Technology and Health Care - Volume 31, issue 3

Authors: Minervini, Giuseppe | Cervino, Gabriele | Chaturvedi, Saurabh | Franco, Rocco | di Francesco, Fabrizio | Fiorillo, Luca | Cicciù, Marco

Article Type: Review Article

Abstract: BACKGROUND: Edentulism conducts to a recognized impairment of oral function with both aesthetic and psychological changes. These patients suffer from a multiplicity of problems with their dentures, such as insufficient stability, retention and pain during mastication. The rehabilitation of a part edentulous patient can be established using a wide range of prosthetic treatment options. The overdenture treatment uses a removable total denture that overlies retained teeth, tooth roots, or dental implants. In the literature it was shown that patients with removable overdentures supported and retained either by tooth roots or implants have more predictable prosthodontic outcomes. …OBJECTIVE: The aim of this review is to provide an overview on the overdenture with a focus on the tooth-supported telescopic overdenture. METHODS: The literature research was performed in the Scopus, Web of Science, and Pubmed electronic databases. Document type was limited to papers written in English, without time restrictions. The Review was recorded in the international PROSPERO (International Prospective Register of Systematic Reviews) database with the following number CRD42022326415. RESULTS: A total of 256 articles published were found from electronic searches, Two independent reviewers carried out the screening and the selection process for the studies. First, duplicate citations were eliminated. Then, the two Authors independently screened the retrieved articles by title and abstract of each citation to determine its suitability for inclusion. Finally, 13 full-text articles satisfied the inclusion criteria. CONCLUSION: Prostheses supported by Frictional telescopic crowns offer an effective treatment alternative for patients with Severely reduced dentitions who do not want implant treatment or complete dentures. Show more

Keywords: Jaw rehabilitation, overdenture, tooth-supported telescopic, full arch rehabilitation, implant

DOI: 10.3233/THC-220641

Citation: Technology and Health Care, vol. 31, no. 3, pp. 791-807, 2023

Authors: Tian, Xiufen | Zheng, Juan | Luo, Yuanyuan | Wei, Chengshi | Ma, Jing | Wang, Dawei | Li, Keyi

Article Type: Research Article

Abstract: BACKGROUND: DNA methylation plays a vital role as an epigenetic change that contributes to chronic periodontitis. OBJECTIVE: This study aimed to integrate two methylation datasets (GSE173081 and GSE59962) and two gene expression datasets (GSE10334 and GES16134) to identify abnormally methylated differentially expressed genes related to chronic periodontitis. METHODS: Differentially methylated genes were obtained. Functional enrichment analysis of DMGs was performed. The protein-protein interaction (PPI) network was constructed using STRING and Cytoscape software. Finally, the hub genes were selected from the PPI network by using CytoHubba. RESULTS: In total, 122 hypomethylated …and highly expressed genes were enriched in the biological mechanisms that are involved in the differentiation of extracellular matrix organization, extracellular structure organization, and cell chemotaxis. The three selected hub genes of the PPI network were IL1B, KDR, and MMP9. A total of 122 hypermethylated and lowly expressed genes were identified, and biological processes, such as cornification, epidermis development, skin development, and keratinocyte differentiation were enriched. CDSN DSG1, and KRT2 were identified as the top 3 hub genes of the PPI network. CONCLUSION: Based on the comprehensive bioinformatics analysis, six hub genes (IL1B, KDR, MMP9, CDSN DSG1, and KRT2) were associated with chronic periodontitis. Our findings provide novel insights into the mechanisms underlying epigenetic changes in chronic periodontitis. Show more

Keywords: Periodontitis, methylation, transcription, bioinformatic analysis, protein-protein interaction, hub genes

DOI: 10.3233/THC-220137

Citation: Technology and Health Care, vol. 31, no. 3, pp. 809-819, 2023

Authors: An, Yang | Xie, Ling | Liu, Yu | Wu, Po | Li, Hao | Jiang, Ji | Zhang, Zhengrui | Yang, Shuyong

Article Type: Research Article

Abstract: BACKGROUND: When the jaw bone is subjected to an external force, the stress is transmitted from the force point along the alveolar bone to the skull and skull base. In the case of a dental implant, the stress distribution is mainly dependent on the implant position, type, and mechanical properties. OBJECTIVE: To investigate the dental implant position influence on the stress distribution and transmission in case of facial frontal trauma. Furthermore, the correlation between facial trauma and skull trauma in the case of a dental implant exists. METHODS: In this study, a Finite …Element Method (FEM) model was constructed based on a real skull shape, size, and anatomy. Dental implants were modeled based on imported CAD Data. Five cases were investigated including no dental implant and the replacement of teeth no. 18, 19 20 and 21. Facial trauma was mimicked by applying an external load on the lower frontal jaw. Finally, the stress distribution based on the bone geometry and implant position were evaluated and compared. RESULTS: Results suggested that a dental implant could significantly influence the stress distribution in the skull in case of facial trauma. In addition, the dental position greatly affects stress transmission from the mandible to the skull bones through the zygomatic arch. CONCLUSION: The position of the dental implant could have a significant role in stress transmission and distribution in case of facial or even brain trauma. Thus, increasing the possibility of a correlation between facial and brain trauma. Show more

