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ObjectiveThis systematic literature review of the integration of artificial intelligence (AI) applications in surgical practice through hand and instrument tracking provides an overview of recent advancements and analyzes current literature on the intersection of surgery with AI. Distinct AI algorithms and specific applications in surgical practice are also examined.MethodsAn advanced search using medical subject heading terms was conducted in Medline (via PubMed), SCOPUS, and Embase databases for articles published in English. A strict selection process was performed, adhering to PRISMA guidelines.ResultsA total of 225 articles were retrieved. After screening, 77 met inclusion criteria and were included in the review. Use of AI algorithms in surgical practice was uncommon during 2013–2017 but has gained significant popularity since 2018. Deep learning algorithms (n = 62) are increasingly preferred over traditional machine learning algorithms (n = 15). These technologies are used in surgical fields such as general surgery (n = 19), neurosurgery (n = 10), and ophthalmology (n = 9). The most common functional sensors and systems used were prerecorded videos (n = 29), cameras (n = 21), and image datasets (n = 7). The most common applications included laparoscopic (n = 13), robotic-assisted (n = 13), basic (n = 12), and endoscopic (n = 8) surgical skills training, as well as surgical simulation training (n = 8).ConclusionAI technologies can be tailored to address distinct needs in surgical education and patient care. The use of AI in hand and instrument tracking improves surgical outcomes by optimizing surgical skills training. It is essential to acknowledge the current technical and social limitations of AI and work toward filling those gaps in future studies.

Background: The majority of pancreatic ductal adenocarcinomas (PDACs) are driven by mutant (mt) KRAS. How mt KRAS and co-driver mutations affect the immune cell (IC) landscape of PDAC remains uncertain. Herein, we characterize the types of IC in the PDAC tumor microenvironment (TME) and the prevalence of immuno-oncologic (IO) biomarkers by genomic and transcriptomic analysis in the context of KRAS status. Materials and methods: 4142 PDAC and 3727 colorectal cancer (CRC) cases with KRAS mt were analyzed using next-generation DNA sequencing, immunohistochemistry, and whole-transcriptome RNA sequencing. Microsatellite instability and deficiency in mismatch repair (MSI-H/dMMR) and tumor mutational burden (TMB) were also assessed. Results: We found KRAS mt in 81% of PDAC, with the most common variant being G12D in PDAC, and fewer cases of KRAS mt were co-expressed with the predictive IO marker MSI-H/dMMR than KRAS-wild-type (wt). However, KRASG12D, KRASG12V, and KRASQ61 mutations had significantly lower TMB than KRAS wt tumors in PDAC. The IC environment of KRAS mt PDAC showed significant differences in nearly all IC types; a similar pattern was observed in CRC but was less pronounced. Conclusions: Therapeutic IO targets like programmed death-ligand 1 are enriched in pancreatic adenocarcinoma cases harboring specific targetable variants of KRAS mt PDAC. Better understanding of the TME could lead to tailored immunotherapeutic strategies to overcome these barriers in KRAS mt PDAC, possibly in combination with molecularly targeted treatment strategies.

Water supply is a crucial concern for planners across all countries, especially in rural communities. This paper proposes a multidimensional approach to examining the effective criteria for water supply projects in rural areas of Iran. The study compares alternative methods of project implementation and employs three multi-criteria decision-making (MCDM) methods: analytical hierarchy process (AHP), Fuzzy-AHP, and technique for order preference by similarity to ideal solution (TOPSIS) to prioritize criteria, sub-criteria, and alternatives. The results indicate that, among the five options analyzed, diverting water from the river and constructing temporary storage dams are the highest priorities, while pipeline branching to the nearby city or village is given the lowest priority. The study reveals that environmental and economic criteria are more critical than social-security and technical-management criteria, while negative environmental impacts and the possibility of risk-taking by subversive agents are the most important among the 14 sub-criteria studied. HIGHLIGHTS The most important criteria and sub-criteria in the implementation of rural water supply (RWS) projects are prioritized.; The fuzzy framework and TOPSIS techniques are integrated into the AHP approach to dissect different RWS choices.; The results indicate the great importance of environmental and economic criteria.; Technical-management and social-security criteria play a secondary role.;

