Deep Learning for Detecting Multi-Level Driver Fatigue Using Physiological Signals: A Comprehensive Approach.

A large share of traffic accidents is related to driver fatigue. In recent years, many studies have been organized in order to diagnose and warn drivers. In this research, a new approach was presented in order to detect multi-level driver fatigue. A multi-level driver tiredness diagnostic database based on physiological signals including ECG, EEG, EMG, and respiratory effort was developed for this aim. The EEG signal was used for processing and other recorded signals were used to confirm the driver's fatigue so that fatigue was not confirmed based on self-report questionnaires. A customized architecture based on adversarial generative networks and convolutional neural networks (end-to-end) was utilized to select/extract features and classify different levels of fatigue. In the customized architecture, with the objective of eliminating uncertainty, type 2 fuzzy sets were used instead of activation functions such as Relu and Leaky Relu, and the performance of each was investigated. The final accuracy obtained in the three scenarios considered, two-level, three-level, and five-level, were 96.8%, 95.1%, and 89.1%, respectively. Given the suggested model's optimal performance, which can identify five various levels of driver fatigue with high accuracy, it can be employed in practical applications of driver fatigue to warn drivers.

CT-ML: Diagnosis of Breast Cancer Based on Ultrasound Images and Time-Dependent Feature Extraction Methods Using Contourlet Transformation and Machine Learning.

Breast diseases are a group of diseases that appear in different forms. An entire group of these diseases is breast cancer. This disease is one of the most important and common diseases in women. A machine learning system has been trained to identify specific patterns using an algorithm in a machine learning system to diagnose breast cancer. Therefore, designing a feature extraction method is essential to decrease the computation time. In this article, a two-dimensional contourlet is utilized as the input image based on the Breast Cancer Ultrasound Dataset. The sub-banded contourlet coefficients are modeled using the time-dependent model. The features of the time-dependent model are considered the leading property vector. The extracted features are applied separately to determine breast cancer classes based on classification methods. The classification is performed for the diagnosis of tumor types. We used the time-dependent approach to feature contourlet sub-bands from three groups of benign, malignant, and health control test samples. The final feature of 1200 ultrasound images used in three categories is trained based on k-nearest neighbor, support vector machine, decision tree, random forest, and linear discrimination analysis approaches, and the results are recorded. The decision tree results show that the method's sensitivity is 87.8%, 92.0%, and 87.0% for normal, benign, and malignant, respectively. The presented feature extraction method is compatible with the decision tree approach for this problem. Based on the results, the decision tree architecture with the highest accuracy is the more accurate and compatible method for diagnosing breast cancer using ultrasound images.

FDCNet: Presentation of the Fuzzy CNN and Fractal Feature Extraction for Detection and Classification of Tumors.

The detection of brain tumors using magnetic resonance imaging is currently one of the biggest challenges in artificial intelligence and medical engineering. It is important to identify these brain tumors as early as possible, as they can grow to death. Brain tumors can be classified as benign or malignant. Creating an intelligent medical diagnosis system for the diagnosis of brain tumors from MRI imaging is an integral part of medical engineering as it helps doctors detect brain tumors early and oversee treatment throughout recovery. In this study, a comprehensive approach to diagnosing benign and malignant brain tumors is proposed. The proposed method consists of four parts: image enhancement to reduce noise and unify image size, contrast, and brightness, image segmentation based on morphological operators, feature extraction operations including size reduction and selection of features based on the fractal model, and eventually, feature improvement according to segmentation and selection of optimal class with a fuzzy deep convolutional neural network. The BraTS data set is used as magnetic resonance imaging data in experimental results. A series of evaluation criteria is also compared with previous methods, where the accuracy of the proposed method is 98.68%, which has significant results.

Injury Patterns among Motorcyclist Trauma Patients: A Cross Sectional Study on 4200 Patients.

