Can Artificial Intelligence Aid Diagnosis by Teleguided Point-of-Care Ultrasound? A Pilot Study for Evaluating a Novel Computer Algorithm for COVID-19 Diagnosis Using Lung Ultrasound.

With the 2019 coronavirus disease (COVID-19) pandemic, there is an increasing demand for remote monitoring technologies to reduce patient and provider exposure. One field that has an increasing potential is teleguided ultrasound, where telemedicine and point-of-care ultrasound (POCUS) merge to create this new scope. Teleguided POCUS can minimize staff exposure while preserving patient safety and oversight during bedside procedures. In this paper, we propose the use of teleguided POCUS supported by AI technologies for the remote monitoring of COVID-19 patients by non-experienced personnel including self-monitoring by the patients themselves. Our hypothesis is that AI technologies can facilitate the remote monitoring of COVID-19 patients through the utilization of POCUS devices, even when operated by individuals without formal medical training. In pursuit of this goal, we performed a pilot analysis to evaluate the performance of users with different clinical backgrounds using a computer-based system for COVID-19 detection using lung ultrasound. The purpose of the analysis was to emphasize the potential of the proposed AI technology for improving diagnostic performance, especially for users with less experience.

Enhancing Rheological and Textural Properties of Gelatin-Based Composite Gels through Incorporation of Sesame Seed Oleosome-Protein Fillers.

In this study, the protein and oleosomes of sesame seeds were extracted individually and used to prepare a gel composed of gelatin, protein, and oleosomes. Mixtures of gelatin and sesame seeds protein were prepared, and oleosomes with different percentages (0, 10, 20 and 30% of their weight) were used. Different amounts of oleosomes in the composite gel samples were examined for their morphological, rheological, and textural properties. The results of the viscoelastic properties of different composite gel samples indicated that a higher percentage of oleosomes would increase the storage modulus (G'), loss modulus (G″), and complex viscosity (η*). The storage modulus of all gel samples was greater than the loss modulus, suggesting a solid behavior. So, in the sample with 30% oleosome, the storage modulus and the loss modulus reached 143,440 Pascals and 44,530 Pascals. The hardness and breaking force in samples containing 30% oleosome reached 1.29 ± 0.02 and 0.17 ± 0.02, respectively. In general, it can be said that composite gels based on gelatin-sesame seed protein modified with oleosome can be used as a part of food components in various dairy products, gelatin desserts, lean meat products and the production of useful products.

Development of stability, antioxidant, and antimicrobial properties of biopolymeric chitosan- modified starch nanocapsules containing essential oil.

Lemon essential oil (LEOs) is used as a bioactive compound with unique health properties as a medicine or dietary supplement. Nevertheless, essential oils are chemical compounds sensitive to light, oxidation, and thermal processes. Therefore, encapsulation technique can be a good way to protect them from degradation and evaporation. In current study, biopolymeric nanocapsules containing lemon essential oils (LEOs) were prepared by the emulsion method. The nanocapsules were characterized by their particle size and Encapsulation efficiency (%) ranged from 339.3 to 553.3 nm and 68.09% to 85.43%, respectively. Long-term storage (30 days) under different temperatures (4°C, 25°C, and 40°C) conditions showed that nanocapsules stored at 4°C were more stable than samples stored at higher temperatures. DPPH and ABTS free radical scavenging activity were measured to evaluate the values of antioxidant activity of LEOs and nanocapsules. The free LEO and nanocapsules were investigated for its antibacterial activity against common Gram-positive and Gram-negative pathogenic microorganisms (Staphylococcus aureus and Escherichia coli) using disk diffusion followed by the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Our results indicated that the encapsulated LEOs had a significant antioxidant and antibacterial activities, as compared to the free LEO. The LEOs nanocapsules in CS and Hicap can be suggested as an important natural alternative with suitable stability, antioxidant, and antibacterial properties to overcome the challenges associated with the direct application of these bioactive compounds in food.

