Technology and Health Care - Volume 30, issue 6

Authors: Li, Jian | Yu, Xiao-Kun | Dong, Xiao-Man | Guo, Lin | Li, Xiao-Feng | Tian, Wei

Article Type: Research Article

Abstract: BACKGROUND: The treatment of sacral fractures accompanied by nerve injury is complex and often leads to an unsatisfactory prognosis and poor quality of life in patients. OBJECTIVE: The present study aimed to investigate the clinical value of using 3.0T magnetic resonance contrast-enhanced three-dimensional (MR CE-3D) nerve view magnetic resonance neurography (MRN) in the diagnosis and management of a sacral fracture accompanied by a sacral plexus injury. METHODS: Thirty-two patients with a sacral fracture accompanied by a sacral plexus injury, including 24 cases of Denis spinal trauma type II and 8 cases of type …III, were enrolled in the study. All patients had symptoms or signs of lumbosacral nerve injury, and an MRN examination was performed to clarify the location and severity of the sacral nerve injury. Segmental localization of the sacral plexus was done to indicate the site of the injury as being intra-spinal (IS), intra-foraminal (IF), or extra-foraminal (EF), and the severity of the nerve injury was determined as being mild, moderate, or severe. Surgical nerve exploration was then conducted in six patients with severe nerve injury. The location and severity of the nerve injury were recorded using intra-operative direct vision, and the results were statistically compared with the MRN examination results. RESULTS: MRN showed that 81 segments had mild sacral plexus injuries (8 segments of IS, 20 segments of IF, 53 segments of EF), 78 segments had moderate sacral plexus injuries (8 segments of IS, 37 segments of IF, and 33 segments of EF), and 19 segments had severe sacral plexus injuries (7 segments of IS, 9 segments of IF, and 3 segments of EF). The six patients who underwent surgery had the following intra-operative direct vision results: 3 segments of moderate injury (IF) and 20 segments of severe injury (7 segments of IS, 10 segments of IF, 3 segments of EF). There was no statistically significant difference in the results between the intra-operative direct vision and those of the MRN examination (p > 0.05). CONCLUSION: MR CE-3D nerve view can clearly and accurately demonstrate the location and severity of sacral nerve injury accompanied by a sacral fracture, and has the potential for being the first choice of examination method for this kind of injury, which would be of important clinical value. Show more

Keywords: Sacral fracture, sacral nerve injury, magnetic resonance, neurography

DOI: 10.3233/THC-213543

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1407-1415, 2022

Authors: Linhart, Christoph | Neuwieser, Dominik | Kussmaul, Adrian C. | Degen, Nikolaus | Greiner, Axel | Kammerlander, Christian | Suero, Eduardo M.

Article Type: Research Article

Abstract: BACKGROUND: Posterior instrumentation using pedicle screws and rods is the most commonly used technique for the treatment of thoracolumbar fractures of the spine. The procedure aims to restore the neurologic and biomechanical functions of the spine and allows for early mobilization and rapid reintegration into society. It is unclear whether the magnitude of correction has an effect on postoperative outcomes. OBJECTIVE: We aimed to determine whether the magnitude of sagittal angular correction during posterior instrumentation of the spine had an effect on postoperative quality of life, pain and function outcomes as measured using the EQ5D-3L and …the Core Outcome Measures Index (COMI) instruments. We also aimed to quantify the correlation between EQ5D-3L and COMI scores. METHODS: We analyzed the pre- and postoperative radiographs of 52 patients who underwent percutaneous pedicle screw placement for thoracolumbar fractures, as well as their self-reported EQ5D-3L and COMI quality of life, pain and functional outcome scores. Regression models were constructed to estimate the effect that the magnitude of Cobb angle correction had on postoperative outcomes. We also estimated the correlation between EQ5D-3L and COMI scores. RESULTS: The median EQ5D-3L TTO score was 0.9 (range, - 0.1 to 1). The median COMI score was 3.1 (range, 0 to 10). There was no significant effect of the magnitude of correction on EQ5d-3L TTO scores (p = 0.3379; R = 0.36) or on COMI scores (p = 0.3379; R = 0.15). Age and bone mineral density were not found to be significant predictors of outcome (p = 0.05). There was a strong correlation between the EQ5D-3L TTO and COMI scores (r = - 0.62). CONCLUSION: The magnitude of Cobb angle correction during pedicle screw instrumentation of thoracolumbar fractures did not influence quality of life, pain or function outcomes. There was good correlation between EQ5D-3L TTO scores and COMI scores. Show more

