Search

Road traffic injuries (RTIs) are a significant cause of death and disability among young people worldwide. Programs that use injury prevention strategies have been shown to effectively reduce the number of injuries. This systematic review aims to present the available evidence on the effectiveness of intervention programs in preventing RTIs among adolescents and young adults. Articles were identified and retrieved from databases including PubMed, Embase, Web of Science, Scopus, Science Direct, Magiran, SID, and Iran Medex. Two reviewers independently screened the articles. Articles published from the first year of publication until January 2018 that met the eligibility criteria were included in the review. These articles covered randomized controlled trials, pretest/post-test interventions, and controlled pretest/post-test interventions aimed at reducing RTIs among adolescents and young people aged 12-26 years. The framework, provided by Murphy and Haddon, were used to categorize the interventions. According to this framework, the interventions were categorized into five groups including education/behavior change, incentive, engineering/technology, legislation/enforcement, and multifaceted programs. The methodological quality of the studies was assessed using the Effective Public Health Practice Project. Of the initial 3165 findings, 13 studies met the inclusion criteria. Eleven of these studies used educational/behavioral approaches, while two employed multifaceted programs. In the educational/behavioral approach, participants' behaviors were considered as outcome variables. Only one of these studies was not successful. Multifaceted interventions were successful in changing behaviors. No studies were found on the effectiveness of other interventions. Eight studies were assessed as having moderate quality. The systematic review shows that educational/behavioral strategies and multifaceted programs are effective in reducing RTIs among young adults and adolescents. However, there is a lack of studies on other potential interventions. The quality of the included studies was moderate, suggesting a need for more rigorous research.

Background: Health care workers (HCWs) in hospitals are at risk of infection with coronavirus disease 2019 (COVID-19). Prevention measures are necessary to protect HCWs against COVID-19., Objective: This study aimed to determine the status of occupational risk factors and prevention measures for COVID-19 in hospitals., Methods: This cross-sectional study was conducted in Iranian hospitals. Based on the results of reviewing the literature and guidelines, two checklists on occupational risk factors and prevention measures for COVID-19 in hospitals were designed and validated. The status of occupational risk factors and prevention measures against COVID-19 in governmental, non-governmental public, private, and military hospitals were determined using designed checklists., Results: Results confirmed the validity of checklists for assessing the status of COVID-19 prevention measures in hospitals. The military hospitals had the lowest mean risk factors compared to other hospitals, but there was no significant difference in occupational risk factors of infection with COVID-19 among governmental, non-governmental public, private, and military hospitals (P-value > 0.05). In the checklist of occupational risk factors of Covid-19, the type of hospital had a significant relationship with the provision and use of personal protective equipment (P-value<0.05). The mean of implementation of prevention measures among all hospitals were not statistically significant difference (P-value > 0.05)., Conclusion: The provided checklists could be a suitable tool for monitoring of status of prevention measures for COVID-19 in hospitals. Improving ventilation systems is necessary in most of the hospitals.

Background and Aim: Regenerative endodontic procedures (REPs) are oriented by the principles of tissue engineering, incorporating dental pulp stem cells (DPSC), crucial growth factors like Transforming growth factor-β (TGF-β1), and scaffolds to facilitate the regeneration of dental pulp tissues. The present study aimed to investigate the effect of photobiomodulation (PBM) therapy, using an 808 nm diode laser on cellular modulation mechanisms in REPs., Method and Material: A total of 108 human dentin discs obtained from intact single root teeth were randomly assigned into six groups (n = 8): 1. Positive control (EDTA), 2. PBM-1 (3 J/cm 2 ), 3. PBM-2 (5 J/cm 2 ), 4. EDTA+PBM-1, 5. EDTA+PBM-2, and 6. Negative control (NaOCl). Then, an extract solution was prepared from each disc and the concentration of released TGF-β1 from the discs was measured using enzyme-linked immunosorbent assay (ELISA). Moreover, the extract solution was added to DPSC culture medium to evaluate cell viability and migration through MTT assay and scratch test, respectively., Result: The group exposed to PBM-1 showed the highest cell viability, while treatment with EDTA and EDTA+PBM-2 decreased cellular viability. Also, the PBM-treated groups showed significantly higher release of TGF-β1 compared to the negative control. EDTA and EDTA+PBM-1 showed the highest release among all the groups. No significant difference was found between EDTA and EDTA+PBM-1, as well as between PBM-1 and PBM-2. Moreover, the PBM-1 group exhibited the highest migration after 24 h, which was significantly greater than other groups, except for the PBM-2 group., Conclusion: According to the obtained data, 808 nm mediated-PBM (3 J/cm2), both independently and in conjunction with EDTA, enhanced the release of TGF-β1 from dentin and improved cell viability and migration of DPSCs. It seems that, PBM under the specific parameters employed in this study, could be an effective adjunctive therapy in REPs., Competing Interests: Declaration of Competing Interest It was declared that no conflicts of interest exist about the publication of this paper., (Copyright © 2023. Published by Elsevier B.V.)

