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Background: The increasing prevalence and occurrence of type 2 diabetes has made it a widespread epidemic. Being the first line of care, family doctors can play an essential role in this field. The knowledge of these doctors about how to deal with the prevention, diagnosis, and correct treatment of patients is fundamental in reducing the burden of this disease in the community. In this study, we decided to evaluate the knowledge and practice of family doctors in Shiraz-Iran and its related factors in managing Diabetes., Method: This analytical cross-sectional study was conducted among family doctors of two primary healthcare centers, Shahadai Wal-Fajr Health Center and the Enghlab Health Center in Shiraz, Iran, from March 2021 to August 2021. A researcher-designed diabetes questionnaire consisting of 21 items and a data collection form including demographic information and other related factors was used in this study. An interviewer asked the questions from participants at their workplace and completed the questionnaires. The data were analyzed by SPSS-20 software. A linear regression test was used to investigate the factors affecting the questionnaire score. A one-way ANOVA test was used to compare questionnaire scores among multiple groups., Results: On average, the participants obtained 62.5% of the total score. The average scores for each question in the screening, the diagnosis, and the treatment sections were 0.5 ± 0.28, 0.65 ± 0.2, and 0.66 ± 0.17, respectively. Physicians' knowledge about the blood sugar threshold for diagnosing Diabetes was suboptimal, and 81.9, 47, 43 correctly mentioned the FBS, 2hrpp BS, and HbA1c threshold, respectively. Although 95% knew the first line medication but 33.6% prescribed 2nd or 3rd medication for DM treatment. Only 43% knew the goal of therapy. Sixty-three doctors (42%) have not registered any referrals for newly diagnosed uncomplicated diabetic patients, and 37.6% referred these new DM cases to an internist or endocrinologist at the first visit. Microvascular complication screening, such as testing for microalbuminuria and ophthalmologist consultation reported by 32. 89% and 8% of physicians, respectively. Years since graduation was the determining factor of the knowledge level of doctors in this study. Regarding the preferred education method, most participants selected the workshop method as the preferred training method. Virtual education was ranked as the second preferred educational method., Conclusion: The knowledge and practice of general family doctors were lower than the optimal level in diabetes screening, diagnosis, and treatment. In the treatment of patients, the knowledge of most of the physicians was appropriate in the early stages of treatment, such as determining the time to start the medication and the first line of treatment, but in the follow-up and more advanced treatment, the knowledge and performance of the doctors were less than expected. They prefer to refer patients to higher levels in the healthcare system. Recently graduated physicians had better knowledge and approach to DM management. Therefore, effective periodic training should be conducted as soon as possible to address this pitfall and improve the quality of care. Workshops and virtual education were the most preferred education methods from the participants' points of view. So, it is suggested that these methods be used as the first training methods. Implementing the specialty training program for family medicine (which has been started in our country for a few years) is the best final solution. In addition, A clinical guideline should be designed for family physicians highlighting these physicians' roles in the management of Diabetes., (© 2023. The Author(s).)

Implant-based reconstruction is the most common method of breast reconstruction. Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding. The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options. Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: The rate of seat belt use in rural societies is less than in urban societies. The present study aimed to determine the effect of demographic and traffic-related variables on seat belt use among rural non-drivers based on the theory of planned behavior (TPB)., Methods: This study was conducted among 450 non-drivers in the rural areas of Hashtroud district in Iran. For collection of data, a questionnaire containing questions about demographic characteristics and general information on traffic-related behaviors of non-drivers, and questions on seat belt use based on constructs of the TPB was used., Results: The lowest seat belt use rate was for non-drivers that sit in the rear seat of a car on rural roads (22.4 % never, 14.4 % always). Also, the rate of seat belt use among parents of participants on rural roads was lower than on city roads. Adherence to traffic rules and having training about seat belt use had significant effects on the construct of TPB, including attitude, subjective norms, perceived behavioral control, behavioral intention, and behavior of seat belt use. With increasing age, subjective norms about seat belt use have improved. The attitude toward seat belt use among females was better than males., Conclusions: The result indicated that most of rural non-drivers did not adhere to traffic rules. Adherence to the traffic rules and having training on seat belt use had a significant impact on seat belt use behavior. Training seat belt use especially by parents could be effective in improving seat belt use.