Keywords: Thoracolumbar fracture, closed reduction, comi-score, EuroQol EQ-5D, quality of life

DOI: 10.3233/THC-213616

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1417-1422, 2022

Authors: Melcher, Carolin | Paulus, Alexander C. | Roßbach, Bjömrn P. | Gülecyüz, Mehmet F. | Birkenmaier, Christof | Schulze-Pellengahr, Christoph von | Teske, Wolfram | Wegener, Bernd

Article Type: Research Article

Abstract: BACKGROUND: Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when non-operative treatment has failed. Apart from acute complications such as hematoma and infections, same-level recurrent lumbar stenosis and adjacent-segment disease (ASD) are factors that can occur after index lumbar spine surgery. OBJECTIVE: The aim of this retrospective case series was to evaluate the outcome of surgery and the odds of necessary revisions. METHODS: Patients who had undergone either decompressive lumbar laminotomy or laminotomy and spinal fusion due to lumbar spinal stenosis (LSS) between 2000 and 2011 were included in …this analysis. Demographic, perioperative and radiographic data were collected. Clinical outcome was evaluated using numeric rating scale (NRS), the symptom subscale of the adapted version of the german Spinal Stenosis Measure (SSM) and patient-sreported ability to walk. RESULTS: Within the LSS- cohort of 438 patients, 338 patients underwent decompression surgery only, while instrumentation in addition to decompression was performed in 100 cases (22.3%). 38 patients had prior spinal operations (decompression, disc herniation, fusion) either at our hospital or elsewhere. Thirty-five intraoperative complications were documented with dural tear with CSF leak being the most common (33/35; 94.3%). Postoperative complications were defined as complications that needed surgery and differentiated between immediate postoperative complications (⩽ 3 weeks post operation) and complications that needed revisions surgery at a later date. Within all patients 51 revisions were classified as immediate complications of the index operation with infections, neurological deficits and hematoma being the most common. Within this group only 22 patients had fusion surgery in the first place, while 29 were treated by decompression. Revision surgery was indicated by 53 patients at a later date. While 4 patients decided against surgery, 49 revision surgeries were planned. 28 were performed at the same level, 10 at the same level plus an adjacent level, and 10 were executed at index level with indications of adjacent level spinal stenosis, adjacent level spinal stenosis plus instability and stand-alone instability. Pre- operative VAS score and ability to walk improved significantly in all patients. CONCLUSIONS: While looking for predictors of revision surgery due to re-stenosis, instability or same/adjacent segment disease none of these were found. Within our cohort no significant differences concerning demographic, peri-operative and radiographic data of patients with or without revision wer noted. Patients, who needed revision surgery were older but slightly healthier while more likely to be male and smoking. Surprisingly, significant differences were noted regarding the distribution of intraoperative and early postoperative complications among the 6 main surgeons while these weren’t obious within the intial index group of late revisions. Show more

Keywords: Lumbar spinal stenosis, claudication, treatment options, lamiotomy, fusion, revision

DOI: 10.3233/THC-223389

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1423-1434, 2022

Authors: Alqahtani, Nasser M. | Alqahtani, Ali Fahed | Zarbah, Mohammad A. | Alqahtani, Saeed M. | Shukla, Anuj Kishor | Kulkarni, Manisha Mangesh