Background and Aim: This study aimed to assess the efficacy of Pistacia lentiscus (P. lentiscus) extract for dentin remineralization. Materials and Methods: This in vitro experimental study evaluated 45 extracted sound human premolars; pH cycling was performed to assess the effect of 10% P. lentiscus extract on dentin remineralization. The samples were randomly assigned to three groups of 1000 ppm sodium fluoride (NaF) solution, 10% P. lentiscus extract, and deionized water. To induce dentinal lesions, the teeth were immersed in a demineralizing solution at 37°C for 96 hours. The demineralized samples were then subjected to pH cycling for 14 days, and then underwent the Vickers microhardness test and scanning electron microscopic (SEM) assessment. Data were analyzed by repeated-measures ANOVA. Results: The mean microhardness in the NaF group was significantly higher than that in the extract and control groups after 14 days (P

In order to investigate the effect of supplementary irrigation on dryland wheat cultivars, an experiment was conducted as a factorial in randomized complete block design with three replications during cropping seasons 2016-2017 and 2017-2018. The factors were drought stress levels (dryland and supplemental irrigation) and wheat cultivars (Homa, Sardari, Rijaw, Ouhadi and Azar2). Supplemental irrigation significantly increased grain yield. In both cropping seasons, drought stress increased free amino acids and glycine betaine and decreased relative water content (RWC) and rate of water loss (RWL). Negative and significant correlation of RWL with free amino acids of leaf and glycine betaine and also positive and significant correlation of RWC with glycine betaine level indicated that the higher the concentration of osmotic compounds in leaves, the lower the rate of leaf water loss and the higher the leaf water content. The results of this study confirmed that adequate water supply by using supplementary irrigation in the most sensitive stages of wheat growth is a viable strategy to improve the physiological traits of the plant and hence obtain an acceptable grain yield under dryland conditions.

Back ground. Liver transplantation is an effective treatment for acute or chronic liver failure and metabolic liver disease, which is associated with good quality of life in over 80 percent of recipients. We aimed to evaluate outcome of duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses in pediatric liver transplant recipients below 15-kg.Methods. In this single-center retrospective study, all children less than 15 kg that have undergone liver transplantation at Nemazee Hospital Organ Transplant Center affiliated with Shiraz University of Medical Sciences from 2009 till 2019, were enrolled. Over a 10-yr period, 181 liver transplants were performed in patients with two techniques including duct-to-duct (Group 1) vs. Roux-en-Y hepaticojejunostomy biliary anastomoses (Group 2). All data was collected from patients’ medical records, operative notes, and post-transplant follow up notes. Data was analyzed by SPSS software V21.Results. Overall, 94 patients had duct to duct anastomosis (group 1) and 87 cases had Roux-en-Y hepaticojejunostomy (group 2). The mean age of the patients was 2.46 ± 1.5. The most common underlying diseases was biliary atresia (32%). The most prevalent complication after the surgery was infection in both groups. cardiopulmonary problems were significantly higher in group 2 (24.1% vs 4.3%) (p < 0.001). The rate of infection was significantly higher in group 2, as well.Conclusion. Our study showed a relatively high rate of post-operative infection which was the most among patients who had undergone Roux-en-Y hepaticojejunostomy. Except from biliary complications which were mostly observed in DD group, other complications were more common among Roux-en-Y group.