Hydralazine-augmented contrast ultrasound imaging improves the detection of hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) detection with B-mode and contrast-enhanced ultrasound (CUS) imaging often varies between subjects, especially in patients with background cirrhosis. Various factors contribute to this variability, including the tumor blood flow, tumor size, internal echoes, and its location in livers with diffuse fibro-cirrhotic changes. OBJECTIVE: Towards improving lesion detection, this study evaluates a vasodilator, hydralazine, to enhance the visibility of HCC by reducing its blood flow relative to the surrounding liver tissue. METHODS: HCC were analyzed for tumor visibility measured for B-mode, CUS, and hydralazine-augmented-contrast ultrasound (HyCUS) in an autochthonous HCC rat model. 21 tumors from 12 rats were studied. B-mode and CUS images were acquired before hydralazine injection. Rats received an intravenous hydralazine injection of 5 mg/kg, then images were acquired 20 min later. Four rats were used as controls. The difference in echo intensity of the lesion and the surrounding tissue was used to determine the visibility index (VI). RESULTS: The visibility index for HCC was found to be significantly improved with the use of HyCUS imaging compared to traditional B-mode and CUS imaging. The visibility index for HCC was 16.5 ± 2.8 for HyCUS, compared to 5.3 ± 4.8 for B-mode and 4.1 ± 3.8 for CUS. The differences between HyCUS and the other imaging modalities were statistically significant, with p-values of 0.001 and 0.02, respectively. Additionally, when compared to control cases, HyCUS showed higher discrimination of HCC (VI = 6.4 ± 1.2) with a p-value of 0.003, while B-mode (VI = 6.7 ± 1.4, p = 0.5) and CUS (VI = 6.4 ± 1.2, p = 0.3) showed lower discrimination. CONCLUSION: Vascular blood flow modulation by hydralazine enhances the visibility of HCC. HyCUS offers a potential problem-solving method for detecting HCC when B-mode and CUS are unsuccessful, especially with background fibro-cirrhotic liver disease. Future evaluation of the approach in humans will determine its translatability for clinical applications.

Liposome System for Encapsulation of Spirulina platensis Protein Hydrolysates: Controlled-Release in Simulated Gastrointestinal Conditions, Structural and Functional Properties.

This study aimed to evaluate the physicochemical, structural, antioxidant and antibacterial properties of chitosan-coated (0.5 and 1% CH) nanoliposomes containing hydrolyzed protein of Spirulina platensis and its stability in simulated gastric and intestine fluids. The chitosan coating of nanoliposomes containing Spirulina platensis hydrolyzed proteins increased their size and zeta potential. The fourier transform infrared spectroscopy (FT-IR) test showed an effective interaction between the hydrolyzed protein, the nanoliposome, and the chitosan coating. Increasing the concentration of hydrolyzed protein and the percentage of chitosan coating neutralized the decreasing effect of microencapsulation on the antioxidant activity of peptides. Chitosan coating (1%) resulted in improved stability of size, zeta potential, and poly dispersity index (PDI) of nanoliposomes, and lowered the release of the hydrolyzed Spirulina platensis protein from nanoliposomes. Increasing the percentage of chitosan coating neutralized the decrease in antibacterial properties of nanoliposomes containing hydrolyzed proteins. This study showed that 1% chitosan-coated nanoliposomes can protect Spirulina platensis hydrolyzed proteins and maintain their antioxidant and antibacterial activities.

Subcutaneous Tissue Response to Adseal and Sure-Seal Root Sealers in Rats: a Histopathological Study.

Introduction and objectives: One of the essential phases of root canal treatment is root canal obturation. Solid or semi-solid materials are the most common obturating materials (paste or softened form). Sealer is a biomaterial that enables the sealing process to be carried. This study aimed to evaluate the inflammatory response to Adseal sealer and Sure-Seal Root sealer in rats. Materials and methods:This experimental study was conducted on 28 Wistar rats that were divided into four groups of seven animals per group based on four time periods (7, 14, 30 and 60 days). Each rat received subcutaneous implants containing Adseal sealer (Meta Biomed, Cheongju, Korea) and Sure-Seal Root sealer (Sure Dent Corporation, Gyeonggi-do, South Korea) tubes as well as an empty tube as a control. After the insertion of the tubes, the first to fourth groups were sacrificed on days 7, 14, 30 and 60, respectively, by injecting a high dose of anesthetics. Subsequently, the histopathologic features of the samples were investigated. Data were analyzed in SPSS software (version 26) using Freidman, Wilcoxon, Kruskal-Wallis and Mann-Whitney U tests. A p-value less than 0.05 was considered statistically significant. Results:On day 7, the severity of inflammation was higher in the Adseal sealer and Sure-Seal Root sealer groups compared to the control group. Moreover, on day 14, the level of inflammation was higher in the Sure-Seal Root sealer group than the Adseal sealer and control groups. In addition, on days 30 and 60, the severity of inflammation was similar in both the case and control groups and decreased in all samples. Formation of granulation tissue was observed in all samples on day 14. There was fibrosis tissue in the Sure-Seal Root sealer samples (71.4%) on day 60; however, no fibrosis tissue was observed in the Adseal sealer and control groups. Conclusion:It is concluded that the Sure-Seal Root sealer might lead to a more inflammatory response compared to the Ad Seal sealer. However, due to decreasing inflammation in sealers over time, both sealers are biocompatible.

