مجله پزشکی دانشگاه علوم پزشکی تبریز
سال چهل و چهارم شماره 4 (پیاپی 160، مهر و آبان 1401)

Today, virtual reality bronchoscopy simulation technique is used increasingly. So, it is essential to validate the effectiveness of its training. The performance of training can be evaluated by synthesis of published works.

Based on PRISMA guideline, we systematically searched PubMed and Scopus databases until April 15, 2022 and obtained the eligible articles. The included studies were English articles that performed virtual reality simulation by flexible and rigid bronchoscopy for novices. Random effect model meta-analysis was performed with heterogeneity tests, Egger’s test, SVE, SVT, and subgroup analysis.

  Sixteen studies comprising two RCTs, seven prospective studies, and seven observational studies were evaluated. Meta-analysis and forest plots showed significant P-values in novices, which indicated virtual reality simulation technique is more effective. Heterogeneity tests showed high heterogeneity in studies of four groups. Published year subgroup analysis explained heterogeneity between studies. Funnel plots and Eggers' test indicated no publication bias between the two groups.

  Simulation-based virtual reality bronchoscopy training is effective in novices but does not reach experts' skills.

Practical Implications: 

The process of bronchoscopy is critical in the evaluation of the lungs. In the past, it was generally taught by having students do it on people. Despite the low danger, this may be stressful for trainees. Using virtual reality as a simulator, this research aimed to analyze the abilities of experts and novices in medical education, as well as the effectiveness of virtual reality in medical education. A new training option for bronchoscopy simulation training can be considered for examination of the airways, particularly in the future years, stressing the need of continued medical education

Brain computer interface (BCI) systems by extracting knowledge from brain signals provide a connection channel to the outside world for disabled people, without physiological interfaces. Event-related potentials (ERPs) are a specific type of electroencephalography signals and P300 is one of the most important ERP components. The critical part of P300-based BCI systems is classification step. In this research, an approach is proposed for P300 classification based on novel machine learning methods using convolutional neural networks (CNN) and autoencoder networks.

In the pre-processing step, channel selection, data augmentation (by ADASYN method), filtering and base-line drift were done. Then, in the classification step, four different CNN classifiers including CNN1D, CNN2D, CNN1D_Autoencoder, and CNN2D-Autoencoder were used for P300 classification.

  After implementation and tuning the networks, 92% as a best accuracy was achieved by CNN2D_Autoencoder. This result was achieved with a considerable tradeoff between complexity and stability.

  The acquired results emphasize the ability of the deep learning methods in P300 classification and approve the advantage of using them in BCI systems. Furthermore, autoencoder versions of CNN networks are more stable and have a faster convergence. Meanwhile, ADASYN is a suitable method for augmentation of P300 data and even ERPs by sustaining the premier feature space without copying data.

Practical Implications:

 Our results can increase the accuracy of P300 detection and simultaneously reduce the volume of data using the proposed model. Consequently, they can improve character recognition in P300-speller systems generally used by amyotrophic lateral sclerosis (ALS) patients.

Cervical cancer begins in superficial cells and over time can invade deeper tissues and surrounding tissues. This paper presents a creative idea of using an ensemble classification algorithm that improves the predictive performance of an artificial intelligence system based on cervical cancer screening. This study aimed to classify Pap-smear images by different machine learning methods to achieve high accuracy detection.

This study was performed on 917 Pap-smear images from the Herlev public database. In the feature extraction stage, 20 geometric features and 76 texture features were extracted. After that, using ensemble classification method, the images were classified into two categories (i.e., normal and abnormal) and then into seven categories (i.e., superficial epithelial, intermediate epithelial, columnar epithelial, mild dysplasia, moderate dysplasia, severe dysplasia and carcinoma) and the accuracy of the proposed method was evaluated.

The algorithm in the ensemble classification was able to achieve accuracy of 99.9% with a processing time of 0.028 second in the two-class classification and accuracy of 76.5% with a processing time of 0.033 second in the seven-class classification.

Based on the results, the designed algorithm can be used as a computer aided diagnostic tool to increase the accuracy and speed of predicting the risk of cervical cancer.

Practical Implications: 

 Cervical cancer is one of the most common cancers among women. Early diagnosis of the disease can save various costs and prevent the patients’ frequent visits to medical centers. This research proposed an artificial intelligence method for automatic classification of cervical cells and improving the accuracy of diagnosis.