Keywords: Dental implant, facial trauma, trauma complications, finite element analysis, stress distribution

DOI: 10.3233/THC-220148

Citation: Technology and Health Care, vol. 31, no. 3, pp. 821-829, 2023

Authors: Duan, Lian | Dang, Guangfu | Ge, Jinling | Gao, Yang | Wang, Lihua

Article Type: Research Article

Abstract: BACKGROUND: Aspheric intraocular lens (IOLs) implantation has been widely applied in cataract surgery. However, there is no consensus on the optimal guidance for the operations in IOLs implantation. OBJECTIVE: This study evaluated the visual function of Chinese cataract patients six months after cataract surgery with two different guiding ideologies. METHODS: We evaluated 50 patients (61 eyes) with implantation of different aspheric IOLs (SN60WF IOLs, ZCB00 IOLs, PY-60AD IOLs, AO IOLs) 6 months after cataract surgery. Twenty-four patients (30 eyes) under individual implantation were ascribed to group 1 and 26 patients (31 eyes) with …randomized implantation were ascribed to the control group (group 2). Postoperatively parameters included monocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), total spherical aberration Z (4, 0) at 5 mm pupil size, and patient satisfaction. The quality of life after operation was assessed through the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). RESULTS: Six months after cataract operation, the contrast sensitivity with glare of group 1 at 2.5 ∘ was 0.697 ± 0.027, and 0.532 ± 0.049 in group 2. Besides, there was no significant difference at any other special frequency. The mean spherical aberration Z (4, 0) at 5 mm pupil size in group 1 was 0.015 ± 0.028 um, and in group 2 was 0.043 ± 0.109 um, with a significant difference (p < 0.01). The mean scores obtained from NEI VFQ-25 were not significantly different. CONCLUSION: It is effective to implant aspheric IOLs individually according to preoperative corneal spherical aberration. Patients obtained better contrast sensitivity with glare at 2.5 ∘ , but there was no significant difference in BCVA, contrast sensitivity at other special frequency, and subjective visual function. Show more

Keywords: Visual function, cataract, aspheric intraocular lens implantation, best-corrected visual acuity, contrast sensitivity

DOI: 10.3233/THC-220154

Citation: Technology and Health Care, vol. 31, no. 3, pp. 831-839, 2023

Authors: Zhao, Huairui | Hua, Jia | Geng, Xiaochuan | Xu, Jianrong | Guo, Yi | Suo, Shiteng | Zhou, Yan | Wang, Yuanyuan

Article Type: Research Article

Abstract: BACKGROUND: High-precision detection for individual and clustered microcalcifications in mammograms is important for the early diagnosis of breast cancer. Large-scale differences between the two types and low-contrast images are major difficulties faced by radiologists when performing diagnoses. OBJECTIVE: Deep learning-based methods can provide end-to-end solutions for efficient detection. However, multicenter data bias, the low resolution of network inputs, and scale differences between microcalcifications lead to low detection rates. Aiming to overcome the aforementioned limitations, we propose a pyramid feature network for microcalcification detection in mammograms, MicroDMa, with adaptive image adjustment and shortcut connections. METHODS: …First, mammograms from multiple centers are represented as histograms and cropped by adaptive image adjustment, which mitigates the impact of dataset bias. Second, the proposed shortcut connection pyramid network ensures that the feature map contains more information for multiscale objects, while a shortcut path that jumps over layers enhances the efficiency of feature propagation from bottom to top. Third, the weights of each feature map at different scales in the fusion are trainable; thus, the network can automatically learn the contributions of all feature maps in the fusion stage. RESULT: Experiments were conducted on our in-house dataset and the public dataset INbreast. When the average number of positives per image is one on the in-house dataset, the recall rates of MicroDMa are the 96.8% for individual microcalcification and 98.9% for clustered microcalcification, which are higher than 69.1% and 91.2% achieved by recent deep learning model. Free-response receiver operating characteristic curve of MicroDMa is also higher than other methods when models are performed on INbreast. CONCLUSION: MicroDMa network is better than other methods and it can effectively help radiologists detect and identify two types of microcalcifications in clinical applications. Show more

Keywords: Deep learning, detection, pyramid network, mammography, breast microcalcification, convolutional neural network