Ultrasound Radiomics for the Detection of Early-Stage Liver Fibrosis.

Objective: The study evaluates quantitative ultrasound (QUS) texture features with machine learning (ML) to enhance the sensitivity of B-mode ultrasound (US) for the detection of fibrosis at an early stage and distinguish it from advanced fibrosis. Different ML methods were evaluated to determine the best diagnostic model. Methods: 233 B-mode images of liver lobes with early and advanced-stage fibrosis induced in a rat model were analyzed. Sixteen features describing liver texture were measured from regions of interest (ROIs) drawn on B-mode images. The texture features included a first-order statistics run length (RL) and gray-level co-occurrence matrix (GLCM). The features discriminating between early and advanced fibrosis were used to build diagnostic models with logistic regression (LR), naïve Bayes (nB), and multi-class perceptron (MLP). The diagnostic performances of the models were compared by ROC analysis using different train-test sampling approaches, including leave-one-out, 10-fold cross-validation, and varying percentage splits. METAVIR scoring was used for histological fibrosis staging of the liver. Results: 15 features showed a significant difference between the advanced and early liver fibrosis groups, p < 0.05. Among the individual features, first-order statics features led to the best classification with a sensitivity of 82.1−90.5% and a specificity of 87.1−89.8%. For the features combined, the diagnostic performances of nB and MLP were high, with the area under the ROC curve (AUC) approaching 0.95−0.96. LR also yielded high diagnostic performance (AUC = 0.91−0.92) but was lower than nB and MLP. The diagnostic variability between test-train trials, measured by the coefficient-of-variation (CV), was higher for LR (3−5%) than nB and MLP (1−2%). Conclusion: Quantitative ultrasound with machine learning differentiated early and advanced fibrosis. Ultrasound B-mode images contain a high level of information to enable accurate diagnosis with relatively straightforward machine learning methods like naïve Bayes and logistic regression. Implementing simple ML approaches with QUS features in clinical settings could reduce the user-dependent limitation of ultrasound in detecting early-stage liver fibrosis.

Mesenchymal stem cells encapsulation in chitosan and carboxymethyl chitosan hydrogels to enhance osteo-differentiation.

BACKGROUND: Recently biomaterials utilized for designing scaffolds in tissue engineering are not cost-effective and eco-friendly. As a result, we design and develop biocompatible and bioactive hydrogels for osteo-tissue regeneration based on the natural polysaccharide chitosan. Three distinct hydrogel components were used for this. METHODS: Hydrogels networks were created using chitosan 2% (CTS 2%), carboxymethyl chitosan 2% (CMC 2%), and 50:50 mixtures of CTS and CMC (CTS/CMC 50:50). Furthermore, scanning electron microscopy (SEM), Fourier transforms infrared spectroscopy (FTIR), degradation, and swelling behavior of design hydrogels were studied. Also, the cytocompatibility and osteo-differentiation potency were examined by encapsulating mesenchymal stem cells derived from adipose tissue (AMSCs) on the designed hydrogels. RESULTS: According to the findings, our results showed an acceptable pore structure, functional groups, and degradation rate of the designed hydrogels for in vitro evaluation. In addition, employing CMC instead of CTS or adding 50% CMC to the hydrogel component could improve the hydrogel's osteo-bioactivity without the use of external osteogenic differentiation agents. CONCLUSION: The CMC-containing hydrogel not only caused early osteogenesis but also accelerated differentiation to the maturity phase of osteoblasts.

Can Sequential Images from the Same Object Be Used for Training Machine Learning Models? A Case Study for Detecting Liver Disease by Ultrasound Radiomics.

Machine learning for medical imaging not only requires sufficient amounts of data for training and testing but also that the data be independent. It is common to see highly interdependent data whenever there are inherent correlations between observations. This is especially to be expected for sequential imaging data taken from time series. In this study, we evaluate the use of statistical measures to test the independence of sequential ultrasound image data taken from the same case. A total of 1180 B-mode liver ultrasound images with 5903 regions of interests were analyzed. The ultrasound images were taken from two liver disease groups, fibrosis and steatosis, as well as normal cases. Computer-extracted texture features were then used to train a machine learning (ML) model for computer-aided diagnosis. The experiment resulted in high two-category diagnosis using logistic regression, with AUC of 0.928 and high performance of multicategory classification, using random forest ML, with AUC of 0.917. To evaluate the image region independence for machine learning, Jenson-Shannon (JS) divergence was used. JS distributions showed that images of normal liver were independent from each other, while the images from the two disease pathologies were not independent. To guarantee the generalizability of machine learning models, and to prevent data leakage, multiple frames of image data acquired of the same object should be tested for independence before machine learning. Such tests can be applied to real-world medical image problems to determine if images from the same subject can be used for training.

