Technology and Health Care - Volume 30, issue 4

Authors: Xing, Dong | Chen, Li | Wang, Lantao | Jin, Jing | Liu, Dong | Liu, Huan | Dong, Shimin

Article Type: Research Article

Abstract: BACKGROUND: Stereotactic radiotherapy (SBRT) is widely used in the treatment of thoracic cancer. OBJECTIVE: To evaluate the efficacy of a non-rebreather mask (NRBM) and high-flow nasal cannula (HFNC) in patients with radiation pneumonia complicated with respiratory failure. METHODS: This was a single-center randomized controlled study. Patients admitted to the EICU of the Fourth Hospital of Hebei Medical University were selected and divided into NRBM and HFNC group. Arterial blood gas analysis, tidal volume, respiratory rates and the cases of patients receiving invasive assisted ventilation were collected at 0, 4, 8, 12, 24, 48, …and 72 h after admission. RESULTS: (1) The PaO2/FiO2, respiratory rates, and tidal volume between the two groups at 0, 4, 8, 12, 24, 48, and 72 h were different, with F values of 258.177, 294.121, and 134.372, all P < 0.01. These indicators were different under two modes of oxygenation, with F values of 40.671, 168.742, and 55.353, all P < 0.01, also varied with time, with an F value of 7.480, 9.115, and 12.165, all P < 0.01. (2) The incidence of trachea intubation within 72 h between HFNC and NRBM groups (23 [37.1%] vs. 34 [54.0%], P < 0.05). The transition time to mechanical ventilation in the HFNC and NRBM groups (55.3 ± 3.2 h vs. 45.9 ± 3.6 h, P < 0.05). (3) The risk of intubation in patients with an APACHE-II score > 23 was 2.557 times than score ⩽ 23, and the risk of intubation in the NRBM group was 1.948 times more than the HFNC group (P < 0.05). CONCLUSION: Compared with the NRBM, HFNC can improve the oxygenation state of patients with radiation pneumonia complicated with respiratory failure in a short time, and reduce the incidence of trachea intubation within 72 h. Show more

Keywords: Non-rebreather mask, high-flow oxygen nasal cannula, radiation pneumonia, respiratory failure, treatment effect

DOI: 10.3233/THC-213597

Citation: Technology and Health Care, vol. 30, no. 4, pp. 869-880, 2022

Authors: He, Yong | Liu, Jingshuai | Li, Feng | Cao, Wujing | Wu, Xinyu

Article Type: Research Article

Abstract: BACKGROUND: The exoskeleton for lower limb rehabilitation is an uprising field of robot technology. However, since it is difficult to achieve all the optimal design values at the same time, each lower extremity exoskeleton has its own focus. OBJECTIVE: This study aims to develop a modular lightweight lower extremity exoskeleton (MOLLEE) with novel compliant ankle joints, and evaluate the movement performance through kinematics analysis. METHODS: The overall structure of the exoskeleton was proposed and the adjustable frames, active joint modules, and compliant ankle joints were designed. The forward and inverse kinematics models were …established based on the geometric method. The theoretical models were validated by numerical simulations in ADAMS, and the kinematic performance was demonstrated through walking experiments. RESULTS: The proposed lower extremity offers six degrees of freedom (DoF). The exoskeleton frame was designed adjustable to fit wearers with a height between 1.55 m and 1.80 m, and waist width from 37 cm to 45 cm. The joint modules can provide maximum torque at 107 Nm for adequate knee and hip joint motion forces. The compliant ankle can bear large flexible deformation, and the relationship between its angular deformation and the contact force can be fitted with a quadratic polynomial function. The kinematics models were established and verified through numerical simulations, and the walking experiments in different action states have shown the expected kinematic characteristics of the designed exoskeleton. CONCLUSIONS: The proposed MOLLEE exoskeleton is adjustable, modular, and compliant. The designed adjustable frame and compliant ankle can ensure comfort and safety for different wearers. In addition, the kinematics characteristics of the exoskeleton can meet the needs of daily rehabilitation activities. Show more

Keywords: Lower extremity exoskeleton, walking rehabilitation, lightweight structure, modular design, compliant joint, kinematics analysis

