Female Cerebellum Seems Sociable; An iTBS Investigation

The cerebellum has been shown to be engaged in tasks other than motor control, including cognitive and affective functions. Prior neuroimaging studies have documented the role of this area in social cognition and despite these findings, no studies have yet examined the causal relationship between the cerebellum and social cognition. This study aimed to investigate the role of the cerebellum in empathy and theory of mind (ToM) in a randomized, placebo-controlled, double-blind, parallel study. 32 healthy participants were assigned to either a sham or active group. For the active group, an intermittent theta-burst stimulation (iTBS) protocol at 100% of the motor threshold was applied to the cerebellum, while the control group received sham stimulation. An eyes-closed EEG session, the Empathy Quotient (EQ) test, and the Reading the Mind in the Eyes Test (RMET) were administered before and after the iTBS session. The results demonstrated differences in cognitive empathy, ToM, and a decrease in the activity of the default mode network (DMN) between the active and sham groups in females. Females also showed a decrease in the activity of the affective empathy network and connectivity in the DMN. We conclude that cognitive empathy and ToM are associated with cerebellar activity, and due to sex-related differences in the cortical organization of this area which is modulated by sex hormones, the stimulation of the cerebellum in males and females yields different results.

Association between dietary phytochemical index and risk of benign prostatic hyperplasia: a case-control study

BACKGROUND

Dietary intake of phytochemicals has been associated with a reduced risk of chronic diseases, but research on their relationship with benign prostatic hyperplasia (BPH) is limited. This case-control study aimed to investigate the association between a Dietary Phytochemical Index (DPI) and BPH risk in a Middle-Eastern population.

METHODS

The study recruited 112 BPH patients and 112 age-matched healthy controls (40-75 years) from Al-Zahra Hospital Clinic in Isfahan, Iran between 2021 and 2022. Dietary intake was assessed using a validated food-frequency questionnaire, and DPI was calculated as the ratio of energy intake from phytochemical-rich foods to total daily energy intake. Logistic regression analysis was performed, adjusting for potential confounders.

RESULTS

In the crude model, participants in the highest DPI tertile had a 70% lower odds of BPH compared to those in the lowest tertile (OR:0.3, 95% CI 0.15-0.61, P-trend = 0.001). After adjusting for confounders, this inverse association remained significant (OR:0.23, 95% CI 0.15-0.63, P-trend = 0.001). Participants with higher DPI consumed more whole grains (p = 0.02), nuts (p < 0.001), legumes (p = 0.02), fruits (p < 0.001), vegetables (p < 0.001), olives and oilve products (p = 0.02), and tomato and its products (p < 0.001) in their diet compared to the lowest tertile. However, red meat (p = 0.03) and refined grains (p < 0.001) were consumed in higher amounts in the lowest tertile compared to the highest DPI tertile.

CONCLUSIONS

This study demonstrates a protective association between DPI and BPH risk in the Middle-Eastern population. Encouraging higher intake of phytochemical-rich foods may help reduce the risk of BPH, highlighting the relevance of nutritional science in promoting prostate health.

Effect of acupressure on pain among older female patients undergoing extracorporeal shock wave lithotripsy: A randomized controlled clinical trial

BACKGROUND AND AIM

Urinary stones are highly prevalent among older people. Extracorporeal lithotripsy is one of the commonly used treatment methods, but it causes pain. Acupressure is a non-pharmacological therapeutic method that is effective in relieving pain among patients with various health conditions. This study aimed to investigate the effect of acupressure on pain among female older people undergoing extracorporeal lithotripsy.

METHOD

This randomized controlled clinical trial was conducted on 66 older female patients undergoing extracorporeal lithotripsy. They were enrolled in the study through convenient sampling and were assigned to the intervention and control groups through the block randomization method. The intervention group underwent acupressure for 16 min which was repeated twice with an interval of 20 min, but the control group received only touch without any pressure for the same period. The McGill Pain Questionnaire and Visual Analogue Scale were completed 60 min before the intervention and immediately after lithotripsy.

FINDINGS

Before the intervention, no statistically significant difference in the quality and intensity of pain between the two groups was observed (p > 0.05). However, after acupressure, the mean scores of quality and intensity of pain decreased significantly (p < 0.001) in the intervention group compared with the control group.

CONCLUSION

Acupressure as a complementary and alternative medicine can reduce pain and suffering among older people undergoing extracorporeal lithotripsy. It can be included in the routine therapeutic measures for relieving pain and suffering during noninvasive methods for older people and reducing their need for medication use and avoiding related pharmacological side effects.

Acute liver injury and contralateral pleural effusion as two rare complications following percutaneous nephrolithotomy: a case report

INTRODUCTION

Percutaneous Nephrolithotomy (PCNL) is a widely used surgical intervention for removing large and complex renal calculi. While considered a safe and effective procedure, it can still lead to severe and rare complications, including bleeding, pulmonary complications, and liver dysfunction.

CASE PRESENTATION

This case report presents a case who underwent PCNL for a kidney stone and subsequently developed a series of rare and severe complications. Following the PCNL procedure, the patient experienced significant bleeding, a known but uncommon complication of PCNL, pulmonary complications, a common complication that may carry a risk of death, and acute liver failure, an exceedingly rare consequence of PCNL.

CONCLUSION

In summary, while PCNL is a valuable technique for treating kidney stones, it is not without risk. This case underscores the importance of recognizing and managing rare complications following PCNL surgery, highlighting the need for vigilance, multidisciplinary care, and timely interventions to ensure favorable patient outcomes.

Development and validation of a task load index for process control room operators (PCRO-TLX)

Process control room operators (PCRO) perform a range of complex cognitive safety-critical tasks. The aim of this exploratory sequential mixed methods study was to develop an occupation specific tool to measure the task load of PCRO using NASA Task Load Index (TLX) methodology. Participants were 30 human factors experts and 146 PCRO at two refinery complexes in Iran. Dimensions were developed via a cognitive task analysis, a research review, and three expert panels. Six dimensions were identified: perceptual demand, performance, mental demand, time pressure, effort, and stress. Data from 120 PCRO confirmed that the developed PCRO-TLX has acceptable psychometric properties, and a comparison with the NASA-TLX confirmed that perceptual, not physical, demand was relevant for measuring workload in PCRO. There was a positive convergence of scores of the Subjective Workload Assessment Technique and the PCRO-TLX. This reliable tool (α = 0.83) is recommended for risk assessing the task load of PCRO.Practitioner summary: There are benefits of having a specific tool to measure task load in safety critical roles. Thus, we developed and validated an easy-to-use targeted tool, the PCRO-TLX, for process control room operatives. Timely use and response will assure optimal production alongside health and safety in an organisation.Abbreviations: PCRO: process control room operator; TLX: task load index; PCRO-TLX: process control room operator task load index; NASA-TLX: National Aeronautics and Space Administration task load index; SWAT: subjective workload assessment technique; DALI: driving activity load index; SURG-TLX: surgery task load index; SIM-TLX: virtual reality simulation task load index; VACP: visual, auditory, cognitive and psychomotor; CVI: content validity index; CVR: content validity ratio; RMSEA: root mean square of error approximation; GFI: goodness of fit index; AGFI: adjusted goodness of fit index; CFI: comparative fit index; ANOVA: analysis of variance; CI: confidence interval.

