A deep ensemble medical image segmentation with novel sampling method and loss function.

Medical image segmentation is a critical task in computer vision because of facilitating precise identification of regions of interest in medical images. This task plays an important role in disease diagnosis and treatment planning. In recent years, deep learning algorithms have exhibited remarkable performance in this domain. However, it is important to note that there are still unresolved issues, including challenges related to class imbalance and achieving higher levels of accuracy. Considering the challenges, we propose a novel approach to the semantic segmentation of medical images. In this study, a new sampling method to handle class imbalance in the medical datasets is proposed that ensures a comprehensive understanding of both abnormal tissues and background characteristics. Additionally, we propose a novel loss function inspired by exponential loss, which operates at the pixel level. To enhance segmentation performance further, we present an ensemble model comprising two UNet models with ResNet backbone. The initial model is trained on the primary dataset, while the second model is trained on the dataset obtained through our sampling method. The predictions of both models are combined using an ensemble model. We have assessed the effectiveness of our approach using three publicly available datasets: Kvasir-SEG, FLAIR MRI Low-Grade Glioma (LGG), and ISIC 2018 datasets. In our evaluation, we have compared the performance of our loss function against four different loss functions. Furthermore, we have showcased the excellence of our approach by comparing it with various state-of-the-art methods.

Tumoricidal properties of thymoquinone on human colorectal adenocarcinoma cells via the modulation of autophagy.

Colorectal cancer (CRC) is deadly anaplastic changes in the gastrointestinal tract with high-rate mortality. In recent years, the application of phytocompounds has been extended along with different therapeutic protocols. Here, we monitored the effects of Thymoquinone (TQ) on autophagy via mitochondrial function after modulation of the Wnt/ß-catenin signaling pathway.Human colorectal adenocarcinoma HT-29 cells were treated with TQ (60 µM) and 15 µM Wnt3a inhibitor (LGK974) for 48 h. The survival rate was evaluated using an MTT assay. The expression of Wnt-related factors (c-Myc, and Axin), angiogenesis (VE-Cadherin), and mitophagy-related factors (PINK1, OPTN) was assessed using real-time PCR assay. Protein levels of autophagy factors (Beclin-1, LC3, and P62) were monitored using western blotting. Using flow cytometry analysis, the intracellular accumulation of Rhodamine 123 was evaluated. The migration properties were analyzed using a scratch wound healing assay.Data indicated that TQ can reduce the viability of HT-29 cells compared to the control cells (p < 0.05). The expression of VE-Cadherin was inhibited while the expression of PINK1 was induced in treated cells (p < 0.05). Both LGK974 and TQ-treated cells exhibited activation of autophagy flux (Beclin-1↑, LC3II/I↑, and p62↓) compared to the control group (p < 0.05). TQ can increase intracellular accumulation of Rhodamine 123, indicating the inhibition of efflux mechanisms in cancer cells. Along with these changes, the migration of cells was also reduced (p < 0.05).TQ is a potential phytocompound to alter the dynamic growth of human colorectal HT-29 cells via the modulation of autophagy, and mitophagy-related mechanisms.

Lavender and metformin effectively propagate progesterone levels in patients with polycystic ovary syndrome: A randomized, double-blind clinical trial.

BACKGROUND: The present study aimed to evaluate the impacts of lavender and metformin on polycystic ovary syndrome (PCOS) patients. METHODS: We performed a randomized, double-blind clinical trial including 68 females aged 18 to 45, fulfilling the Rotterdam criteria for PCOS. The patients were randomized to receive lavender (250 mg twice daily) or metformin (500 mg three times a day) for 90 days. The serum progesterone was measured at baseline and after 90 days, one week before their expected menstruation. Moreover, the length of the menstrual cycle was documented. RESULTS: Our results showed that lavender and metformin treatment notably increased the progesterone levels in PCOS patients (increasing from 0.35 (0.66) and 0.8 (0.69) to 2.5 (6.2) and 2.74 (6.27) ng/mL, respectively, P < 0.001). However, we found no significant differences between the increasing effects of both treatments on progesterone levels. In addition, all patients in the lavender or metformin groups had baseline progesterone levels <3 ng/mL, reaching 14 (45.2%) patients >3 ng/mL. Lavender and metformin remarkably attenuated the menstrual cycle length in PCOS patients (decreasing from 56.0 (20.0) and 60 (12.0) to 42.0 (5.0) and 50.0 (14.0) days, respectively, P < 0.001). Furthermore, the decreasing effects of lavender on the menstrual cycle length were greater than the metformin group; however, it was not statistically significant (P = 0.06). CONCLUSION: Lavender effectively increased progesterone levels and regulated the menstrual cycles in PCOS patients, similar to metformin. Therefore, lavender may be a promising candidate for the treatment of PCOS.

