paid work activity (OR: 3.11; 95%CI: 2.07-4.67), playing (OR: 14.64; 95%CI: 6.34-33.80), walking (OR: 57.09; 95%CI: 28.95-112.59), driving (OR: 2.86; 95%CI: 1.23-6.63), and recreation activities (OR: 44.11; 95%CI: 14.04-138.54). Higher age and education were the other risk factors for MAFRI, as well as residing in rural areas., Conclusion: This study revealed considerable incidence of fall injuries in Iranian population especially in rural regions who need access to protective equipment. People need to be warned about the constant risk of fall even during non-avoidable activities such as walking, playing, driving and paid/unpaid working especially in older ages. Implementation of fall prevention measures, home and behavioural modifications are recommended., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Breast cancer is the leading type of malignancy and the leading cause of cancer-related deaths in women worldwide. The screening programs and advances in the treatment of patients with breast cancer have led to an increase in overall survival. Cancer registry systems play an important role in providing basic data for research and the monitoring of the cancer status. In this study, the results of the 10-year national cancer registry (NCR) of Iran in breast cancer are reviewed. NCR database records were searched for primary breast cancer records according to ICD-O-3 coding and the cases were reviewed. A total of 52,068 cases were found with the coding of primary breast cancer. Females constituted 97.1% of the cases. Breast cancer was the leading type of cancer in Iranian females, accounting for 24.6% of all cancers. The mean age of the women with breast cancer was 49.6 years (95%CI 49.5-49.6). Most of the cases (95.7%) were registered as having invasive pathologies (behavior code 3). The most common morphology of primary breast cancer was invasive ductal carcinoma (ICD-O 8500/3) followed by invasive lobular carcinoma (ICD-O 8520/3) with relative frequencies of 77.8% and 5.2%, respectively. The average annual crude incidence of primary breast cancer in females was 22.6 (95%CI 22.1-23.1) per 100,000 females, with an age-standardized rate (ASR) of 27.4 (95%CI 22.5-35.9). There were no data on survival, staging or immunohistochemical marker(s) of the breast-cancer-registered cases. The incidence of breast cancer in Iran is lower than in low-middle-income neighboring countries. The NCR data registry of breast cancer is not accurate in monitoring the effect of screening programs or determining the current status of breast cancer in Iran. Screening programs of breast cancer in Iran have failed to enhance the detection of the patients with in situ lesion detection. A quality breast cancer registry and a screening program for breast cancer are both needed., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objectives: To investigate the incidence and determinants of non-fatal injuries, and the cost imposed on victims in an Iranian population aged 15-64 years., Design: Cross-sectional household survey., Methods: Three-stage probability sampling was conducted for selection of a representative sample of Iranians. Data on the demographics, history and cost of injury were obtained from face-to-face interviews and telephone calls., Results: In total, 7886 subjects were included in this study. The annual incidence rate of all injuries was 905 (95% confidence interval 853-957) per 1000 population (approximately nine injuries per ten Iranians). The mean (±standard error) incidence rates of first aid injuries (FAIs; medical care not required) and medical-attended injuries (MAIs; medical treatment sought) were 737 ± 24 and 168 ± 12 per 1000 population, respectively. Young, urban females were at highest risk for FAIs, and single males were at highest risk for MAIs. The most common injury description was as follows: non-paid work (activity), home (place), inanimate mechanical force (mechanism), upper limb (site of injury) and open wound (type of injury). For MAIs, the most common place of treatment was hospital. Traffic-related injuries had the highest total cost and the lowest out-of-pocket cost. Total and out-of-pocket costs of non-fatal injuries in Iran in 2011 have been estimated to be US$6,111,138,000 and US$1,480,411,000, respectively., Conclusion: Non-fatal injuries are an under-recognized public health problem. Cost-control policies are essential to reduce the out-of-pocket cost of injuries., (Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Chronic low-grade