Article Type: Research Article

Abstract: BACKGROUND: The prime concern of an implant-supported prosthesis (ISP) is to maintain an optimal proximal contact tightness, which further maintains arch integrity, improves masticatory effectiveness, and minimizes peri-implantitis. OBJECTIVE: To investigate the loss of proximal contact tightness between single tooth implant-supported prosthesis and the adjacent natural teeth. METHODS: Forty patients treated by a single mandibular first molar ISP, aged between 18–50 years were selected. All were randomly allocated in Group I and Group II. Group I, 20 subjects who have received ISP without an insertion of Essix retainer, and Group II patients received …an insertion with Essix retainer. The groups were subdivided into Subgroup A, B, and Subgroup C, D, in which A and C are control groups. To measure the tightness at proximal contact points, a digital force analyzer was used. Proximal contact tightness (PCT) was measured immediately after the placement of the prosthesis, 3 months, 6 months, and 1-year follow-up respectively, and the PCT values at end of 1 year were statistically evaluated. Statistical analysis was done, mean and standard deviation was calculated by independent sample t -test wit p < 0.05 as a statistically significant value. RESULTS: In Group I, towards the end of 1 year, 2.09 N (65.5%) and 1.50 N (53.1%) loss of PCT were found on mesial and distal contact areas respectively. In Group II, loss of PCT at mesial contact area was 0.87 N (28.9%) and at distal contact area was 1.77 N (53.3%), which is significantly less compared with the non-usage of Essix retainer (p < 0.05). CONCLUSION: The usage of Essix retainer, PCT increases especially on the mesial contact area. The frequency of contact loss was decreased. Thus, to minimize the loss of proximal contact the usage of Essix retainer is recommended. Show more

Keywords: Proximal contact loss, implant supported prosthesis (ISP), contact area, digital force analyzer

DOI: 10.3233/THC-220028

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1435-1442, 2022

Authors: Cerón-Zamora, Eduardo | Scougall-Vilchis, Rogelio José | Lara-Carrillo, Edith | Contreras-Bulnes, Rosalía | Robles-Bermeo, Norma Leticia | Mendoza-Rodríguez, Martha | Medina-Solís, Carlo Eduardo | Maupomé, Gerardo

Article Type: Research Article

Abstract: BACKGROUND: Adverse effects can occur during orthodontic treatment. OBJECTIVE: To evaluate the relationship between prevalence and severity of enamel demineralization using a laser-fluorescence device, with length of orthodontic treatment time. METHOD: A cross-sectional study was conducted in 60 patients in a university orthodontic clinic. A clinical examination to establish demineralization at four sites on each tooth (premolar to premolar) was performed using the DIAGNOdent pen. The dependent variable was enamel demineralization, from which the prevalence (at least one affected site), extension (percentage of affected teeth) and adjusted average (average of the mean DIAGNOdent …values per tooth) were calculated. The length of time for orthodontic treatment was determined in months. Various sociodemographic and clinical covariates were included. RESULTS: Average number of months under orthodontic treatment was 26.37 ± 24.81 months. Prevalence of enamel demineralization was 80.0%, its extension was 21.9% ± 17.2 and adjusted average of DIAGNOdent values was 6.09 ± 1.75. By quadrant, the teeth most affected were 14 (34.4%), 24 (25.0%), 31 (30.2%) and 44 (33.3%). No significant relationship (p > 0.05) was observed between enamel demineralization and length of time under orthodontic treatment. CONCLUSIONS: A high prevalence of dental demineralization was observed. In this sample, no relationship was observed between months under treatment and dental demineralization, or with other variables included in the study. Show more

Keywords: Oral health, dental demineralization, orthodontic treatment, DIAGNOdent

DOI: 10.3233/THC-220039

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1443-1452, 2022

Authors: Dragan, Irina F. | Wright, Tanya | Holtzman, Lucrezia Paterno | Ausenda, Federico | Malik, Umer | Al-hamoudi, Nawwaf | Karimbux, Nadeem | Alasqah, Mohammed