BACKGROUND: Motorcyclists are among the most vulnerable groups of road accident victims, who are prone to a growing mortality rate due to the constant rise in the number of accidents. This study was performed to investigate the injury patterns among motorcyclist trauma patients admitted to Kamyab Hospital, the largest trauma center affiliated with Mashhad Univercity of Medical Sciences, Mashhad, Iran, due to an accident. METHODS: This cross-sectional study was conducted on motorcyclists referred to our hospital due to accidents from August 23, 2014 to August 22, 2016 to receive treatment. After the accurate examination of the collected data and correction of the potential errors, they were subjected to analysis. The gathered data included the demographic variables, injury pattern, accident time, and accident type. Data analysis was performed in Stata Software, version 12. RESULTS: A total of 4,205 motorcycle accident cases were hospitalized (14% of all cases were hospitalized during the two-year study period). The mean age of the patients was 30 years, and 88% of them were male (a male to female ratio of 7.3). Car- and pedestrian-motorcycle collisions were the most common causes of injury that accounted for 68% and 22% of the cases, respectively. The head was the most commonly injured site of the body; in this regard, 59.7% of the admitted patients and 85.4% of total death cases had a head injury. In addition, 67% of the target population received trauma in more than two parts of their body. The elbow, arm, and hip were the least regions involved. CONCLUSION: Motorcycle accidents cause severe physical injuries to the patients' body. Head injury was the most common type of trauma, leading to a wide range of disabilities. Therefore, the use of crash helmets and avoidance of dangerous driving behaviors will remarkably decrease such trauma.

Hybrid silica-coated Gd-Zn-Cu-In-S/ZnS bimodal quantum dots as an epithelial cell adhesion molecule targeted drug delivery and imaging system.

Dual-modal imaging probes based on fluorescence (FL) and magnetic resonance (MR) modalities have attracted great attention due to their ability to combine the target specificity and high penetration into body tissues. In this study, we developed a potent nanocarrier with an effective photoluminescent emission and MR imaging capacity to deliver the doxorubicin to breast cancer 4T1 cells. The nanocarrier was fabricated by coating of quantum dots (QDs) with mesoporous silica followed by amine functionalization of the silica surface. Then, the doxorubicin was loaded into the silica pores and biheterofunctional PEG was covalently bound to the surface of core-shell quantum dot mesoporous silica nanoparticles. In order to target the DOX-loaded nanoparticles, the EpCAM DNA aptamer was attached on the surface of the DOX-loaded PEGylated nanoparticles. The synthesized NPs were analyzed for their size distribution, morphology, zeta potential and magnetic susceptibility using HRTEM, SEM and VSM analysis. The QD-encapsulated mesoporous silica revealed spherical shapes with an average particle size of 100 nm. The maximum encapsulation efficacy of doxorubicin in the silica pores was 25%. The in vitro release assessment demonstrated the pH-sensitive release of doxorubicin from the designed formulations. The in vitro cytotoxicity assays indicated that the aptamer targeted nanoparticles showed greater cytotoxicity than both non-targeted NPs and free DOX toward 4T1 and MCF-7 cell lines. The in vivo studies in 4T1 tumor-bearing Balb/c mice demonstrated that EpCAM aptamer could specifically deliver the DOX-loaded nanoparticles into the tumor tissue and cause remarkable inhibition of tumor growth as compared to non-targeted formulation and free DOX. Moreover, the in vivo MR and fluorescent imaging in 4T1 tumor-bearing mice confirmed the accumulation and residence of targeted system in tumor tissue even 24 h post-injection. This work presents a novel system for preparing bimodal imaging theranostic NPs through hybridization of silica and magnetic-fluorescent quantum dots.

Adipocyte lineage differentiation potential of MSCs isolated from reaming material.

Mesenchymal stem cells (MSCs) obtained from various sources have been used for different therapeutic applications including tissue regeneration. Reamer/irrigator/aspirator (RIA) has been increasingly used in recent years for the derivation of MSCs. Here in this investigation we have comparatively analyzed MSCs obtained from iliac crest bone marrow (ICBM) and RIA for their morphology, cluster determinant (CD) markers, and adipogenic differentiation capacity. MSCs were isolated, cultured, and purified from both sources and then flow cytometric studies were performed to study their characteristics. The differentiation potential of RIA and ICBM was examined by an Oil Red O staining protocol. Moreover, the tissue-specific markers related to adipogenesis were analyzed by real-time polymerase chain reaction (RT-PCR). The cells were cultured in the relevant induction medium and then adipogenic lineage differentiation was tested and confirmed for all MSC preparations. Additionally, analysis by flow cytometer was indicative of RIA derived MSCs (RIA-MSCs) having a more homogenous population than ICBM derived MSCs. The RIA-MSCs differentiation toward adipogenic lineage was more efficient compared with ICBM-MSCs. Direct comparative analysis of RIA to ICBM-MSCs indicated that the RIA-MSCs had a higher potential toward adipocyte lineage differentiation compared with ICBM-MSCs.

Bone defect healing is induced by collagen sponge/polyglycolic acid.

