Technology and Health Care - Volume 31, issue 2

Authors: Xiao, Wanyi | Zhao, Xinyu | Li, Chunqiang | Huang, Qianpeng | He, Anqi | Liu, Gang

Article Type: Research Article

Abstract: BACKGROUND: To date, a few studies indicated that probiotics are beneficial to pouchitis, but no meta-analyses summarized the outcomes of probiotics in pouchitis in detail. OBJECTIVE: This meta-analysis discusses probiotics in the prevention of pouchitis for patients after ileal pouch-anal anastomosis (IPAA) and the relationship between probiotics preventive effect and the duration of therapy and history. METHODS: PubMed, EMBASE and Cochrane Library databases were searched from inception until February 2022. Risk ratio (RR), mean difference (MD) and their 95% confidence interval (CI) were analyzed by Review Manager 5.3. The subgroup analysis was also …performed to explore the agent for influencing outcomes. RESULTS: A total of 8 studies were included in this meta-analysis. The incidence of pouchitis in probiotics was significantly lower than that in the control (RR = 0.19, 95%CI [0.12, 0.32], P ⁢ ï ⁢ ¼ ⁢ œ 0.00001), and the PDAI (pouchitis disease activity index) in probiotics was also significantly lower (MD = - 5.65, 95%CI [- 9.48, - 1.83]). After the subgroup analysis, we found that probiotics work better in the short-term (RR = 0.12, 95%CI [0.04, 0.40], P = 0.0004), but may not achieve the desired effect in the long-term (RR = 1.20, 95%CI [0.40, 3.60], P = 0.75). CONCLUSIONS: Probiotics are beneficial in the prevention of pouchitis after IPAA, especially in the short-term. Show more

Keywords: Pouchitis, probiotics, proctocolectomy, restorative, IPAA

DOI: 10.3233/THC-220402

Citation: Technology and Health Care, vol. 31, no. 2, pp. 401-415, 2023

Authors: Hsieh, Jui-Chien | Shih, Hsing | Xin, Ling-Lin | Yang, Chung-Chi | Han, Chih-Lu

Article Type: Research Article

Abstract: BACKGROUND: Because clinically used 12-lead electrocardiography (ECG) devices have high falsepositive errors in automatic interpretations of atrial fibrillation (AF), they require substantial improvements before use. OBJECTIVE: A clinical 12-lead ECG pre-processing method with a parallel convolutional neural network (CNN) model for 12-lead ECG automatic AF recognition is introduced. METHODS: Raw AF diagnosis data from a 12-lead ECG device were collected and analyzed by two cardiologists to differentiate between true- and false-positives. Using a stationary wavelet transform (SWT) and independent component analysis (ICA) noise reduction was conducted and baseline wandering was corrected for the …raw signals. AF patterns were learned and predicted using a parallel CNN deep learning (DL) model. (1) The proposed method alleviates the decreased ECG QRS amplitude enhances the signal-to-noise ratio and clearly shows atrial and ventricular activities. (2) After training, the CNNbased AF detector significantly reduced false-positive errors. The precision of AF diagnosis increased from 77.3% to 94.0 ± 1.5% as compared to ECG device interpretation. For AF screening, the model showed an average sensitivity of 96.8 ± 2.2%, specificity of 79.0 ± 5.8%, precision of 94.0 ± 1.5%, F1-measure of 95.2 ± 1.0%, and overall accuracy of 92.7 ± 1.5%. CONCLUSIONS: The method can bridge the gap between the research and clinical practice The ECG signal pre-processing and DL-based AF interpretation can be rapidly implemented clinically. Show more

Keywords: 12-lead ECG, atrial fibrillation, stationary wavelet transform, independent component analysis, convolutional neural network, deep learning

DOI: 10.3233/THC-212925

Citation: Technology and Health Care, vol. 31, no. 2, pp. 417-433, 2023

Authors: He, Fan | Wang, Xinyu | Hua, Lu | Guo, Tingting

Article Type: Research Article

Abstract: BACKGROUND: In recent years, arterial stenosis has become one of the serious diseases threatening people’s life and health. OBJECTIVE: The main purpose of the present study is to examine the changes of hemodynamic parameters in different stenosis locations of arteries. METHODS: An arterial stenosis model with fluid-structure interaction and microcirculation as the outlet boundary of seepage is adopted in this paper. Considering the interaction between blood and arterial wall, a numerical simulation is carried out using the finite element method. RESULTS: The results show that hemodynamic parameters are sensitive to …the change of stenosis location. The closer to the microcirculation zone the stenosis location, the lower the blood flow velocity, pressure and the wall shear stress. In addition, the velocity trend is transformed from the gradual increase to decrease with the increasing distance away from the inlet when the stenosis location moves to the microcirculation zone. CONCLUSION: This work proves that the stenosis location has a great influence on hemodynamics based on microcirculation function. Microcirculation is an important factor that cannot be ignored in the numerical simulation of arterial hemodynamics. The numerical results could provide the potential of clinical preconditions for disease diagnosis and treatment. Show more

Keywords: Stenosis, microcirculation, hemodynamics, fluid-structure interaction

DOI: 10.3233/THC-213165

Citation: Technology and Health Care, vol. 31, no. 2, pp. 435-445, 2023

Authors: Sharma, Swati | Makkar, Monika | Luthra, Reena | Arora, Suraj | Pathania, Poonam | Das, Gotam | Chaturvedi, Saurabh

Article Type: Research Article

Abstract: BACKGROUND: Endodontically treated teeth are structurally more susceptible to root fractures. Proper tooth restorations with digitally fabricated or fibre post following endodontic therapy is essential to restore function and esthetics. OBJECTIVE: The aim of this in vitro study is to evaluate the fracture load of digitally fabricated and prefabricated fibre posts in endodontically treated teeth. METHODS: Sixty extracted human single rooted teeth were selected. The crowns were sectioned at the cement-enamel junction to standardize the remaining root length at 15 mm from the apices. Cleaning, shaping and obturation was done using conventional …step back technique to an ISO K-file size 40. The roots were divided into two groups of 30 samples each: Group S: teeth reinforced with digitally fabricated posts; Group F: teeth reinforced with fibre posts. Each group was further divided into three subgroups (S7, S9, S12, F7, F9, F12) based on lengths 7, 9 and 12 mm at which the posts were cemented. Composite resin core was fabricated and prepared to receive a complete metal crown. Universal testing machine was used to measure the compressive load required to fracture the teeth. RESULTS: The highest fracture resistance of 1532N was observed with fibre posts at 12 mm of post space length followed by digitally fabricated post 1398N at 12 mm, but the difference was not statistically significant. CONCLUSION: The highest fracture resistance was observed in the teeth restored with fibre posts with 12 mm length and the lowest with digitally fabricated post with 7 mm length. As the length of post increases irrespective of type of post fracture resistance increased. Show more