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).)

Background: Inadvertent supra-aortic arterial injuries during central venous catheterization can lead to devastating outcomes. These have been traditionally been managed with open repair or covered stent placement; only recently have percutaneous closure been incorporated into the management of these iatrogenic arterial injuries., Methods: We performed a MEDLINE literature search in the English language, using the PubMed web-based search engine across years 2000 to 2020. This report reviews 34 published case reports and series reporting 71 iatrogenic supra-aortic arterial injuries managed with percutaneous vascular closure devices., Results: In our review, the use of a closure device was successful in 87% of cases, even in some cases involving sheath sizes greater than 8F. The devices used in these situations caused minimal complications and offered a quick means to control bleeding. Thus, percutaneous closure devices are a helpful tool that offers an alternative to more invasive open surgical repair., Conclusions: Vascular closure devices offer a minimally invasive and effective approach to the treatment of inadvertent supra-aortic arterial injury following CVC., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Root perforation is an adverse event that may accidentally occur during root canal treatment and can adversely affect the treatment plan and tooth prognosis. This study aimed to assess the accuracy of cone beam computed tomography (CBCT) for detecting the strip and furcal perforations with different sizes., Methods: The mesiolingual canals of 155 extracted human mandibular first molars were instrumented and randomly divided into four experimental groups and one control group (n = 31). Furcal (in the pulp chamber floor) and strip perforations with 0.5, 1, 1.5, and 2 mm in diameter were manually created. The teeth were randomly mounted in bovine ribs and scanned using CBCT. Two radiologists unaware of the study groups observed the images and reported the greatest perforation diameter. The inter-observer agreements were calculated. The diagnostic accuracy was compared for furcal and strip perforations with different sizes., Results: The inter-observer agreement for detecting furcal and strip perforations with different sizes were good. The diagnostic accuracy was 100% for the absence of perforation in each group., Conclusions: CBCT can detect the absence of perforation with high accuracy. The diagnostic accuracy of CBCT in the presence of strip and furcal perforation with different sizes was not significant., (© 2023. The Author(s) under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology.)

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.

Introduction: Approximately one-third of surgical patients exhibit low health literacy, and 39% of our patients are primary Spanish speakers. We first evaluated the current content of our arteriovenous fistula/graft discharge instruction (DCI) templates. Using the Plan-Do-Study-Act cycle quality improvement methodology, we then aimed to optimize the readability and formally translate new DCI and evaluate usage and inappropriate bouncebacks following implementation., Methods: Current arteriovenous fistula/graft template content was reviewed by the literacy department for readability and vascular faculty for completeness and accuracy. The literacy department edits were categorized by word choice, added/removed content, format change, and grammatical errors. Two vascular surgeons rated completeness and accuracy on a Likert scale (1-5). Retrospective chart review was performed for telephone calls and emergency department bouncebacks for 3 mo flanking new DCI implementation., Results: Of the 10 templates, all were in English and word count ranged from 192 to 990 words. Despite each template including all necessary subcategories, the median number of edits per 100 words was 9.2 [7.0-9.5]. Approximately half of the edits (5.4 [5.1-5.5]) were word choice edits. Overall, experts rated completeness at 3.9 [3.2-4.2] and accuracy at 4.0 [3.7-4.1]. Highest template utilization occurred during post-implementation months 1 (90%) and 3 (100%) with orientation sessions. There was a significant increase in concordant Spanish DCI use (P < 0.01) and no inappropriate bouncebacks after implementation., Conclusions: Our study demonstrated notable variability in the content and readability of our vascular access instruction templates. New DCI had strong usage and language concordance; continued use may decrease bouncebacks., (Copyright © 2022 Elsevier Inc. All rights reserved.)

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.)