Article Type: Research Article

Abstract: BACKGROUND: The natural Omega-3 lipids in the OADM serve to reduce inflammation. Preliminary results in a human model reported no adverse events and favorable healing and esthetic outcomes. OBJECTIVE: The primary objective of this animal model study was to histologically evaluate the use of Omega-3 piscine acellular dermal matrix (OADM) as a soft tissue alternative in surgically created mucogingival defects. METHODS: Bilateral maxillary canines in 6 adult beagle dogs were randomly assigned to the test (OADM) and control sub-epithelial connective tissue graft (SCTG) groups. Dehiscence defects 4 × 6 mm …were created surgically on the buccal surfaces. The OADM/SCTG were placed to completely cover the root surface to the level of the cemento-enamel junction and sutured with resorbable sling sutures. The gingival flap was repositioned to cover the grafts. At two months follow-up, the dogs were sacrificed, and block samples were retrieved, including the whole canine and periodontium. The histological outcomes were evaluated using qualitative analysis. RESULTS: The qualitative histological analysis revealed the oral, sulcular and junctional epithelium had healed with normal appearance on both test and control sites. None of the test (OADM) samples presented with any foreign body reaction. CONCLUSION: The use of this new piscine xenograft resulted in minimal complications and the attachment apparatus healed normally. Show more

Keywords: Acellular dermal matrix, mucogingival defects, connective tissue graft, xenograft, dentistry

DOI: 10.3233/THC-220068

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1453-1461, 2022

Authors: Wu, Keqing | Wang, Hongmei | Wang, Yujue | Duan, Shengbao | Gao, Xin

Article Type: Research Article

Abstract: BACKGROUND: Precise classification of incomplete antibody reactants (IAR) in the Coombs test is the primary means to prevent incompatible blood transfusions. Currently, an automatic and contactless method is required for accurate IAR classification to avoid human error. OBJECTIVE: We present an ensemble learning algorithm that integrates five convolutional neural networks and the least absolute shrinkage and selection operator (LASSO) regression algorithm into an IAR intensity classification model. METHODS: A dataset including 1628 IAR and corresponding labels of IAR intensity categories ((-), (1+), (2+), (3+), and (4+)) was used. We trained the ensemble model …using 1302 IAR and validated its performance using 326 IAR. The optimal ensemble model was used to assist immunologists in classifying IAR. The chord diagrams based on the human-machine interaction were established. RESULTS: The ensemble model achieved 98.8%, 98.4%, 99.7%, 99.5%, and 99.4% accuracies in the (-), (1+), (2+), (3+), and (4+) categories, respectively. The results were compared with those of manual classification by immunologists (average accuracy: 99.2% vs. 75.6%). Using the model, all three immunologists achieved increased accuracy (average accuracy: + 8.4%). CONCLUSIONS: The proposed algorithm can thus effectively improve the accuracy and efficiency of IAR intensity classification and facilitate the automation of haemolytic disease screening equipment. Show more

Keywords: Antibodies, Coombs test, neural network, least absolute shrinkage and selection operator (LASSO), blood transfusion

DOI: 10.3233/THC-213621

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1463-1474, 2022

Authors: Peng, Quchen | Yan, Yunqi | Qian, Lijun | Suo, Shiteng | Guo, Yi | Xu, Jianrong | Wang, Yuanyuan

Article Type: Research Article

Abstract: BACKGROUND: The incidence of liver tumors is among the top three in China. The treatments of benign and malignant tumors are different. Accurate diagnosis plays an important role in guiding the treatment of tumors. OBJECTIVE: The aim of this study is to solve the following: (1) blurred boundary between the liver tumor and other organs causes incorrect segmentation of liver tumor boundaries; (2) large difference in tumor size and the diversity in texture and grayscale are major challenges in liver tumor classification tasks. METHODS: Firstly, the liver tumor is segmented from the original …CT images by a tumor segmentation network, UNet++ with fusion loss and atrous spatial pyramid pooling (FLAS-UNet++). The proposed segmentation method can solve the problem of tumor edge segmentation error by learning the tumor edge information. Secondly they are adaptively cropped according to the tumor volume to reduce the over-fitting and over-sensitivity of the deep network. Thirdly an improved Dense Block is designed to pay more attention to the changes in grayscale and texture between benign and malignant tumors. Finally, the features extracted from the network combined with tumor volume, patient’s sex and age, are sent to a classifier for diagnosis. RESULT: Liver tumor segmentation results show that the dice, HD95 reached 71.9%, 12.1 mm, respectively. The classification results show that the accuracy, specificity, sensitivity and area under curve reached 82.4%, 79.8%, 84.4%, 87.5%, respectively. The segmentation and classification results are both better than other’s methods and mainstream networks. CONCLUSIONS: In order to solve existing problems of liver tumor CT image classification methods, our method realizes the accurate segmentation and classification of liver tumors in CT images and has important clinical application value. Show more