DOI: 10.3233/THC-220235

Citation: Technology and Health Care, vol. 31, no. 3, pp. 841-853, 2023

Authors: Lee, Youngho | Kim, Sun Kyung | Yoon, Hyoseok | Choi, Jongmyung | Go, Younghye | Park, Gun Woo

Article Type: Research Article

Abstract: BACKGROUND: Smart glass technology offers remote interaction between health professionals for telehealth, alleviating healthcare disparities in isolated areas. OBJECTIVE: To evaluate the professionals’ perceptions of smart glass technology as a tool for telehealth and distance learning. METHOD: This mixed-method study on health professionals in 10 different island areas in Korea involved participants experiencing a smart glass-based telehealth system using the scenario of clinical consultation with remote specialists. A group pre- and post-test design was used to examine the change in attitude and perceived importance among health professionals about using smart glasses in telehealth. …RESULTS: Forty-seven participants completed both pre-and post-evaluation of smart glasses. A positive, statistically significant change in participants’ perceptions of smart glasses regarding their implications for telehealth and distance learning (p < 0.05) was found. Fifty-one health workers provided feedback on smart glasses, and a majority expressed their expectations of quality care with telehealth using advanced technology. The main concerns were patients’ privacy issues and inadequate technology for seamless application. CONCLUSION: The incorporation of smart glass technology offers great potential to enrich telehealth as well as distance learning for unskilled health professionals in isolated areas. Future studies are needed to increase efforts to secure a high level of acceptance for clinical consultation with remote specialists on this newly developed device. Show more

Keywords: Smart glasses, telehealth, isolated areas, health professionals

DOI: 10.3233/THC-220242

Citation: Technology and Health Care, vol. 31, no. 3, pp. 855-865, 2023

Authors: Pushpa, B. | Baskaran, B. | Vivekanandan, S. | Gokul, P.

Article Type: Research Article

Abstract: BACKGROUND: Fatty liver disease is a common condition caused by excess fat in the liver. It consists of two types: Alcoholic Fatty Liver Disease, also called alcoholic steatohepatitis, and Non-Alcoholic Fatty Liver Disease (NAFLD). As per epidemiological studies, fatty liver encompasses 9% to 32% of the general population in India and affects overweight people. OBJECTIVE: An Optimized Support Vector Machine with Support Vector Regression model is proposed to evaluate the volume of liver fat by image analysis (LFA-OSVM-SVR). METHOD: The input computed tomography (CT) liver images are collected from the Chennai liver foundation …and Liver Segmentation (LiTS) datasets. Here, input datasets are pre-processed using Gaussian smoothing filter and bypass filter to reduce noise and improve image intensity. The proposed U-Net method is used to perform the liver segmentation. The Optimized Support Vector Machine is used to classify the liver images as fatty liver image and normal images. The support vector regression (SVR) is utilized for analyzing the fat in percentage. RESULTS: The LFA-OSVM-SVR model effectively analyzed the liver fat from CT scan images. The proposed approach is activated in python and its efficiency is analyzed under certain performance metrics. CONCLUSION: The proposed LFA-OSVM-SVR method attains 33.4%, 28.3%, 25.7% improved accuracy with 55%, 47.7%, 32.6% lower error rate for fatty image classification and 30%, 21%, 19.5% improved accuracy with 57.9%, 46.5%, 31.76% lower error rate for normal image classificationthan compared to existing methods such as Convolutional Neural Network (CNN) with Fractional Differential Enhancement (FDE) (CNN-FDE), Fully Convolutional Networks (FCN) and Non-negative Matrix Factorization (NMF) (FCN-NMF), and Deep Learning with Fully Convolutional Networks (FCN) (DL-FCN). Show more

Keywords: CT scans, deep learning, liver fat, image analysis, liver segmentation, support vector regression, visual image processing

DOI: 10.3233/THC-220254

Citation: Technology and Health Care, vol. 31, no. 3, pp. 867-886, 2023

Authors: Ryu, JongSong | Hong, SunChol | Liang, Shili | Pak, SinIl | Zhang, Lei | Wang, Suqiu | Lian, Yueqi

Article Type: Research Article

Abstract: BACKGROUND: The imaging photoplethysmography (iPPG) method is a non-invasive, non-contact measurement method that uses a camera to detect physiological indicators. On the other hand, wearing a mask has become essential today when COVID-19 is rampant, which has become a new challenge for heart rate (HR) estimation from facial videos recorded by a camera. OBJECTIVE: The aim is to propose an iPPG-based method that can accurately estimate HR with or without a mask. METHODS: First, the facial regions of interest (ROI) were divided into two sub-ROIs, and the original signal was obtained through spatial …averaging with different weights according to the result of judging whether wearing a mask or not, and the CDF, which emphasizes the main component signal, was combined with the improved POS suitable for real-time HR estimation to obtain the noise-removed BVP signal. RESULTS: For self-collected data while wearing a mask, MAE, RMSE, and ACC were 1.09 bpm, 1.44 bpm, and 99.08%, respectively. CONCLUSION: Experimental results show that the proposed framework can estimate HR stably in real-time in both cases of wearing a mask or not. This study expands the application range of HR estimation based on facial videos and has very practical value in real-time HR estimation in daily life. Show more

