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Objective Tobacco smoke exposure is a major risk factor for aortic aneurysm development. However, the initial aortic response to tobacco smoke, preceding aneurysm formation, is not well understood. We sought to create a model to determine the effect of solubilized tobacco smoke (STS) on the thoracic and abdominal aorta of mice as well as on cultured human aortic smooth muscle cells (HASMCs). Methods Tobacco smoke was solubilized and delivered to mice via implanted osmotic minipumps. Twenty male C57BL/6 mice received STS or vehicle infusion. The descending thoracic, suprarenal abdominal, and infrarenal abdominal segments of the aorta were assessed for elastic lamellar damage, smooth muscle cell phenotype, and infiltration of inflammatory cells. Cultured HASMCs grown in media containing STS were compared to cells grown in standard media in order to verify our in vivo findings. Results Tobacco smoke solution caused significantly more breaks in the elastic lamellae of the thoracic and abdominal aorta compared to control solution ( P< .0001) without inciting an inflammatory infiltrate. Elastin breaks occurred more frequently in the abdominal aorta than the thoracic aorta ( P < .01). Exposure to STS-induced aortic microdissections and downregulation of α-smooth muscle actin (α-SMA) by vascular smooth muscle cells (VSMCs). Treatment of cultured HASMCs with STS confirmed the decrease in α-SMA expression. Conclusion Delivery of STS via osmotic minipumps appears to be a promising model for investigating the early aortic response to tobacco smoke exposure. The initial effect of tobacco smoke exposure on the aorta is elastic lamellar damage and downregulation of (α-SMA) expression by VSMCs. Elastic lamellar damage occurs more frequently in the abdominal aorta than the thoracic aorta and does not seem to be mediated by the presence of macrophages or other inflammatory cells.

Objective: The aim of this study is to compare markers found in wound fluid of healing and non-healing diabetic foot ulcers using tandem mass spectrometry. Methods: Wound fluid samples were collected using a microfilament, centrifugated and frozen at -80C. Clinical outcome of the ulcers was determined after 6 months follow-up. Proteomic analysis of the samples was conducted and compared between 5 healing and 3 non-healing ulcers using the Fisher’s exact test with Benjamini-Hochberg’s corrected P values. Pathway-specific analysis was done to examine the functional differences in up- and downregulated proteins. Results: Up to 2155 proteins were identified in each sample, 113 of which were differentially expressed between two groups. Proteins upregulated in non-healing wounds were mainly associated with neutrophil degranulation, inflammatory/immune response, and cell adhesion and migration. The downregulated proteins were linked to smooth muscle cell proliferation, regulation of gene expression, and Wnt signaling pathway, proteins regulated by insulin and glucose and most of the proteins involved in negative regulation of apoptosis. Conclusions: Our findings signal activation of naive inflammatory pathway and cell migration, and potential downregulation of gene transcription and expression, cytoskeleton and intracellular calcium control mechanisms in non-healing diabetic ulcers. Disclosure N. Vatankhah: None. V. Jalili: None. Y. Jahangiri: None.

This study investigates if different diabetic treatment regimens affects diabetic foot ulcer healing. From January 2013 to December 2014, 107 diabetic foot ulcers in 85 patients were followed until wound healing, amputation or development of a non-healing ulcer at the last follow-up visit. Demographic data, diabetic treatment regimens, presence of peripheral vascular disease, wound characteristics and outcome were collected. Non-healing wound was defined as major or minor amputation or those who didn't have complete healing until the last observation. Median age was 60.0 years (range: 31.1-90.1) and 58 cases (68.2%) were males. Twenty-four cases reached a complete healing (healing rate: 22.4%). Median follow-up period in subjects with classified as having chronic wounds was 6.0 months (range: 0.7-21.8). Insulin treatment was a part of diabetes management in 52 (61.2%) cases. Insulin therapy significantly increased the wound healing rate (30.3% [20/66 ulcers] vs. 9.8% [4/41 ulcers]) (P=0.013). In multivariate random-effect logistic regression model, adjusting for age, gender, smoking status, type of diabetes, hypertension, chronic kidney disease, peripheral arterial disease, oral hypoglycemic use, wound infection, involved side, presence of Charcot's deformity, gangrene, osteomyelitis on x-ray, and serum hemoglobin A1C levels, insulin treatment was associated with a higher chance of complete healing (beta±SE: 15.2±6.1, P=0.013). Systemic insulin treatment can improve wound healing in diabetic ulcers after adjusting for multiple confounding covariates. This article is protected by copyright. All rights reserved.