inflammation and oxidative stress (OS) appear to be two main pathways involved in the pathogenesis of polycystic ovary (PCO) syndrome. Therefore, targeting these pathways by means of anticytokine and antioxidant agents might be a therapeutic alternative approach to the current treatments of PCO syndrome. In this study, we investigated the protective effects of pentoxifylline (PTX), a drug with antioxidant and anti-tumor necrosis factor alpha (TNF-α) properties, in hyperandrogenism-induced PCO rats. The inflammatory and OS responses and their connections with ovarian functionality in induced PCO rats were investigated through ovarian histopathologic examination and a series of biochemical measurements including serum estradiol, progesterone, testosterone, insulin, and TNF-α, ovarian and serum lipid peroxidation, total antioxidant power, and reactive oxygen species. Experimental PCO was induced in rats by oral administration of letrozole (1 mg/kg body weight) for 21 consecutive days. In a different group, PTX was administrated orally (50 mg/kg/d) for 21 days simultaneous with letrozole to assess its potential protective effects. The letrozole-induced PCOs were characterized by irregular cycles, high incidence of subcapsular ovarian cysts with diminished or scant granulosa cell layers, increased number of atretic preantral and antral follicles, and absence of CL. In addition, the letrozole-induced PCO rats exhibited notable increase in lipid peroxidation and reactive oxygen species of serum and ovary, serum testosterone, insulin, and TNF-α and significant decline in total antioxidant power, serum estradiol, and serum progesterone. Our results indicated that all the identified pathologic parameters and biochemical characteristics in letrozole-induced PCO rats in this study were preserved close to normal levels by simultaneous PTX treatments. Present results demonstrate that there is a direct connection between ovarian dysfunction and increased OS and inflammation in PCO. For the first time, the beneficial effects of PTX as a powerful antioxidant and TNF-α blocker in hyperandrogenism-induced PCO are reported., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This article presents a new and sensitive method for the determination of trace amounts of fungicide carbendazim by dispersive liquid-liquid microextraction (DLLME) combined with UV-vis spectrophotometry. The method is based on the reduction of Fe(III) to Fe(II) by carbendazim, its reaction with potassium ferricynide to form a blue product and extraction into CCL4 by DLLME technique using methyltrioctylammonium chloride (Aliquat 336) as a disperser agent. Under the established optimum conditions, the calibration graph was linear in the range of 5-600 ng mL(-1) of carbendazim with a limit of detection of 2.1 ng mL(-1). The relative standard deviations for eight replicate determinations of 50 and 300 ng mL(-1) of carbendazim were 3.9% and 1.0%, respectively. The proposed method was successfully applied to determination of carbendazim in soil and water samples., (Copyright © 2014 Elsevier B.V. All rights reserved.)

A highly selective optical sensor for Fe (II) ions was developed based on entrapment of a sensitive reagent, 2,4,6-tri(2-pyridyl)-s-triazine (TPTZ), in a silica sol-gel thin film coated on a glass substrate. The thin films fabricated based on tetraethoxysilane (TEOS) as precursor, sol-gel pH∼3, water:alkoxyde ratio of 4:1 and TPTZ concentration of 0.112 mol L(-1). The influence of sol-gel parameters on sensing behavior of the fabricated sensor was also investigated. The fabricated sensor can be used for determination of Fe (II) ion with an outstanding high selectivity over a dynamic range of 5-115 ng mL(-1) and a detection limit of 1.68 ng mL(-1). It also showed reproducible results with relative standard deviation of 3.5% and 1.27% for 10 and 90 ng mL(-1) of Fe (II), respectively, along with a fast response time of ∼120 s. Total iron also was determined after reduction of Fe (III) to Fe (II) using ascorbic acid as reducing agent. Then, the concentration of Fe (III) was calculated by subtracting the concentration of Fe (II) from the total iron concentration. Interference studies showed a good selectivity for Fe (II) with trapping TPTZ into sol-gel matrix and appropriately adjusting the structure of doped sol-gel. The sensor was compared with other sensors and was applied to determine iron in different water samples with good results., (Copyright © 2014 Elsevier B.V. All rights reserved.)