DOI: 10.3233/THC-213177

Citation: Technology and Health Care, vol. 30, no. 4, pp. 881-894, 2022

Authors: Liu, Sen | Yuan, Han | Liu, Jiali | Lin, Hai | Yang, Cuiwei | Cai, Xiaodong

Article Type: Research Article

Abstract: BACKGROUND: Resting tremor is an essential characteristic in patients suffering from Parkinson’s disease (PD). OBJECTIVE: Quantification and monitoring of tremor severity is clinically important to help achieve medication or rehabilitation guidance in daily monitoring. METHODS: Wrist-worn tri-axial accelerometers were utilized to record the long-term acceleration signals of PD patients with different tremor severities rated by Unified Parkinson’s Disease Rating Scale (UPDRS). Based on the extracted features, three kinds of classifiers were used to identify different tremor severities. Statistical tests were further designed for the feature analysis. RESULTS: The support vector …machine (SVM) achieved the best performance with an overall accuracy of 94.84%. Additional feature analysis indicated the validity of the proposed feature combination and revealed the importance of different features in differentiating tremor severities. CONCLUSION: The present work obtains a high-accuracy classification in tremor severity, which is expected to play a crucial role in PD treatment and symptom monitoring in real life. Show more

Keywords: Comprehensive assessment, parkinson’s disease, tremor severity, tri-axial accelerometers, feature analysis

DOI: 10.3233/THC-213205

Citation: Technology and Health Care, vol. 30, no. 4, pp. 895-907, 2022

Authors: Frazão, Murillo | Werlang, Luis Augusto | Azevedo, Cássio | Kunz, Adelar | Peltz, Maikel

Article Type: Research Article

Abstract: BACKGROUND: Cyclergometry with functional electrical stimulation (FES-cycling) is a feasible method for rehabilitation. The concept is to promote exercise induced by depolarization of the motoneuron and muscular contraction. OBJECTIVE: To measure acute physiological responses to FES-cycling. METHODS: Retrospective study of data from ten healthy volunteers who performed FES-cycling, passive cycling and neuromuscular electrical stimulation (NMES) alone. Metabolic, ventilatory and cardiovascular parameters were analyzed. RESULTS: Oxygen uptake enhanced 97 ± 15% during FES-cycling, with medium effect size compared to NMES and large effect size compared to passive cycling. …Energy expenditure enhanced 102 ± 15% during FES-cycling, with medium effect size compared to NMES and large effect size compared to passive cycling. Minute ventilation enhanced 115 ± 26% during FES-cycling, with small effect size compared to NMES and medium effect size compared to passive cycling. Cardiac output enhanced 21 ± 4% during FES-cycling, with medium effect size compared to NMES and passive cycling. Arterial – mixed venous oxygen content difference enhanced 60 ± 8% during FES-cycling, with a medium effect size compared to NMES and large effect size compared to passive cycling. CONCLUSIONS: FES-cycling enhances metabolic, ventilatory and cardiovascular demands and the physiological responses are higher than NMES and passive cycling. Show more

Keywords: FES-cycling, exercise, oxygen uptake, NMES, electrical stimulation, cycling

DOI: 10.3233/THC-213220

Citation: Technology and Health Care, vol. 30, no. 4, pp. 909-918, 2022

Authors: Yuan, Gaoteng | Dong, Yinping | Zhou, Xiaofeng

Article Type: Research Article

Abstract: BACKGROUND: Gynecological diseases threaten women’s health, and vaginal microecological testing is a common method for detecting gynecological diseases. Efficient and accurate microecological testing methods have always been the goal pursued by gynecologists. OBJECTIVE: In order to automatically identify different types of microbial images in vaginal micromorphology detection, this paper proposes a vaginal microecological image recognition method based on Gabor texture analysis combined with long and short-term memory network (LSTM) model. METHOD: Firstly, we denoise the microecological morphological im-ages, which selects the area of interest and sets the label of the microorganism according to …the doctors label. Secondly, texture analysis is carried out for the region of interest, which uses Gabor filters with 8 directions and 5 scales to filter the region of interest to extract the texture features on the image. Comparing the differences between different microbial image features, and screening suitable features to reduce the number of features. Then, we design an LSTM model to analyze the relationship of image features in different categories of microorganisms. Finally, we use the full connection layer and Softmax function to realize the automatic recognition of different microbial images. RESULTS: The experimental results show that the image classification accuracy of 8 common microorganisms is 81.26%. CONCLUSION: Texture analysis combined with LSTM network strategy can identify different kinds of vaginal micro ecological images. Gabor-LSTM model has better classification effect on imbalanced data sets. Show more