Keywords: Post and core, glass fibre post, digitally fabricated post, endodontically treated teeth, fracture resistance

DOI: 10.3233/THC-213690

Citation: Technology and Health Care, vol. 31, no. 2, pp. 447-458, 2023

Authors: He, Chen | Xiao, Yixuan | Li, Xinwei | Deng, Zhipeng | Qian, Yu | Zhao, Jing | Yu, Hongliu

Article Type: Research Article

Abstract: BACKGROUND: The limited number of hip prostheses users makes it less feasible to conduct amputee tests for prosthesis development in the clinic, which restricts the development efficiency of the intelligent prostheses. OBJECTIVE: This study proposes a hip disarticulation prostheses test system (HDPTS) to supplement the amputee tests for hip disarticulation prosthesis (HDP) evaluation, which would potentially facilitate the prosthesis evaluation safety and development efficiency. METHODS: The hip trajectory of an individual with normal gait was acquired and reproduced by calculating the corresponding movement joint angle of a manipulator. Then, an HDP was fit …on an amputee and on the HDPTS respectively to obtain the hip and knee joint angles of the HDP during walking. Comparing the root mean square error (RMSE) of the expected and planned trajectory, the joint angles between the amputee test and HDPTS test, to verify the feasibility and accuracy of the HDPTS for prosthesis evaluation. RESULTS: The RMSE between the expected and planned trajectory value was less than 1.20 mm (< 0.19%). The RMSE of the joint angles between the amputee test and HDPTS test were 2.18 ∘ (1.8%) and 3.13 ∘ (5.92%) for hip and knee joint respectively. CONCLUSION: The HDPTS was found accurate in hip trajectory reproduction and feasible in gait simulation for the prosthesis evaluation, which could potentially supplement the amputee test for prosthesis design thus improving prosthesis test safety and development efficiency. Show more

Keywords: Hip disarticulation, gait simulation, prosthesis evaluation, prosthesis test system, trajectory planning

DOI: 10.3233/THC-220091

Citation: Technology and Health Care, vol. 31, no. 2, pp. 459-469, 2023

Authors: Kim, Kyoung-Il | Im, Sang-Cheol | Kim, Kyoung

Article Type: Research Article

Abstract: BACKGROUND: Many previous studies have cited the importance of trunk stabilization exercises in patients with stroke. However, the evidence for optimal trunk stabilization exercises for patients with stroke is still lacking. OBJECTIVE: To investigate the effects of laser pointer visual feedback in trunk stabilization exercises that are important for improving trunk dysfunction in patients with stroke. METHODS: In total, 30 patients with chronic stroke were randomly assigned to experimental and control groups. The experimental group underwent a traditional stroke rehabilitation program and trunk stabilization exercises using laser pointer visual feedback. The control group …underwent a traditional stroke rehabilitation program and trunk stabilization exercises without visual feedback. Pre- and postintervention results after 6 weeks were evaluated using the Berg Balance Scale, static and dynamic plantar pressure, 10-m walk test, and the Korean version of the Fall Efficacy Scale. The results were analyzed using a general linear repeated measurement model. RESULTS: Both groups showed significant improvements in BBS scores, static plantar pressure, dynamic plantar pressure, 10 MWT, and K-FES scores after 6 weeks of intervention (P < 0.05). Compared to the control group, significant improvements were observed in the experimental group in the Berg Balance Scale scores, dynamic paretic posterior plantar pressure, 10-m walk test, and Korean version of the Fall Efficacy Scale scores (P < 0.025). CONCLUSION: Our results demonstrated the effectiveness of visual feedback during trunk stabilization exercises for resolving trunk dysfunction in patients with stroke. Trunk stabilization exercises using laser pointer visual feedback have been found to be more effective in balance, walking, and fall efficacy in patients with stroke. Show more

Keywords: Stroke, visual feedback, stabilization exercise, balance, gait

DOI: 10.3233/THC-220100

Citation: Technology and Health Care, vol. 31, no. 2, pp. 471-483, 2023

Authors: Zhang, Wenxin | Qu, Shoufang | Chen, Qiong | Yang, Xuexi | Yu, Jing | Zeng, Shuang | Chu, Yuxing | Zou, Hao | Zhang, Zhihong | Wang, Xiaowen | Jing, Ruilin | Wu, Yingsong | Liu, Zhipeng | Xu, Ren | Wu, Chunyan | Huang, Chuanfeng | Huang, Jie

Article Type: Research Article

Abstract: BACKGROUND: Along with the dramatic development of molecular diagnostic testing for the detection of oncogene variations, reference materials (RMs) have become increasingly important in performance evaluation of genetic testing. OBJECTIVE: In this study, we built a set of RMs for genetic testing based on next-generation sequencing (NGS). METHOD: Solid tumor tissues were selected as the samples of RMs for preparation. NGS was used to determine and validate the variants and the mutation frequency in DNA samples. Digital PCR was used to determine the copy numbers of RNA samples. The performance of the RMs …was validated by six laboratories. RESULTS: Thirty common genetic alterations were designed based on these RMs. RMs consisted of a positive reference, a limit of detection reference, and a negative reference. The validation results confirmed the performance of the RMs. CONCLUSION: These RMs may be an attractive tool for the development, validation, and quality monitoring of molecular genetic testing. Show more

Keywords: Reference materials, genetic testing, quality control, oncogene variants

DOI: 10.3233/THC-220102

Citation: Technology and Health Care, vol. 31, no. 2, pp. 485-495, 2023

Authors: Yang, Hai-Ping | Chen, Yue-Ling | Liu, Zong-Jian | Hao, Yi | Chen, Lin | Zhang, Zhen-Hua | He, Ning | Wang, Jing