The aim of this meta-analysis was to investigate whether the blood concentrations of patients with multiple sclerosis (MS) are associated with those of the healthy control group in terms of trace elements including zinc (Zn), iron (Fe), manganese (Mn), magnesium (Mg), selenium (Se), and copper (Cu). A comprehensive search was performed in online databases including PubMed, Scopus, Embase, and Web of Science for studies, which have addressed trace elements in MS up to July 23, 2020. The chi-square test and I 2 statistic were utilized to evaluate inter-study heterogeneity across the included studies. Weighted mean differences (WMDs) and corresponding 95% CI were considered as a pooled effect size (ES). Twenty-seven articles (or 32 studies) with a total sample comprised of 2895 participants (MS patients (n = 1567) and controls (n = 1328)) were included. Pooled results using random-effects model indicated that the levels of Zn (WMD = - 7.83 mcg/dl, 95% CI = - 12.78 to - 2.87, Z = 3.09, P = 0.002), and Fe (WMD = - 13.66 mcg/dl, 95% CI = - 23.13 to - 4.19, Z = 2.83, P = 0.005) were significantly lower in MS patients than in controls. However, it was found that levels of Mn (WMD = 0.03 mcg/dl, 95% CI = 0.01 to 0.04, Z = 2.89, P = 0.004) were significantly higher in MS patients. Yet, no significant differences were observed in the levels of Mg, Se, and Cu between both groups. This meta-analysis revealed that the circulating levels of Zn and Fe were significantly lower in MS patients and that Mn level was significantly higher than those in the control group. However, it was found that there was no significant difference between MS patients and controls with regard to levels of Mg, Se, and Cu., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

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.

Background: Spinal drains are used to ameliorate spinal cord ischemia (SCI), but their use may result in inherent morbidity and mortality. Although prophylactic spinal drain has proven of benefit in open repairs, that is not the case for endovascular repairs. The aim of this study was to assess the outcomes of spinal cord protection with and without the routine use of spinal drains during fenestrated-branched endovascular repair (F-BEVAR)., Methods: A retrospective single center study was performed using a prospectively maintained dataset of all patients undergoing F-BEVAR over a 4-year period. The primary endpoint of the study was the frequency of SCI. Prophylactic spinal drain was placed pre-operatively in 33 patients (23%) with a median time for removal of 3 days (IQR, 2-3 days). Routine intraoperative neuromonitoring was used. Spinal cord protection relied primarily on maintaining a perioperative systolic blood pressure between 140 and 160 mm Hg or a mean arterial pressure >90 mm Hg, avoiding hypotension, preservation of as many collateral beds as possible, staged repairs and early lower extremity reperfusion based on neuromonitoring., Results: A total of 145 patients, 104 men (71%) and 41 women (28%) with a median age of 70 years (interquartile range [IQR], 53-62) underwent F-BEVAR. Branched custom-made devices (CMDs) (11%), fenestrated CMDs (70%) and off-the-shelf T-Branch device (17%) were used with a median number of branches/fenestrations of 4 (IQR, 3-4). SVS classification of implantation zones were determined as follows: 9 (6%) zone 2, 21 (20%) zone 3, 26 (18%) zone 4 and 89 (61%) zone 5. SCI was present in 8 patients (5.5%) and classified according to the SVS SCI grading system as follows: 1 grade 1, 5 grade 2 and 2 grade 3a. When evaluating implantation zone independently of coverage length and patency of collateral beds, a high implantation zone (1-4) was not associated with SCI (P = 0.9). Similarly, prophylactic spinal drain did not demonstrate association with the occurrence of SCI (3[9%] vs. 5[4%], with and without spinal drain, respectively) (P = 0.3). For patients with high implantation zones, staged repair was performed in 38 patients (26%) at a median time of 2 months (IQR, 2-6 months). Among these patients, the frequency of SCI was 13%. Staged repair was associated with an 80% reduction in the frequency of SCI (OR, 0.19 [95% CI, 0.04-0.084]) (P = 0.02)., Conclusion: F-BEVAR can be performed with a minimal risk of SCI without the need for routine prophylactic spinal drains. High implantation zones did not predict SCI after F-BEVAR; however, staged repair significantly decreased the risk of SCI after F-BEVAR., (Copyright © 2021 Elsevier Inc. All rights reserved.)