Keywords: Microecological detection, Gabor, LSTM, feature extraction, image classification

DOI: 10.3233/THC-213509

Citation: Technology and Health Care, vol. 30, no. 4, pp. 919-936, 2022

Authors: Chen, Ruijuan | Sun, Zhihui | Diao, Xiaofei | Wang, Huiquan | Wang, Jinhai | Li, Ting | Wang, Yao

Article Type: Research Article

Abstract: BACKGROUND: Emotional intelligence plays a vital role in human-computer interaction, and EEG signals are an objective response to human emotions. OBJECTIVE: We propose a method to extract the energy means of detail coefficients as feature values for emotion recognition helps to improve EEG signal-based emotion recognition accuracy. METHOD: We used movie clips as the eliciting material to stimulate the real emotions of the subjects, preprocessed the collected EEG signals, extracted the feature values, and classified the emotions based on them using Support Vector Machine (SVM) and Stacked Auto-Encoder (SAE). The method was verified …based on the SJTU emotion EEG database (SEED) and the self-acquisition experiment. RESULTS: The results show that the accuracy is better using SVM. The results based on the SEED database are 89.06% and 79.90% for positive-negative and positive-neutral-negative, respectively. The results based on the self-acquisition data are 98.05% and 89.83% for the same, with an average recognition rate of 86.57% for the four categories of fear, sad (negative), peace (neutral) and happy (positive). CONCLUSION: The results demonstrate the validity of the feature values and provide a theoretical basis for implementing human-computer interaction. Show more

Keywords: Wavelet transform, EEG signal, emotion recognition, support vector machine

DOI: 10.3233/THC-213522

Citation: Technology and Health Care, vol. 30, no. 4, pp. 937-949, 2022

Authors: Jamshidnezhad, Amir | Hosseini, Seyed Mohsen | Mahmudi, Mandana | Mohammadi-Asl, Javad

Article Type: Research Article

Abstract: BACKGROUND: Timely and accurate diagnosis of genetic diseases can lead to proper action and prevention of irreparable events. OBJECTIVE: In this work we propose an integrated genetic-neural network (GNN) to improve the prediction risk of trisomy diseases including Down’s syndrome (T21), Edwards’ syndrome (T18) and Patau’s Syndrome (T13). METHODS: A dataset including 561 pregnant were created. In this integrated model, the structure and input parameters of the proposed multilayer feedforward network (MFN) were optimized. RESULTS: The results of execution of the GNN on the testing dataset showed that the developed …model can be accurately classify the anomalies from healthy fetus with 97.58% accuracy rate, and 99.44% and 85.65% sensitivity, and specificity, respectively. In the proposed GNN model, the Levenberg Merquident (LM) algorithm, the Radial Basis (Radbas) function from various types of functions were selected by the proposed GA. Moreover, maternal age, Nuchal Translucency (NT), Crown-rump length (CRL), Pregnancy-associated plasma protein A (PAPP-A) were selected by the proposed GA as the most effective factors for classifying the healthfetuses from the cases with fetal disorders. CONCLUSION: The proposed computerized model increases the diagnostic performance of the physicians especially in the accurate detection of healthy fetus with non – invasive and low – cost treatments. Show more

Keywords: Trisomy syndromes, optimization, artificial neural networks, genetic algorithms

DOI: 10.3233/THC-213628

Citation: Technology and Health Care, vol. 30, no. 4, pp. 951-965, 2022

Authors: Ma, Yi-Chuan | Chen, Ai-Qi | Guo, Fei | Yu, Juan | Xu, Min | Shan, Dan-Dan | Zhang, Shun-Hua