 The endocannabinoid system (ECS) is a complex of neurotransmitters in the central nervous system (CNS) and plays a key role in regulating cognitive and physiological processes. Also, 2-Arachidonoylglycerol (2-AG) is one of the imperative endocannabinoids with key roles in the CNS. It acts as a signaling lipid and activates the cannabinoid CB1 receptor. In addition, 2-AG is involved in a variety of physiological functions such as energy balance, emotion, pain sensation, cognition, and neuroinflammation. Hence, rapid and specific diagnosis of 2-AG is of great importance in medical neuroscience. Routine methods used in detection of 2-AG are not sensitive and specific. Therefore, the development of new methods in this area has been one of the most important research areas in recent years.

 Herein, an innovative immunosensor was developed for quantification of 2-AG. To this end, gold nanostars (GNSs) were synthesized and conjugated with a specific biotinylated antibody activated by EDC/NHS against 2-AG. The resultant bio-conjugate was immobilized on the gold electrode surface and used to detect and analyze 2-arachidonylglycerol antigen by cyclic voltammetry (CV), square wave voltammetry (SWV), differential pulse voltammetry (DPV), and electrochemical impedance spectroscopy techniques.

  For the first time, 2-AG protein was measured with an excellent linear range of 0.00048-1 ng/L and lower limit of quantification of 0.00048 ng/L by electroanalysis method. The designed immunosensor showed high sensitivity and specificity in the presence of interfering antigens, which proved its appropriate use in the diagnosis of neurological disorders.

 The remarkable achievement of the present study is the development of a new immunosensor for the sensitive and accurate detection of 2-AG. The fabricated sensor substrate showed good analytical results for the target analyte. Regardless of the appropriate sensitivity and selectivity of the designed biosensor, the stability of the sensor is low and it is recommended to use it immediately after preparation. Also, the immunosensor engineered in this research was very economical and had a very fast and good performance compared to the usual and traditional methods for detecting 2-AG.

Practical Implications:

  For the first time, 2-AG protein was measured with an excellent linear range of 0.00048-1 ng/L and lower limit of quantification of 0.00048 ng/L by electro analysis method. The designed immunosensor showed high sensitivity and specificity in the presence of interfering antigens, which proved its appropriate use in the diagnosis of neurological disorders.

  Unwanted pregnancy can affect the sweet experience of motherhood and put a person at the crossroads of abortion or childbirth unaware of how each choice can affect a person's mental health, especially anxiety and depression. This study aimed to compare the rates of anxiety and depression between two groups of women with the experience of induced abortion and unwanted delivery.

  This research was conducted among 420 women with experience of unwanted pregnancy, including 210 women with a history of induced abortion and 210 women with a history of unwanted delivery. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were the main tools for gathering the related information. We collected demographic information, including marital status, age, number of children, occupation, and level of education. The associated data was analyzed based on an independent t-test using the Statistical Package for the Social Sciences (SPSS) software 19.

  The results showed that the rate of anxiety among women with a history of unwanted delivery was higher than those with induced abortion. Although there was no significant difference in depression between the two groups, most subscales of depression such as feelings of failure, dissatisfaction, guilt, self-blame, suicidal ideation, crying, apathy, indecision, feelings of worthlessness, impotence, changes in sleep patterns, irritability, changes in appetite, difficulty in concentration, fatigue, and sexual apathy in the group with a history of abortion were higher than the group of women with a history of unwanted delivery. In addition, the rate of anxiety and depression was higher among single women with experience of induced abortion than married ones (P<0.05).

  According to the results, different levels of depression are more likely to occur among women who experience induced abortion under the influence of cultural, social, and religious factors. On the other hand, the level of anxiety among mothers who choose the path of childbirth in the situation of unwanted pregnancy is higher due to the responsibilities of parenthood. Furthermore, the relationships out of the formal marriage in traditional societies like Iran are taboos and do not meet social acceptance; so single mothers have to abort secretly without having the right to choose. This coercion can explain the higher rate of anxiety and depression among single women with a history of induced abortion than married ones.

Practical Implications:

  The results of the present study can be used in the field of applied research and the development of preventive and therapeutic protocols and cover a large number of mothers and infants affected by anxiety disorders and depression due to unwanted pregnancies.

  Fragile X-associated premature ovarian insufficiency is clinically defined as a type of early ovarian failure with irregular menstrual cycles, increased follicle-stimulating hormone, premature menopause, and infertility. Genetically, the CGG trinucleotide repeat expansion in the 5'-untranslated region of the FMR1 gene is recognized as a causative factor. The aim of this study was to standardize molecular detection methods and estimate the number of repeats among patients with premature ovarian insufficiency.