We have evaluated the capability of a collagen/poly glycolic acid (PGA) scaffold in regeneration of a calvarial bone defects in rabbits. 4 bone critical size defects (CSD) were created in the calvarial bone of each rabbit. The following 4 treatment modalities were tested (1) a collagen/PGA scaffold (0.52% w/w); (2) the collagen/PGA scaffold (0.52% w/w) seeded with adipose-derived mesenchymal stem cells (AD-MSCs, 1 × 106 cells per each defect); (3) AD-MSCs (1 × 106 cells) no scaffold material, and (4) blank control. The rabbits were then divided into 3 random groups (of 5) and the treatment outcomes were evaluated at 4, 8 and 12 weeks. New bone formation was histologically assessed. Experimental groups were analyzed by CT scan and real-time PCR. Histological analysis of bone defects treated with collagen/PGA alone exhibited significant fibrous connective tissue formation at the 12 weeks of treatments (P ≤ 0.05). There was no significant difference between collagen/PGA alone and collagen/PGA + AD-MSCs groups. The results were confirmed by CT scan data showing healing percentages of 34.20% for the collage/PGA group alone as compared to the control group and no difference with collagen/PGA containing AD-MSCs (1 × 106 cells). RT-PCR analysis also indicated no significant differences between collagen/PGA and collagen/PGA + AD-MSC groups, although both scaffold containing groups significantly express ALP and SIO rather than groups without scaffolds. Although there was no significant difference between the scaffolds containing cells with non-cellular scaffolds, our results indicated that the Collagen/PGA scaffold itself had a significant effect on wound healing as compared to the control group. Therefore, the collagen/PGA scaffold seems to be a promising candidate for research in bone regeneration.

Synthesis of theranostic epithelial cell adhesion molecule targeted mesoporous silica nanoparticle with gold gatekeeper for hepatocellular carcinoma.

AIM: In this study, we report the fabrication of epithelial cell adhesion molecule targeted 5-fluorouracil (5-FU) encapsulated PEGylated mesoporous silica nanoparticles (NPs) hybridized with gold NPs (PEG-Au@Si-5-FU) as gatekeeper for theranostic applications. MATERIALS & METHODS: The prepared targeted and nontargeted formulations were evaluated in vitro in terms of their cellular internalization and toxicity. The prepared theranostic hybrid system was also implemented for computed tomography of HepG2 tumor-bearing nude mice in vivo. RESULTS: Fluorescence microscopy and MTT assay demonstrated that the developed epithelial cell adhesion molecule-PEG-Au@Si-5-FU had higher cytotoxicity than nontargeted PEG-Au@Si-5-FU in 2D and 3D HepG2 cell cultures. Moreover, the targeted hybrid system was preferentially accumulated in HepG2 tumor cells in vitro and in vivo. CONCLUSION: This work introduces a novel strategy for developing multimodal NPs via nanoparticulate hybrid materials.

Evaluation of Clinical Results and Complications of Structural Allograft Reconstruction after Bone Tumor Surgery.

BACKGROUND: Massive bone allograft is an option in cases of limb preservation and reconstruction after massive benign and malignant bone tumor resection. The purpose of this study was to analyze the outcome of these procedures at Imam Reza Hospital, Mashhad University of Medical Sciences. METHODS: In this study, 113 cases have been presented. Eleven cases were excluded (patients has a traumatic defect or they passed away before the completion of the study's two-year follow up period). Each patient completed a questionnaire, went through a physical examination and, if indicated, X-ray information was collected. The patients were divided into three groups: chemotherapy, chemotherapy plus radiation therapy, and no-adjuvant-therapy. RESULTS: Fifty-four cases were male and the mean age was 24.5±5.39. The number of cases and indications for surgery were: 33 cases of aggressive benign tumors or low grade malignant bone tumors (large bone defects) including 16 germ cell tumors, eight aneurysmal bone cysts, five low grade osteosarcomas, and four chondrosarcomas. Another 69 cases were high-grade malignant bone tumors including 42 osteosarcomas, 21 Ewing's sarcoma, and six other high grade osteosarcomas. Patients were divided into three groups: the first group received no adjuvant therapy, the second group received chemotherapy, and the third group received chemotherapy plus radiotherapy. The location of tumors were as follows: eight cases in the pelvic bone, 12 in the proximal femur, 18 in the femoral shaft, 36 in the distal femur, 12 in the proximal tibia, and 16 in the humeral bone. The 12 cases of proximal femoral defects were reconstructed by allograft composite prosthesis, 18 diaphyseal defects with intercalary allograft, and 36 distal femoral defects were reconstructed using osteoarticular allograft. The rate of deep infection was 7:8% (eight patients) and in this regard, we found a significant difference among the three groups, such that most cases of infection occurred in the adjuvant chemotherapy plus radiation therapy group. Allograft fracture occurred in six patients and prevalence was the same in all groups. Only in six cases of radio-chemotherapy nonunion occurred, so we used autogenous bone graft for union. Local recurrence was observed in six patients: three belonged to the adjuvant chemotherapy group and the other three were in the chemo-radiotherapy group; no significant difference was observed between these two groups. However, there was a significant difference between these two and the group that received no adjuvant therapy. Also, there were 11 cases of metastases and Restriction of knee joint motion occurred in 48 cases of osteo-cartilaginous grafts of the distal femur and proximal tibia. CONCLUSION: Although structural allograft is an appropriate choice in limb reconstruction after massive resection of involved tissues in malignant and invasive bone tumors, the risk of complications such as nonunion and infection in massive allograft increases in cases of adjuvant (chemotherapy and radiotherapy) modalities of treatment. Whereas the rate of tumor recurrence, metastasis, and restrictions in range of motion during a short term follow up after implantation showed no significant difference among the evaluated groups. Consequently, further attention and constant periodic visits of the patients and checking for local recurrence and distant metastasis should be done after surgery.

