Haptics-Enabled Teleoperation for Robotics-Assisted Minimally Invasive Surgery

The lack of force feedback (haptics) in robotic surgery can be considered to be a safety risk leading to accidental tissue damage and puncturing of blood vessels due to excessive forces being applied to tissue and vessels or causing inefficient control over the instruments because of insufficient applied force. This project focuses on providing a satisfactory solution for introducing haptic feedback in robotics-assisted minimally invasive surgical (RAMIS) systems. The research addresses several key issues associated with the incorporation of haptics in a master-slave (teleoperated) robotic environment for minimally invasive surgery (MIS). In this project, we designed a haptics-enabled dual-arm (two masters - two slaves) robotic MIS testbed to investigate and validate various single-arm as well as dual-arm teleoperation scenarios. The most important feature of this setup is the capability of providing haptic feedback in all 7 degrees of freedom (DOF) required for RAMIS (3 translations, 3 rotations and pinch motion of the laparoscopic tool). The setup also enables the evaluation of the effect of replacing haptic feedback by other sensory cues such as visual representation of haptic information (sensory substitution) and the hypothesis that surgical outcomes may be improved by substituting or augmenting haptic feedback by such sensory cues

Predictors of the Social Distancing Behaviors during COVID-19 Pandemic using Protection Motivation Theory in Iran: A cross sectional study

Background: Social distancing is a key behavior to minimize Coronavirus disease 2019 (COVID-19) infections. Since the change of behavior is the only way to prevent this pandemic, this study aimed to predict the social distancing behaviors during the COVID-19 pandemic using protection motivation theory (PMT). Methods: This cross-sectional study was conducted through a convenience sampling method on 796 individuals over 15 years old from urban and rural areas of different cities in Iran during 2020. The data were collected online using demographic characteristics form, PMT and social distancing behaviors questionnaires. Afterward, the obtained data were analyzed in SPSS software (version 16) through linear correlation coefficient and hierarchical regression tests. Results: The Mean±SD score of social distancing behaviors was obtained at 4.42±0.31. The results of the hierarchical linear regression model showed that after adjusting the effect of socio-demographic variables, self-efficacy (Beta=0.238, P<0.001) was the strongest predictor of social distancing behaviors during the COVID-19 pandemic, followed by intention (Beta=0.233, P<0.001) and perceived severity (Beta=0.083, P=0.028). PMT constructs and intention was able to predict 40% of social distancing behaviors in total. Conclusions: In the prevalence of infectious diseases, individuals differ in adherence to social distancing behaviors. The PMT was a useful framework for prediction social distancing behaviors during the COVID-19 pandemic. Therefore, this theory can be used as a framework in designing educational programs to increase self-efficacy and encourage individuals to observe social distancing behaviors as a result

Genomic Assessment of Blood-Derived Circulating Tumor DNA in Patients With Colorectal Cancers: Correlation With Tissue Sequencing, Therapeutic Response, and Survival.

PurposeGenomic alterations in blood-derived circulating tumor DNA (ctDNA) from patients with colorectal cancers were correlated with clinical outcomes.Patients and methodsNext-generation sequencing of ctDNA (54- to 73-gene panel) was performed in 94 patients with colorectal cancer.ResultsMost patients (96%) had metastatic or recurrent disease at the time of blood draw. The median number of nonsynonymous alterations per patient was three (range, zero to 30). The most frequently aberrant genes were TP53 (52.1% of patients), KRAS (34%), and APC (28.7%). Concordance between tissue and blood next-generation sequencing ranged from 63.2% (APC) to 85.5% (BRAF). Altogether, 74 patients (79%) had one or more nonsynonymous alterations, 69 (73%) had one or more potentially actionable alterations, and 61 (65%) had an alteration actionable by a drug approved by the US Food and Drug Administration (on or off label). Lung metastases correlated with improved survival from diagnosis in univariable analysis. ctDNA of 5% or more from blood tests as well as EGFR and ERBB2 (HER2) nonsynonymous alterations correlated with worse survival (but only ERBB2 remained significant in multivariable analysis). No two patients had identical molecular portfolios. Overall, 65% versus 31% of patients treated with matched (n = 17) versus unmatched therapy (n = 18) after ctDNA testing achieved stable disease for 6 months or more, partial response, or complete response (P = .045); progression-free survival, 6.1 versus 2.3 months (P = .08); and survival not reached versus 9.4 months (P = .146; all by multivariable analysis).ConclusionPatients with colorectal cancer have heterogeneous ctDNA profiles, and most harbor potentially actionable ctDNA alterations. Matched therapy yielded higher rates of stable disease for 6 months or more, partial response, or complete response. ctDNA assessment may have clinical utility and merits further investigation