Keywords: Heart rate (HR), real-time, mask, imaging photoplethysmography (iPPG), spatial averaging

DOI: 10.3233/THC-220322

Citation: Technology and Health Care, vol. 31, no. 3, pp. 887-900, 2023

Authors: Jing, Gao | Xia, Zhang | Lei, Quan

Article Type: Research Article

Abstract: BACKGROUND: Genetic manipulation on the NO-sGC-cGMP pathway has been rarely achieved, partially due to complexity of the soluble guanylyl cyclase (sGC) enzyme. OBJECTIVE: We aim to develop gene therapy directly targeting the pathway to circumvent cytotoxicity and tolerance after prolonged use of NO-donors and the insufficiency of PDE inhibitors. METHODS: In this study, we constructed lentivirus vectors expressing GUCY1A3 and GUCY1B3 genes, which encoded the α 1 and β 1 subunits of soluble guanylyl cyclase (sGC), respectively, to enhance cGMP synthesis. We also constructed lentiviral vector harboring …PDE5A shRNA to alleviate phosphodiesterase activity and cGMP degradation. RESULTS: Transductions of human HEK293 cells with the constructs were successful, as indicated by the fluorescent signal and altered gene expression produced by each vector. Overexpression of GUCY1A3 and GUCY1B3 resulted in increased sGC enzyme activity and elevated cGMP level in the cells. Expression of PDE5A shRNA resulted in decreased PDE5A expression and elevated cGMP level. Co-transduction of the three lentiviral vectors resulted in a more significant elevation of cGMP in HEK293 cells without obvious cytotoxicity. CONCLUSION: To the best of our knowledge, this is the first study to show that co-expression of exogenous subunits of the soluble guanylyl cyclase could form functional enzyme and increase cellular cGMP level in mammalian cells. Simultaneous expression of PDE5A shRNA could alleviate feedback up-regulation on PDE5A caused by cGMP elevation. Further studies are required to evaluate the effects of these constructs in vivo . Show more

Keywords: Soluble guanylyl cyclase, PDE5A, lentiviral vector, cGMP, gene therapy

DOI: 10.3233/THC-220333

Citation: Technology and Health Care, vol. 31, no. 3, pp. 901-910, 2023

Authors: Jiang, Yunfei | Zhang, Shuang

Article Type: Research Article

Abstract: BACKGROUND: The impact of the current most effective vibration frequency on the balance ability of the elderly needs further verification. OBJECTIVE: To explore the effect of whole-body vibration training (WBVT) at three different frequencies on the balance ability of older women. METHODS: Ninety-three older women were randomly divided into low frequency (15 Hz), intermediate frequency (30 Hz), high-frequency (45 Hz), and control groups. The subjects in the vibration group underwent WBVT of the same amplitude twice a week for approximately 15 min per session. RESULTS: The speed of movement of …the centre of pressure in the left and right directions with eyes closed was 7.9% lower in the static balance ability test in the intermediate frequency group after 36 weeks (P < 0.05). In the high frequency group, after WBVT, the total length of centre of pressure movement and speed of centre of pressure movement in the left and right directions were 9.9% and 8.7% lower, respectively, in the dynamic balance test (P < 0.05), and the speed of closed eye movement in the left and right directions was 12.5% lower in the static balance test (P < 0.05). CONCLUSION: WBVT at 30 and 45 Hz improved static balance in the right and left directions when older women had their eyes closed. WBVT at 45 Hz improved dynamic balance in the right and left directions in older women, and WBVT did not improve static balance in older women when their eyes were open. Show more

Keywords: Whole-body vibration training, different frequencies, older women, balance

DOI: 10.3233/THC-220343

Citation: Technology and Health Care, vol. 31, no. 3, pp. 911-919, 2023

Authors: Hu, Yang | Wu, Yanqing | Tu, Jianglong | Su, Hai | Zeng, Luchuan | Lei, Jie | Xia, Linglin