A Rare Case of Orthokeratinized Odontogenic Cyst (OOC) in the Posterior Mandible of a Young Adult 18-Year-Old Boy.

Orthokeratinized Odontogenic Cyst (OOC) is a rare odontogenic cyst, which is important because it has a low recurrence potential, but it has a percentage of the potential for malignant changes. OOC characteristics can be different from OKC (odontogenic keratocyst), which was once classified in its category. The microscopic view of OOC cyst is the reason for its easy identification from OKC, the orthokeratinized epithelial covering and the clear granular layer, and the hyperplasia of the basal layer, and the smooth surface of this cyst. OOC cyst treatment is conservative and can be usually carried out by enucleation. In terms of gender predominance, it is often reported in men. Furthermore, OOC is more common in the 3rd and 4th decades of life. Hereby, we report a rare case of OOC in the posterior mandible of a young adult 18-year-old boy and its treatment method. The clinical and diagnostic points of view and the treatment options were discussed in this article.

Antiproliferative and apoptotic effects of conditioned medium released from human amniotic epithelial stem cells on breast and cervical cancer cells.

INTRODUCTION: Human amniotic membrane (hAM) and its cells have been proposed for several clinical applications, including cancer therapy. However, reports on the anticancer effects of human amniotic epithelial stem cells-conditioned media (hAECs-CM) are limited. This work aims to evaluate the anticancer effects of hAECs-CM on cervical cancer and breast cancer cell lines in vitro. METHODS: Human term placentas were gained from uncomplicated Cesarean sections from healthy donor women. After amnion peeling from the chorion, its epithelial stem cells were isolated and cultured, and its conditioned medium (CM) was collected for experiments. MTT assay was performed to assess cancer cells viability. Migration rate of cancer cells was examined via wound healing assay. Cell-cycle distribution and apoptosis were determined using flow cytometry. RESULTS: Based on MTT assay hAECs-CM was cytotoxic against cancerous cell lines in a dose-time-dependent manner. After 48 h of treatment with hAECs-CM pure, the cell viability of breast cancer cells includes MCF-7 and MDA-MB-231 reached to 73.2% and 65.5%, respectively. In the same situation, HeLa cervical cancer cell line revealed the lowest viability by 47.3%. The wound-healing assay displayed an incomplete wound closure of scratched MDA-MB-231 cells and significant inhibition of cell migration after hAECs-CM treatment. The results also revealed that hAECs-CM exerted anti-proliferation activity by prompting cell cycle arrest and apoptosis of cancer cells.Conclusions: hAECs-CM is a potent candidate for inducing apoptosis and simultaneously inhibition of the proliferation and migration of cancer cells via inhibiting cell cycle blockade.

Effects of crocin on T-bet/GATA-3 ratio, and miR-146a and miR-106a expression levels in lung tissue of ovalbumin-sensitized mice.