BackgroundMany patients with advanced heart failure (HF) are administered chronic intravenous inotropic support (CIIS) as bridge to surgical therapy; some ultimately never receive surgery. We aimed to describe reasons patients “crossover” from CIIS as bridge therapy to palliative therapy, and compare end-of-life outcomes to patients initiated on CIIS as palliative therapy.MethodsSingle-institution, retrospective cohort study of patients on CIIS as bridge or palliative therapy between 2010 and 2016; data obtained through review of health records and multi-disciplinary selection meeting minutes, was analyzed using descriptive and inferential statistics.ResultsOf 246 patients discharged on CIIS as bridge therapy, 37 (16%) (male n = 28, 76%; African American n = 22, 60%) ultimately never received surgery. 67 matched patients on CIIS as palliative therapy were included for analysis (male n = 47, 70%; African American n = 47, 70%). The most common reasons for “crossover” from CIIS as bridge therapy to palliative therapy were frailty (n = 10, 27%), cardiac arrest (n = 5, 13.5%), and progressive non-cardiac illnesses (n = 6, 16.2%). A similar percentage of patients in the bridge (n = 28, 76%) and palliative (n = 48, 72%) groups died outside the hospital (P=0.66); however, fewer bridge patients received hospice care compared to the palliative group (35% vs 69%, P < 0.001). Comparing patients who died in the hospital, bridge patients (n = 9; 100%) were more likely to die in the intensive care unit than palliative patients (n = 8; 42%) (P < 0.001).ConclusionPatients on CIIS as bridge therapy who do not ultimately receive surgical therapy “crossover” to palliative intention due to frailty, or development of or identification of serious illnesses. Nevertheless, these “bridge to nowhere” patients are less likely to receive palliative care or hospice and more likely to die in the intensive care unit than patients on CIIS as palliative therapy.

Background: Online Monte Carlo (MC) treatment planning is very crucial to increase the precision of intraoperative radiotherapy (IORT). However, the performance of MC methods depends on the geometries and energies used for the problem under study. Objective: This study aimed to compare the performance of MC N-Particle Transport Code version 4c (MCNP4c) and Electron Gamma Shower, National Research Council/easy particle propagation (EGSnrc/Epp) MC codes using similar geometry of an INTRABEAM® system.Material and Methods: This simulation study was done by increasing the number of particles and compared the performance of MCNP4c and EGSnrc/Epp simulations using an INTRABEAM® system with 1.5 and 5 cm diameter spherical applicators. A comparison of these two codes was done using simulation time, statistical uncertainty, and relative depth-dose values obtained after doing the simulation by each MC code. Results: The statistical uncertainties for the MCNP4c and EGSnrc/Epp MC codes were below 2% and 0.5%, respectively. 1e9 particles were simulated in 117.89 hours using MCNP4c but a much greater number of particles (5e10 particles) were simulated in a shorter time of 90.26 hours using EGSnrc/Epp MC code. No significant deviations were found in the calculated relative depth-dose values for both in the presence and absence of an air gap between MCNP4c and EGSnrc/Epp MC codes. Nevertheless, the EGSnrc/Epp MC code was found to be speedier and more efficient to achieve accurate statistical precision than MCNP4c. Conclusion: Therefore, in all comparisons criteria used, EGSnrc/Epp MC code is much better than MCNP4c MC code for simulating an INTRABEAM® system. Background:Online Monte Carlo (MC) treatment planning is very crucial to increase the precision of intraoperative radiotherapy (IORT). However, the performance of MC methods depends on the geometries and energies used for the problem under study. Objective: This study aimed to compare the performance of MC N-Particle Transport Code version 4c (MCNP4c) and Electron Gamma Shower, National Research Council/easy particle propagation (EGSnrc/Epp) MC codes using similar geometry of an INTRABEAM® system. Material and Methods: This simulation study was done by increasing the number of particles and compared the performance of MCNP4c and EGSnrc/Epp simulations using an INTRABEAM® system with 1.5 and 5 cm diameter spherical applicators. A comparison of these two codes was done using simulation time, statistical uncertainty, and relative depth-dose values obtained after doing the simulation by each MC code. Results: The statistical uncertainties for the MCNP4c and EGSnrc/Epp MC codes were below 2% and 0.5%, respectively. 1e9 particles were simulated in 117.89 hours using MCNP4c but a much greater number of particles (5e10 particles) were simulated in a shorter time of 90.26 hours using EGSnrc/Epp MC code. No significant deviations were found in the calculated relative depth-dose values for both in the presence and absence of an air gap between MCNP4c and EGSnrc/Epp MC codes. Nevertheless, the EGSnrc/Epp MC code was found to be speedier and more efficient to achieve accurate statistical precision than MCNP4c. Conclusion: Therefore, in all comparisons criteria used, EGSnrc/Epp MC code is much better than MCNP4c MC code for simulating an INTRABEAM® system.