Background: The high prevalence of diabetes and the importance of long-term follow-up of these patients encourage finding an inexpensive and applicable educational method to control the disease. Distance education based on mobile technology and Short message service (SMS) can be an effective way to manage this disease by eliminating time and place limitations. Due to the world's high penetration rate, SMS is one of the best ways to transfer information and health education., Objective: This study aimed to compare the effect of SMS- and group-based education in managing diabetes type 2 and compare them with a control group., Method: A total of 168 patients with diabetes type 2 under the coverage of three family physician clinics were randomly allocated into three groups. The education was conducted in 12 one-hour sessions once a week in the group-based arm, and a daily short message was sent to the participants in the SMS group. The control group also underwent routine care at the family physician clinic. The duration of the education was 3 months. At baseline and 3 months later, fasting blood sugar (FBS), 2 hours postprandial sugar (2hppBS), and HBA1c, as well as diabetes self-management questionnaire score (DSMQ), were measured., Results: The comparison of the three groups in terms of changes in FBS (P-value: 0.001), 2hppBS (8 P-value: < 0.001) and HbA1c (P-value: < 0.001) were significantly different after 3 months. In pairwise analysis, 2hppBS was the only significantly different parameter between the group- and SMS-based education (P-value: 0.035)., Conclusion: Although the effect of both educational methods via SMS or group education was better than the control group in controlling diabetes, these two methods were not statistically different. Due to spending a lot of time and money on group-based education, it is better to replace it with education by SMS., (© 2022. The Author(s).)

Objective: Blunt abdominal aortic injury in children is a rare clinical entity with which most vascular surgeons have minimal experience. The evidence for management recommendations is limited. We have reported a single institution's experience in the care of pediatric abdominal aortic injuries., Methods: We performed a retrospective review of consecutive pediatric patients who had been diagnosed with blunt traumatic abdominal aortic injury at our institution from 2008 to 2019., Results: A total of 16 pediatric patients (50% male) were identified. They ranged in age from 4 to 17 years. All had been involved in motor vehicle collisions and had been restrained passengers with a seatbelt in use. Five patients (31%) were hypotensive en route or on arrival. Seven patients (44%) had been transferred from another hospital. The median injury severity score was 34 (interquartile range, 19-35). The infrarenal aortic injuries were stratified using the aortic injury grading classification (five, two, seven, and two with grade 1, 2, 3, and 4, respectively). Concurrent nonaortic injuries included solid organ (63%; n = 10), hollow viscus (88%; n = 14), brain (25%; n = 4), hemothorax or pneumothorax (25%; n = 4), spine fractures (81%; n = 13), and nonspine fractures (75%; n = 12). Of the 16 patients, 9 (56%) had required aortic repair. Three had required immediate revascularization for distal ischemia. The remaining six patients (38%) had undergone delayed repair, with a median interval to repair of 52 days (range, 2-916 days). One half of the delayed repairs were performed during the index hospitalization. On repeat axial imaging, the three patients who had undergone delayed repair were found to have enlarging pseudoaneurysms or flow-limiting dissections and had subsequently undergone repair during the index hospitalization. Only one patient had undergone endovascular repair. No deaths occurred, and the median follow-up was 7 months (interquartile range, 3-28 months) for our study population. All postoperative patients demonstrated stable imaging findings without requiring further intervention. Seven patients, whose injury grades had ranged from 1 to 3, were observed. Their repeat imaging studies demonstrated either stability or resolution of their aortic injury. However, one half of the patients had been lost to follow-up after discharge or after their first postoperative clinic visit., Conclusions: Delayed aortic intervention can be safely performed for most pediatric patients with blunt abdominal aortic injuries with preserved distal perfusion to the lower extremities. This finding suggests that transfer to a tertiary center with vascular expertise is a safe and feasible management strategy. However, the progression of