Objective The neutrophil-to-lymphocyte ratio (NLR) has been used as a surrogate marker of systemic inflammation. We sought to investigate the association between NLR and wound healing in diabetic wounds. Methods The outcomes of 120 diabetic foot ulcers in 101 patients referred from August 2011 to December 2014 were examined retrospectively. Demographic, patient-specific, and wound-specific variables as well as NLR at baseline visit were assessed. Outcomes were classified as ulcer healing, minor amputation, major amputation, and chronic ulcer. Results The subjects' mean age was 59.4 ± 13.0 years, and 67 (66%) were male. Final outcome was complete healing in 24 ulcers (20%), minor amputation in 58 (48%) and major amputation in 16 (13%), and 22 chronic ulcers (18%) at the last follow-up (median follow-up time, 6.8 months). In multivariate analysis, higher NLR (odds ratio, 13.61; P = .01) was associated with higher odds of nonhealing. Conclusions NLR can predict odds of complete healing in diabetic foot ulcers independent of wound infection and other factors.

This study investigates if different diabetic treatment regimens affect diabetic foot ulcer healing. From January 2013 to December 2014, 107 diabetic foot ulcers in 85 patients were followed until wound healing, amputation or development of a nonhealing ulcer at the last follow-up visit. Demographic data, diabetic treatment regimens, presence of peripheral vascular disease, wound characteristics, and outcome were collected. Nonhealing wound was defined as major or minor amputation or those who did not have complete healing until the last observation. Median age was 60.0 years (range: 31.1-90.1 years) and 58 cases (68.2%) were males. Twenty-four cases reached a complete healing (healing rate: 22.4%). The median follow-up period in subjects with classified as having chronic wounds was 6.0 months (range: 0.7-21.8 months). Insulin treatment was a part of diabetes management in 52 (61.2%) cases. Insulin therapy significantly increased the wound healing rate (30.3% [20/66 ulcers] vs. 9.8% [4/41 ulcers]) (p = 0.013). In multivariate random-effect logistic regression model, adjusting for age, gender, smoking status, type of diabetes, hypertension, chronic kidney disease, peripheral arterial disease, oral hypoglycemic use, wound infection, involved side, presence of Charcot's deformity, gangrene, osteomyelitis on x-ray, and serum hemoglobin A1C levels, insulin treatment was associated with a higher chance of complete healing (beta ± SE: 15.2 ± 6.1, p = 0.013). Systemic insulin treatment can improve wound healing in diabetic ulcers after adjusting for multiple confounding covariates.

Current threshold recommendations for elective abdominal aortic aneurysm (AAA) repair are based solely on maximal AAA diameter. Peak wall stress (PWS) has been demonstrated to be a better predictor than AAA diameter of AAA rupture risk. However, PWS calculations are time-intensive, not widely available, and therefore not yet clinically practical. In addition, PWS analysis does not account for variations in wall strength between patients. We therefore sought to identify surrogate clinical markers of increased PWS and decreased aortic wall strength to better predict AAA rupture risk.Patients treated at our institution from 2001 to 2014 for ruptured AAA (rAAA) were retrospectively identified and grouped into patients with small rAAA (maximum diameter 6 cm) or large rAAA (6 cm). Patients with large (6 cm) non-rAAA were also identified sequentially from 2009 for comparison. Demographics, vascular risk factors, maximal aortic diameter, and aortic outflow occlusion (AOO) were recorded. AOO was defined as complete occlusion of the common, internal, or external iliac artery. Computational fluid dynamics and finite element analysis simulations were performed to calculate wall stress distributions and to extract PWS.We identified 61 patients with rAAA, of which 15 ruptured with AAA diameter 60 mm (small rAAA group). Patients with small rAAAs were more likely to have peripheral arterial disease (PAD) and chronic obstructive pulmonary disease (COPD) than were patients in the large non-rAAA group. Patients with small rAAAs were also more likely to have AOO compared with non-rAAAs60 mm (27% vs 8%; P = .047). Among all patients with rAAAs, those with AOO ruptured at smaller mean AAA diameters than in patients without AOO (62.1 ± 11.8 mm vs 72.5 ± 16.4 mm; P = .024). PWS calculations of a representative small rAAA and a large non-rAAA showed a substantial increase in PWS with AOO.We demonstrate that AOO, PAD, and COPD in AAA are associated with rAAAs at smaller diameters. AOO appears to increase PWS, whereas COPD and PAD may be surrogate markers of decreased aortic wall strength. We therefore recommend consideration of early, elective AAA repair in patients with AOO, PAD, or COPD to minimize risk of early rupture.