In determining the quality of oils, heavy metal content, physical-chemical indices, and fatty acid profile, especially trans fatty acids are important factors. In this study, animal oil samples of different regions of Ilam province studied. After digestion and extraction by microwave-assisted acid digestion, the heavy metals content of the samples measured by an improved flame atomic absorption spectroscopy method. Moreover, after extraction and derivatization of the oils, the fatty acid profile was analyzed by gas chromatography. To facilitate the conclusion of the data obtained, samples of different regions of the province are divided into three parts: northern, southern, and central cities. According to the results, copper, cobalt, and chromium levels were reported in the range of 0.04-4.47, 0.02-2.33, and 0.02-3.54 mg/kg, respectively, which were below the maximum permissible levels. It was revealed that using the modified gas chromatography method, it is possible to separate and measure 27 fatty acids simultaneously. Besides, an acceptable degree of extraction of oleic and linoleic acid is extracted to calculate the cis and trans isomers, which was achieved.

Background & Aims: Medication errors are major healthcare concerns across the world, which cause mortality and physical and psychological complications in patients, their families, and the community every year. Considering the key role of nurses in direct patient care, the present study aimed to investigate the prevalence, barriers to medication error reports, and influential factors in medication errors in the viewpoint of nurses. Materials & Methods: This cross-sectional, descriptive-analytical study was conducted on 140 nurses employed in the teaching hospitals in Bojnurd, Iran in 2017. Data were collected using a questionnaire consisting of four sections, including the demographic data, evaluation of the type of medication errors, cause of not reporting medication errors, and their influential factors. Data analysis was performed in SPSS version 16. Results: The most important causes of medication errors included ward-related factors (3.40±0.69), factors related to nursing management (3.31±0.91), and nurse-related factors (3.16±0.78). In addition, the most important cause of not reporting medication errors was the process of error reports. Significant associations were also observed between the demographic characteristics of the nurses, medication errors, medication protocols, nurse-related factors, ward-related factors, fear of the consequences of error reporting, factors related to the error report process, and fear of the managerial factors. Conclusion: Considering that most medication errors were correlated with ward-related and managerial factors, nursing managers must focus on correcting the influential processes in medication errors and their reporting, simultaneously seeking strategies to control and mitigate these errors.

BACKGROUND AND OBJECTIVE: Studies have shown that plants of Family Cuscutaceae can affect the growth and development of cancer cells. It is important that the herbs used for non-cancerous cells do not have cytotoxic effects. The present study was conducted to evaluate the effects of hydroalcoholic extracts of Cuscuta europaea on the viability of breast cancer cells (MCF7) compared to non-cancerous kidney epithelial cells (Vero cell line). METHODS: In this experimental study, Vero cells and MCF7 cells were prepared from Pasteur Institute Cell Bank and divided into the control group and the groups treated with doses of 0.01, 0.1, 1 and 10 mg / ml. 48 hours after exposure, the cytotoxic effect of the extract was measured by MTT. FINDINGS: Compared with the control group, exposure to dose of 0.01, 0.1, 1 and 10 mg/ml of hydroalcoholic extract of Cuscuta europaea reduced the viability of MCF7 cells (54.47±0.35, 55±0.42, 44.62±0.38, and 4.64±0.73%, respectively) and Vero cells (58.42±0.45, 48.61±0.55, 43.14±0.23, and 5.35±0.27%, respectively) (p

Background & Aims: Communication skills are the foundation of clinical capabilities in healthcare providers. The process of delivering bad news is one of the most challenging aspects of clinical communication in health care, which has subtle psychological details. The present study aimed to assess the knowledge of nursing students regarding the conveying of bad news to patients and their companions in the hospitals affiliated to Bushehr University of Medical Sciences, Iran. Materials & Methods: This cross-sectional, descriptive-analytical study was conducted in 2017 in order to assess the knowledge of nursing students at Bushehr University of Medical Sciences regarding the delivery of bad news to patients and their companions. Data were collected using a valid and reliable researcher-made questionnaire. Data analysis was performed in SPSS version 18 using descriptive and analytical statistics. Results: The nursing students had moderate to high knowledge of delivering bad news to patients. In addition, significant associations were observed between the knowledge level, passing the courses of nursing ethics and professional communication (P=0.011), and academic year of education (P=0.037), so that the students who had passed the courses and were in inferior academic years had higher knowledge levels in this regard. However, no significant correlation was observed between the knowledge level, gender (P=0.550), and interest in the academic discipline (P=0.546). Conclusion: Adequate knowledge of professional ethics and effective communication is an advantage for healthcare providers. Based on the obtained results, presenting additional courses on professional ethics and communication skills in nursing education, as well as related training programs, by medical education authorities could lead to better outcomes in this regard.