Knee Extension Exercise Effects on Physiological and Psychophysical Performance: Normal Weight Versus Obese Office Workers

BACKGROUND

Knee extension exercise is useful and practical for obese and overweight people as this form of exercise is effective in minimizing body weight loading on joints and improving the body's physiological function. This study aimed to compare the physiological and psychophysical parameters of office workers while computer-based working in an active workstation equipped with an active footrest (AFR) prototype with a mechanism for performing knee extension exercises in a sitting position, and also to compare the physiological and psychophysical parameters among normal-weight and obese office workers.

METHODS

In this quasi-experimental study, the physiological parameters of heart rate (HR) and energy expenditure (EE) (measured with the Fitbit Charge HR smartwatch) were measured in two cross-over random sessions for 32 office workers (16 normal-weight and 16 obese) aged 28 to 50 years (M = 42.72, standard deviation [SD] = 4.37) while performing office tasks in sitting and active workstations (equipped with AFR). Perceived physical exertion, comfort, fatigue, and liking were also measured by rating the participants.

FINDINGS

Short-term activity of the participants with AFR performing computer tasks significantly improved physiological and psychophysical parameters compared with the participants in sitting workstations. However, there was no significant difference in the effect of AFR on physiological and psychophysical parameters between normal-weight and obese participants.

CONCLUSIONS/APPLICATION TO PRACTICE

Given the significant increase in EE and HR resulting from exercise with AFR compared with the conventional workstation, the use of AFR can help office workers achieve the minimum standard of physical activity at their workplace.

Targeting the insula with transcranial direct current stimulation; A simulation study

Insula is considered an important region of the brain in the generation and maintenance of a wide range of psychiatric symptoms, possibly due to being key in fundamental functions such as interoception and cognition in general. Investigating the possibility of targeting this area using non-invasive brain stimulation techniques can open new possibilities to probe the normal and abnormal functioning of the brain and potentially new treatment protocols to alleviate symptoms of different psychiatric disorders. In the current study, COMETS2, a MATLAB based toolbox was used to simulate the magnitude of the current density and electric field in the brain caused by different transcranial direct current stimulation (tDCS) protocols to find an optimum montage to target the insula and its 6 subregions for three different current intensities, namely 2, 3, and 4 mA. Frontal and occipital regions were found to be optimal candidate regions.. The results of the current study showed that it is viable to reach the insula and its individual subregions using tDCS.

A convolutional recurrent neural network with attention for response prediction to repetitive transcranial magnetic stimulation in major depressive disorder

Prediction of response to Repetitive Transcranial Magnetic Stimulation (rTMS) can build a very effective treatment platform that helps Major Depressive Disorder (MDD) patients to receive timely treatment. We proposed a deep learning model powered up by state-of-the-art methods to classify responders (R) and non-responders (NR) to rTMS treatment. Pre-treatment Electro-Encephalogram (EEG) signal of public TDBRAIN dataset and 46 proprietary MDD subjects were utilized to create time-frequency representations using Continuous Wavelet Transform (CWT) to be fed into the two powerful pre-trained Convolutional Neural Networks (CNN) named VGG16 and EfficientNetB0. Equipping these Transfer Learning (TL) models with Bidirectional Long Short-Term Memory (BLSTM) and attention mechanism for the extraction of most discriminative spatiotemporal features from input images, can lead to superior performance in the prediction of rTMS treatment outcome. Five brain regions named Frontal, Central, Parietal, Temporal, and occipital were assessed and the highest evaluated performance in 46 proprietary MDD subjects was acquired for the Frontal region using the TL-LSTM-Attention model based on EfficientNetB0 with accuracy, sensitivity, specificity, and Area Under the Curve (AUC) of 97.1%, 97.3%, 97.0%, and 0.96 respectively. Additionally, to test the generalizability of the proposed models, these TL-BLSTM-Attention models were evaluated on a public dataset called TDBRAIN and the highest accuracy of 82.3%, the sensitivity of 80.2%, the specificity of 81.9% and the AUC of 0.83 were obtained. Therefore, advanced deep learning methods using a time-frequency representation of EEG signals from the frontal brain region and the convolutional recurrent neural networks equipped with the attention mechanism can construct an accurate platform for the prediction of response to the rTMS treatment.

Plexiform neurofibromatosis of the bladder leading to cystectomy: A rare complication of von Recklinghausen disease

We report a 20-year-old man with neurofibromatosis type 1 presenting with frequent episodes of suprapubic pain. The episodes started 6 months ago, occurred 1 h a day, and were not related to urination. A prostate-sparing cystectomy with orthotopic diversion was performed. Histopathological assessment of the specimen confirmed bladder plexiform neurofibromatosis.

Effectiveness of Bromelain in the control of postoperative pain after periodontal surgery: A crossover randomized clinical trial

Background

This study aimed to compare the analgesic effects of Ibuprofen and bromelain after periodontal surgery.

Methods

A double-blinded crossover clinical trial was conducted on 22 patients needing two crown lengthening surgeries without bone surgery or with limited bone surgery on two quadrants of the maxilla, with control and test sides. Each quadrant was randomly assigned to bromelain (500 GUD) or ibuprofen (400 mg). Immediately after the surgery and 6 hours after it, the first dose of the drugs was packaged in the same capsules in A and B. Postoperative pain was evaluated during the first 8 hours and on the following day using a visual analog scale (VAS).

Results

Using the VAS, the Ibuprofen group showed significantly lower mean pain scores than the bromelain group at 4 hours (P=0.047). In contrast, there were no significant differences between the two groups at 2, 6, 8, 10, 12, 24, and 48 hours (P>0.05).

Conclusion

The effectiveness of bromelain for pain control following periodontal surgery was comparable to that of Ibuprofen. Therefore, bromelain can be an efficient replacement for ibuprofen in managing pain after periodontal surgery, especially in patients with gastric ulceration and increased bleeding tendency.

An effective brain connectivity technique to predict repetitive transcranial magnetic stimulation outcome for major depressive disorder patients using EEG signals

One of the most effective treatments for drug-resistant Major depressive disorder (MDD) patients is repetitive transcranial magnetic stimulation (rTMS). To improve treatment efficacy and reduce health care costs, it is necessary to predict the treatment response. In this study, we intend to predict the rTMS treatment response in MDD patients from electroencephalogram (EEG) signals before starting the treatment using machine learning approaches. Effective brain connectivity of 19-channel EEG data of MDD patients was calculated by the direct directed transfer function (dDTF) method. Then, using three feature selection methods, the best features were selected and patients were classified as responders or non-responders to rTMS treatment by using the support vector machine (SVM). Results on the 34 MDD patients indicated that the Fp2 region in the delta and theta frequency bands has a significant difference between the two groups and can be used as a significant brain biomarker to assess the rTMS treatment response. Also, the highest accuracy (89.6%) using the SVM classifier for the best features of the dDTF method based on the area under the receiver operating characteristic curve (AUC-ROC) criteria was obtained by combining the delta and theta frequency bands. Consequently, the proposed method can accurately detect the rTMS treatment response in MDD patients before starting treatment on the EEG signal to avoid financial and time costs to patients and medical centers.