This meta-analysis was conducted aiming to summarize the results obtained from the previous studies so that the effect of opium on blood lead levels (BLLs) can be investigated. Scopus, Embase, PubMed, and Web of Science (ISI) were systematically searched up to June 2020. Heterogeneity of the included studies was evaluated using Cochrane's Q test and the I 2 statistic. A random-effects model was used to pool the weighted mean differences (WMDs) and their 95% confidence intervals (CIs). Out of a total of 2372 citations, eleven articles with 916 participants (487 opium addicts and 429 controls) were included in the study. The meta-analysis results showed that there were higher lead levels (WMD = 14.59 μg/dL, 95% CI = 11.59 to 17.92, Z = 8.60, P < 0.001) in opium addicts than in the control group. The degree of heterogeneity observed (P < 0.001, I 2 = 98.1%) might be mainly the result of the type of sampling and of consumption. Moreover, the findings of meta-regression analyses indicated that publication year (β = 1.23, P = 0.287), total sample size (β = 0.05, P = 0.728), and quality scores (β = - 2.91, P = 0.546) had no effects on lead levels in opium addicts. In the sensitivity analysis, it was found that the pooled WMDs remained stable after excluding one by one study. Oral opium consumption increased the amount of lead in the bloodstream, and the measurement of lead levels in opium addicts' blood may be regarded as a useful test to diagnosis and prognosis of disorders that may lead poisoning causes., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

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.)

Purpose: To describe a sequential deployment technique of the Zenith® t-Branch™ device for branched endovascular aortic aneurysm repair that might reduce potential rotation and increases optimal positioning of the device., Technique: After obtaining bilateral groin and right brachial access, the device is advanced over a through-and-through brachio-femoral guidewire and positioned based on prior measurements and landmarks. The t-Branch device is deployed one branch at a time and each visceral branch is sequentially catheterized from brachial access using live CT-fusion and intravascular ultrasound guidance. Full deployment prior to branch catheterization is avoided to maintain device stability, reduced spontaneous rotation, wider working room and freedom in positioning of the device while target artery catheterization is secured., Conclusion: Sequential catheterization amid progressive deployment of the Zenith® t-Branch™ device is an effective method of deployment of the device that ensures optimal positioning and secured catheterization of the target vessels.

Background: Exposure to the coronavirus (COVID-19) in industrial workplaces has caused concerns all over the world. Implementation of prevention measures is the best solution for protection of workers' health., Objective: The present study investigated prevention measures and risk factors for the COVID-19 infection in Iranian small, medium, and large industries., Methods: This study was conducted on 349 occupational health, safety, and environment professionals working in different industries. Data was collected using a checklist of prevention measures for COVID-19 and a questionnaire of risk factors for the infection., Results: The results demonstrated that 32.60% of industries reported positive cases of COVID-19. The mean of prevention measures in all the dimensions, except use of personal protective equipment (PPE), was in favorable status. Among prevention measures against COVID-19, the dimensions of education, engineering controls, use of PPE, use of hand washing soap and disinfectant, and physical distance were not significantly different among small, medium, and large industries. However, administrative controls were statistically lower in small and medium industries compared to the large industries. Moreover, screening was statistically lower in small industries than in large industries. The mean risk factors of ventilation, use of common tools and equipment, and physical distance as well as total risk factors were not statistically different among different industries., Conclusion: Workers are at risk of COVID-19 infection. The risk factors of ventilation, sharing tools and equipment, and physical distance are critical in classification of risk of infection with COVID-19 in industrial settings.

We present a rare case of a 10-cm right subclavian artery pseudoaneurysm, with slow growth over 4 years after a traumatic fracture of the right clavicle. The patient had multiple prior endovascular attempts of embolization and stenting at other hospitals; despite this the pseudoaneurysm continued to grow and caused mass effect and neurologic symptoms. We present our open approach for the repair and a review of literature.