The relation between microstructure and the fracture mechanisms of δ-TRIP steel with different Nb-content has been investigated using complementary methods of light microscopy, SEM, EDS, EBSD, X-ray phase analysis and tensile test. The results revealed a close dependency between the presences of constitutive phases i.e. ferrite, bainite, retained austenite and martensite and the mode and characteristics of fracture. All samples revealed almost different fractography pattern which could be associated to the effect of Nb microalloying element. The different fractography patterns were consisted of dimple rupture, riverside and Wallner lines pattern. The proportion of the cleavage fracture in comparison of dimple rapture increased by increasing the Nb-content due to the increase of primary martensite in the microstructure.

Background: Quality of work life is the reaction of employees to their work specially the individual results at work and mental health that affects their personal experience and work results. Objective: The aim of this study was to determine the effect of workload on quality of work life in staff of the teaching hospitals affiliated to Shahid Beheshti University of Medical Sciences, Tehran. Methods: This analytical study was conducted in 530 staff of four hospitals affiliated to the Shahid Beheshti University of Medical Sciences that were selected by Cochrane sampling method during 2014. The measurement tools were demographic questionnaire, Walton's quality of work life questionnaire (including 32 questions and eight dimensions), and the NASA TLX workload scale. Data were analyzed using Pearson’s correlation coefficient. Findings: The mean scores of quality of work life and workload were 48.21±13.34 and 64.70±11.44, respectively. There was negative significant correlation between workload and quality of work life (r= -0.0161). Conclusion: With regards to the results, it seems that high workload is one of the most important factors of reduced quality of work life that can be reduced through proper organization and planning.

Background: Postoperative shivering is an important common complication after general anesthesia. This may lead to dissatisfaction and a sense of discomfort, especially in parturients undergoing cesarean section. In addition to warming, many drugs have been investigated for prevention of shivering. The aim of this study was to evaluate the efficacy of intravenous paracetamol for prevention of shivering after general anesthesia in cesarean section. Materials and Methods: In this prospective randomized double-blind controlled clinical trial, 110 pregnant women, physical Status I or II, based on the classification of American Society of Anesthesiologists (ASA), aged 18–40 years, who were scheduled for elective cesarean section under general anesthesia were included in the study. They were randomly divided into two groups of 55 each. One group received 100 ml normal saline, and another group received 1 g of paracetamol in 100 ml normal saline intravenously, 15 min after the delivery of the baby. The anesthesia technique was similar in both the groups. Tympanic membrane temperature was measured before and after the induction of anesthesia and every 15 min till the end of recovery from anesthesia. Postanesthetic shivering was graded on a scale of 0 to 4; if the score was more than 2, it was treated with 25 mg pethedine. Vital signs and side effects were recorded during the surgery and recovery period. Results: There were no significant differences between the two groups regarding age, weight, height, and duration of surgery (P > 0.05). Shivering was seen in 5 parturients (9.1%) in paracetamol group (group A) and 28 parturients (50.9%) in the saline group (group N). On a scale of 0 to 4, shivering was of lower intensity in paracetamol group compared to the saline group (P < 0.05). There was a fall in core temperature in both the groups after induction of anesthesia, which was statistically similar (P > 0.05). There was no difference in the incidence of hypotension, nausea, and vomiting among the two groups (P > 0.05). Conclusion: The prophylactic use of intravenous paracetamol during surgery is effective for the prevention of postoperative shivering.

Background: The purpose of this study was to investigate the application of the Monte Carlo technique to calculate and analysis of dosimetric parameters for electron beams used in radiotherapy. This technique is based on statistical method and has a powerful role in different radiotherapy aspects. Materials and Methods: The simulated medical linear accelerator was the Varian Clinac 2100C. The electron beams 9, 12 and 20 MeV were simulated by MCNP4C Monte Carlo code. The beam geometry was 10 × 10 cm2 applicator, 100 cm SSD on the surface of homogenous water phantom. Central-axis percentage depth dose (PDD) curves and dose profile (off axis ratio) were obtained to compare with experimental measurements.  Results: The comparisons between calculated and experimental results show good agreement (within ±3%). Conclusions: The MCNP4C code is a powerful tool for acquiring electron dosimetry results as well as other applications in radiotherapy.