Attention-Based Convolutional Recurrent Deep Neural Networks for the Prediction of Response to Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder

Repetitive Transcranial Magnetic Stimulation (rTMS) is proposed as an effective treatment for major depressive disorder (MDD). However, because of the suboptimal treatment outcome of rTMS, the prediction of response to this technique is a crucial task. We developed a deep learning (DL) model to classify responders (R) and non-responders (NR). With this aim, we assessed the pre-treatment EEG signal of 34 MDD patients and extracted effective connectivity (EC) among all electrodes in four frequency bands of EEG signal. Two-dimensional EC maps are put together to create a rich connectivity image and a sequence of these images is fed to the DL model. Then, the DL framework was constructed based on transfer learning (TL) models which are pre-trained convolutional neural networks (CNN) named VGG16, Xception, and EfficientNetB0. Then, long short-term memory (LSTM) cells are equipped with an attention mechanism added on top of TL models to fully exploit the spatiotemporal information of EEG signal. Using leave-one subject out cross validation (LOSO CV), Xception-BLSTM-Attention acquired the highest performance with 98.86% of accuracy and 97.73% of specificity. Fusion of these models as an ensemble model based on optimized majority voting gained 99.32% accuracy and 98.34% of specificity. Therefore, the ensemble of TL-LSTM-Attention models can predict accurately the treatment outcome.

Comparison of intravenous sedation with propofol, dexmedetomidine and midazolam in double-J ureteral stent removal

BACKGROUND

According to the favorable effects of combination therapy to provide better sedation during double-j stent removal and lack of studies investigating the sedative effect of propofol, dexmedetomidine, and midazolam during this procedure. This study aimed to compare the effects of intravenous sedation with propofol, dexmedetomidine and midazolam in double-J ureteral stent removal.

METHODS

This double-blinded randomized clinical trial was conducted on 120 patients aged 18-72 who underwent double-J ureteral stent removal in Alzahra hospital, Isfahan, Iran from September to November 2021. Patients were randomly divided into 3 groups. In the first group, propofol was titrated with normal saline and was infused with a loading dose of 0.5 mg/kg and a maintenance dose of 1.5-2.5 mg/kg/h. In the second group, Dexmedetomidine was titrated with normal saline and was infused at a dose of 1 µg/kg within 10 min and then continued at 0.45-0.55 µg/kg. In third group, midazolam was titrated was infused with a loading dose of 0.05 mg/kg and a maintenance dose of 0.05 mg/kg/h. 50 mg of fentanyl was also infused in all the groups. If the patients did not reach the desired sedation level, 10 mg ketamine was infused as a rescue sedative agent for all three groups and repeated if needed in all groups.

RESULTS

The current study was conducted on 120 patients who underwent double-J ureteral stent removal. The comparison of the sedative effect of midazolam, dexmedetomidine, and propofol showed significant differences among the three groups and was higher in the midazolam group (P=0.018). Between the three groups systolic blood pressure and mean arterial pressure was significantly lower in the propofol group (P=0.002). Heart rate was significantly lower in the dexmedetomidine group during both surgery and recovery time (P<0.001). There was no significant difference among the groups during surgery regarding oxygen saturation (P value =0.84). The intergroup comparison indicates that the mean score of surgeon satisfaction is significantly higher in the midazolam group (P-value =0.039).

CONCLUSION

According to this study midazolam was superior to two other groups and was associated with deeper sedation and higher satisfaction among both patient and surgeon.

Evaluation of the efficacy of oxidized cellulose (surgicel) in reducing blood loss in suprapubic simple open prostatectomy: A randomized clinical trial

Background

Simple open prostatectomy is still the treatment of choice for removing large prostates; however, peri-surgical bleeding accompanied by this technique has always been a challenge for urologist surgeons. Therefore, the present study aimed to investigate the effect of surgicel on reducing bleeding in trans-vesical prostatectomy.

Materials and Methods

The present double-blinded clinical trial included 54 patients with Benign Prostatic Hyperplasia (BPH), divided into two groups of 27, and underwent trans-vesical prostatectomy. After removing the prostate, the prostate adenoma was weighed in the first group. Then, two surgicel were inserted into the prostate loge for prostate adenomas weighing 75 g or less. For larger prostates, another surgicel was inserted for each 25 g weight higher than the limit of 75 g. However, no Surgicel was inserted in the control group. Other steps of the procedure were the same in both groups. Moreover, hemoglobin and hematocrit levels were assessed in both groups; preoperation, intra-operative, 24 h, and 48 h postoperative. In addition, all the fluid used for bladder irrigation was collected, and its hemoglobin level was assessed.

Results

According to our results, no intergroup difference in hemoglobin level changes, hematocrit changes, International Prostate Symptom Score (IPSS), postoperative hospital stay, and number of packed cells received. However, the postoperative blood loss in bladder lavage fluid was significantly higher in the control group (120.83 ± 46.66 g) as compared to the surgicel group (72.56 ± 32.53 g) (P < 0.001).

Conclusion

The present study concluded that using surgicel in trans-vesical prostatectomy could reduce postoperative bleeding without increasing the chance of postoperative complications.

Evaluating the effectiveness of tranexamic acid administration in reducing bleeding in benign prostate hyperplasia patients underwent open prostatectomy: A double-blind randomized clinical trial

Background

Blood loss of postoperative after prostate surgery could be related with an increase in urinary fibrinolytic activity. Tranexamic acid (TXA) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously. This study aimed to evaluate the effectiveness TXA administration in reducing bleeding in benign prostatic hyperplasia (BPH) patients who underwent open prostatectomy.

Materials and Methods

This double-blind randomized clinical trial was conducted on patients with BPH who underwent open prostatectomy. The first group received TXA (1 gr IV from during surgery to 48 h after surgery, 3 times/day). Twenty-four hours after surgery, the two groups were compared in terms of bleeding rate. Hemoglobin (Hb), hematocrit (HCT), and platelet (Plt) counts were also assessed before and after the intervention.

Results

Intervention and control groups were comparable in terms of basic and baseline values of variables at the beginning of the study (P > 0.05). The mean bleeding volume in TXA group was significantly lower than the control group 112.11 ± 53.5 and 190.00 ± 97.5 CC; P ≤ 0.001). Mean hospitalization (3.28±0.46 vs. 4.38 ± 0.95 days P < 0.001) and surgery duration (98.11 ± 37.11 vs. 128.00 ± 39.12 h; P = 0.001) were significantly lower in TXA group compared to control intervention.

Conclusion

According to the findings of the current study, the administration of TXA led to reduce bleeding in BPH patients who underwent open prostatectomy. Furthermore, the mean Hb, HCT, levels were significantly affected by TXA. TXA treatment approach also can reduce the surgery and hospitalization time effectively. TXA approach is recommended as effective procedure in BPH patients who underwent open prostatectomy.

Evaluation of SARS-CoV-2 Serum Level in Patients Vaccinated With Sinopharm/BBIBP-CorV With Kidney Transplantation

BACKGROUND

Every year, a large number of people undergo kidney transplants because of various reasons leading to renal failure. These patients usually have low immunoglobulin levels due to the use of immunosuppressive drugs. In recent years, the COVID-19 pandemic has been a major global health risk. Patients who are immunocompromised or who have diabetes are especially at risk.

METHODS

In this study, we enrolled 156 patients who had undergone kidney transplant and had received 2 doses of Sinopharm/BIBP-CorV. The serum antibody levels against COVID-19 spike glycoprotein (immunoglobulin [Ig] G and IgM) were measured using a sandwich enzyme-linked immunosorbent assay kit to evaluate whether different immunosuppressive drugs could affect the body's response to the said vaccine.