PGA-incorporated collagen: Toward a biodegradable composite scaffold for bone-tissue engineering.

Nowadays composite scaffolds based on synthetic and natural biomaterials have got attention to increase healing of non-union bone fractures. To this end, different aspects of collagen sponge incorporated with poly(glycolic acid) (PGA) fiber were investigated in this study. Collagen solution (6.33 mg/mL) with PGA fibers (collagen/fiber ratio [w/w]: 4.22, 2.11, 1.06, 0.52) was freeze-dried, followed by dehydrothermal cross-linking to obtain collagen sponge incorporating PGA fibers. Properties of scaffold for cell viability, proliferation, and differentiation of mesenchymal stem cells (MSCs) were evaluated. Scanning electron microscopy showed that collagen sponge exhibited an interconnected pore structure with an average pore size of 190 µm, irrespective of PGA fiber incorporation. The collagen-PGA sponge was superior to the original collagen sponge in terms of the initial attachment, proliferation rate, and osteogenic differentiation of the bone marrow-MSCs (BM-MSC). The shrinkage of sponges during cell culture was significantly suppressed by fiber incorporation. Incorporation of PGA fiber is a simple and promising way to reinforce collagen sponge without impairing biocompatibility. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2020-2028, 2016.

Leech therapy in nearly total amputation of fingers without vascular repair: a case report.

INTRODUCTION: In the absence of microvascular replantation or in crash injury cases in which obtaining an acceptable function is not possible, amputation of the injured finger seems to be the best treatment modality. Some studies recommended leech therapy for this kind of injury after vascular repair to decrease venous congestion. CASE PRESENTATION: In this case report, the authors presented a case of leech therapy after near total amputation of the fingers. A 25-year-old patient was admitted following a sawing injury with crashed bundles of the third, fourth and fifth fingers. Microvascular surgery was not performed because of crush injury. DISCUSSION: After a simple repair and pin fixation, the patient was treated using leech therapy. The result was satisfactory. The third and fourth fingers were salvaged. It seems that in cases where a small part of the skin is still attached to the amputated part, even with complete crash of both bundles, leech therapy can help salvage the amputated fingers.

Exploring the reasons for orthopedic implant failure in traumatic fractures of the lower limb.

BACKGROUND: A damaged orthopedic implant in the body can cause problems for the patient and disrupt the therapeutic process. This study investigates various factors for orthopedic implant failures in patients with traumatic lower limb fractures who referred to a trauma center in Mashhad, Iran. METHODS: This was a prospective study of 23 patients referred to Kamyab University Hospital with failed orthopedic implants in 2009. We included any patient with an orthopedic device previously implanted secondary to a traumatic lower limb fracture who later presented to Kamyab University Hospital because of a failed implant. For all patients, a thorough history was taken and the necessary investigations that included radiographic studies were performed. We investigated the quality of the failed devices by chemical analysis, metal hardness testing and metallography. The results were statistically analyzed.  RESULTS: The mean age of the patients was 33 ± 19 years. There were 19 (82.5%) male and 4 (17.4%) female patients. In 14 (60.9%) cases, there were failed femoral implants and 9 (39.1%) cases had failed implants for tibial fractures. We compared the implants against ASTM standards. According to chemical analysis, all internally produced devices and one of the leading international brands were within the expected standard. However, in 3 cases chemical analysis showed a deviation from the standards. These were manufactured by "miscellaneous" companies. In one (4.3%) case the device failure was iatrogenic, in 14 (60.9%) it was due to faulty implants and in 8 (34.8%) cases, the patients were non-compliant with instructions. Hardness testing was satisfactory in all cases and metallographic studies showed good quality for the leading international brands, satisfactory quality for the internally produced devices and poor quality for the miscellaneous devices. CONCLUSION: The implants classified as miscellaneous were of poor quality. Thus, we cannot recommend their use in orthopedic surgeries. We recommend using credible, known brands.