Hyalomma and Rhipicephalus (Acari: Ixodidae: Rhipicephalinae) are the most important ectoparasites and biological vector of pathogen agents. The taxonomy of some Hyalomma and Rhipicephalus species is more debatable. The traditional taxonomy of ticks have been revolutionized using polymerase chain reaction. The specificity, efficiency and accuracy of PCR is highly dependent on the oligonucleotide primers. In this study, five primers designed for amplification of a fragment ITS2 so-called TAH-1, TAH-2, TRH (for Hyalomma) and TAH-3, TAH-4 (for Rhipicephalus). Successfully, 24 and 29 ITS2 sample was sequenced using these primers. As well as, an ITS2 phylogenetic tree were constructed using BEAST basis on the Bayesian Inference (BI) method. The most Hyalomma and Rhipicephalus species well differentiated using ITS2 fragment since the designed primer fail to amplify gene target in few cases.

Background: Objective: To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation (DKT). Methods: From May to October 2011, 5 patients (4 women and 1 man) with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava (IVC) were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal (or external) iliac artery and external iliac vein, respectively.Results: Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2–6 months of post-operation follow up.Conclusion: Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time.

Background: Portal vein thrombosis (PVT) has been mentioned as a potential obstacle to liver transplantation (LTx).Objective: To review the impact of PVT on orthotopic liver transplant (OLT) outcome.Method: Between January 2006 and April 2009, 440 OLT were performed in Shiraz Transplant Unit of whom, 35 (7.9%) cases had old PVT with recanalization. Data were retrospectively collected regarding the demographics,indication for OLT, Child-Turgot-Pugh classification, pre-transplant diagnosis of PVT, perioperative course and managements, relapse of PVT, early post-operative mortality and morbidity. All patients received liver from deceased donors, underwent thrombendvenectomy with end-to-end anastomosis without interposition graft and evaluated daily for 5 days and thereafter, biweekly by duplex sonography during the follow-up period for 2 months. They were treated by therapeutic doses of heparin followed by warfarin to maintain an INR of 2–2.5.Results: The causes of end-stage liver disease were hepatitis B in 11, cryptogenic cirrhosis in 11, primary sclerosingcholangitis in 5 and other causes in 8 recipients. Extension of thrombosis was through confluence of superior mesenteric and splenic vein in 32 and to superior mesenteric vein in 3 patients. The mean±SD operationtime was 7.2±1.5 hrs. The mean±SD transfusion requirement was 5.4±2.8 units of packed cells. The mean±SD duration of hospital stay in these patients was 17.7±10.9 days. Eight patients died; 1 developed early in-hospital PVT, 1 had hepatic vein thrombosis, and 1 died of in-hospital ischemic cerebrovascular accident,despite a full anticoagulant therapy. The mean±SD follow-up period for those 28 patients discharged from hospital was 16.6±7.9 months; none of them developed relapse of PVT. The overall mortality and morbiditywas 28% and 32%, respectively. There was no relapse of PVT in the other patients.Conclusion: The presence of PVT at the time of OLT is not a contraindication for the operation but those with PVT have a more difficult surgery, develop more postoperative complications, and experience a higher in-hospital mortality.

The purpose of this research was to evaluate the quality of preserved kilka for human consumption. The different preservation methods (CSW and crushed ice) were used and the results were compared with the traditional method. Two main parameters (TVN and Histamine) of collected samples were measured in different preservation-time, namely: a) Time zero (after fishing), b) T5 and T10 (5 and 10 hours duration from fishing ground to processing room). The mean value of Histamine of T10 (10 hours after fishing) for traditional, CSW and crushed ice methods were determined 10.3, 2.2 and 1.5mg/100, respectively. On the other hand, the measured TVN values above mentioned methods were 22.3, 19.0 and 17.0 mg/100, respectively. The results showed a significant difference between the traditional method and two other methods (P