RESULTS

We found that only patients receiving Rapamune had increased IgM secondary to COVID-19 vaccine. None of the immunosuppressive drugs in this study have shown a positive correlation with increased IgG levels. The only factor that showed a significant effect on both IgM and IgG was a positive history of COVID-19, which was correlated with increased levels of serum IgG/M.

CONCLUSIONS

Only patients treated with Rapamune showed an acute immune reaction to the vaccine in the form of positive serum IgM levels, and no rise of serum IgM antibody was observed in COVID-19-naive patients. Patients who had a previous history of COVID-19 infection showed an elevated serum IgM and IgG level, suggesting that vaccines in general and Sinopharm/BIBP-CorV in particular are not enough to ensure immunity against COVID-19 in transplant recipients. We recommend further studies using different types of vaccines and immunosuppressive drugs.

Electrophysiological and behavioral effects of unilateral and bilateral rTMS; A randomized clinical trial on rumination and depression

BACKGROUND

Rumination is significantly frequent in major depressive disorder (MDD). However, not a lot of studies have investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on rumination.

METHODS

61 participants with a minimum Hamilton Depression Rating Scale (HAM-D) score of 20 were randomly assigned to sham, bilateral stimulation (BS) or unilateral stimulation (US) groups. EEG, The Ruminative Response Scale (RRS), and HAM-D were administered before and after the 20 sessions of rTMS. Phase locked values (PLV) were calculated as a measure of connectivity.

RESULTS

There was a significant decrease in HAM-D scores in both BS and US. In responders, BS and US differed significantly in RRS total scores, with greater reduction in BS. PLV significantly changed in the default mode network (DMN) in delta, theta, alpha, and beta in BS, in responders of which PLV decreased in the DMN in beta and gamma. Positive correlations between PLV and brooding in delta and theta, and negative correlations between PLV and reflection were found in theta, alpha, and beta. In US, connectivity in the DMN increased in beta, and PLV increased in theta and beta, and decreased in alpha and beta in its responders. Positive correlations between PLV and brooding in the delta and theta, as well as negative correlations between PLV and reflection in theta were observed in the DMN.

CONCLUSION

US and BS resulted in different modulations in the DMN, however, both could alleviate both rumination and depression. Reductions in the beta and alpha frequency bands in the DMN can be considered as potential EEG-based markers of response to bilateral and unilateral rTMS, respectively.

An Efficient Approach for Driver Drowsiness Detection at Moderate Drowsiness Level Based on Electroencephalography Signal and Vehicle Dynamics Data

Background

Drowsy driving is one of the leading causes of severe accidents worldwide. In this study, an analyzing method based on drowsiness level proposed to detect drowsiness through electroencephalography (EEG) measurements and vehicle dynamics data.

Methods

A driving simulator was used to collect brain data in the alert and drowsy states. The tests were conducted on 19 healthy men. Brain signals from the parietal, occipital, and central parts were recorded. Observer Ratings of Drowsiness (ORD) were used for the drowsiness stages assessment. This study used an innovative method, analyzing drowsiness EEG data were in respect to ORD instead of time. Thirteen features of EEG signal were extracted, then through Neighborhood Component Analysis, a feature selection method, 5 features including mean, standard deviation, kurtosis, energy, and entropy are selected. Six classification methods including K-nearest neighbors (KNN), Regression Tree, Classification Tree, Naive Bayes, Support vector machines Regression, and Ensemble Regression are employed. Besides, the lateral position and steering angle as a vehicle dynamic data were used to detect drowsiness, and the results were compared with classification result based on EEG data.

Results

According to the results of classifying EEG data, classification tree and ensemble regression classifiers detected over 87.55% and 87.48% of drowsiness at the moderate level, respectively. Furthermore, the classification results demonstrate that if only the single-channel P4 is used, higher performance can achieve than using data of all the channels (C3, C4, P3, P4, O1, O2). Classification tree classifier and regression classifiers showed 91.31% and 91.12% performance with data from single-channel P4. The best classification results based on vehicle dynamic data were 75.11 through KNN classifier.

Conclusion

According to this study, driver drowsiness could be detected at the moderate drowsiness level based on features extracted from a single-channel P4 data.

Remember NIBS? tACS improves memory performance in elders with subjective memory complaints

Subjective memory complaints (SMC), the main cognitive component of which is event memory, is a predictor of Alzheimer's disease in elderly people. The purpose of this trial was to investigate the effect of transcranial alternating current stimulation (tACS) with theta frequency (6 Hz) on the medial prefrontal cortex (mPFC) in the improvement of episodic memory in individuals with SMC in a double blind, randomized, and sham-controlled parallel study. Sixteen participants with SMC received either active or sham theta tACS on the mPFC. EEG was recorded, and Rey Auditory Verbal Learning Test (RAVLT) was administered. tACS resulted in a significant improvement in episodic memory performance as measured by RAVLT. EEG data revealed a decrease in theta power; decrease in theta, alpha, and gamma current source density (CSD) in the postcentral, insula, and cingulate gyrus; and decrease in theta and gamma phase synchronization as a result of active tACS, compared to the sham group. Moreover, a significant correlation between delayed recall score of RAVLT and CSD in left inferior gyrus in theta frequency band was observed. The results of the current study showed that theta tACS of the mPFC can improve event memory in individuals with SMC through modulating the activity in the frontal and temporal regions in the brain and thus can be considered a potential therapeutic intervention for this population.

A case of xanthogranulomatous pyelonephritis leading to nephrobronchial fistula and lung abscess: does it always manifest with respiratory symptoms?

Xanthogranulomatous pyelonephritis (XGP) is a serious manifestation of chronic kidney inflammation that can expand to adjacent structures. Here we report a case of XGP extending beyond the diaphragm through a nephrobronchial fistula to form a lung abscess in a 70-year-old man. The patient presented to the emergency department with severe right flank colic pain, nausea, vomiting and nonspecific constitutional symptoms for the past 4 months. Although the patient did not complain of any respiratory symptoms, initial evaluations revealed severe right-sided hydroureteronephrosis with debris, as well as an area of infiltration in the right lung lower lobe (RLL). Given the patient's condition, a thorough work-up was expedited to investigate the potential association between the symptoms. Ultimately, a diagnosis of XGP with expansion to the RLL through the right hemidiaphragm was developed. A right radical nephrectomy, right lower lobectomy and right hemidiaphragm resection were carried out. XGP was confirmed on the basis of the pathological evaluation of the resected specimens.

Visual ergonomics, performance and the mediating role of eye discomfort: A structural equation modelling approach

The purpose of this study was to model the visual ergonomic factors affecting the performance in human computer interaction. A cross-sectional study using structural equation modelling was performed with a sample of 200 participants. The measuring instruments included Office Lighting Survey Questionnaire, performance assessment questionnaires, visual ergonomics assessment, and an eye discomfort assessment. The hypothetical model evaluated workplace lighting status and visual ergonomics as precursors, performance as the output, and eye discomfort as a mediator. The results showed that eye discomfort directly affected performance. Visual ergonomics also had a significant direct effect on eye discomfort. The final model suggested a significant new path between the quality of lighting and visual ergonomics. Also, the quality of lighting had an indirect effect on eye discomfort and performance, and the effect of visual ergonomics on performance was the same. Improving the lighting quality and visual ergonomics can reduce eye discomfort and increase performance.