To study the effects of the combination of 670 nm and 810 nm diode lasers on diabetic wound healing parameters in rats.An alternative to traditional treatment modalities for diabetic ulcers is low-level laser therapy (LLLT). A number of published studies demonstrate the beneficial effects of LLLT, although several other studies also exist which indicate results to the contrary.Four groups were present in our study: Diabetic-laser (n = 5), Diabetic-control (n = 4), Nondiabetic-laser (n = 5) and Nondiabetic-control (n = 5) groups. Two intervention (laser) groups underwent low level laser therapy using 670 nm diode laser (500 mW, 10 J, 48 s) in the wound context, and 810 nm diode laser (250 mW, 12 J, 50 s) to the wound margins. The wound area was measured using computer software after digital microscopic photography on days 0, 3, 6, 9, 12, 15, 20, and 24.There were no statistically significant differences between the diabetic and non-diabetic groups in the wound area, percentage of open wound area, and wound healing rate throughout the repeated measurements of the study. After seven days of low level laser therapy in the non-diabetic group, urine excretion was significantly increased in comparison with the control group.Overall, our study showed results of measured wound healing parameters that were not significantly different in the LLLT group compared with the control group. The urine volume increase in non-diabetic rats after LLLT was an incidental observation that warrants future study.

Foot screening is one of the most effective means of preventing foot complications in diabetes. Therefore the aim of this study was to perform a screening program for people with type 2 diabetes at risk of foot complications.Physical examinations consisting of vascular, neurological, musculoskeletal, and dermatologic examinations were performed. We used a Semmes-Weinstein monofilament and a 128-Hz tuning fork to test peripheral neuropathy. The study population was categorized based on Scottish Intercollegiate Guidelines into three groups of low, medium, and high risk for diabetes foot disease.Of a total of 148 people with type 2 diabetes, 4.7% had an active foot ulcer, and 41.9% were classed as low risk, 40.6% as medium risk, and 12.8% as high risk.Considering the potential of developing risk of foot disease in people with diabetes, it is recommended that foot screening should be performed by primary care practitioners and specialists to detect foot disease in an early stage. Foot screening program for people with diabetes should also be taken into account by health policy makers in national guidelines.

Aim The aim of this study was to evaluate the impact of a simple educational program on the knowledge and practice of people with type 2 diabetes in relation to the foot at risk in Tehran, Iran. Methods One hundred and forty-eight people with type 2 diabetes underwent a structured interview using a 32-item designed questionnaire (DiFoKaPS-32) about their knowledge of foot care standards in diabetes and their personal foot care behaviours. Each participant in the study received a single 20min education session individually. The mode of the intervention was face-to-face. Results The applied educational intervention aimed at patients with type 2 diabetes has improved their knowledge and practice about diabetic foot care ( P P =0.011; Wilcoxon Signed Ranks test, respectively). Knowledge and practice scores were increased significantly after the education in the lean group (BMI≤25) rather than the obese ones. Conclusions In conclusion the findings of our study have shown that a simple face-to-face education is an effective and applied method to improve the knowledge about foot care. It has also shown that it could increase the motivation and change the behaviour of people with type 2 diabetes regarding their feet. In addition, the obese patients referring to a diabetic clinic need much more attentions and tighter care programs.