Article Type: Research Article

Abstract: BACKGROUND: Middle cerebral artery (MCA) occlusion is extremely common, especially unilateral artery, which can result in a significant incidence of cerebral infarction. OBJECTIVE: To assess the value of whole-brain computed tomography perfusion (CTP) imaging combined with dynamic CT angiography (dCTA) in the evaluation of pial collateral circulation in patients with MCA occlusion. METHODS: Whole-brain CTP and dCTA images were acquired in 58 patients with unilateral MCA occlusion. All patients were divided into three groups according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score (by CTA). The …CTP parameters were analysed, including relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT), and relative time to peak (rTTP). Patients were followed up with the modified Rankin scale (mRS). All cases in this study were confirmed by DSA. RESULTS: The CTP parameters of the MCA blood supply area on the affected side of patients with different degrees of stenosis were significantly different from those on the unaffected side. There are significant differences in the CTP parameters and openings of the Willis circle in patients with different degrees of stenosis. Significant differences were found in the number of patients with good prognosis. CONCLUSIONS: Whole-brain CT perfusion combined with dynamic CTA can structurally and functionally evaluate the establishment of pial collateral circulation and its effect on cerebral hemodynamic changes. Show more

Keywords: CT perfusion, dynamic CTA, pial collateral circulation, middle cerebral artery occlusion

DOI: 10.3233/THC-213118

Citation: Technology and Health Care, vol. 30, no. 4, pp. 967-979, 2022

Authors: Rostetter, Renzo | Jenni, Beatrice | Eggmann, Sabrina | Meyer, Jan T. | Schmitt, Kai-Uwe

Article Type: Research Article

Abstract: BACKGROUND: Early mobilization is important to improve critically ill patients’ outcomes, but barriers to its implementation are common. A suitable in-bed device to exercise patients’ legs might facilitate early mobilization. OBJECTIVE: The aim of this study was to develop an in-bed leg press that would facilitate early mobilization and enhance strength training of patients in acute care settings. METHODS: A user-centered design approach was applied to develop the device. The process was assessed by different instruments: the system usability scale (SUS) questionnaire, the Kano model questionnaire and interviews with end-users. RESULTS: …Through several iterations of a user-centered design process, the prototype of an in-bed leg press was developed and tested. The assessment, based on SUS, Kano and interviews, indicates high usability and demonstrates the advantages of a user-centered design process. CONCLUSIONS: An interprofessional user-centered design approach was successfully implemented to develop a medical device. The early involvement of end-users resulted in a design that already shows a high degree of production readiness. The resulting device fulfilled all core requirements from a therapeutic point of view and included key features related to its practical use. Show more

Keywords: Early mobilization, rehabilitation, user-centered design, user involvement, leg exercise

DOI: 10.3233/THC-213511

Citation: Technology and Health Care, vol. 30, no. 4, pp. 981-992, 2022

Authors: Ramalingam, Vinodhkumar | Cheong, Soon Keng | Lee, Poh Foong

Article Type: Research Article

Abstract: BACKGROUND: Brainwaves studies on pain are gaining more attention in recent years. However, the target group in a similar study on collegiate athletes with musculoskeletal pain is still under explore. OBJECTIVE: The objective is to investigate the differences of the brainwaves response and its association with pain interference of the collegiate athletes with and without musculoskeletal pain. METHODS: Collegiate athletes (n = 49) were recruited and categorized into pain group (PG) (n = 25) and no-pain group (NPG) (n = …24). Brainwaves were recorded for 2 minutes with eyes closed in a resting state using EEG. Pain intensity and pain interference were documented using visual analogue scale and brief pain inventory, respectively. Independent t -test was used to compare brainwaves of PG and NPG, and Spearman’s correlation was used to find the association between brain waves and pain interference. RESULTS: Findings showed a significant decrease (p < 0.05) in brain waves in PG on left temporal regions as compared to NPG. Frontal beta, theta, and gamma waves were found to be negatively correlated with participants’ pain interference. CONCLUSION: This outcome potentially contributes EEG as an alternative non-invasive tool for an objective pain assessment method in health care technology to aid in the rehabilitation process. Show more

Keywords: Brainwaves, musculoskeletal pain, collegiate athletes, pain

DOI: 10.3233/THC-213633

Citation: Technology and Health Care, vol. 30, no. 4, pp. 993-1003, 2022

Authors: Lüdemann, Martin | Sulastyanto, Saskia | Raab, Peter | Schoen, Christoph | Rudert, Maximilian