Article Type: Research Article

Abstract: BACKGROUND: Circular RNAs (circRNAs) are a new class of noncoding RNAs, which interfere with gene transcription by absorbing microRNAs (miRNAs). OBJECTIVE: The expression profile and roles of circRNAs in unstable angina (UA) patients remains unclear. METHODS: An initial screening of circRNA expression by microarray analysis was performed using blood samples from three pairs of UA patients and matched healthy individuals. The differential expression of the chosen six circRNAs from the results of the microarray analysis was validated by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: The microarray results demonstrated that …some circRNAs were markedly different in UA patients, when compared with matched healthy individuals. In these UA patients, 22 circRNAs were upregulated and six circRNAs were downregulated when a P -value of < 0.05 was considered as a cut-off level and the fold change was > 1.5. Among the six circRNAs chosen for further analysis, qRT-PCR identified that five of these were upregulated, and the remaining circRNA was downregulated. By comparing the outcome of the six candidate circRNAs between the circRNAs microarray assay and RT-PCR validation, it was found that four circRNAs (hsa_circ_0002229, hsa_circ_0005580, hsa_circ_0046667, and hsa_circ_0001451) had the same variation trend. CONCLUSION: The present study provided the expression profile of circRNAs in UA patients. Moreover, some circRNAs have the potential to be biomarkers for the detection of UA patients. Further studies with a larger population will focus on hsa_circ_0002229, hsa_circ_0005580, hsa_circ_0046667 and hsa_circ_0001451. Show more

Keywords: Unstable angina, circular RNAs, expression profile, biomarkers

DOI: 10.3233/THC-220131

Citation: Technology and Health Care, vol. 31, no. 2, pp. 497-505, 2023

Authors: Anderson, Philip Mark | Rudert, Maximilian | Holzapfel, Boris Michael | Meyer, Julian Stefan | Weißenberger, Manuel | Bölch, Sebastian Philipp

Article Type: Research Article

Abstract: BACKGROUND: The incidence of conversion total hip arthroplasty (cTHA) following reduction and fixation for proximal femur fractures will increase in parallel to the aging population worldwide. OBJECTIVE: The goal of this study is to report the frequency of bacterial detection and the outcome of cTHA at the authors’ institution and to analyze preoperative factors that correlate with higher rates of bacterial growth and septic revision. METHODS: 48 patients who had been converted to THA after osteosynthesis of a proximal femur fracture either by a one- or two-stage procedure were included. Septic failure rate …and the frequency of bacterial detection at the time of fixation device removal were calculated. The influence of different preoperative factors was examined by the odds ratio. A receiver operating characteristic curve of c-reactive protein (CRP) for detection of bacterial growth at the time of fixation device removal was calculated. RESULTS: 18.8% patients showed positive bacterial cultures, with Staph. epidermidis being the most frequent pathogen (33.3%). Septic failure after cTHA occurred in 4.2%. Fixation with cephalomedullary nails and complications with the internal fixation showed higher odds for bacterial growth at time of cTHA. CRP for predicting bacterial growth had an area under the curve of 0.661. Implant survival was worse when temporary spacers were used. CONCLUSION: Bacterial detection rate at the time of cTHA is high, whereas septic failure rates are low. Isolated evaluation of inflammatory blood markers without other diagnostic modalities for infection is not decisive and does not justify a two-stage approach with implantation of a temporary spacer. Show more

Keywords: Conversion, total hip arthroplasty, hip, periprosthetic joint infection

DOI: 10.3233/THC-220136

Citation: Technology and Health Care, vol. 31, no. 2, pp. 507-516, 2023

Authors: Takeo, Atsumi | Okazaki, Hideto | Takeda, Kotaro | Nakagawa, Yuki | Sonoda, Shigeru

Article Type: Research Article

Abstract: BACKGROUND: The number of wheelchair users is increasing as the population ages. However, there is still lack of tools to objectively assess posture during wheelchair propulsion. OBJECTIVE: The purpose of this study was to develop a system to measure trunk and pelvis ROM (range of motion) while driving a wheelchair and to assess the reproducibility of the measured posture changes and cyclic fluctuations during propulsion. METHODS: Motion recorders were attached to the sternum and pelvis of fifteen healthy adults, and a pressure sensor was attached to the right heel. Subjects drove a standard …wheelchair using their right leg and trunk and pelvis ROM was measured in two separate sessions. To detect the trend of postural changes during propulsion, a trend curve was computed from the measured ROM using a low-pass filter and then subtracted from the measured ROM waveforms. The resulting curves were normalized and averaged, and the maximum, minimum, and amplitude of the cyclic variation during propulsion were assessed for reproducibility. RESULTS: Intraclass correlation coefficients of the maximum, minimum, and amplitude ranged from 0.65 to 0.84. CONCLUSIONS: The proposed method can estimate the posture change and the periodic fluctuation during wheelchair propulsion with high reproducibility. Show more

Keywords: Wheelchair propulsion, motion recorder, motion analysis, reproducibility, posture

DOI: 10.3233/THC-220139

Citation: Technology and Health Care, vol. 31, no. 2, pp. 517-525, 2023

Authors: Cao, Yuzhen | Ma, Huizhan | Fan, Yinuo | Liu, Yuzhen | Zhang, Haifeng | Cao, Chengcheng | Yu, Hui

Article Type: Research Article

Abstract: BACKGROUND: Colposcopy is one of the common methods of cervical cancer screening. The type of cervical transformation zone is considered one of the important factors for grading colposcopic findings and choosing treatment. OBJECTIVE: This study aims to develop a deep learning-based method for automatic classification of cervical transformation zone from colposcopy images. METHODS: We proposed a multiscale feature fusion classification network to classify cervical transformation zone, which can extract features from images and fuse them at multiple scales. Cervical regions were first detected from original colposcopy images and then fed into our multiscale …feature fusion classification network. RESULTS: The results on the test dataset showed that, compared with the state-of-the-art image classification models, the proposed classification network had the highest classification accuracy, reaching 88.49%, and the sensitivity to type 1, type 2 and type 3 were 90.12%, 85.95% and 89.45%, respectively, higher than the comparison methods. CONCLUSIONS: The proposed method can automatically classify cervical transformation zone in colposcopy images, and can be used as an auxiliary tool in cervical cancer screening. Show more

Keywords: Cervical cancer, deep learning, colposcopy, image processing, feature fusion

DOI: 10.3233/THC-220141

Citation: Technology and Health Care, vol. 31, no. 2, pp. 527-538, 2023

Authors: Zhou, Xinyi | Dong, Chunshan | Zhang, Jun | Sun, Peng | Lu, Qiang | Ma, Xiang