Background: About 50% of obsessive-compulsive disorder patients still suffer significant symptoms even after the recommended first-line therapy. This demonstrates the necessity to investigate strategies to improve alleviation of symptoms., Objective: The main objective of this study was to investigate the efficacy of a 5-hydroxytryptophan 3 receptor antagonist, tropisetron, as an adjuvant therapy to selective serotonin reuptake inhibitors, in ameliorating obsessive-compulsive disorder symptoms., Methods: Men and women between the ages of 18-60 years diagnosed with obsessive-compulsive disorder, based on DSM5, who had a Yale-Brown obsessive compulsive scale score of more than 21 were recruited in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either tropisetron (5 mg twice daily) and fluvoxamine (100 mg daily initially followed by 200 mg daily after week 4) or placebo and fluvoxamine. The primary outcome of interest in this study was the Yale-Brown obsessive compulsive scale total score decrease from baseline., Results: One hundred and eight participants were equally randomized into two groups; 48 participants in each group finished the trial. The Yale-Brown obsessive compulsive total score significantly dropped in both groups while the tropisetron group participants experienced a significantly higher decrease in their scores (Greenhouse-Geisser F (1.53-65.87)=3.516, p -value=0.04). No major adverse effect was observed in any of the groups., Conclusion: This trial showed a significant efficacy for tropisetron over placebo in treatment of obsessive-compulsive disorder symptoms when added to fluvoxamine.

We report a case of saphenous vein bypass aneurysm and arteriovenous fistula in a 65-year-old man, 20 years after an in situ vein bypass for occlusive disease. He was found to have patent venous branches which kept the bypass open despite distal anastomotic occlusion. The saphenous vein was successfully excised without distal revascularization due to sufficient native arterial flow. This is the first reported case of aneurysmal degeneration of an in situ vein conduit with occluded distal anastomosis and patent venous side branches. Ultrasound surveillance is warranted for all bypass procedures, and early endovascular or open revisions can prevent late complications., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Experimental studies provide evidence for antidepressant effects of Palmitoylethanolamide (PEA) in animal models of depression. We aimed to evaluate the efficacy and tolerability of PEA add-on therapy in treatment of patients with major depressive disorder (MDD)., Methods: In a randomized double-blind, and placebo-controlled study, 58 patients with MDD (DSM-5) and Hamilton Depression Rating Scale (HAM-D) score ≥ 19 were randomized to receive either 600 mg twice daily Palmitoylethanolamide or placebo in addition to citalopram for six weeks. Patients were assessed using the HAM-D scale at baseline and weeks 2, 4, and 6., Results: Fifty-four individuals completed the trial. At week 2, patients in the PEA group demonstrated significantly greater reduction in HAM-D scores compared to the placebo group (8.30 ± 2.41 vs. 5.81 ± 3.57, P = .004). The PEA group also demonstrated significantly greater improvement in depressive symptoms [F (3, 156) = 3.35, P = .021] compared to the placebo group throughout the trial period. The patients in the PEA group experienced more response rate (≥ 50% reduction in the HAM-D score) than the placebo group (100% vs. 74% respectively, P = .01) at the end of the trial. Baseline parameters and frequency of side effects were not significantly different between the two groups., Limitations: The population size in this study was small and the follow-up period was relatively short., Conclusions: Palmitoylethanolamide adjunctive therapy to citalopram can effectively improve symptoms of patients (predominantly male gender) with major depressive disorder. PEA showed rapid-onset antidepressant effects which need further investigation., (Copyright © 2018 Elsevier B.V. All rights reserved.)

DNA methylation patterns have been recognised as cancer-specific markers with high potential for clinical applications. We aimed at identifying methylation variations that differentiate between breast cancers and other breast tissue entities to establish a signature for diagnosis. Candidate genomic loci were analysed in 117 fresh-frozen breast specimens, which included cancer, benign and normal breast tissues from patients as well as material from healthy individuals. A cancer-specific DNA methylation signature was identified by microarray analysis in a test set of samples (n = 52, p < 2.1 × 10(-4)) and its performance was assessed through bisulphite pyrosequencing in an independent validation set (n = 65, p < 1.9 × 10(-7)). The signature is associated with SFRP2 and GHSR genes, and exhibited significant hypermethylation in cancers. Normal-appearing breast tissues from cancer patients were also methylated at these loci but to a markedly lower extent. This occurrence of methylated DNA in normal breast tissue of cancer patients is indicative of an epigenetic field defect. Concerning diagnosis, receiver operating characteristic curves and the corresponding area under the curve (AUC) analysis demonstrated a very high sensitivity and specificity of 89.3 and 100 %, respectively, for the GHSR methylation pattern (AUC >0.99). To date, this represents the DNA methylation marker of the highest sensitivity and specificity for breast cancer diagnosis. Functionally, ectopic expression of GHSR in a cell line model reduced breast cancer cell invasion without affecting cell viability upon stimulation of cells with ghrelin. Our data suggest a link between epigenetic down-regulation of GHSR and breast cancer cell invasion.

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.)