The aim of this study was to determine the knowledge and practice of foot care in people with type 2 diabetes. We carried out a cross-sectional study. A questionnaire was completed by 148 patients with type 2 diabetes in Tehran, Iran. Knowledge score was calculated and the current practice was determined. The mean knowledge score was 6.6 (standard deviation +/-3.0) out of a possible 16. Illiterate patients were the least knowledgeable (P= 0.008). Lack of adequate knowledge includes the following: 56% not aware of the effect of smoking on the circulation to the feet, 60% failed to inspect their feet and 42% did not know to trim their toenails. High risk practices including use of irritants to water (66.5%) and walking barefoot (62%). The results of this study highlight the patients' inadequate knowledge of self-care about their foot and lack of optimal podiatry service in Iran. These findings have implications for further evaluation, planning and management of patient care in diabetic foot disease.

Our objective was to examine whether wrist circumference is associated with incident type 2 diabetes mellitus, independently of general (body mass index [BMI]) or central (waist circumference [WC]) adiposity measures in a cohort of an Iranian adult population.A total of 9330 subjects ≥ 20 years of age were included in the cross-sectional study. For prospective analysis, subjects with prevalent diabetes were excluded, leaving 6393 subjects (2716 males and 3677 females). The standard 2-hour postchallenge plasma glucose test was performed at baseline and during follow-up. Cox regression analysis was used to estimate the hazard ratio of diabetes for wrist circumference.During a mean follow-up of 8.8 years, 649 new cases of diabetes occurred. At baseline, using linear regression models, we showed significant linear associations between wrist circumference and diabetes risk factors in both genders, and this association remained significant after controlling for BMI or WC among females. In prospective evaluation, wrist circumference was significantly associated with incident diabetes (multivariable-adjusted hazard ratio = 1.17 [1.03-1.32] and 1.31 [1.18-1.45] for males and females, respectively). After controlling for the subjects' BMI or WC, wrist circumference was an independent predictor of diabetes only among females. Wrist circumference was an independent predictor of metabolic syndrome only among women even after adjustment for BMI, WC, or both.Wrist circumference is a significant predictor of diabetes in both genders of adult population. However, its predictability is independent of BMI or WC only among females. Because of its simple and easy-to-detect nature, wrist circumference could be considered as a new anthropometric assessment for prediction of type 2 diabetes and metabolic syndrome.

To examine the change in general and central adiposity measures as a predictor of incident dysglycemia during a 6-year follow-up.A total of 4029 (2333 women and 1696 men) non-dysglycemic Iranians aged ≥ 20 years, underwent standard fasting and 2-h post-challenge plasma glucose tests at baseline and follow-up.During follow-up, 458 new cases of dysglycemia occurred. In multivariable models including baseline values of each anthropometric measure, odds ratios (ORs) for dysglycemia incidence corresponding to a 1-SD increase in changes of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and hip circumference (HC), were 1.32, 1.56, 1.39, 1.51 and 1.39 for men and 1.59, 1.50, 1.37, 1.47, and 1.38, for women, respectively (all P0.05). After controlling for weight change and WC change among men and women, respectively, HC change did not remain as a predictor. Using the paired homogeneity test, there was no superiority for changes in central obesity measures compared to changes in BMI to predict dysglycemia.The association between HC changes and incident dysglycemia was dependent upon changes in central and general adiposity measures, where the former did not have higher predictability than the latter in prediction of dysglycemia.

Background: Migraine headache significantly impacts the health of individuals and of society. The application of simple physical nonpharmacological techniques could greatly reduce the therapeutic costs and side effects in acute onset of such headaches. Methods: Ten male patients (mean age was 32.0 ± 10.59 years) with acute onset of a migraine headache according to IHS-2004 diagnostic criteria were enrolled in the study. Neck and upper thoracic spine massage and manipulation technique was performed. Headache pain intensity was assessed before and after the intervention by means of a verbal analog scale. Results: Following treatment, headache pain intensity was significantly reduced compared to the pretreatment values (1.85 ± 1.11 vs. 5.80 ± 2.25, p = .005). As a percentage, this represents a mean pain reduction of 68.77% ± 18.56. No side effects were observed, and all of the patients reported satisfaction with the intervention. Conclusion: Our results show that the applied cervical and upper thoracic massage and manipulation technique could reduce the headache attack pain intensity in patients with migraine headaches, though further testing, including study designs that make use of control groups, is needed.

Reason for Withdrawal Withdrawn because review authors are unable to continue work on this review. To view the published versions of this article, please click the 'Other versions' tab.