Article Type: Research Article

Abstract: BACKGROUND: Lung-protective ventilation (LPV) strategies have been considered as best practice in the care of critically patients. OBJECTIVE: This study aimed to investigate the effects individualized perioperative LPV with a positive end-expiratory pressure (PEEP) and low tidal volumes (V T ) based on a target airway plateau pressure (Pplat) in patients during and after an operation compared with conventional ventilation in elderly patients during abdominal surgery. METHODS: Sixty-one elderly patients with American Society of Anesthesiologists (ASA) I to III undergoing open abdominal surgery received either conventional ventilation (8 ml/kg - …1 V T ; CV group) or LPV (V T was adjusted to a target Pplat [⩽ 20 cm H 2 O]) in the volume-controlled mode with PEEP (9 cm H 2 O; LPV group) ventilation. RESULTS: Patients in the LPV group showed significantly lower pH values (7.30 ± 0.07 vs. 7.38 ± 0.05, P < 0.001) and respiratory indexes than that of CV group (0.806 ± 0.339 vs. 0.919 ± 0.300, P = 0.043) at the end of surgery. Compared with the CV group, the dynamic lung compliance (33.39 ± 3.163 vs. 30.15 ± 2.572, P < 0.001) was significantly higher, and the body temperature remained significantly more favorable in the LPV group (35.9 ± 0.3 vs. 35.1 ± 0.4, P < 0.001). Patients in the LPV group had significantly faster postoperative recovery than that of the CV group (P < 0.001). CONCLUSIONS: The study showed that LPV could be beneficial for ventilation, core body temperature, and postoperative recovery in elderly patients with healthy lungs. Show more

Keywords: Tidal volume, positive end-expiratory pressure, airway plateau pressure, lung function, postoperative recovery

DOI: 10.3233/THC-220144

Citation: Technology and Health Care, vol. 31, no. 2, pp. 539-551, 2023

Authors: Mo, Ting-Ting | Zhu, Yun-Sen | Zhang, Jiang-Nan | Zhang, Wei-Kang | Jiang, Chang

Article Type: Research Article

Abstract: BACKGROUND: Total hip replacement (THR) for Crowe type IV developmental dysplasia of the hip (DDH) is still challenging due to specific joint deformities and the high incidence of post-operative complications. OBJECTIVE: This study aimed to evaluate the clinical effect of trochanteric slide osteotomy (TSO) combined with a cementless femoral conical stem in THR for the treatment of Crowe type IV DDH. METHODS: Thirty-one total hip replacements (26 patients) with Crowe type IV DDH were performed using TSO combined with a cementless femoral conical stem. Surgical outcomes were evaluated using leg length discrepancy (LLD), …Harris hip score, and post-operative complications. RESULTS: The average pre-operative LLD was 51 mm (range 46–58 mm), decreasing to an average of 10 mm (range 8–12 mm) post-operatively. As a result, the post-operative incidence of the Trendelenburg sign significantly decreased compared with the pre-operative incidence (P < 0.05). Bony union was identified in 26 hips (83.9%), fibrous union in four (12.9%), and non-union in one (3.2%). No acetabular or femoral component loosening, dislocation, or deep infection around the component was found in any of the patients during the follow-up period (27 to 39 months). The average Harris hip score improved from 63.0 ± 3.0 (range 58–69) to 93.3 ± 2.0 (range 91–96). CONCLUSION: TSO combined with a cementless conical stem in THR is an appropriate option for patients with high congenital hip dislocation. Show more

Keywords: Hip dysplasia, hip replacement, greater trochanter, slide osteotomy, conical stem

DOI: 10.3233/THC-220147

Citation: Technology and Health Care, vol. 31, no. 2, pp. 553-563, 2023

Authors: Hu, Jie | Meng, Qiaoling | Zhu, Yudi | Zhang, Xin | Wu, Weiming | Yu, Hongliu

Article Type: Research Article

Abstract: BACKGROUND: During neurological rehabilitation training for patients with lower limb dysfunction, active rehabilitation training based on interactive force recognition can effectively improve participation and efficiency in rehabilitation training. OBJECTIVE: This study proposes an active training strategy for lower-limb rehabilitation robots based on a spring damping model. METHODS: The active training strategy included a kinetic model of the human-machine system, calculated and verified using a pull-pressure force sensor We used a dynamic model of the human-machine system and tensile force sensors to identify the human-machine interaction forces exerted by the patient Finally, the spring damping …model is used to convert the active interaction force into the offset angle of each joint, obtaining the active interaction force followed by the active movement of the lower limbs RESULTS: The experimental results showed that the rehabilitation robot could follow the active interaction force of the subject to provide assistance, thus generating the following movement and effectively helping patients improve joint mobility. CONCLUSION: The active flexibility training control strategy based on the virtual spring damping model proposed in this study is feasible, and motion is stable for patients with lower limb dysfunction after stroke Finally, the proposed active training method can be implemented in future work in other rehabilitation equipment and combined virtual reality technology to improve rehabilitation training experience and increase patient participation. Show more

Keywords: Spring damping model, neurological rehabilitation, human-machine system, lower limb rehabilitation

DOI: 10.3233/THC-220163

Citation: Technology and Health Care, vol. 31, no. 2, pp. 565-578, 2023

Authors: Liu, Xiaoling | Li, Lu | Xie, Xueqin | Zhuang, Duohan | Hu, Chunsheng

Article Type: Research Article

Abstract: BACKGROUND: Lung adenocarcinoma (LUAD) is one of the most common cancers with high morbidity and mortality and remains a crucial factor endangering human health. OBJECTIVE: This study aimed to elucidate the potential treatment target and prognostic biomarker in patients with LUAD through a comprehensive bioinformatics analysis. METHODS: The three public microarray datasets of GSE118370, GSE116959, and GSE43767 were obtained from the GEO data resource. The DEGs were explored between LUAD and non-malignant samples using GEO2R online tool in GEO data resource. GO along with KEGG analysis of DEGs were examined using WebGestalt tool. …The STRING web resource was employed to develop the PPI network of DEGs, whereas Cytoscape software was employed to perform module analysis. Finally, the mRNA, protein expression along with survival analysis of hub genes were explored via GEPIA, HPA along with Kaplan-Meier plotter web resource, respectively. RESULTS: Only 82 upregulated and 105 downregulated DEGs were found among the three datasets. Further, GO analysis illustrated that 187 DEGs were primary enriched in extracellular structure organization, tube development along with cell adhesion. The KEGG enrichments showed that these DEGs were primary linked to leukocyte transendothelial migration, vascular smooth muscle contraction along with ECM-receptor interaction. Among the 187 DEGs, the 10 hub genes (P4HB, SPP1, CP, GOLM1, COL1A1, MMP9, COL10A1, APOA1, COL4A6, and TIMP1) were identified. The mRNA along with protein levels of hub genes in LUAD tissues were further verified by Oncomine, UCSC Xena, GEPIA and HPA databases. Additionally, overall survival curves illustrated that LUAD patients with the higher levels of P4HB, SPP1, COL1A1, and MMP9 were dramatically linked to shorter overall survival. CONCLUSIONS: The current study identified DEGs candidate genes (P4HB, SPP1, COL1A1, and MMP9) and pathways in LUAD using bioinformatics analysis, which could enhance our understanding of pathogenesis along with underlying molecular events in LUAD, and these hub genes and pathways may help provide candidate treatment targets for LUAD. Show more