Sex differences in rTMS treatment response: A deep learning-based EEG investigation

INTRODUCTION

The present study aimed to investigate sex differences in response to repetitive transcranial magnetic stimulation (rTMS) in Major Depressive Disorder (MDD) patients. Identifying the factors that mediate treatment response to rTMS in MDD patients can guide clinicians to administer more appropriate, reliable, and personalized interventions.

METHODS

In this paper, we developed a novel pipeline based on convolutional LSTM-based deep learning (DL) to classify 25 female and 25 male patients based on their rTMS treatment response.

RESULTS

Five different classification models were generated, namely pre-/post-rTMS female (model 1), pre-/post-rTMS male (model 2), pre-rTMS female responder versus pre-rTMS female nonresponders (model 3), pre-rTMS male responder vs. pre-rTMS male nonresponder (model 4), and pre-rTMS responder versus nonresponder of both sexes (model 5), achieving 93.3%, 98%, 95.2%, 99.2%, and 96.6% overall test accuracy, respectively.

CONCLUSION

These results indicate the potential of our approach to be used as a response predictor especially regarding sex-specific antidepressant effects of rTMS in MDD patients.

Cold Cognition as Predictor of Treatment Response to rTMS; A Retrospective Study on Patients With Unipolar and Bipolar Depression

Background

Cognitive impairments are prevalent in patients with unipolar and bipolar depressive disorder (UDD and BDD, respectively). Considering the fact assessing cognitive functions is increasingly feasible for clinicians and researchers, targeting these problems in treatment and using them at baseline as predictors of response to treatment can be very informative.

Method

In a naturalistic, retrospective study, data from 120 patients (Mean age: 33.58) with UDD (n = 56) and BDD (n = 64) were analyzed. Patients received 20 sessions of bilateral rTMS (10 Hz over LDLPFC and 1 HZ over RDLPFC) and were assessed regarding their depressive symptoms, sustained attention, working memory, and executive functions, using the Beck Depression Inventory (BDI-II) and Neuropsychological Test Automated Battery Cambridge, at baseline and after the end of rTMS treatment course. Generalized estimating equations (GEE) and logistic regression were used as the main statistical methods to test the hypotheses.

Results

Fifty-three percentage of all patients (n = 64) responded to treatment. In particular, 53.1% of UDD patients (n = 34) and 46.9% of BDD patients (n = 30) responded to treatment. Bilateral rTMS improved all cognitive functions (attention, working memory, and executive function) except for visual memory and resulted in more modulations in the working memory of UDD compared to BDD patients. More improvements in working memory were observed in responded patients and visual memory, age, and sex were determined as treatment response predictors. Working memory, visual memory, and age were identified as treatment response predictors in BDD and UDD patients, respectively.

Conclusion

Bilateral rTMS improved cold cognition and depressive symptoms in UDD and BDD patients, possibly by altering cognitive control mechanisms (top-down), and processing negative emotional bias.

Subjective and objective survey of office lighting: effects on alertness, comfort, satisfaction, and safety

BACKGROUND

Lighting is one of the workplace factors that can relevantly impact workers' health, performance, safety, and job satisfaction. Brightness, natural light and color temperature are the factors that affect the quality of lighting. This study involved subjective and objective evaluation of office lighting and its effects on workers' alertness, comfort, satisfaction, safety, and performance in a prominent government office.

METHODS

Visual comfort, alertness, performance, safety and satisfaction were assessed subjectively using the questionnaires and rating scales. Moreover, illuminance, color temperature of light sources, and natural light availability were evaluated objectively.

RESULTS

 The findings of this study indicated that the use of natural light in the workplace could increase the illuminance and color temperature of light in the workplace and improve alertness, visual comfort, satisfaction and worker's preference. Conclusions: To improve the quality of lighting in the workplace, factors affecting it, such as the color temperature and the availability of natural light, should be considered.

Reducing opioid use disorder and overdose deaths in the United States: A dynamic modeling analysis

Opioid overdose deaths remain a major public health crisis. We used a system dynamics simulation model of the U.S. opioid-using population age 12 and older to explore the impacts of 11 strategies on the prevalence of opioid use disorder (OUD) and fatal opioid overdoses from 2022 to 2032. These strategies spanned opioid misuse and OUD prevention, buprenorphine capacity, recovery support, and overdose harm reduction. By 2032, three strategies saved the most lives: (i) reducing the risk of opioid overdose involving fentanyl use, which may be achieved through fentanyl-focused harm reduction services; (ii) increasing naloxone distribution to people who use opioids; and (iii) recovery support for people in remission, which reduced deaths by reducing OUD. Increasing buprenorphine providers' capacity to treat more people decreased fatal overdose, but only in the short term. Our analysis provides insight into the kinds of multifaceted approaches needed to save lives.

A field study of mental workload: conventional bus drivers versus bus rapid transit drivers

Road traffic accidents are increasing worldwide and cause a high number of fatalities and injuries. Mental Work Load (MWL) is a contributing factor in road safety. The primary aim of this work was to study important MWL factors and then compare conventional and BRT (Bus Rapid Transit) drivers' MWL. This study evaluated bus drivers' MWL using the Driving Activity Load Index (DALI) questionnaire conducted with 123 bus drivers in Tehran. The results revealed significant differences between conventional and BRT drivers' mental workload. Moreover, data modelling showed that some organisational and environmental factors such as bus type, working hours per day, road maze, and route traffic volume contribute to drivers' mental workload. These findings suggest some essential customised factors that may help measure and offer practical solutions for decreasing the level of bus drivers' MWL in real-world road driving. Practitioner summaryMental workload is affected by several contributing factors. Depending on the working context, some of these contributing factors have a more significant influence on the level of the experienced MWL. Therefore, the main factors influencing the MWL of BRT and conventional bus drivers were assessed in their real-life environment.Abbreviations: MWL: mental work load; BRT: bus rapid transit; CB: conventional bus; DALI: driving activity load index; NASA-TLX: NASA task load index; SWAT: subjective workload assessment technique; EEG: electroencephalography electrocardiogram; fNIRS: functional magnetic resonance imaging; ITS: intelligent transportation systems; AVL: automated vehicle location.

Transdiagnostic Role of Glutamate and White Matter Damage in Neuropsychiatric Disorders: A Systematic Review

Introduction

Neuropsychiatric disorders including Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Major Depressive Disorder (MDD), Bipolar Disorder (BD), and Schizophrenia (SZ) have been considered distinct categories of diseases despite their overlapping characteristics and symptomatology.

Objectives

We aimed to provide an in-depth review elucidating the role of glutamate/Glx and white matter (WM) abnormalities from a transdiagnostic perspective.

Methods

The PubMed online database was searched for studies published between 2010 and 2021. After careful screening, 399 studies were included.

Results

The findings point to decreased levels of glutamate in the Anterior Cingulate Cortex in both SZ and BD, whereas Glx is elevated in the Hippocampus in SZ and MDD. With regard to WM abnormalities, the Corpus Callosum and superior Longitudinal Fascicle were the most consistently identified brain regions showing decreased fractional anisotropy (FA) across all the reviewed disorders, except GAD. Additionally, the Uncinate Fasciculus was found to be affected in all the reviewed disorders, except OCD. Decreased FA was also found in the inferior Longitudinal Fasciculus, inferior Fronto-Occipital Fasciculus, Thalamic Radiation, and Corona Radiata in SZ, BD, and MDD. Decreased FA in the Fornix and Corticospinal Tract were found in BD and SZ patients. The Cingulum and Anterior Limb of Internal Capsule exhibited decreased FA in MDD and SZ patients.