Article Type: Research Article

Abstract: BACKGROUND: In the past, various efforts have been made to investigate diagnostic tools for periprosthetic-joint-infection (PJI). It is little-known about the diagnostic utility of polymerase-chain-reaction (PCR) in this context, especially concerning the role of multiplex-PCR assays comparing with conventional tissue culture. OBJECTIVE: Evaluation of an automated-multiplex-PCR cartridge system for patients with suspicion of PJI in comparison with conventional microbiological culture and 16S-rDNA-PCR. METHODS: On suspicion of PJI synovial fluid specimen were taken preoperatively or periprosthetic tissue was collected intraoperatively. Microbiological analysis included conventional culture, 16S-rDNA-PCR and automated-multiplex-PCR (Unyvero-i60-ITI ® ). …The European-Bone-and-Joint-Infection-Society (EBJIS) criteria were used for PJI diagnosis. Positive and negative percent agreement was calculated. Total percentage agreement and Cohen’s kappa coefficient were calculated. Sensitivity, specificity and positive predictive value of conventional culture, 16S-rDNA-PCR and multiplex-PCR were calculated. Ten specimens of proved PJI were used as control group. RESULTS: Fifty specimen were suitable for culture. 14 (28%) were classified as PJI, 36 (72%) were aseptic. Coagulase-negative staphylococci was the most frequent detected pathogen. Concordance-rate between mPCR and culture results was 75.6% with a Cohen’s kappa of 0.28. Concordance-rate between mPCR and 16S-rDNA was 82.9%, Cohen’s kappa was 0.13. Concordance analysis between culture results and 16S-rDNA lead to a concordance-rate of 88.9%. Cohen’s kappa was calculated with 0.6. With regard to the microbiological culture as reference, sensitivity of the mPCR was 0.33 and specificity was 0.91. Sensitivity and specificity of the 16S-rDNA-PCR was 0.55 and 0.97. The positive predictive value was 0.57 for the mPCR and 0.83 for the 16S-rDNA-PCR. CONCLUSIONS: Due to fair agreement between mPCR and conventional microbiological culture, the tested multiplex-PCR could be an additional instrument for the detection of PJI but is not superior over the conventional culture. Show more

Keywords: Periprosthetic joint infection, multiplex-PCR, microbiological diagnosis, synovial fluid, 16S rDNA PCR

DOI: 10.3233/THC-213248

Citation: Technology and Health Care, vol. 30, no. 4, pp. 1005-1015, 2022

Authors: Cheng, Kang-Jie | Liu, Yun-Feng | Wang, Joanne H. | Wang, Russell | Xia, Jiang | Xu, Xu | Jiang, Xian-Feng | Dong, Xing-Tao

Article Type: Research Article

Abstract: BACKGROUND: Customized prosthetic joint replacements have crucial applications in severe temporomandibular joint problems, and the combined use of porous titanium scaffold is a potential method to rehabilitate the patients. OBJECTIVE: The objective of the study was to develop a design method to obtain a titanium alloy porous condylar prosthesis with good function and esthetic outcomes for mandibular reconstruction. METHODS: A 3D virtual mandibular model was created from CBCT data. A condylar defect model was subsequently created by virtual condylectomy on the initial mandibular model. The segmented condylar defect model was reconstructed by either …solid or porous condyle with a fixation plate. The porous condyle was created by a density-driven modeling scheme with an inhomogeneous tetrahedral lattice structure. The porous condyle, supporting fixation plate, and screw locations were topologically optimized. Biomechanical behaviors of porous and solid condylar prostheses made of Ti-6Al-4V alloy were compared. Finite element analysis (FEA) was used to evaluate maximum stress distribution on both prostheses and the remaining mandibular ramus. RESULTS: The FEA results showed levels of maximum stresses were 6.6%, 36.4% and 47.8% less for the porous model compared to the solid model for LCI, LRM, and LBM loading conditions. Compared to the solid prosthesis, the porous prosthesis had a weight reduction of 57.7% and the volume of porosity of the porous condyle was 65% after the topological optimization process. CONCLUSIONS: A custom-made porous condylar prosthesis with fixation plate was designed in this study. The 3D printed Ti-6Al-4V porous condylar prosthesis had reduced weight and effective modulus of elasticity close to that of cortical bone. The Show more

DOI: 10.3233/THC-213534

Citation: Technology and Health Care, vol. 30, no. 4, pp. 1017-1030, 2022