Article Type: Research Article

Abstract: BACKGROUND: At present, the clinical diagnosis of white matter change (WMC) patients depends on cranial magnetic resonance imaging (MRI) technology. This diagnostic method is costly and does not allow for large-scale screening, leading to delays in the patient’s condition due to inability to receive timely diagnosis. OBJECTIVE: To evaluate whether the burden of WMC is associated with the degree of invisible hand tremor in humans. METHODS: Previous studies have shown that tremor is associated with WMC, however, tremor does not always have imaging of WMC. Therefore, to confirm that the appearance of WMC …causes tremor, which are sometimes invisible to the naked eye, we achieved an optical-based computer-aided diagnostic device by detecting the invisible hand tremor, and we proposed a calculation method of WMC volume by using the characteristics of MRI images. RESULTS: Statistical analysis results further clarified the relationship between WMC and tremor, and our devices are validated for the detection of tremors with WMC. CONCLUSIONS: The burden of WMC volume is positive factor for degree of invisible hand tremor in the participants without visible hand tremor. Detection technology provides a more convenient and low-cost evaluating method before MRI for tremor diseases. Show more

Keywords: WMC, tremor, segmentation, multiple linear regression, hands

DOI: 10.3233/THC-220361

Citation: Technology and Health Care, vol. 31, no. 3, pp. 921-931, 2023

Authors: Lee, Yeji | Lee, Hyun Ju | Tae, Ki Sik

Article Type: Research Article

Abstract: BACKGROUND: Non-invasive Brain-Computer Interface (BCI) uses an electroencephalogram (EEG) to obtain information on brain neural activity. Because EEG can be contaminated by various artifacts during the collection process, it has primarily evolved into motor imagery (MI) with a low risk of contamination. However, MI has a disadvantage in that accurate data is difficult to obtain. OBJECTIVE: The goal of this study was to determine which motor imagery and movement execution (ME) of the knee has the best classification performance. METHODS: Ten subjects were selected to provide MI and ME data for four different …types of knee exercise. The experiment was conducted to keep the left, right, and both knees extend or bend for five seconds, and there was a five seconds break between each movement. Each motion was performed 20 times and the MI was carried out in the same protocol. Motions were classified through a modified model of the Lenet-5 of CNN (Convolution Neural Network). RESULTS: The deep learning data was classified, and a study discovered that ME (98.91%) could be classified significantly more accurately than MI (98.37%) (p < 0.001). CONCLUSION: If future studies on other body movements are conducted, we anticipate that BCI can be further developed to be more accurate. And such advancements in BCI can be used to facilitate the patient’s communication by analyzing the user’s movement intention. These results can also be used for various controls such as robots using a combination of MI and ME. Show more

Keywords: Brain-Computer Interface (BCI), electroencephalogram (EEG), motor imagery (MI), movement execution (ME), deep learning

DOI: 10.3233/THC-220363

Citation: Technology and Health Care, vol. 31, no. 3, pp. 933-942, 2023

Authors: Kim, Sung Shin | Park, Jun Sik | Choi, Dongil | Shin, Yumi | Jo, Kyeyeob | Kim, Youngkyung | Kim, Sun Ok | Kweon, Hyosun | Lee, Anna | Bae, Young-Hyeon

Article Type: Research Article

Abstract: BACKGROUND: An electric bed can easily change posture from a lying position and was effective in preventing pressure ulcer. OBJECTIVE: This study aimed to identify the optimal posture for the prevention of pressure ulcers by analyzing pressure changes applied to the pelvic region. METHODS: Pressure changes resulting from lateral rotations of the body using an electronic adjustable bed and changes in the posture and angles of the trunk and knees were assessed. Twelve conditions with varying angles of the trunk and knees (15–35 ∘ in 5 ∘ …increments) and varying lateral angles (20–35 ∘ in 5 ∘ increments) were tested. The pressure (maximum and average) and contact area in the pelvic region of 20 individuals without disabilities were calculated. RESULTS: The conditions in which the average and maximum pressures did not increase according to the increase in angle were 25 ∘ for the upper body and knee angles and 35 ∘ for the side. CONCLUSIONS: The body pressure changed according to the posture rather than according to physical characteristics. Lateral rotation combined with changes in the angles of the trunk and knees effectively prevented pressure ulcers. Changes in the posture at various angles prevented an increased pressure on the body. Show more

Keywords: Pressure ulcer, body posture, positioning bed, body pressure, pressure area

DOI: 10.3233/THC-220376

Citation: Technology and Health Care, vol. 31, no. 3, pp. 943-954, 2023

Authors: von Schudnat, Christian | Lahmann, Benjamin | Schoeneberg, Klaus-Peter | Albors-Garrigos, Jose | De-Miguel-Molina, María