Keywords: Bioinformatics, differentially expressed gene, lung adenocarcinoma, protein-protein interaction, Kaplan-Meier plotter

DOI: 10.3233/THC-220165

Citation: Technology and Health Care, vol. 31, no. 2, pp. 579-592, 2023

Authors: Zheng, Yuan-Yuan | Ni, Le-Yi | Ni, Fei-Fei | Wang, Xiao-Qian | Chen, Yu-Mei | Guo, Min | Dong, Xiao-Xia | Pan, Qiong-Hui | Chen, Cong

Article Type: Research Article

Abstract: BACKGROUND: The clinical manifestations of myofascial pelvic pain (MFPP) are mainly acute or chronic muscle pain at one or more trigger points in the pelvic cavity or pelvic floor. OBJECTIVE: This study aims to explore the predictive value of pelvic floor myoelectric parameters with respect to MFPP and the effect of its clinical treatment. METHODS: Two hundred and one women followed up in the Wenzhou People’s Hospital 6–12 weeks postpartum between July 2020 and July 2021. They were divided into an MFPP group (n = 90) and a …non-MFPP group (n = 102), but 9 MFPP patients without a pelvic floor electromyography evaluation were not included. The general demographic data and pelvic floor electromyography evaluation parameters of the two groups were compared; the related factors of postpartum women suffering from MFPP were analyzed, and a nomogram model of the postpartum risk of suffering from MFPP was established. The 99 patients with postpartum MFPP were divided into a treatment group (n = 10) and a control group (n = 89). The difference in visual analog scale scores between the two groups initially and after three months of treatment was compared to evaluate the effective remission rate of postpartum MFPP after treatment. RESULTS: A significant difference was observed in the relaxation time at the rapid contraction stage (z = 4.369, p < 0.05) and the tension contraction stage (z = 135.645, p < 0.01) between the MFPP group and the non-MFPP group. The nomogram model for predicting postpartum MFPP was established with nine variables as potential predictors. The calibration chart and C index of 0.68 (95% CI: 0.65–0.71) proved that the model had a certain degree of discrimination. The clinical decision-making curve showed that the model could increase the net benefit rate of patients. The pain relief rate in the treatment group was significantly higher than that in the control group (p < 0.01). CONCLUSION: There is a significant correlation between postpartum MFPP and relaxation time at rapid contraction stage and tension contraction stage. The risk prediction nomogram model of postpartum MFPP established with nine potential predictors has a certain prediction capability, and clinical treatment can effectively relieve MFPP in postpartum patients. Show more

Keywords: Postpartum, pelvic floor muscle, myofascial pelvic pain, pelvic floor myoelectric parameter, nomogram model, trigger point, manipulation therapy, machine learning, artificial intelligence

DOI: 10.3233/THC-220186

Citation: Technology and Health Care, vol. 31, no. 2, pp. 593-605, 2023

Authors: Zuo, Yufeng | Wang, Yuxin | Liu, Shu | Yan, Hongxu | Liu, Lin | Wang, Xing

Article Type: Research Article

Abstract: BACKGROUND: The Ling sound test cannot provide the test of Chinese tone for preschool children with hearing aid and cochlear implants. OBJECTIVE: The paper tries to design a new tone test method composed of the Ling sound test and four Chinese tones to evaluate the hearing level of Chinese hearing-impaired children. METHODS: The tone identification rates of 20 cochlear implant children were statistically analyzed to verify the validity of the Ling sound test in the Chinese tone version. In addition, this paper analyzed the pronunciation characteristics of the Ling sound test in the …Chongqing-accented Mandarin version of 20 subjects. RESULTS: The identification rate of Ling six sounds was more than 97.0%, the identification rate of tone was more than 81.0%, and the identification rate of vowels was 83.1%, which was higher than that of consonants 79.0%. The Ling sound test n the Chongqing-accented Mandarin version has a narrower frequency range. CONCLUSION: The results verify the effectiveness and feasibility of the Ling sound test in the Chinese tone version in the assessment of frequency range and tone identification for cochlear implant users. Show more

Keywords: Cochlear implants, tone identification, hearing impairment, the Ling sound test, audiologic rehabilitation

DOI: 10.3233/THC-220189

Citation: Technology and Health Care, vol. 31, no. 2, pp. 607-620, 2023

Authors: Zhang, Liang | Liu, Benyuan | Ji, Zhenyu

Article Type: Research Article

Abstract: BACKGROUND: The dielectric properties of tissues are very important physical factors for the investigation and application of bio-electromagnetism. However, the size of the active sample tissue is usually limited in actual measurement, making it difficult to meet the requirements of the existing high-frequency measurement methods, thus influencing the measurement results. OBJECTIVE: The present study aimed to systematically investigate the various factors influencing the effective measurement area of the open-ended coaxial probe, including the design size of the probe and the dielectric properties of the object to be measured. METHODS: The simplified material mixing …model, in which several types of materials were set as the material under test (MUT) and the perfect conductor (PEC) was set as the specific material, was used in the simulation to study the effective measurement area of eight types of probes with different sizes for the dielectric measurement of different MUTs. Different concentrations of NaCl solutions and three types of coaxial probes were used in the actual measurement to verify the simulation results. RESULTS: According to the simulation results, the effective measurement area, especially the effective measurement radius, was closely related to the outer conductor radius of the probe. The effective measurement area of the probe decreased when the outer conductor radius of the probe reduced. Moreover, the change in the effective measurement area of the probe was independent of the MUT when the cross-sectional size of the probe was smaller than a certain threshold value. The experimental results also confirmed this conclusion. CONCLUSION: According to the research results, the independent variable dimension could be effectively reduced and the modeling difficulty was reduced when the analysis model of the effective measurement area of the probe was established. Show more