Keywords: Liver CT image, liver tumor segmentation, FLAS-UNet++, liver tumors classification, IDenseNet

DOI: 10.3233/THC-213655

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1475-1487, 2022

Authors: Zou, Tengyue | Huang, Haojun | Huang, Xuanyu | Chen, Jialun | Pan, Xiaodong | Xin, Jiawei

Article Type: Research Article

Abstract: BACKGROUND: The injury of the knee joint is found to be directly related to the fatigue caused by excessive exercise. Many previous studies used wearable devices to measure the angle of knee joint during activities, but did not pay enough attention to the load of knee joint related to the fatigue degree of it. OBJECTIVE: A wearable embedded system was designed to sense the motion state and load of knee joint and uses the sensoring data to estimate and predict the fatigue degree of knee joint during exercise in real time, so as to prevent it …from being injured. METHODS: An economical wearable system is designed to measure the parameters of the knee joint during exercises. Then the warning message and recommended healthy lasting time are able to be sent to users to avoid excessive exercise. 24 healthy volunteers aged 20–25 years were involved in the experiments. Two famous evaluation scales for knee joint from Department of Orthopedics (Lysholm score and IKDC score) were adopted to evaluate the protective effect. RESULTS: After 14 days of the first stage testing, all the participants with wearable devices reported healthy knee joint state to verify the effectiveness of the system. For the second stage, the testing group equipped with wearable warning devices did not receive obvious change in the two scales. However, Lysholm score of control group dropped by at least 7.4 and IKDC score dropped by at least 11.1 which were significantly reduced. CONCLUSION: Only using human perception to prevent knee joint fatigue had a risk of failure while the designed wearable system could protect the knee successfully from injuries during exercises, such as running, badminton, table tennis and basketball. Moreover, female gender and a high BMI value may be two factors that increase the risk of knee injuries during sports. Show more

Keywords: Knee joint, fatigue, injury, wearable device, exercise

DOI: 10.3233/THC-213579

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1489-1502, 2022

Authors: Lingampally, Pavan Kalyan | Doss, Arockia Selvakumar Arockia | Kadiyam, Vikram Reddy

Article Type: Research Article

Abstract: BACKGROUND: This article examines a dynamic wearable assistive device for individuals suffering from pain in the neck. As a part of the clinical treatment, static braces/cervical collars are suggested, however, these collars aid the person in maintaining the upright position of the head but restrict the head motion to a single configuration. To address this problem, a dynamic wearable assistive cervical collar is fabricated based on human anatomical head/neck data. OBJECTIVE: The objective of this study is to observe the strain acting on the neck surface muscles for bending and compression neck movements with and without …the neck brace using a strain sensor. METHODS: To evaluate the performance of this device, experimental trials were conducted on test subjects to find out the angular tilt of the head with the device worn using the cervical range of motion (CROM) device. In addition, a neck surface muscle strain study is also conducted using strain sensors to investigate the strain produced while using the wearable assistive device. The strain on the neck surface muscle is measured using NI-9236 strain DAQ (data acquisition system). In this experimental study, a group of aged individuals with minor neck pain were recruited to study the head/neck movements. RESULTS: It was found that by using the proposed assistive device, test subjects were able to mimic 65% of human head/neck movements like flexion, extension, lateral bending, and rotation, and the strain generated from the neck surface muscle was minimal. CONCLUSION: The results show that using the designed assistive device reduced the strain on neck surface muscle, and strain obtained is within the range of 40 × 10 - 6 to 80 × 10 - 6 , and may aid in recovery of the individuals suffering with neck pain. Show more

Keywords: Neck surface muscle strain, cervical collar, parallel manipulator, dropped head syndrome, active range of motion

DOI: 10.3233/THC-220101

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1503-1513, 2022