Predictive value of pregnancy-associated plasma protein-A in relation to fetal loss: A systematic review and meta-analysis

Background: For a woman with bleeding and threatened abortion, ultrasound scan is done to confirm the viability of the fetus; however, 10-15% of the embryos are eventually aborted. Distinguishing between women with good and poor prognosis can be a helpful approach. Objective: This study aimed to review the predictive value of Pregnancy-associated Plasma Protein A (PAPP-A) in relation to the diagnosis of fetal loss. Materials and Methods: The articles published in multiple databases including Web of Science, PubMed, MEDLINE, Scopus, and Persian databases such as ISC, Magiran, and IranMedx were searched for articles published until May 2019. MeSH terms was used for searching the databases including fetal loss OR pregnancy loss OR abortion OR miscarriage with the following word using AND; Pregnancy-Associated Plasma Protein- A OR PAPP-A. Two reviewers extracted data and recorded them in a pre-defined form and assessed the quality of articles using the Newcastle-Ottawa tool. Meta-analysis was done using the Comprehensive Meta-Analysis/2.0 software and MetaDisc. Results: A total number of 16 studies were eligible for the qualitative data synthesis, out of which 8 studies were included in the meta-analysis. All studies had high and medium quality. The forest plot analysis showed a sensitivity of 57% (95% CI: 53-63%), a specificity of 83% (95% CI: 80-85%), a positive likelihood ratio of 3.52 (95% CI: 2.44- 5.07), a negative likelihood ratio of 0.54 (95% CI: 0.37-0.79), and a diagnostic odds ratio of 6.95 (95% CI: 3.58-13.50). Conclusion: PAPP-A cannot be recommended on a routine basis for predicting fetal loss and still further research with a combination of other biomarkers is required. Key words: Pregnancy-associated plasma protein-A, Fetal loss, Pregnancy, Systematic review

Detection rate of actionable mutations in diverse cancers using a biopsy-free (blood) circulating tumor cell DNA assay.

Analysis of cell-free DNA using next-generation sequencing (NGS) is a powerful tool for the detection/monitoring of alterations present in circulating tumor DNA (ctDNA). Plasma extracted from 171 patients with a variety of cancers was analyzed for ctDNA (54 genes and copy number variants (CNVs) in three genes (EGFR, ERBB2 and MET)). The most represented cancers were lung (23%), breast (23%), and glioblastoma (19%). Ninety-nine patients (58%) had at least one detectable alteration. The most frequent alterations were TP53 (29.8%), followed by EGFR (17.5%), MET (10.5%), PIK3CA (7%), and NOTCH1 (5.8%). In contrast, of 222 healthy volunteers, only one had an aberration (TP53). Ninety patients with non-brain tumors had a discernible aberration (65% of 138 patients; in 70% of non-brain tumor patients with an alteration, the anomaly was potentially actionable). Interestingly, nine of 33 patients (27%) with glioblastoma had an alteration (6/33 (18%) potentially actionable). Overall, sixty-nine patients had potentially actionable alterations (40% of total; 69.7% of patients (69/99) with alterations); 68 patients (40% of total; 69% of patients with alterations), by a Food and Drug Administration (FDA) approved drug. In summary, 65% of diverse cancers (as well as 27% of glioblastomas) had detectable ctDNA aberration(s), with the majority theoretically actionable by an approved agent

The Effect of Cognitive-Behavioral Counseling on Maternal-Fetal Attachment among Pregnant Women with Unwanted Pregnancy: A Randomized Clinical Trial

Background: Unwanted pregnancy is an event bringing about adverse effects on the mother, the baby and, ultimately, on the whole family. The establishment and enhancement of maternal-fetal attachment play a role in the promotion of emotional communication between the mother and the child in the future. This study aimed at investigating the effect of cognitive-behavioral counseling on maternal-fetal attachment among pregnant women with unwanted pregnancy. Methods: In this randomized clinical trial, 60 eligible pregnant women with unwanted pregnancy and gestational age of 22-28 weeks who had referred to healthcare centers in Mashhad, a city in the northeast of Iran, were selected and they were through random block  assignment divided into two groups of counseling with the cognitive-behavioral approach (n = 30) and the control group (n = 30). In addition to the routine pregnancy care, the cognitive-behavioral counseling group received 4 group counseling sessions on a weekly basis, while the control group only received the routine pregnancy care from healthcare providers. Maternal-fetal attachment before and after intervention in the two groups was assessed through Cranley’s Maternal-Fetal Attachment Scale. Comparison of mean scores within and between the two groups was performed using SPSS 21 through independent and paired t-tests. Results:  At the end of the study and after the intervention, the mean scores of maternal-fetal attachment in the intervention and control groups were  94.06±11.73 and 80.16 ± 10.09, respectively, and the difference between the groups was significant. Although the difference between the mean scores of each group at the beginning and the end of the study was significant, this difference between the two groups was also noticeable (21.56 ± 12.16 versus 7.40 ± 12.39) and statistically significant . Conclusion: Cognitive-behavioral counseling can be effective in enhancing the maternal-fetal attachment in unwanted pregnancies; therefore, it is recommended to be integrated into pregnant women's healthcare programs