Keywords: Dielectric measurement, effective measurement area, coaxial probe, bioelectromagnetism, biological tissues

DOI: 10.3233/THC-220192

Citation: Technology and Health Care, vol. 31, no. 2, pp. 621-633, 2023

Authors: Yang, Dong-Yi | Cheng, Xue | Bu, Xing-Yao | Yan, Zhao-Yue | Qu, Ming-Qi | Zhao, Yue-Wu | Kong, Ling-Fei | Wang, Yao-Wei | Luo, Jian-Chao

Article Type: Research Article

Abstract: BACKGROUND: Glioblastoma is the most common and most aggressive type of primary brain tumor. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of intranasal granulocyte-macrophage colony stimulating factor (GM-CSF) administration combined with chemoradiotherapy in patients with glioblastoma who underwent surgery. METHODS: Ninety-two patients were randomly divided into two groups: a control group (n = 46), who received radiotherapy with adjuvant local delivery of nimustine hydrochloride (ACNU) and systemic administration of temozolomide, and an intervention group (n = 46), …who received intranasal GM-CSF prior to each cycle of adjuvant chemotherapy in addition to the treatment of the control group. Karnofsky performance status (KPS) scores, progression-free survival (PFS), overall survival (OS), and adverse effects were calculated and compared between the two groups. RESULTS: Compared with the control group, the intervention group had longer PFS (7.8 vs. 6.9 months, P = 0.016) and OS (19.2 vs. 17.1 months, P = 0.045, without adjustment for interim analyses). The KPS scores were also higher in the intervention group than in the control group after 6 months (84.35 ± 8.86 vs. 80.65 ± 7.72; t = 4.552, P = 0.036). Furthermore, the patients in the intervention group had lower incidence of neutropenia and thrombocytopenia (8.7% vs. 29.5%, P = 0.012; 8.7% vs. 18.2%, P = 0.186). Other adverse events were similar in both groups, and most adverse events were grade I/II and resolved spontaneously. CONCLUSION: Intranasal GM-CSF enhances the efficacy of the local ACNU administration combined with oral temozolomide chemotherapy. The survival and performance status were significantly improved in patients with glioblastoma after surgery. Additionally, the GM-CSF therapy was able to reduce the occurrence of chemotherapy-related neutropenia and thrombocytopenia. Show more

Keywords: Glioblastoma, GM-CSF, intranasal, rendezvous chemoradiotherapy, survival

DOI: 10.3233/THC-220194

Citation: Technology and Health Care, vol. 31, no. 2, pp. 635-645, 2023

Authors: Wang, Yu | Mei, Li | Zhao, Shuya | Xing, Xianghui | Wu, Guofeng

Article Type: Research Article

Abstract: BACKGROUND: The integrity and stability of collagen are crucial for the dentin structure and bonding strength at dentin-resin interface. Natural plant-derived polypehenols have been used as collagen crosslinkers. OBJECTIVE: The aims of the study were to develop novel chitosan oleuropein nanoparticles (CS-OL-NPs), and to investigate the CS-OL-NPs treated dentin’s the resistance to enzymatic degradation and mechanic property. METHODS: CS-OL-NPs were developed using the ionotropic gelation method. Release and biocompatibility of the CS-OL-NPs were tested. Twenty demineralized dentin collage specimens were randomized into four interventions groups: A, Deionized Water (DW); B, 5% glutaraldehyde solution …(GA); C, 1 mg/ml chitosan (CS); and D, 100 mg/L CS-OL-NPs. After 1-min interventions, dentin matrix were evaluated by the micro-Raman spectroscopy for the modulus of elasticity test. Collagen degradation was assessed using hydroxyproline (HYP) assay. RESULTS: CS-OL-NPs were spherical core-shape with a size of 161.29 ± 8.19 nm and Zeta potential of 19.53 ± 0.26 mV. After a burst release of oleuropein in the initial 6 h, there was a long-lasting steady slow release. CS-OL-NPs showed a good biocompatibility for the hPDLSCs. The modulus of elasticity in the crosslinked groups were significantly higher than that in the control group (P < 0.05 for all). The specimens treated with CS-OL-NP showed a greater modulus of elasticity than those treated with GA and CS (P < 0.05 for both). The release of HYP in the crosslinked group was significantly lower than that in the non-crosslinked groups (P < 0.05 for all). CONCLUSION: CS-OL-NPs enhanced the dentin mechanical property and resistance to biodegradation, with biocompatibility and potential for clinical application. Show more

Keywords: Dentin collagen, oleuropein, cross-linking, nanoparticles

DOI: 10.3233/THC-220195

Citation: Technology and Health Care, vol. 31, no. 2, pp. 647-659, 2023

Authors: Okawa, Ryuya | Yasui, Go | Mihara, Ban | Hayashi, Norio

Article Type: Research Article

Abstract: BACKGROUND: The failure of cerebrospinal fluid (CSF) signal suppression in postmortem fluid-attenuated inversion recovery (FLAIR) of the brain is a problem. OBJECTIVE: The present study was to clarify the relationship between the temperature of deceased persons and CSF T 1 , and to optimize the postmortem brain FLAIR imaging method using synthetic MRI. METHODS: Forehead temperature was measured in 15 deceased persons. Next, synthetic MRI of the brain was performed, the CSF T 1 was measured, and the optimal TI was calculated. Two types of FLAIR …images were obtained with the clinical and optimal TI. The relationship between forehead temperature and the CSF T 1 and optimal TI was evaluated. The optimized FLAIR images were physically and visually evaluated. RESULTS: The CSF T 1 and optimal TI were strongly correlated with forehead temperature. Comparing the average SNR and CNR ratios and visual evaluation scores of the two FLAIR images, those captured with the optimal TI showed statistically lower SNR, higher CNR, and higher visual evaluation scores (p < 0.01). CONCLUSIONS: Synthetic MRI enables the quantification of the CSF T 1 resulting from postmortem temperature decreases and calculation of the optimal TI, which could aid in improving the failure of CSF signal suppression and in optimizing postmortem brain FLAIR imaging. Show more

Keywords: Synthetic magnetic resonance imaging, autopsy imaging, inversion time, cerebrospinal fluid, fluid-attenuated inversion recovery