Article Type: Research Article

Abstract: BACKGROUND: The continuous decrease of healthcare resources requires hospitals to improve efficiency while striving to improve quality standards that deliver better patient outcomes. OBJECTIVE: The objective of this study was to analyze whether the implementation of digital support systems during orthopedic surgery positively affected clinical processes and quality ratios. METHODS: A retrospective case-control study of 297 knee joint replacement procedures was conducted between 2015 and 2020. Thirty-five patients were allocated to the treatment and control groups after they were identified with exact matching and estimation of the propensity score. Both groups were balanced regarding …the selected covariates. The effect of the surgical procedure manager (SPM) on the incidence of acute haemorrhagic anaemia between the two groups was evaluated with a t -test, and the odds ratio was calculated. RESULTS: SPM-supported surgery has no significant influence on the incidence of acute haemorrhagic anaemia but leads to significantly shorter hospital stay (1.93 days), changeover (4.14 minutes) and recovery room time (20.20 minutes). In addition, it reduces the standard deviation of operation room times. CONCLUSIONS: The study concludes that SPM enhances surgical efficiency and maintains quality outcomes. To overcome their increasing financial pressure hospital management should commercially evaluate the implementation of digital support systems. Show more

Keywords: Quality improvement, efficiency, operating rooms, the standard of care, digital technology, surgical procedure manager

DOI: 10.3233/THC-220395

Citation: Technology and Health Care, vol. 31, no. 3, pp. 955-968, 2023

Authors: Jiménez-Gayosso, Sandra Isabel | Morales-Luckie, Raúl Alberto | Robles-Bermeo, Norma Leticia | Hernández-Martínez, César Tadeo | Villalobos-Rodelo, Juan José | Islas-Zarazúa, Rosalina | Navarrete-Hernández, José de Jesús | Patiño-Marín, Nuria | Medina-Solís, Carlo Eduardo | Maupomé, Gerardo

Article Type: Research Article

Abstract: BACKGROUND: Prefabricated metal crowns (PMCs) have been widely used in pediatric dentistry due to their great success in various clinical situations. However, it is important to know the local effects, such as changes in pH in the oral environment. OBJECTIVE: To evaluate the pH variations before and after placement of PMCs. METHODS: A quasi-experimental study (before and after) was performed with 32 pediatric patients who needed rehabilitation with PMCs at a pediatric dentistry clinic in a public university. Measurements were made using a pH potentiometer before PMC placement, one week after, and one …month after placement. ANOVA and Pearson correlation were performed in SPSS. RESULTS: The average age of the participants was 5.9 ± 1.6 years, and 53.1% were female. The average pH before, one week after, and one month after crown placement was 7.46 ± 0.37, 7.00 ± 0.32, and 7.1 ± 0.19, respectively. Significant differences (p < 0.05) were observed between the three pH measurements. We found differences when comparing the basal pH values to those at one week (p = 0.001) and one month (p = 0.002). CONCLUSION: Although there were statistically significant differences in the pH change values before and after the placement of crowns, these differences may not have a clinical impact. Show more

Keywords: Oral health, pediatric dentistry, prefabricated metal crowns, pH

DOI: 10.3233/THC-220433

Citation: Technology and Health Care, vol. 31, no. 3, pp. 969-976, 2023

Authors: Milovanovic, Aleksandar | Saveljic, Igor | Filipovic, Nenad

Article Type: Research Article

Abstract: BACKGROUND: The fractional flow reserve (FFR) index has been widely accepted as a standard diagnostic method for identifying functional relevance of coronary stenosis. Since the invasive techniques used for its determination are associated with a certain risk of vascular injury, as well as with an increased cost, several non-invasive procedures have been developed. OBJECTIVE: The aim of this study was to compare FFR values for the coronary artery obtained by computational fluid dynamics (CFD) and coronary computed tomography angiography (CCTA). METHODS: Computation of FFR has been performed using both numerical and the analytical …method. The numerical method employs CFD to solve the governing equations which relate to mass and momentum conservation (the continuity equation and the Navier-Stokes equations) as well as CCTA to generate the three-dimensional computational domain. After imposing the appropriate boundary conditions, the values of the pressure change are calculated and the FFR index is determined. Based on Bernoulli’s law, the analytical method calculates the overall pressure drop across the stenosis in the coronary artery, enabling FFR determination. RESULTS: The clinical data for twenty patients who underwent invasive coronary angiography are used to validate the results obtained by using CFD (together with CCTA) simulation and analytical solution. The medically measured FFR compared to the analytical one differs by about 4%, while, the difference is about 2.6% when compared to the numerical FFR. For FFR values below 0.8 (which are considered to be associated with myocardial ischemia) the standard error has a value of 0.01201, while the standard deviation is 0.02081. For FFR values above 0.80, these values are slightly higher. Bland-Altman analysis showed that medical measurement and numerical FFR were in good agreement (SD = 0.0292, p < 0.0001). CONCLUSIONS: The analytically calculated FFR has a slightly lower coefficient of determination than the numerically computed FFR when compared with experimental one. However, it can still give a reliable answer to the question of whether patients need a stent, bypass surgery or only drug treatment and it requires a significantly lower computation time. Show more