Comparative study of peroneal tenosynovitis as the complication of intraarticular calcaneal fracture in surgically and non-surgically treated patients.

BACKGROUND: Calcaneus has the most fracture prevalence among tarsal bones. About 3/4 of calcaneal fractures are intra-articular fractures with displacement. The majority of calcaneal fractures occur in 21 - 35 year old young men, and that are mostly active people, these fractures cause complete disability for 15 months. Moreover, inappropriate treatment leads to lots of social and economical damages. OBJECTIVES: In this study we compared the incidence and the severity of peroneal tenosynovitis as a complication of non-operative and operative treatment of intra-articular calcaneal fractures. In this study, some other complications of this fracture were also analyzed and the prevalence of the complication was higher in non-operated patients. PATIENTS AND METHODS: A total of 140 patients with intra-articular calcaneal fracture were analyzed prospectively. These patients were divided into 2 groups: operated group and non-operated group. RESULTS: In non-operated group (56 patients), 22 patients were complicated by peroneal tenosynovitis. In operated group (84 patients), 8 patients had the same complication. Statistical analysis revealed that the prevalence, and the severity of this complication in the mentioned groups had a meaningful difference. The results in operated group were much better than the non-operated one. CONCLUSIONS: Although some of the orthopedic surgeons are not interested to manage these fractures surgically and most of them treat these cases conservatively (casting, etc.), in most displaced intra-articular calcaneal fractures, surgical treatment is the method of choice. Moreover, in non-surgical treatment the prevalence of these complications among the patients is more and as a result, inevitable social, occupational and familial damages occur.

New method to remove a broken guide pin in the hip joint.

Removing a broken guide wire is difficult and challenging. This article reports a method that was used to successfully remove a broken guide wire in 3 patients who underwent operative treatment for intertrochanteric fractures of the femur. Under general anesthesia, the first patient was placed on the orthopedic fracture table, and closed reduction of the hip fracture was performed under the image intensifier. A 2-mm non-threaded pin was used in the center of the femoral neck, and the amount of reaming required was determined. The reaming proceeded without any difficulty until the reamer failed to progress, which was attributed to the presence of a sclerotic or calcar region. Under fluoroscopy, on an anteroposterior view, the pin was parallel with the reamer; however, the authors failed to check the lateral image. After reaming through the hard tissue, the reamer suddenly passed through easily. On checking under the scope, it was noted that the pin was broken. The tip of the pin passed the acetabulum but did not enter the pelvis. Efforts to remove the broken pin failed. An attempt to reach the pin using a dynamic hip screw reamer also failed. Ultimately, the broken pin was removed using a 2-mm cannulated drill bit under fluoroscopy. After the experience with the first patient, in the other 2 cases, the authors used a cannulated drill bit to avoid any extensive reaming and trauma to the tissues. With this method, the authors were able to remove the broken pin easily in a few minutes.

Clavicular fracture and upper-extremity deep venous thrombosis.

Upper-extremity deep venous thrombosis (DVT) is considered an uncommon clinical event with considerable potential for morbidity. This article presents a case of upper-extremity DVT following a clavicular fracture. A 25-year-old man presented with pain and distortion of the left midclavicular area after falling on his left shoulder during martial arts practice. Following physical examination and radiography, he was diagnosed with a simple displaced clavicle fracture at the middle third. The patient had no previous surgery or medical problem, and did not smoke. No family history of blood clotting disorders were present and neurovascular examination appeared normal on the symmetric contralateral side. A figure-of-8 bandage was applied to support the arm and the patient was discharged. One week later, he returned with swelling and severe pain in his left arm. On examination, a DVT was suspected and the figure-of-8 brace was removed. A Doppler ultrasonography was performed and the presence of a thrombus extending from the brachial axillary veins to the distal subclavian vein with no flow in that segment was revealed. The patient was placed in a sling instead of a figure-of-8 bandage to immobilize the arm, while anticoagulation therapy with enoxaparin was started (1 mg/kg every 12 hours, 80 mg subcutaneous daily for 3 months). The swelling was reduced after 5 days. At 2-week follow-up, the patient had no pain and the swelling had completely disappeared.