DOI: 10.3233/THC-220230

Citation: Technology and Health Care, vol. 31, no. 2, pp. 661-674, 2023

Authors: Mao, He | Fang, Peng | Zheng, Yue | Tian, Lan | Li, Xiangxin | Wang, Pu | Peng, Liang | Li, Guanglin

Article Type: Research Article

Abstract: BACKGROUND: Grip force estimation is highly required in realizing flexible and accurate prosthetic control. OBJECTIVE: This study presents a method to accurately estimate continuous grip force from surface electromyography (sEMG) under three forearm postures for unilateral amputees. METHODS: Ten able-bodied subjects and a transradial amputee were recruited. sEMG signals were recorded from six forearm muscles on the dominant side of each able-bodied subject and the stump of amputee. Meanwhile, grip force was synchronously measured from the ipsilateral hands of able-bodied subjects and contralateral hand of amputee. Three force profiles (triangle, trapezoid, and fast …triangle) were tested under three forearm postures (supination, neutral and pronation). Two algorithms (Generalized Regression Neural Network (GRNN) and Multilinear Regression Model (MLR)) were compared using several EMG features. The estimation performance was evaluated by coefficient of determination (R 2 ) and mean absolute error (MAE ). RESULTS: The optimal regressor combining TD and GRNN achieved R 2 = 96.33 ± 1.13% and MAE = 2.11 ± 0.52% for the intact subjects, and R 2 = 86.86% and MAE = 2.13% for the amputee. The results indicated that multiple grip force curves under three forearm postures could be accurately estimated for unilateral amputees using mirrored bilateral training. CONCLUSIONS: The proposed method has the potential for precise force control of prosthetic hands. Show more

Keywords: Electromyography, amputees, rehabilitation, machine learning

DOI: 10.3233/THC-220283

Citation: Technology and Health Care, vol. 31, no. 2, pp. 675-689, 2023

Authors: Lu, Jinmiao | Wang, Guangfei | Ying, Xiaohua | Li, Zhiping

Article Type: Research Article

Abstract: BACKGROUND: The medicine selection method is a critical and challenging issue in medical insurance decision-making. OBJECTIVES: This study proposed a real-world data-based multi-criteria decision analysis (MCDA) model with a hybrid entropic weight Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) algorithms to select satisfactory drugs. METHODS: The evaluation index includes two levels: primary criteria and sub-criteria. Firstly, we proposed six primary criteria to form the value health framework. The primary criteria’s weights were derived from the policymakers’ questionnaire. Meanwhile, clinically relevant sub-criteria were derived from high-quality (screened by GRADE scores) …clinical-research literature. Their weights are determined by the entropy weight (EW) algorithm. Secondly, we split the primary criteria into six mini-EW-TOPSIS models. Then, we obtained six ideal closeness degree scores (ICDS) for each candidate drug. Thirdly, we get the total utility score by linear weighting the ICDS. The higher the utility score, the higher the ranking. RESULTS: A national multicenter real-world case study of the ranking of four generic antibiotics validated the proposed model. This model is verified by comparative experiments and sensitivity analysis. The whole ranking model was consistent and reliable. Based on these results, medical policymakers can intuitively and easily understand the characteristics of each drug to facilitate follow-up drug policy-making. CONCLUSION: The ranking algorithm combines the objective characteristics of medicine and policy makers’ opinions, which can improve the applicability of the results. This model can help decision-makers, clinicians, and related researchers better understand the drug assessment process. Show more

Keywords: Medicine, evaluation, multicriteria, ranking, model, analysis

DOI: 10.3233/THC-220355

Citation: Technology and Health Care, vol. 31, no. 2, pp. 691-703, 2023

Authors: Worasawate, Denchai | Asawaponwiput, Warisara | Yoshimura, Natsue | Intarapanich, Apichart | Surangsrirat, Decho

Article Type: Research Article

Abstract: BACKGROUND: Parkinson’s disease (PD) is a long-term neurodegenerative disease of the central nervous system. The current diagnosis is dependent on clinical observation and the abilities and experience of a trained specialist. One of the symptoms that affects most patients is voice impairment. OBJECTIVE: Voice samples are non-invasive data that can be collected remotely for diagnosis and disease progression monitoring. In this study, we analyzed voice recording data from a smartphone as a possible medical self-diagnosis tool by using only one-second voice recording. The data from one of the largest mobile PD studies, the mPower study, was …used. METHODS: A total of 29,798 ten-second voice recordings on smartphone from 4,051 participants were used for the analysis. The voice recordings were from sustained phonation by participants saying /aa/ for ten seconds into an iPhone microphone. A dataset comprising 385,143 short one-second audio samples was generated from the original ten-second voice recordings. The samples were converted to a spectrogram using a short-time Fourier transform. CNN models were then applied to classify the samples. RESULTS: Classification accuracies of the proposed method with LeNet-5, ResNet-50, and VGGNet-16 are 97.7 ± 0.1%, 98.6 ± 0.2%, and 99.3 ± 0.1%, respectively. CONCLUSIONS: We achieve a respectable classification performance using a generalized approach on a dataset with a large number of samples. The result emphasizes that an analysis based on one-second clip recorded on a smartphone could be a promising non-invasive and remotely available PD biomarker. Show more

Keywords: PD voice, audio classification, convolutional neural network, mPower study

DOI: 10.3233/THC-220386

Citation: Technology and Health Care, vol. 31, no. 2, pp. 705-718, 2023

Authors: Simic, Vladimir | Milosevic, Miljan | Milicevic, Vladimir | Filipovic, Nenad | Kojic, Milos

Article Type: Research Article

Abstract: BACKGROUND: Mechanical forces at the micro-scale level have been recognized as an important factor determining various biological functions. The study of cell or tissue mechanics is critical to understand problems in physiology and disease development. OBJECTIVE: The complexity of computational models and efforts made for their development in the past required significant robustness and different approaches in the modeling process. METHOD: For the purpose of modeling process simplifications, the smeared mechanics concept was introduced by M. Kojic as a general concept for modeling the deformation of composite continua. A composite smeared finite element …for mechanics (CSFEM) was formulated which consists of the supporting medium and immersed subdomains of deformable continua with mutual interactions. Interaction is modeled using 1D contact elements (for both tangential and normal directions), where the interaction takes into account appropriate material parameters as well as the contact areas. RESULTS: In this paper we have presented verification examples with applications of the CSFEMs that include the pancreatic tumor tissue, nano-indentation model and tumor growth model. CONCLUSION: We have described CSFEM and contact elements between compartments that can interact. Accuracy and applicability are determined on two verification and tumor growth examples. Show more