Keywords: Coronary artery stenosis, fractional flow reserve, CFD, Bernoulli’s law

DOI: 10.3233/THC-220435

Citation: Technology and Health Care, vol. 31, no. 3, pp. 977-990, 2023

Authors: Shu, Yan | Li, Ling | Shu, Fanglian | Wei, Yanhong | Zhang, Li | Zhou, You

Article Type: Research Article

Abstract: BACKGROUND: Foot drop is one of the most common complications after stroke. OBJECTIVE: This study investigates the role of an adjustable medical foot support pillow in preventing foot drop and improving the lower limb function of patients after stroke. METHODS: A total of 88 patients with strokes admitted to our hospital from September 2019 to September 2020 were selected and categorised into the control (n = 44) and intervention groups (n = 44) using a random number table. The control group received routine rehabilitation …nursing, while the intervention group adopted a self-made adjustable medical foot support pillow based on routine rehabilitation nursing. After four weeks, the simplified Fugl Meyer Assessment (FMA) and the modified activities of daily living (ADL) scales were used to measure the ankle range of motion of the lower limbs. The lower limb motor function, ADL, and ankle mobility before and after treatment, as well as the incidence of foot ptosis, were compared between the two groups. RESULTS: After the procedure, the intervention group was superior to the control group in the FMA score of the lower extremities, ADL score, and ankle joint mobility in the lower limbs, indicating statistically significant differences (P < 0.05). The incidence rate of foot drop was lower in the intervention group than in the control group, and the difference was statistically significant (P < 0.05). CONCLUSION: The adjustable medical foot support pillow can prevent foot drop in patients after stroke, improve lower limb function, provide a favourable basis for walking training, and improve the ADL of patients. Show more

Keywords: Stroke, foot drop, rehabilitation, mobility limitation, rehabilitation

DOI: 10.3233/THC-220462

Citation: Technology and Health Care, vol. 31, no. 3, pp. 991-1001, 2023

Authors: Chen, Hongbing | Su, Tong | Wang, Qi | Zheng, Zhe | Li, Hongwei | Li, Jianbo

Article Type: Research Article

Abstract: BACKGROUND: Aneurysms are associated with a mortality rate of 81% or more in cases of rupture. Intraluminal thrombus (ILT) is a common complication of aneurysms, it can greatly increase the risk of rupture. Especially for some of the more complex aneurysms, physicians need to consider the risk of thrombosis or progression and precisely formulate a treatment plan. Therefore, it is particularly important to assess the level of thrombosis risk through haemodynamics. OBJECTIVE: To analyse the haemodynamic indices and compare the thrombosis risk in a double false lumen abdominal aortic dissection aneurysm using computational fluid dynamics (CFD). …METHODS: Computer tomography angiography (CTA) imaging data were collected from a patient with a double false lumen abdominal aortic dissection aneurysm, and three different lesion morphology aneurysm models were established, double false lumen abdominal aortic dissection aneurysm, single false lumen abdominal aortic dissection aneurysm and saccular abdominal aortic aneurysm, in order to analyse the flow velocity, time-averaged shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT) of blood flow, and endothelial cell activation potential (ECAP). RESULTS: All three aneurysms were in a low-flow state within the body, and the low-flow velocity flow in the proximal vessel wall extended to the right common iliac artery; the vortex intensity was more intense in the abdominal aortic dissection aneurysm than in the saccular abdominal aortic aneurysm. The risk area for thrombosis was concentrated in the expansion part of the aneurysm and the false lumen. The RRT and ECAP maxima of the double false lumen abdominal aortic dissection aneurysm were much greater than those of the single false lumen dissection aneurysm and saccular aortic aneurysm. CONCLUSION: Low-velocity blood flow, high OSI, low TAWSS, high RRT, and high ECAP regions correlate with the risk of thrombosis. The double false lumen type of abdominal aortic dissection aneurysm had some specificity in this case. The risk of thrombosis in the patient was extremely high, and the largest risk zone was within the smaller false lumen, which could be because the smaller false lumen was connected to the true lumen by only one breach. The results of the study provide some guidance in the early screening and development of treatment plans. Show more

Keywords: Abdominal aortic dissection aneurysm, CTA, computational fluid dynamics (CFD), thrombosis risk, patient-specific simulation