Conclusions

The results suggest a gradual increase in severity from GAD to SZ defined by the number of brain regions with WM abnormality which may be partially caused by abnormal glutamate levels. WM damage could thus be considered a potential marker of some of the main neuropsychiatric disorders.

Disclosure

No significant relationships.

Investigating the effect of background music on cognitive and skill performance: A cross-sectional study

BACKGROUND: Existing studies on the impact of background music in the workplace have reported varying results, from improving production and performance to being known as an annoying factor. Given the lack of evidence of the background music influence on the cognitive factors in the work place in previous studies and the lack of study on the effect of background music on skill performance when gender and personality type is considered, research in this area seems necessary. OBJECTIVE: The purpose of the present study is to investigate the influence of background music on cognitive and skill performance in the work place with regard to gender and personality type. METHODS: This study was conducted with the participation of 52 students (26 males and 26 females) aged between 18–30 years old. Sustained attention, working memory, fine finger and gross manual dexterity skills and personality type were assessed. Participants were randomly tested once when being exposed to classical instrumental music and once again when faced with complete silence RESULTS: Playing background music improved students working memory but had no significant effect on sustained attention. Music also improved skill performance.Overall, memory performance and fine finger dexterity were found significantly better in extroverts when compared to introverts during playing background music. CONCLUSION: Background music improves working memory and speeds up performance in skill tasks, however the role of personality type in influencing background music on cognitive and skill performance needs further investigation.

Transdiagnostic role of glutamate and white matter damage in neuropsychiatric disorders: A Systematic Review

Neuropsychiatric disorders including generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SZ) have been considered distinct categories of diseases despite their overlapping characteristics and symptomatology. We aimed to provide an in-depth review elucidating the role of glutamate/Glx and white matter (WM) abnormalities in these disorders from a transdiagnostic perspective. The PubMed online database was searched for studies published between 2010 and 2021. After careful screening, 401 studies were included. The findings point to decreased levels of glutamate in the Anterior Cingulate Cortex in both SZ and BD, whereas Glx is elevated in the Hippocampus in SZ and MDD. With regard to WM abnormalities, the Corpus Callosum and superior Longitudinal Fascicle were the most consistently identified brain regions showing decreased fractional anisotropy (FA) across all the reviewed disorders, except GAD. Additionally, the Uncinate Fasciculus displayed decreased FA in all disorders, except OCD. Decreased FA was also found in the inferior Longitudinal Fasciculus, inferior Fronto-Occipital Fasciculus, Thalamic Radiation, and Corona Radiata in SZ, BD, and MDD. Decreased FA in the Fornix and Corticospinal Tract were found in BD and SZ patients. The Cingulum and Anterior Limb of Internal Capsule exhibited decreased FA in MDD and SZ patients. The results suggest a gradual increase in severity from GAD to SZ defined by the number of brain regions with WM abnormality which may be partially caused by abnormal glutamate levels. WM damage could thus be considered a potential marker of some of the main neuropsychiatric disorders.

Evaluating the efficacy of intraplaque injection of dexamethasone with oral tadalafil in the chordee patients with Peyronie disease

BACKGROUND

Some studies demonstrated the effect of the combination of modalities in Peyronie's disease (PD) therapy; however, there is no comprehensive study for evaluation of dexamethasone and phosphodiesterase type 5 (PDE5) inhibitors such as tadalafil in the treatment of PD, so the study aimed to evaluate the efficacy of intraplaque injection of dexamethasone with oral tadalafil in the patients with PD.

MATERIALS AND METHODS

This double-blinded randomized, controlled trial was conducted on the patients with PD referred to Alzahra and Khorshid hospitals, Isfahan, Iran. Then the patients were randomly divided into two groups as intervention and control groups. In the intervention group, tadalafil (5 mg PO) was administered once daily for 12 weeks and dexamethasone (8 mg) was injected once a week for 12 weeks. In the control group, the verapamil (5 mg: 2 cc) was injected once a week for 12 weeks. Before and after 12 weeks, an ultrasound was performed to assess the size, number and location of the plaque. The degree of penile curvature from the midline, dorsal and lateral curvature was also determined.

RESULTS

The means of penis curvature in the intervention and control groups before therapy were 34.09±7.05˚ and 31.09±7.06˚, respectively (P=0.097) and also after therapy were 27.3±7.79˚ and 24.6±6.64˚, respectively (P=0.13). The means of plaque count in the intervention and control groups before treatment were 2.0±1.03 and 1.96±1.06, respectively (P=0.9) and after treatment were 1.22±0.71 and 1.40±0.79, respectively (P=0.34). The means of plaque size in the intervention and control groups were 12.31±4.9 cm and 12.45±4.12 cm, respectively (P=0.9) and after intervention 7.8±3.08 and 9.03±3.46 cm, respectively (P=0.15).

CONCLUSION

According to these findings, there was no significant difference between intervention and control groups regarding the degree of penis curvature, and the count and size of the plaque. Therefore, it seems that tadalafil therapy with dexamethasone did not improve PD compared to verapamil.

Evaluation of glomerular filtration rate decline in patients with renal colic

PURPOSE

The aim of current study was to evaluate glomerular filtration rate (GFR) decline in patients with renal colic.

MATERIALS AND METHODS

This descriptive analytical study was conducted on patients with definitive diagnosis of renal colic in Alzahra hospital. Data including gender, age, and underlying disease were extracted from medical records. GFR and creatinine level were assessed before and 3 months after stone excretion. Hydronephrosis severity was assessed by ultrasound procedure.

RESULTS

In current study, 224 patients with renal colic and mean age 45.6±11.35 years old were selected. The mean GFR before and 3 months after urinary stone excretion were 45.89±18.84 and 61.13±22.10 ml/minute, respectively (P<0.01). The mean creatinine at the beginning and 3 months after urinary stone excretion was 1.93±0.46 and 1.59±0.43 mg/dl, respectively (P<0.01). The most frequency of patients with different hydronephrosis degrees was related to score 3 (n=92). There was significant difference between hydronephrosis severity in terms of GFR (P=0.000). No significant difference was seen between the mean GFR at the beginning of the study and at 3 months after urinary stone excretion in terms of diabetes and hypertension (P>0.05).

CONCLUSION

We observed significant difference between hydronephrosis severity in terms of GFR. This indicated that the increase of hydronephrosis degree was associated with worse renal function. Moreover, urinary stone excretion led to the increase of GFR and the decrease of creatinine level. In addition, the mean GFR was not influenced by diabetes and hypertension.

Cognitive demands and mental workload: A filed study of the mining control room operators

Cognitive demand and mental workload assessment are essential for the optimal interaction of human-machine systems. The aim of this study was to investigate the cognitive demands and mental workload as well as the relationship between them among the mining control room operators.

This cross-sectional study was performed on 63 control room operators of a large mining plant located in Iran. Cognitive demands and mental workload were assessed using cognitive task analysis (CTA) and NASA Task Load Index (NASA-TLX), respectively and the analysis was performed using SPSS version 21. Independent samples T-test, Mann-Whitney U test and multivariate linear regression were used for data analysis.