Objectives: Although various studies have revealed the beneficial effects of crocin (derived from saffron), such as anti-inflammatory, anti-cancer, antioxidant, and immune modulator, however, its exact mechanism is unknown. The present study aimed to investigate the effect of crocin on the expression ratio of T-bet/GATA-3 as an indicator of altered immune responses in the lung tissue of ovalbumin (OVA)-sensitized mice. In addition, the effect of crocin on the expression level of miR-146a and miR-106a in the lung tissue OVA-sensitized mice was investigated. Materials and Methods: Mice were randomly divided into five groups (n=6): Control; OVA, OVA + Crocin 25, OVA + Cro 50, and OVA + Cro100 groups. Crocin was administrated intraperitoneally at doses of 25, 50, and 100 mg/kg for five consecutive days. One day after asthma induction, animals were euthanized, and lungs were sampled for pathological and gene expression analysis. Results: OVA-sensitization led to increased inflammation and histopathological changes in the lung tissue of mice. In addition, GATA-3 expression increased (P<0.001) and T-bet expression decreased (P<0.001) in OVA-sensitized groups. The T-bet/GATA3 ratio was also reduced markedly in asthma groups (P<0.001). Furthermore, increased expression of miR-146a and miR-106a levels was evident in the lung tissue of OVA-sensitized mice (P<0.001 for both). Intervention with high concentrations of crocin (50 and 100 mg/kg) significantly reduced airway inflammation, GATA-3 expression, miR-146a expression, and miR-106a expression and corrected the T-bet/GATA-3 ratio (P<0.05 to P<0.001). Conclusion: Treatment with crocin led to a decrease in the severity of lung inflammation in OVA-sensitized mice, which is probably through the reduction of the T-bet/GATA-3 ratio, and mir-146a and mir-106a expression level.

Tinnitus, sound intolerance, and mental health: the role of long-term occupational noise exposure.

PURPOSE: Whereas chronic noise exposure (CNE) is a known risk factor for tinnitus, little is known about how a history of CNE impacts tinnitus characteristics and its comorbid symptoms. METHODS: Seventy-five participants with chronic tinnitus (59m/16f, 22-78 years, 48 with sensory-neural hearing loss, and 27 with a normal audiogram) including 43 individuals with (Tin-CNE group) and 32 without (Tin group) a history of long-term occupational noise exposure were studied. Tinnitus characteristics were rated by a visual analog scale, and tinnitus comorbid symptoms were scored using self-assessment questionnaires. RESULTS: The Tin-CNE group showed reduced uncomfortable loudness level (ULL), sound tolerance, and quality of life (QoL), and increased tinnitus loudness, tinnitus handicap, anxiety, depression, insomnia severity, and tinnitus annoyance scores compared to the Tin group. Higher tinnitus loudness and a lower anxiety score were observed in participants with hearing loss relative to those without. Using a stepwise regression model also showed that tinnitus-related characteristics, hyperacusis, and tinnitus comorbid symptoms enhance one another. CONCLUSIONS: The findings were in support of accumulative evidence indicating the adverse auditory and non-auditory effects of CNE, including exacerbated sound intolerance and tinnitus-related psychiatric symptoms. The results also showed that tinnitus alone can affect mental health regardless of hearing loss.

Cancer Care Management During the COVID-19 Pandemic.

New cases of the novel coronavirus, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are increasing around the world. Currently, health care services are mainly focused on responding to and controlling the unique challenges of the coronavirus disease 2019 (COVID-19) pandemic. These changes, along with the higher susceptibility of patients with cancer to infections, have profound effects on other critical aspects of care and pose a serious challenge for the treatment of such patients. During the COVID-19 pandemic, it is important to provide strategies for managing the treatment of patients with cancer to limit COVID-19-associated risks at this difficult time. The present study set out to summarize the latest research on epidemiology, pathogenesis, and clinical features of COVID-19. We also address some of the current challenges associated with the management of patients with cancer during the COVID-19 pandemic and provide practical guidance to clinically deal with these challenges.

In situ growth of zeolitic imidazolate framework-8 on woven cotton yarn for the thin film microextraction of quercetin in human plasma and food samples.