aortic injuries was seen as early as within 48 hours and as late as 30 months after injury, underscoring the importance of long-term surveillance. However, in our cohort, 50% of the children were lost to follow-up, highlighting the need for a more structured surveillance strategy., (Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Upper extremity (UE) access is frequently used for fenestrated-branched endovascular aortic aneurysm repair (F-BEVAR), particularly for complex repairs. Traditionally, left-side UE access has been used to avoid crossing the arch and the origin of the supra-aortic vessels, which could potentially result in cerebral embolization and an increased risk of perioperative cerebrovascular events. More recently, right UE has been more frequently used as it is more convenient and ergonomic. The purpose of this study was to assess the outcomes and cerebrovascular events after F-BEVAR with the use of right- vs left-side UE access., Methods: During an 8-year period, 453 patients (71% male) underwent F-BEVAR at a single institution. UE access was used in more complex repairs. Left UE access was favored in the past, whereas right UE access is currently the preferred UE access side. Brachial artery cutdown was used in all patients for the placement of a 12F sheath. Outcomes were compared between patients undergoing right vs left UE access. End points included cerebrovascular events, perioperative mortality, technical success, and local access-related complications., Results: UE access was used in 361 (80%) patients. The right side was used in 232 (64%) and the left side in 129 (36%) patients for the treatment of 88 (25%) juxtarenal, 135 (38%) suprarenal, and 137 (38%) thoracoabdominal aortic aneurysms. Most procedures were elective (94%). Technical success was achieved in 354 patients (98%). In-patient or 30-day mortality was 3.3%. Five (1%) perioperative strokes occurred in patients undergoing right UE access, of which three were ischemic and two were hemorrhagic. No transient ischemic attacks occurred perioperatively. Two hemorrhagic strokes were associated with permissive hypertension to prevent spinal cord ischemia. No perioperative strokes occurred in patients undergoing left UE access (P = .16). Overall, perioperative strokes occurred with similar frequency in patients undergoing UE (5, 1%) and femoral access only (1, 1%) (P = .99). Arm access-related complications occurred in 15 (5%) patients, 11 (4.8%) on the right side and 4 (6%) on the left side (P = .74)., Conclusions: Right UE access can be used for F-BEVAR with low morbidity and minimal risk of perioperative ischemic stroke or transient ischemic attacks. In general, UE access is not associated with an increased risk of perioperative stroke compared with femoral access only. Tight blood pressure control is, however, critical to avoid intracranial bleeding related to uncontrolled hypertension., (Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Road Traffic Injuries (RTIs) are the important causes of unintentional injuries and deaths. In this respect, seat belt wearing is an influential factor in reducing the mortality and severity of road traffic injuries. The rate of seat belt use among is lower adolescents, compared to adults. The present study aimed to investigate the influential factors on seat belt-weraing behavior among adolescent students as car occupants based on the Theory of Planned Behavior (TPB)., Study Design:   A cross-sectional design., Methods: This study was conducted among 952 adolescent students studying in grades 7, 8, and 9 in the schools of Tabriz, Iran, in the 2019-20 academic year. A researcher-made questionnaire was designed based on TPB for data collection, the validity and reliability of which have been confirmed., Results: The results indicated that the rate of seat belt use in the front seat inside the city was lower than that outside the city. Regarding TPB constructs, perceived behavioral control (β=0.137; 95% CI: 0.006-0.013; P<0.001), subjective norm (β=0.313; 95% CI: 0.021-0.032; P<0.001), and attitude (β=0.322; 95% CI: 0.034-0.053; P<0.001) had a significant and positive relationship with the intention of seat belt-wearing behavior. Moreover, the behavioral intention (β=0.571; 95% CI: 0.62-0.64; P<0.001) had a significantly positive relationship with seat belt-wearing behavior., Conclusion: The Theory of Planned Behavior is appropriate to determine predictor factors of seat belt-weraing behavior among adolescent students as car occupants. In addition, the results of the present study may provide a theoretical basis for policy-making to improve adolescent students' seat belt use.