Twelve cognitive demands were extracted after observing the tasks and conducting semi-structured interviews with the control room staff. The mean scores of total cognitive demands and MWL were 6.60 and 72.89, respectively, and these two indicators showed a positive and significant correlation (r = 0.286; P = 0.023). The participants’ demographic characteristics such as age, education, and work experience did not affect mental workload, but the two cognitive demands (memory and defect detection) affected MWL.

High cognitive demands and mental workload indicate poor interaction between humans and machines. Due to the effect of memory load and defect detection on mental workload, it is recommended to assign cognitive tasks based on memory and defect detection to the machine to reduce the mental workload and improve human-machine interaction.

Designing and Usability testing of a New Prototype Active Footrest for Knee Extension Exercise Among Office Workers

OBJECTIVES

The active factor along with light exercise can reduce static muscle work and increase muscle flexibility and endurance. Accordingly, this study aimed to design and prototype a new active footrest, implemented in conventional sitting workstations and to test its usability among office workers.

METHODS

The steps taken to design and prototype the active footrest were a) selection of an exercise appropriate for goals of ergonomic interventions, b) idea development, c) selection of the best conceptual design, d) design with SOLIDWORKS version 2016 software, and e) fabrication of a prototype. Afterward, the usability of the active footrest prototype was assessed among 20 office workers (10 females) using field data by the System Usability Scale.

RESULTS

Upon the completion of the design steps, the active footrest prototype was prototyped by taking into account design criteria (e.g. functionality, inclusive design, easy application, and reduction of additional body movement), anthropometric data and mechanical properties. The participants rated the usability of the active workstation as 89 ± 8.21 (out of 100) and indicating good usability results.

CONCLUSION

In this study, an active footrest was designed and prototyped to perform knee extension exercise with the capability of being implemented in conventional sitting workstations.

The Relationship Between Helmet Weight, Cognitive Performance, and Mental Workload

Introduction: This study sought to examine the effects of helmet weight on cognitive performance and mental workload. Twenty participants were studied in 3 one-hour sessions. Methods: The study participants were requested to read and work with computers under the following 3 conditions: wearing no helmets, wearing a helmet that weighed 800 g (A), and a helmet weighing 1500 g (B). “N-back” task and Continuous Performance Test (CPT) were employed to assess cognitive performance. At the same time, NASA-TLX and Thermal Comfort and Fatigue Perception Scale were used to evaluate mental workload and comfort. At the end of the intervention sessions, perceived mental workload, thermal comfort, and fatigue in the head were measured. Moreover, the research participants’ cognitive performance was gauged before and after the sessions. Results: The present study findings revealed that helmet weight significantly impacted cognitive performance (P<0.001). However, no significant difference was detected in the participants’ mental workload before and after the intervention. Conclusion: Helmet weight could affect cognitive performance. Therefore, in designing helmets, the helmet’s weight should be considered an essential factor.

An investigation of the effects of different shift schedules on the fatigue and sleepiness of officers on oil tankers during cargo handling operations

Cargo handling is an operation, which requires a high level of performance from the officer of the watch (OOW). This study aimed to investigate the effect of different shift schedules on sleep quality, cognitive performance, and sleepiness of 139 OOWs on oil tankers with 4on-8off shifts, during the first shift of cargo handling. Sleep quality (Pittsburgh Sleep Quality Index (PSQI)), level of sleepiness (the Karolinska Sleepiness Scale (KSS)), Psychomotor Vigilance Task (PVT), and Arrow Flanker task performance were examined. The results showed that OOWs with (00:00-04:00, 12:00-16:00) and (04:00-08:00, 16:00-20:00) shifts had impaired cognitive performance and higher sleepiness during the cargo handling operation, and they also experienced impaired sleep quality. The results demonstrated that the circadian rhythm and homeostatic sleep drive have a greater impact on cognitive performance and sleepiness than time on shifts. These results suggest that allocating rest hours immediately before the cargo handling operation may reduce the risk of fatigue. Practitioner Summary: To the best of our knowledge, this maritime field study shows for the first time the prevalence of seafarers' sleepiness and cognitive performance while on duty during cargo handling, using a pre-post shift comparison between three different shifts. The results show the negative effects of keeping watch at night on sleep quality, sleepiness, and the impaired cognitive performance both in the day and the night shifts.

Diagnostic utility of a-methylacyl COA racemase in prostate cancer of the Iranian population

Background:

Considering the great variations in the reported prevalence of prostate cancer across the world possibly due to different genetic and environmental backgrounds, we aimed to determine the expression pattern and the diagnostic utility of α-methylacyl coenzyme A racemase (AMACR) among Iranian patients with prostate adenocarcinoma.

Materials and Methods:

In this cross-sectional study, formalin-fixed paraffin-embedded tissues of 58 patients with a definitive pathologic diagnosis of prostatic adenocarcinoma were evaluated. The expression of AMACR, intensity, and extensity of its staining was determined in selected samples by immunohistochemical technique.

Results:

AMACR expression was significantly higher in neoplastic compared to normal tissue (P < 0.05). The expression of AMACR was significantly associated with the age of the patients (P = 0.04). The intensity of the staining was associated with the grade of the prostate adenocarcinoma (P = 0.04). There was no significant relationship between AMACR expression and perineural invasion. The sensitivity, specificity, positive predictive value, and negative predictive value of AMACR were 90%, 96%, 96%, and 90%, respectively.

Conclusion:

Findings from our study indicate that AMACR could be used as a diagnostic tool for the diagnosis of prostate adenocarcinoma. However, due to false-positive staining in the mimicker of prostatic adenocarcinoma, it is recommended to use it in combination with basal cell markers.

Correlation between ultrasound bladder parameters with severity of symptoms and response to treatment in patients with benign prostatic hyperplasia under medical treatment

BACKGROUND

Benign prostatic hyperplasia (BPH) is the most common benign mass in men, there are not standard parameter for diagnosis of BPH based on ultrasound bladder parameter, so the aim of the study was correlation between ultrasound bladder parameters with severity of symptoms and response to treatment in patients with benign prostatic hyperplasia under medical treatment.

METHODS

This prospective cross-sectional study was performed on 100 men over 40 years of age with a diagnosis of BPH referred to the urology clinics of Al-Zahra and Khorshid hospitals, Isfahan, Iran in 2018-2020. The International Prostate Symptom Score (IPSS), bladder wall thickness, bladder weight, Intravesical prostatic protrusion (IPP) and response to treatment were examined before and after treatment. Patients underwent standard drug treatment with a Tamsulosin 0.4 mg daily and finasteride 5 mg daily for BPH and followed for a period of 3-6 months.

RESULTS

There were significant differences between severity of symptoms before treatment with age, bladder was thickness, bladder weight and IPP (P<0.001). The symptoms of 76 patients were recovered and 24 patients not changed After treatment, so the patients were compared based on outcomes to treat, all patients with mild symptoms, 28 patients with moderate symptoms and 18 patients with severe symptoms were recovered, so the treatment outcome was significant based on symptoms (P<0.001). The means of age, bladder wall thickness and bladder weight in recovered group was significantly lower than not changed group (P<0.001). Also the frequency of IPP in the recovered group was significantly lower than not changed group (P<0.001).