The most effective sexual function and dysfunction interventions in individuals with multiple sclerosis: A systematic review and meta-analysis.

Background: Sexual dysfunction has many factors in multiple sclerosis, but there is no reliable treatment for this challenge. Objective: Determining effective sexual function or dysfunction interventions in individuals with multiple sclerosis. Materials and Methods: To find the relevant published interventional studies that at least had an English abstract or in Persian, we searched International Statistical Institute, PubMed, Scopus, Cochrane, Medline, PsycINFO, EMBASE, CINAHL, and Google Scholar from January 1990 to June 2021. The results were analyzed using RevMan 5.3 software. The p < 0.05 was considered significant. Results: Out of 568 articles, 41 were included after deleting the duplicate and irrelevant articles. Studies were divided into 2 groups of sexual function (n = 27) and dysfunction (n = 14). Interventions in each category have 4 subgroups: psychoeducational, exercise and rehabilitation, and medical and multi-type interventions. For improving sexual function, more than half of psychoeducational interventions showed a significant improvement after interventions (p = 0.0003). In sexual dysfunction studies, most of the interventions (n = 13/14) had improved at least one subscale of sexual dysfunction. Medical interventions were effective on men's sexual dysfunction, and psychoeducational interventions had been more effective in women's sexual dysfunction. Conclusion: Psychoeducational and medical interventions are the commonest effective interventions. The psychoeducational studies conducted specifically on women had a positive impact, and only 4 articles with medical interventions were specifically targeted at men, which had a positive effect.

Contrast-enhanced ultrasound for assessing blood flow modulation of hepatocellular carcinoma by hydralazine.

Modulating aberrant tumor microvasculature provides unique opportunities for enhancing ultrasound imaging of hepatocellular carcinoma (HCC). This study aims to use contrast-enhanced ultrasound to evaluate the potential of a potent vasodilator, hydralazine, to attenuate blood flow in HCC while enhancing it in the surrounding liver tissue. The "steel effect," where blood flow is diverted from the lesion to the surrounding tissue aims to enhance lesion-tissue contrast. Methods: HCC was induced in six rats by oral ingestion of diethylnitrosamine for 12 weeks. 10 tumors were studied to assess the enhancement in HCC tumors and surrounding tissue. Contrast-enhanced ultrasound images (CEUS) of each tumor were acquired before and after hydralazine injection. The enhancement of images was analyzed for the qualitative and quantitative assessment of HCC enhancement. Peak enhancement (PE) was calculated, representing the maximum signal intensity reached during the transit of the contrast bolus for both the tumor and the surrounding tissue. Intravenous administration of hydralazine significantly reduced CEUS signals in HCC tumors. The visual examination of images showed that the enhancement of tumors dramatically decreased after hydralazine injection. On the other hand, the surrounding tissue showed an increased enhancement. PE for the HCC changed from (71.8 ± 5) pre hydralazine to (28.7± 4.9), a 61.7% reduction after hydralazine injection, p=0.01. Future studies validating the technique in clinical settings for enhancing lesion-tissue contrast may allow physicians greater precision and accuracy in HCC surveillance for early detection of small tumors.

Machine learning improves early detection of liver fibrosis by quantitative ultrasound radiomics.

Progression of liver fibrosis to cirrhosis, a severe non-reversible process, is one of the most critical risk factors in developing hepatocellular carcinoma and liver failure. Detection of liver fibrosis at an early stage is therefore essential for better patient management. Ultrasound (US) imaging can provide a noninvasive alternative to biopsies. This study evaluates quantitative US texture features to improve early-stage versus advanced liver fibrosis detection. 157 B-mode US images of different liver lobes acquired from early and advanced fibrosis rat cases were used for analysis. 5-6 regions of interest were placed on each image. Twelve quantitative features that describe liver texture changes were extracted from the images, including first-order histogram, run length (RL), and gray level co-occurrence matrix (GLCM). The diagnostic performance of individual features was high with AUC ranging from 0.80 to 0.94. Logistic regression with leave-one-out cross-validation was used to evaluate the performance of the combined features. All features combined showed a slight improvement in performance with AUC = 0.95, sensitivity = 96.8%, and specificity = 93.7%. Quantitative US texture features characterize liver fibrosis changes with high accuracy and can differentiate early from advanced disease. Quantitative ultrasound, if validated in future clinical studies, can have a potential role in identifying fibrosis changes that are not easily detected by visual US image assessments.

Predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior in Kashan, Iran.

BACKGROUND: The incidence of application of medicinal herbs during pregnancy has increased significantly among women over the past years; however, the safety and efficacy of medicinal herbs during pregnancy are still unclear. The aim of the present study was to categorize the predictors of self-medication with herbal remedies during pregnancy based on the theory of planned behavior (TPB). METHODS: The present descriptive-analytical study was conducted on 300 pregnant women referred to Kashan health center to receive prenatal care services in 2020. The study participants were randomly selected using stratified random sampling with proportional allocation. The data collection tool was a two-part researcher made questionnaire. The first part of the questionnaire included demographic information, midwifery information, and questions related to women's awareness about herbal medicine. The second part of the questionnaire was designed based on the theory of planned behavior including attitudes, perceived behavioral control, subjective norms, intention, and behavior performance. Data were analyzed using descriptive statistics, regression analysis, and SPSS version 18.0. RESULTS: The mean age of participants was 28. 7±5.4 years (range, 15-45 years), the majority were housewives (88.3%) and had secondary education (39.3%). A total of 164 women (57. 1%) used medicinal herbs during pregnancy. The individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with behavioral intention (P < 0.05). Similarly, subjective norms were the most predictor of using herbal medicine among pregnant women (P < 0.05). CONCLUSION: The findings revealed that more than 50 % of pregnant women used medicinal herbs during pregnancy. The present study showed that the individual's attitude towards herbal medicines consumption, subjective norm, and perceived behavioral control was correlated with intention of herbal medicine use among pregnant women. Likewise, subjective norms were the most predictor of herbal medicine use among pregnant women. The TPB should be addressed in planning health education programs and modifying health behaviors, including self-medication, especially during pregnancy.

Developing multicomponent edible films based on chitosan, hybrid of essential oils, and nanofibers: Study on physicochemical and antibacterial properties.

Plastic waste is one of the major threats to the environment, and an urgent need to replace synthetic plastics with sustainable materials is progressively growing. Herein, sustainable films based on chitosan, Satureja, and Thyme essential oils (EOs), and chitosan nanofibers (NF) were developed for the first time. To this end, 1% (w/w) of EOs and 2 wt% of NF were incorporated into the chitosan solution. Despite the very similar chemical structure of carvacrol and thymol, which are the major constituents of Satureja and Thyme EOs, respectively, they imposed notably different effects on the physicochemical properties of chitosan films. Thyme EO was more efficient at establishing hydrogen bonds with chitosan. The disruptive effect of EOs on the crystalline network of chitosan was demonstrated through X-ray diffraction analysis. Satureja and Thyme EOs decreased and increased the barrier property of the chitosan films against water vapor, respectively. However, the barrier property was greatly improved in the presence of chitosan nanofibers. Satureja EO exhibited a more efficient antibacterial property against E. coli rather than Thyme EO. The fruits and vegetables, coated by the chitosan/EO/NF system, were less perished as compared with the control and chitosan-coated samples indicating the promising potential of the developed system to be used as edible and sustainable films and coatings due to their enhanced antibacterial and barrier properties.

Inactive Hepatitis B Carrier and Pregnancy Outcomes: A Systematic Review and Meta-analysis.

BACKGROUND: We aimed to explore whether maternal asymptomatic hepatitis B (HB) infection effects on pre-term rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia, gestational hypertension, or antepartum hemorrhage. METHODS: We searched the PubMed, Scopus, and ISI web of science from 1990 to Feb 2015. In addition, electronic literature searches supplemented by searching the gray literature (e.g., conference abstracts thesis and the result of technical reports) and scanning the reference lists of included studies and relevant systematic reviews. We explored statistical heterogeneity using the, I2 and tau-squared (Tau2) statistical tests. RESULTS: Eighteen studies were included. Preterm rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia, gestational hypertension and antepartum hemorrhage were considerable outcomes in this survey. The results showed no significant association between inactive HB and these complications in pregnancy. The small amounts of P-value and chi-square and large amount of I2 suggested the probable heterogeneity in this part, which we tried to modify with statistical methods such as subgroup analysis. CONCLUSION: Inactive HB infection did not increase the risk of adversely mentioned outcomes in this study. Further, well-designed studies should be performed to confirm the results.