This study explored the in-situ growth of zeolitic imidazolate framework-8 on woven cotton yarn for the first time. The applicability of highly flexible and natural cotton yarn-polypyrrole-layered double hydroxide-zeolitic imidazolate framework-8 composite (CY- PPy-LDH-ZIF8) was introduced for the extraction of quercetin in plasma and food samples. For increasing the contact area of the analyte and the prepared sorbent, the green substrate was woven and employed as the substrate for the construction of ZIF8. Extraction, separation, and determination of the analyte were performed by TFME-HPLC-UV. Due to the large surface area, the number of cages and unique porous structure of the zeolitic imidazolate framework-8 (ZIF8) as well as hydrogen bonding, ionic and π-π interactions between the analyte and the ZIF8, the prepared thin film showed a high affinity towards the target analyte. The affecting parameters on the extraction efficiency, including pH of the sample solution, extraction time, stirring rate, desorption time, and elution solvent volume were investigated and optimized through applying Box-Behnken Design (BBD). Under optimum conditions, calibration curves were found to be linear in the range of 0.2-200 µg L-1 with r2 > 0.9958. The limits of detection (based on S/N = 3), limits of quantification (based on S/N = 10), and intra-day, as well as inter-day RSDs, were lower than 0.21 µg L-1, 0.70 µg L-1 and 5.6%, respectively.

Oncological Emergencies from Pathophysiology and Diagnosis to Treatment: A Narrative Review.

Oncological emergencies are defined as any acute possible morbid or life-threatening events in patients with cancer either because of the malignancy or because of their treatment. These events may occur at any time during malignancy, from symptoms present to end-stage disease. The aim of this study is the review of urgent conditions results from cancer or cancer treatment side effects that need to be addressed immediately. In this study, a comprehensive and in-depth narrative review was carried out by searching the databases of PubMed, Scopus, Science Direct, Google Scholar with the keywords of "cancer, emergency, metabolic emergency, neutropenic fever" along with the words, "tumor lysis syndrome, chemotherapeutic emergency, diagnosis, treatment " in last two decades. Patients suffering from cancer mostly face the challenges that we are classified in different categories, including metabolic, hematologic, cardiovascular, neurologic, respiratory, infectious, and chemotherapeutic emergencies. These patients mostly complain of headaches, nausea, pain, and fever. In conclusion, knowledge of oncology emergencies and palliative care as part of a team approach is critical for treating cancer patients. In this light, it is pivotal for physicians to focus on the early detection of oncological emergencies. Moreover, training programs for cancer patients help them to timely recognize and report the oncologic emergency symptoms, leading to avoid deleterious consequences and unnecessary healthcare costs as well as improve the quality of life in these patients.

Assessment of the correlation between various risk factors and orofacial cleft disorder spectrum: a retrospective case-control study.

BACKGROUND: Orofacial clefts (OFCs) comprise a wide range of malformations, including cleft lip, cleft palate, and cleft lip with cleft palate, which can vary in terms of etiology, severity, and disease burden. OBJECTIVES: This study aimed to evaluate the correlation between various risk factors and orofacial cleft disorder spectrum in newborns. STUDY DESIGN: A total of 323 cases and 400 controls were enrolled in this study and evaluated in terms of the maternal history of abortion or miscarriage, child's sex, maternal and paternal age, maternal history of systemic disease, history of medication therapy during pregnancy, birth order, consanguineous marriage, and complications during pregnancy. RESULTS: Analysis of the results suggested that consanguineous marriage, a maternal history of abortion/miscarriage, and complications during pregnancy could potentially increase the risk of OFCs in children (P < 0.05). However, the analyses revealed that the other variables could not potentially increase the risk of OFCs (P > 0.05). CONCLUSIONS: Multiple cofactors may simultaneously contribute to the formation of such abnormalities; therefore, a comprehensive, multidisciplinary care program is necessary to ensure a successful pregnancy period and the birth of a healthy newborn.

Effect of Mild Cognitive Impairment and Alzheimer Disease on Auditory Steady-State Responses.