Effect of sexual enrichment program on the sexual satisfaction of pregnant women in Iran: A randomized clinical trial

Background: To improve the sexual satisfaction of pregnant women, there needs to be a culturally appropriate sex education program. This study aimed at determining the effectiveness of a sexual enrichment program on the sexual satisfaction of pregnant women. Methods: This single-blind randomized clinical trial was conducted on 61 pregnant women aged 18 to 35 years old with low-risk pregnancies and gestational ages of 14 to 32 weeks, who had referred to three healthcare centers in Mashhad. The participants were randomly assigned to two groups of control (n = 31) and intervention (n = 30) based on a table of blocks of four. The intervention group, in addition to receiving routine pregnancy training, participated in six one-hour sessions of a sexual enrichment program held on a weekly basis, while the control group received only the routine pregnancy healthcare. Larson's sexual satisfaction questionnaire was used to assess the sexual satisfaction of pregnant women prior to the study and two weeks after the intervention. Comparison of mean scores between and within the two groups was performed using SPSS software (version 21) using independent and paired t-tests. Results: After the intervention, there was a significant difference between the mean sexual satisfaction scores of the two groups (p = 0.02). Comparison of the differences between the mean sexual satisfaction scores of the intervention group before and after the intervention indicated a significant change (p = 0.009), while in case of the control group this change was not significant (p = 0.46). Conclusion: A sexual enrichment program can be effective in improving the sexual satisfaction of pregnant mothers. Keywords: Sexual satisfaction, Pregnant women, Sexual enrichment program, Clinical tria

The Role of N-Acetylcysteine in Platelet Aggregation and Reperfusion Injury in Recent Years

Introduction: N-acetylcysteine (NAC) is an amino acid that contains a cysteine group and is currently used widely in various fields of medical research especially in cardiology. In this review, potential benefits of NAC in the aggregation of platelet and reperfusion injury are evaluated. Methods and Results: The available evidence was collected by searching Scopus, Pub-Med, Medline, Cochrane central register of controlled trials, and Cochrane database systematic reviews. Our searching was performed without time limitation and only English language articles were included in this review. Key words used as search terms included “N-acetylcysteine”, “platelet aggregation”, “reperfusion injury”. Over the past decade, several investigations were carried out to ascertain reperfusion injury and antiplatelet properties of NAC, and in this article the results of investigations in both models (human and animal) were addressed in details. The results revealed that NAC has an important antiplatelet property in animal models while this effect is not very significant in human models and needs more investigations. However, its reperfusion injury in both models is worth noticing. Conclusions: Due to the limited data about effectiveness of NAC in both human and animal as antiplatelet agent, more investigation is needed to evaluate NAC efficacy in platelet aggregation and reperfusion injury especially in human studies in the future

Effect of Melatonin on Cardiac Injury after Primary Percutaneous Coronary Intervention: a Randomized Controlled Trial

Abstract Several studies have reported that the antioxidant properties of melatonin can provide cardiac protection through scavenging of free radicals. This study sought to investigate the efficacy of melatonin on cardiac biomarkers, myocardial-specific protein high sensitive troponin-T (hsTnT) and creatine kinase-MB (CK-MB), in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). In this randomized clinical trial, a total of 40 patients with STEMI planned to undergo pPCI were randomly assigned to two groups of receiving melatonin plus standard treatment [n=20] and control group, receiving only standard therapy [n=20]. The following parameters including hsTnT and CK-MB were assessed preoperatively (baseline) and at 6 hours after procedure. Melatonin could significantly reduce the level of CK-MB (118.2 ± 21.09 IU/L in the treated group versus 198.24 ± 20.94 IU/L in the control group; p-value = 0.01). However, there was no difference in the mean hs-TnT level between two groups (2491 ± 664 μg/L vs. 2801 ± 620 μg/L; p value = 0.73). Our results revealed that melatonin can be considered as a safe adjunctive medication to the standard regimen after pPCI for the aim of decreasing cardiovascular events. Meanwhile, this was a pilot study with a small number of patients and further studies are needed to confirm the beneficial effect of melatonin in patients with STEMI