CONCLUSION

The use of ultrasound parameters has a high value in determining the response to treatment in BPH patients and the diagnostic value of IPSS, IPP, bladder wall thickness and bladder weight were important determined response to treatment and severity of disease. Also relation between bladder weight with response to treatment and severity of disease were evaluated for first time in the current study.

Development and validation of a Nurse Station Ergonomics Assessment (NSEA) tool

Background

Nurse stations are one of the primary units for supporting effective functioning of any hospital. They are important working environments that demand adherence to known ergonomic principles for the well-being of both staff and patients. The aim of this study was to develop a psychometrically tested tool for the assessment of the ergonomic conditions of nurse workstations in hospitals.

Methods

Ten hospitals, with a total of 133 nurse stations participated in this mixed-methods research. The domains and items of the tool were developed based on a literature review, an experts’ panel, and interviews with nurses.

Results

The final nurse station ergonomic assessment (NSEA) tool has good psychometric properties. Validity was assessed by face validity and content validity. Reliability was evaluated using inter-rater agreement and test-retest reliability analyses with a four-week interval between assessments. The NSEA is comprised of 64 items across eight domains: layout and location (7 items), workspace (11 items), security-safety (5 items), environmental conditions (8 items), counter (8 items), chair (13 items), desk (9 items), and monitor (3 items).

Conclusions

The NSEA adds to the literature a tool for managers to ensure they comply with legal requirements and support best practice for those working on hospital wards. The NSEA can be used to identify challenges for healthcare professionals who use nurse stations and support the execution of targeted interventions to improve human-environment interactions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00600-8.

A novel convolutional neural network method for subject-independent driver drowsiness detection based on single-channel data and EEG alpha spindles

A significant number of fatal accidents are caused by drowsy drivers worldwide. Driver drowsiness detection based on electroencephalography (EEG) signals has high accuracy and is known as a reference method for evaluating drowsiness. Among brain waves, EEG alpha spindle activity is a silent feature of decreasing alertness levels. In this paper, based on the detection of EEG alpha spindles, a novel driver drowsiness detection method is presented. The EEG spindles were detected using Continuous Wavelet Transform (CWT) analysis and the Morlet function. To do so, the signal is divided into 30-s epochs, and the observer rating of drowsiness determines the drowsiness level in each epoch. Tests were conducted on 17 healthy males in a driving simulator with a monotonous driving scenario. The Convolutional Neural Network (CNN) is used for classifying EEG signals and automatically learns features of the early drowsy state. The subject-independent classification results for single-channel P4 show 94% accuracy.

Occupational stress assessment of health care workers (HCWs) facing COVID-19 patients in Kerman province hospitals in Iran

BACKGROUND

The health care workers (HCWs) at the frontline of fighting COVID-19 are at higher risk for mental health problems, including stress, anxiety, depression, and insomnia. This study aimed at assess the status of occupational stress in the three occupational groups of nurses, physicians and hospital cleaning crew facing COVID-19 patients in hospitals of Kerman province in Iran.

METHODOLOGY

This cross-sectional descriptive analytical study was performed on 290 medical staffs including nurses, physicians and cleaning crew facing COVID-19 patients working in different hospitals in Iran in 2020. Demographic information form and occupational Stress Questionnaire (HSE tool indicator) were used to collect data. The health and safety executive (HSE) questionnaire has 35 questions and 7 areas, which was developed in the 1990s by the UK Health and Safety Institute to measure occupational stress.

RESULTS

The mean score of total dimensions among HCWs was 2.93. Communications, Manager support, Changes and Demand factors with scores of 2.76, 2.77, 2.83 and 2.87 had the greatest impact on participants' stress levels, respectively. Also, Colleague support factor with a score of 3.38 had the least effect on stress levels. Also, according to the results, 87% of nurses, 79% of cleaning crew and 67% of physicians had a partial to high levels of stress that, on average, 77.5% of the HCWs participating in this study had at least a small amount of stress.

CONCLUSIONS

The mean stress score among the participants of the present study was between high stress level and moderate stress level. Factors such as communications, manager support, change and demand had the greatest impact on employee stress levels. Therefore, by improving the communication between people working in hospitals, increasing managers' support for staff, and reducing workplace demands such as reducing workload and improving workplace environment, the stress level of staff in hospitals during the outbreak of COVID-19 can be reduced.

Spontaneous nephrocutaneous fistula due to xanthogranulomatous pyelonephritis with secondary enterocutaneous fistula: a rare case report

Chronic infection, especially in the setting of obstruction like calculous disease, may result in the fistula tract development of fistula tract from kidney to the other proximal organs. However, nephrocutaneous fistula is a rare complication, and the primary cause of its development is previous surgical intervention, trauma, or malignancy. Our case was a 26-year-old Afghan man with xanthogranulomatous pyelonephritis (XGP) resulted in spontaneous nephrocutaneous fistula. The patient underwent radical nephrectomy. Our case shows that previous surgery is not the only cause of fistula. After surgery, he presented with secondary enterocutaneous fistula due to surgery or chronic underlying inflammation. After systemic antibiotic therapy and total parenteral nutrition, he became well and discharged from the hospital. As a result, XGP is a rare subtype of chronic pyelonephritis that requires immediate evaluation and early diagnosis. Patients should be considered for possible complications such as fistulas. Physicians should be aware of this issue for appropriate diagnosis and treatment.

Catastrophic retroperitoneal hemorrhage in COVID-19 patients under anticoagulant prophylaxis

COVID-19 patients are at high risk for both capillary micro thrombi and large vessel thrombosis. Anticoagulant administration in COVID-19 patients, especially in ICU setting, is recommended by some researchers. However, clinical guidelines don't yet recommend anticoagulation therapies in therapeutic doses in these patients. In this article, we try to introduce a less known complication of heparin application in COVID-19 patients. Retroperitoneal hemorrhage when involves the psoas muscle might be deadly because of the large volume of bleeding before causing any significant alarm. It is very important to be careful in diagnosing and managing this complication.

Effectiveness of Illness Management Program on Positive/Negative Symptoms, and Insight of Schizophrenic Patients

Background: Schizophrenia is a chronic disorder with positive and negative symptoms, and insight is involved in its prognosis. Illness management is considered a skill and strategy for patients with some mental disorders. Objectives: We aimed to investigate the illness management effectiveness on the positive and negative symptoms and insight in schizophrenic patients. Materials & Methods: This study was a quasi-experimental, controlled study with a pre-test-posttest design. The study population included all schizophrenic patients admitted to the Shafa Hospital, Guilan Province in the North of Iran, from March 2019 to April 2020. The sample included 30 schizophrenic patients selected using the convenience sampling method and was divided into 2 groups (experimental and control groups), with 15 patients in each group. For data collection, the scale for the assessment of negative symptoms, the scale for the assessment of positive symptoms, and the scale to assess unawareness of mental disorders were used before and after the intervention. Illness management was performed on the experimental group as group therapy. The control group did not undergo any concomitant intervention. Data analysis was performed in SPSS software version 24 using the univariate analysis of variance in normal distribution and the non-parametric Kruskal-Wallis test for the variable which didnchr('39')t follow the normal distribution.. Results: Results indicated that illness management could effectively alleviate the positive and negative symptoms and improve the insight in schizophrenic patients (P<0.01). Conclusion: Illness management was influential on the positive and negative symptoms of schizophrenia. Thus, this therapeutic modality can be used as an effective technique in hospitalized schizophrenic patients.