INTRODUCTION: Mild Cognitive Impairment (MCI), a disorder of the elderly people, is difficult to diagnose and often progresses to Alzheimer Disease (AD). Temporal region is one of the initial areas, which gets impaired in the early stage of AD. Therefore, auditory cortical evoked potential could be a valuable neuromarker for detecting MCI and AD. METHODS: In this study, the thresholds of Auditory Steady-State Response (ASSR) to 40 Hz and 80 Hz were compared between Alzheimer Disease (AD), MCI, and control groups. A total of 42 patients (12 with AD, 15 with MCI, and 15 elderly normal controls) were tested for ASSR. Hearing thresholds at 500, 1000, and 2000 Hz in both ears with modulation rates of 40 and 80 Hz were obtained. RESULTS: Significant differences in normal subjects were observed in estimated ASSR thresholds with 2 modulation rates in 3 frequencies in both ears. However, the difference was significant only in 500 Hz in the MCI group, and no significant differences were observed in the AD group. In addition, significant differences were observed between the normal subjects and AD patients with regard to the estimated ASSR thresholds with 2 modulation rates and 3 frequencies in both ears. A significant difference was observed between the normal and MCI groups at 2000 Hz, too. An increase in estimated 40 Hz ASSR thresholds in patients with AD and MCI suggests neural changes in auditory cortex compared to that in normal ageing. CONCLUSION: Auditory threshold estimation with low and high modulation rates by ASSR test could be a potentially helpful test for detecting cognitive impairment.

Validity and reliability of Abbreviated Mental Test Score (AMTS) among older Iranian.

BACKGROUND: Cognitive impairment is common among older people and is associated with increased morbidity and mortality. The main aim of this study was to evaluate the validity of the Persian version of the Abbreviated Mental Test Score (AMTS) as a screening tool for dementia. METHODS: Data were obtained from a cross-sectional study. One hundred and one older adults who were members of Iranian Alzheimer Association and 101 of their siblings were entered into this study by convenient sampling. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for diagnosing dementia and the Mini-Mental State Examination were used as the study tools. The gathered data were analyzed by the Mann-Whitney U-test, the Kruskal-Wallis test, Spearman's rank correlation coefficient, and the receiver-operating characteristic. RESULTS: The AMTS could successfully differentiate the dementia group from the non-dementia group. Scores were significantly correlated with Diagnostic and Statistical Manual of Mental Disorders diagnosis for dementia and Mini-Mental State Examination scores (P < 0.001). Educational level (P < 0.001) and male sex (P = 0.015) were positively associated with AMTS, whereas (P < 0.001) was negatively associated with AMTS. Total Cronbach's α coefficient was 0.90. The scores 6 and 7 showed the optimum balance between sensitivity (99% and 94%, respectively) and specificity (85% and 86%, respectively). CONCLUSIONS: The Persian version of the AMTS is a valid cognitive assessment tool for older Iranian adults and can be used for dementia screening in Iran.

Vitamin D and Evening Primrose Oil Administration Improve Glycemia and Lipid Profiles in Women with Gestational Diabetes.

UNLABELLED: Limited data are available assessing the effects of vitamin D and evening primrose oil (EPO) administration on markers of insulin resistance and lipid concentrations in gestational diabetes mellitus (GDM). This study was designed to evaluate the effects of vitamin D and EPO administration on insulin resistance and lipid concentrations among women with GDM. In this prospective randomized, double-blind, placebo-controlled clinical trial, 60 participants with GDM were divided into 2 groups of either 1000 IU vitamin D3 and 1000 mg EPO or placebo for 6 weeks. At the beginning and end of the study, fasting blood samples were obtained from the participants to measure related variables. After 6 weeks of intervention, changes in fasting plasma glucose (-3.6 ± 7.5 vs. +1.5 ± 11.4 mg/dL, P = 0.04), serum insulin concentrations (-2.0 ± 5.3 vs. +4.6 ± 10.7 µIU/mL, P = 0.004), homeostasis model of assessment (HOMA) insulin resistance (-0.5 ± 1.1 vs. +1.1 ± 2.5, P = 0.003), HOMA-B cell function (-7.7 ± 23.3 vs. +17.4 ± 42.9, P = 0.007) and the quantitative insulin sensitivity check index (+0.01 ± 0.02 vs. -0.01 ± 0.02, P = 0.007) in the vitamin D plus EPO group were significantly different from the placebo group. In addition, compared with the placebo, vitamin D and EPO supplementation resulted in significant reductions in serum TAG (-20.0 ± 54.3 vs. +34.3 ± 38.2 mg/dL, P < 0.001), VLDL (-4.0 ± 10.9 vs. +6.9 ± 7.6 mg/dL, P < 0.001), TC (-22.1 ± 32.6 vs. +5.3 ± 20.1 mg/dL, P < 0.001), LDL concentrations (-18.0 ± 25.5 vs. +1.8 ± 15.7 mg/dL, P = 0.001) and TC/HDL (-0.3 ± 0.4 vs. +0.3 ± 0.5 mg/dL, P < 0.001). We did not observe any significant effect of vitamin D and EPO supplementation on serum HDL concentrations. CLINICAL TRIAL REGISTRATION NUMBER: http://www.irct.ir : IRCT201509115623N52.