Objective: Target artery stenosis might affect the outcomes of fenestrated/branched endovascular aortic aneurysm repair (F-BEVAR). The aim of the present study was to assess the effects of preoperative stenosis of the celiac artery (CA) and superior mesenteric artery (SMA) on the target artery outcomes after F-BEVAR., Methods: During a 4-year period, 287 consecutive patients, 204 men (71%) and 83 women (29%), had undergone F-BEVAR using fenestrated (83%), fenestrated-branched (4.5%), branched (3.5%), and off-the-shelf t-Branch (9%) devices (Cook Medical Inc, Bloomington, Ind). Preoperative SMA and CA significant stenosis was defined as a computed tomography angiography-based intraluminal diameter reduction >50%. The primary endpoints included primary patency, freedom from target vessel instability, and patient survival., Results: The median patient age was 71 years (interquartile range, 67-77 years). Suprarenal (36%), juxtarenal (25%), and thoracoabdominal (39%) aortic aneurysms were treated. The technical success rate was 99%. The 30-day survival was 97%. Among 981 stented vessels, 179 (18%) were CAs and 270 (27.5%) were SMAs. Significant preoperative CA stenosis was identified in 39 patients (22%) and SMA stenosis in 24 (9%). The median follow-up was 29.9 months. The primary patency rates at 12, 36, and 60 months were 98%, 92%, and 92% for the CA and 99%, 98%, and 98% for the SMA, respectively. Primary patency was significantly lower in the patients with previous significant CA stenosis than in those without stenosis (83%, 83%, and 76% vs 100%, 100%, and 97% at 12, 36, and 60 months, respectively; P < .01). Freedom from celiac branch instability was also significantly lower among patients with significant stenosis (84%, 84%, and 76% vs 100%, 93%, and 93% at 12, 36, and 60 months; P < .01). The presence of significant SMA stenosis did not affect either primary patency or freedom from target vessel instability. The survival rates at 12, 36, and 60 months were significantly lower for the patients with CA stenosis than for those without stenosis (67%, 61%, and 55% vs 90%, 84%, and 82%, respectively; P < .01). Similarly, lower survival rates were observed for patients with significant SMA stenosis (70%, 60%, and 60% vs 87%, 79%, and 78% at 12, 36, and 60 months, respectively; P = .04)., Conclusions: F-BEVAR was associated with overall primary patency rates >90% for the CA and SMA. Preoperative CA stenosis was associated with lower primary patency and freedom from target vessel instability. In contrast, neither SMA branch primary patency nor freedom from target vessel instability were affected by preoperative SMA stenosis. We found visceral artery stenosis was a marker of atherosclerosis burden associated with reduced mid- and long-term patient survival., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: This study analyzes the therapeutic effects of intravenous infusion of iloprost in wound healing, healing of the amputation stump wound, improvement in intermittent claudication and prevention of major amputation in patients with Buerger's disease., Methods: In a prospective study, 19 patients with known Buerger's disease, received intravenous iloprost infusion, 6 hours per day for 10 days. Iloprost with a dose of 0.5-2 ng/kg/min according to the patients' tolerance and using cardiac monitoring during the whole infusion period was administered for 6 hours/day using saline solution. Patients with larger wounds underwent simultaneous transmetatarsal or Ray amputation of the involved toe(s). All patients were discharged after 10 days. Patients were followed to detect their healing changes., Results: Nineteen patients, 19-55 years old received 0.5-2 ng/kg/min iloprost intravenously for 6 hours/day for 10 days. During this period, there was relative improvement in resting pain, but no significant amelioration was noticed in wound healing. In a 2 years follow-up, 14 patients showed a complete healing of the amputation stump and increased distance of walking without any pain. Some previous candidates of major amputation did not need amputation anymore. Five patients (26%) did not respond to therapy., Conclusion: Although Buerger's disease patients who were under iloprost therapy, may not show significant changes in wound healing during treatment and at discharge, late results have proved that iloprost infusion is promising in improving wound healing and claudication and preventing major amputations.

Estrogen receptor α (ERα) upregulation causes abnormal cell proliferation in about two thirds of breast cancers, yet understanding of the underlying mechanisms remains incomplete. Here, we show that high expression of the microRNA miR-375 in ERα-positive breast cell lines is a key driver of their proliferation. miR-375 overexpression was caused by loss of epigenetic marks including H3K9me2 and local DNA hypomethylation, dissociation of the transcriptional repressor CTCF from the miR-375 promoter, and interactions of ERα with regulatory regions of miR-375. Inhibiting miR-375 in ERα-positive MCF-7 cells resulted in reduced ERα activation and cell proliferation. A combination of expression profiling from tumor samples and miRNA target prediction identified RASD1 as a potential miR-375 target. Mechanistic investigations revealed that miR-375 regulates RASD1 by targeting the 3' untranslated region in RASD1 mRNA. Additionally, we found that RASD1 negatively regulates ERα expression. Our findings define a forward feedback pathway in control of ERα expression, highlighting new strategies to treat ERα-positive invasive breast tumors., (Copyright © 2010 AACR.)