Keywords: Smeared mechanics, tissue mechanics, composite smeared finite element, tumor growth

DOI: 10.3233/THC-220414

Citation: Technology and Health Care, vol. 31, no. 2, pp. 719-733, 2023

Authors: O’Connor, Matthew | Kolb, Christof | Klein, Norbert | Rauwolf, Thomas | Kuster, Stefan | Kääb, Stefan | Tilz, Roland Richard | Bänsch, Dietmar | Ince, Hüseyin | Belke, Roberto | Hauser, Tino | Rietsch, Katrin | Krämer, Jan F. | Wessel, Niels | Lennerz, Carsten

Article Type: Research Article

Abstract: BACKGROUND: Atrial fibrillation (AF) is associated with significant morbidity and is predicted by atrial high rate events. The early detection of AF is paramount to timely interventions to reduce the morbidity of AF. The DX ICD system combined with Home Monitoring ® allows for continuous atrial rhythm monitoring without the need for a dedicated atrial lead. OBJECTIVE: To establish the reaction to and timing of reactions to the detection of atrial high rate episodes (AHRE). METHODS: A prospective cohort of DX ICD systems was followed up and the response …to AHREs was collected and evaluated. RESULTS: A total of 234 patients were enrolled; an AHRE ⩾ 6 min was detected in 13.7% of patients (n = 32) within a mean follow-up duration of 16 months. A high rate of oral anticoagulation (OAC) prescription was seen with the detection of AHREs in patients with a not-low risk CHA 2 DS 2 -VASc score. There was a delay in this prescription highlighting the potential to improve the timeliness of patient care in this group of patients. CONCLUSIONS: The DX ICD system provides rapid and ongoing atrial rhythm monitoring such that physicians are rapidly aware of AHRE without the need for a dedicated atrial lead, but local protocols are needed to improve the response time of anti-coagulation prescription. Show more

Keywords: DX technology, home monitoring, atrial high rate events, atrial fibrillation, oral anticoagulation

DOI: 10.3233/THC-220432

Citation: Technology and Health Care, vol. 31, no. 2, pp. 735-746, 2023

Authors: Wang, Yadan | Zheng, Chichao | Wang, Yuanguo | Feng, Shuai | Liu, Mingzhou | Peng, Hu

Article Type: Research Article

Abstract: BACKGROUND: Pixel-based beamforming realizes dynamic focusing at the pixel level with a focused beam by assuming that the received signals are composed of spherical pulses. Far-focused pixel-based (FPB) imaging was proposed to avoid artifacts around the focal depth. However, the contrast improvement is limited. OBJECTIVE: We propose an adaptive weighting method based on dynamic phase coherence factor (DPCF) to improve the image contrast while preserving the speckle pattern. METHODS: The phase variation is dynamically estimated based on the noise energy proportion of echo signals and it is used to calculate phase coherence weights …for suppressing interference and preserving desired signals. A depth-dependent parameter is designed for DPCF to enhance the performance of noise and clutter suppression in the far-field region. We further use the subarray averaging technique to smooth the speckle texture. RESULTS: The proposed method was evaluated on simulated, phantom experimental, and in vivo data. Results show that, compared with the phase coherence factor (PCF) based method, DPCF respectively leads to average CR improvements by more than 60% and 24% in simulation and experiment, while obtaining an improved speckle signal-to-noise ratio. CONCLUSIONS: The proposed method is a potentially valuable approach to obtaining high-quality ultrasound images in clinical applications. Show more

Keywords: Ultrasound imaging, far-focused pixel-based imaging, adaptive beamforming, phase coherence factor

DOI: 10.3233/THC-220450

Citation: Technology and Health Care, vol. 31, no. 2, pp. 747-770, 2023

Authors: Arslan, Tuğba | Gültekin, Muhammet Zeki

Article Type: Research Article

Abstract: BACKGROUND: Patellofemoral pain syndrome (PFPS) is one of the musculoskeletal system pathologies frequently encountered especially in women. OBJECTIVE: The aim of the current study was to compare the efficacy of an online exercise program with a home exercise program including the same exercises, and a control group planned for females with PFPS. METHODS: The study included 60 females with PFPS aged 33.17 ± 6.84. Participants were randomly divided into 3 groups. One of the groups was given a 6-week home program consisting of evidence-based exercises. Exercises consisting of the same …exercises were supervised online to another group. The third group did not receive any intervention. Pain, knee joint range of motion, muscle strength in flexion and extension and hip posterolateral muscle group, patellofemoral joint functionality, quality of life, recurrence of injury and fear of movement were measured at preintervention and postintervention. RESULTS: Participation in the online supervised exercise group was seen to result in a greater decrease in pain during activity and kinesiophobia, and a greater increase in the quality of life mental health sub-dimension compared to the home exercise group. CONCLUSION: Online supervised exercise groups could be an alternative telerehabilitation method for exercise programs established for women with PFPS. Show more

Keywords: Anterior knee pain, muscle strength, physiotherapy, quality of life, telemedicine

DOI: 10.3233/THC-220533

Citation: Technology and Health Care, vol. 31, no. 2, pp. 771-782, 2023

Authors: Qi, Bao-Chang | Gao, Long | Wang, Jian | Ran, Jian

Article Type: Case Report

Abstract: BACKGROUND: Although tibial shaft fractures are the third most common long bone fractures in children after the forearm and femur, nonunion of these fractures are rare in the pediatric population. CASE REPORT: Despite seldom seen, tibial nonunion is very complex and it is also a devastating complication of tibial fracture especially when infected. Numerous methods have been employed to treat pediatric tibial nonunion, but there is no consensus. Here, we present a case of a child with right tibial shaft fracture nonunion. We treated this patient with ipsilateral free non-vascularized fibular graft. RESULTS: …Both the nonunion site and fibular donor site united well with good function in the injured extremity and no adverse events. CONCLUSION: We recommend the use of ipsilateral free non-vascularized fibular graft for the treatment of pediatric tibial shaft nonunion. Show more

Keywords: Pediatric tibial shaft nonunion, ipsilateral free non-vascularized fibular graft

DOI: 10.3233/THC-220126

Citation: Technology and Health Care, vol. 31, no. 2, pp. 783-787, 2023

Article Type: Research Article

DOI: 10.3233/THC-229019

Citation: Technology and Health Care, vol. 31, no. 2, pp. 789-789, 2023