Validity and Reliability of "Parental Attitudes of Various Aspects of Cochlear Implantation" Questionnaire.

INTRODUCTION: Parents are such important members of the cochlear-implant team that analysis of their views is essential in order to improve services and outcomes. The authors developed a tool to assess parental attitudes towards various aspects of cochlear implantation in children who had passed aural rehabilitation sessions. The authors then went on to determine the validity and reliability of this questionnaire. MATERIALS AND METHODS: A questionnaire entitled, "Parental attitudes towards various aspects of cochlear implantation", was prepared and assessed for content validity by experts in the field. The questionnaire comprised six subgroups, each scored using a five-point Likert scale. Parents of children with severe-to-profound congenital hearing loss who had undergone an aural rehabilitation program between 2007 and 2012 were eligible to take part in the questionnaire validation study (n=92, mean age of cochlear implantation 3.97 years). Test-retest reliability was subsequently assessed in 17 patients within 1 month. RESULTS: The content validity index of the questionnaire was 98.68%.The external and internal reliability of the questionnaire was assessed using Cronbach's alpha (0.844 and 0.892, respectively). Mean scores of the six subgroups of the questionnaire, including communication skills, academic skills, social skills, cochlear-implant center services, costs of surgery and rehabilitation programs and decision-making process and total were 84.6%, 75.0%, 84.0%, 78.8%, 83.4%, 67.0% and 79.2%, respectively. CONCLUSION: Overall, the results supported the validity, reliability and sensitivity of the questionnaire for use both in centers for cochlear implantation or aural rehabilitation clinics. The questionnaire would provide a valuable means of assessing the impact of cochlear implantation on children's lives.

Relationship between behavioral hearing thresholds and estimated auditory steady-state response thresholds in children with a history of neonatal hyperbilirubinemia.

Increased serum bilirubin levels during infancy increase the risk of hearing loss in infants. This study aimed to investigate the relationship between pure-tone audiometry hearing thresholds and thresholds estimated using auditory steady-state responses (ASSRs) in children with a history of neonatal hyperbilirubinemia, and to evaluate the usefulness of 90-Hz ASSR in estimating hearing thresholds in children. This study was conducted on 26 children (13 girls and 13 boys) who were aged 2.4-11 years and had a history of neonatal hyperbilirubinemia (bilirubin level >17 mg/dL). ASSR thresholds were compared with behavioral thresholds and were interpreted after considering the amount and type of hearing loss. Of the 26 children, 12 had normal hearing thresholds, and 14 had varying degrees of sensorineural hearing loss. In general, a high correlation (r ≥ 0.81, p < 0.01) was found between the ASSR and behavioral thresholds. The highest correlation was observed at 2,000 Hz (r = 0.88, p < 0.01). No significant difference was observed (p > 0.13) between mean behavioral and ASSR thresholds at 52 studied ears. The results of this study showed that 90-Hz ASSR assessments provide reliable estimates of behavioral hearing thresholds in children who have a history of neonatal hyperbilirubinemia and sensorineural hearing loss or normal hearing.