 After obtaining a consent form and blood sampling, genomic DNA was extracted and treated with sodium bisulfite. The FMR1 gene is located on X chromosome and one allele is methylated by X-inactivation. As a result, the methylation-specific polymerase chain reaction (MS-PCR) was performed using two pairs of specific primers for methylated and non-methylated DNA yelding the products of 108+3n and 168+3n bp, respectively. Following clinical evaluations, 20 sporadic patients and two families with at least two patients were studied.

 The mean level of follicle-stimulating hormone was 85.45±44.73UI/L in sporadic and 75.72±33.61UI/L in familial cases. Ultrasound examinations reported atrophic ovaries in sporadic and familial cases by 80% and 75%, respectively. The evaluation of the trinucleotide repeat expansions on agarose gels showed that two sporadic patients were carriers of FMR1 intermediate alleles (10%). No cases of pre-mutation or full mutation were observed in other sporadic or familial cases and the trinucleotide repeat expansions were estimated between 15 and 35.

 Due to the role of the FMR1 gene trinucleotide repeat expansion in women with premature ovarian insufficiency, a fast and cost-effective molecular detection method is of particular importance. This test will be beneficial not only in ovarian dysfunction, but also to identify pre-mutations that may expand in next generations leading to fragile X syndrome.

Practical Implications:

 In young women, the detection of expanded CGG trinucleotide repeats in the 5'-untranslated region of the FMR1 gene along with genetic counseling will provide them to plan reproductive life.

 It is essential to identify influential motivational factors to create willingness and improve skills in health staff, especially nurses. This study aimed to determine the factors affecting the willingness and ability of nurses to deal with different disasters in some hospitals of Tehran, Iran.

This cross-sectional study used a researcher-made questionnaire consisting of three parts: 1) demographic questions, 2) questions indicating the level of nurses' willingness and the ability to respond to various disasters, and 3) questions about obstacles for working in disasters.

 A total of 308 questionnaires were completed. While 60.7% of respondents were male, 39.3% were female. The level of willingness and ability of participants to work in disasters indicated that the highest willingness and ability were associated with natural disasters (floods, earthquakes), and the lowest willingness and ability were related to participating in response to epidemics. The prioritization of the participants concerning the most critical barriers of appropriate response to the disasters demonstrated that caring for children in natural disasters and mass casualty incident, family health in chemical disasters, fear of contamination in nuclear disasters, and fear of infection in an epidemic were the main obstacles. The factors of gender, age, marital status, and health level of individuals affected the level of willingness and ability of participants. Besides, the parameters, including income level and caring for the elderly and disabled people influenced the willingness of nurses to participate in times of crisis.

  The professional preparation of health care personnel to perform their duties in critical conditions is essential. Hence, preventive measures to minimize the risk and strengthen the ethical obligations of employees in this profession in crises will be beneficial.

Practical Implications:

 The findings of this study provide an opportunity to strengthen the ability and willingness of health care workers to address barriers to intervention in times of crisis. Also, health care centers should support the staff caring for children, the elderly, and disabled people.

 The purpose of this study was to compare the meta-diagnostic constructs of emotion regulation, negative repetitive thoughts, cognitive flexibility, and social adjustment in two groups of adolescents with and without preclinical symptoms of emotional disorders.

 The samples of this cross-sectional and comparative research includes included 140 teenagers who were divided into two groups. Adolescents were divided into two groups based on the diagnostic interview and DASS-21 questionnaire. Statistical analysis of the data was done using the Mann-Whitney and Chi- 2 square tests.

 Cognitive flexibility and emotion regulation in the group of healthy adolescents was significantly higher than the group of adolescents with preclinical symptoms. However, the level of social adjustment was not significantly different between the two groups of adolescents with preclinical symptoms and healthy adolescents.

The significant difference between the two groups of teenagers in meta-diagnostic structures shows the importance of these factors in the process of prevention, diagnosis, and treatment of emotional disorders and symptoms such as anxiety and depression.

Practical Implications:

Considering the existence of significant differences in the two groups of adolescents in meta-diagnostic cognitive and emotional structures, effective measures can be taken in order toto prevent the complete clinical manifestation of emotional disorders; . As a result of these measures, he took an important step can be taken in to reducing reduce the financial, psychological, and social costs caused by these disorders