DOI: 10.3233/THC-220481

Citation: Technology and Health Care, vol. 31, no. 3, pp. 1003-1015, 2023

Authors: Yang, Cun | Yang, Lei | Gao, Guo-Dong | Zong, Hui-Qian | Gao, Duo

Article Type: Research Article

Abstract: BACKGROUND: Artificial intelligence (AI) technology is a promising diagnostic adjunct in fracture detection. However, few studies describe the improvement of clinicians’ diagnostic accuracy for nasal bone fractures with the aid of AI technology. OBJECTIVE: This study aims to determine the value of the AI model in improving the diagnostic accuracy for nasal bone fractures compared with manual reading. METHODS: A total of 252 consecutive patients who had undergone facial computed tomography (CT) between January 2020 and January 2021 were enrolled in this study. The presence or absence of a nasal bone fracture was …determined by two experienced radiologists. An AI algorithm based on the deep-learning algorithm was engineered, trained and validated to detect fractures on CT images. Twenty readers with various experience were invited to read CT images with or without AI. The accuracy, sensitivity and specificity with the aid of the AI model were calculated by the readers. RESULTS: The deep-learning AI model had 84.78% sensitivity, 86.67% specificity, 0.857 area under the curve (AUC) and a 0.714 Youden index in identifying nasal bone fractures. For all readers, regardless of experience, AI-aided reading had higher sensitivity ([94.00 ± 3.17]% vs [83.52 ± 10.16]%, P < 0.001), specificity ([89.75 ± 6.15]% vs [77.55 ± 11.38]%, P < 0.001) and AUC (0.92 ± 0.04 vs 0.81 ± 0.10, P < 0.001) compared with reading without AI. With the aid of AI, the sensitivity, specificity and AUC were significantly improved in readers with 1–5 years or 6–10 years of experience (all P < 0.05, Table 4 ). For readers with 11–15 years of experience, no evidence suggested that AI could improve sensitivity and AUC (P = 0.124 and 0.152, respectively). CONCLUSION: The AI model might aid less experienced physicians and radiologists in improving their diagnostic performance for the localisation of nasal bone fractures on CT images. Show more

Keywords: Nasal bone fracture, artificial intelligence, sensitivity, specificity, deep learning

DOI: 10.3233/THC-220501

Citation: Technology and Health Care, vol. 31, no. 3, pp. 1017-1025, 2023

Authors: Zhang, Weiyi | Liang, Hongping

Article Type: Research Article

Abstract: BACKGROUND: Preeclampsia (PE) has adverse effects on pregnant women, fetuses, and newborns [1], and accounts for 3%–10% of pregnancy-related diseases globally. OBJECTIVE: This study aimed to screen a series of prenatal markers (pregnancy-associated plasma protein [PAPP-A], β -human chorionic gonadotropin [β -hCG], alpha fetoprotein [AFP], and estriol [uE3]) to establish a risk model and evaluate the diagnostic values of the markers for predicting PE. METHODS: Sixty-five pregnant women were enrolled in this study. They were divided into two groups containing healthy pregnant women (n = …51, the non-PE group) and pregnant women with PE (n = 14, the PE group). According to the stage of pregnancy, the pregnant women in each group were divided into early, middle, and late pregnancy groups for statistical analysis. The levels of PAPPA-A β -hCG, AFP, and uE3 were compared among these groups. Then, a risk model was established, and PE was diagnosed using receiver operating characteristic (ROC) curve results. RESULTS: In the early pregnancy group, the differences in the levels of PAPP-A, AFP, and uE3 between the PE and non-PE groups were statistically significant (P < 0.001, P = 0.029, and P = 0.033, respectively), while the difference in the single remaining marker was not statistically significant. A ROC curve analysis revealed that in early pregnancy, the sensitivity and specificity of PAPP-A were 76.5% and 71.4%, respectively, and the sensitivity and specificity of β -hCG were 82.4% and 57.1%, respectively. The sensitivity and specificity of the combination of the two markers for diagnosing PE were 86.3% and 57.1%, respectively. CONCLUSION: This study demonstrated that the combination of PAPP-A and β -hCG has diagnostic value for PE in pregnant women. Accordingly, we should formulate innovative PE screening strategies to target the prevention of PE and create important conditions for predictive and preventive personalized medical treatments. Show more

Keywords: Pregnancy-associated plasma protein-A, β-human chorionic gonadotropin, alpha fetoprotein, estriol, preeclampsia

DOI: 10.3233/THC-220523

Citation: Technology and Health Care, vol. 31, no. 3, pp. 1027-1037, 2023

Authors: Keser, Merve | Gulnar, Burak | Baser, Baris

Article Type: Research Article

Abstract: BACKGROUND: Transverse maxillary deficiency is one of the most common skeletal anomalies. The incidence of posterior crossbite caused by maxillary deficiency is between 2.7% and 23.3%. Unilateral posterior crossbite is more common than bilateral crossbite. The most common treatment for skeletal posterior crossbite is rapid maxillary expansion (RME), in which the base of the maxillary bone is expanded by separating the midpalatal suture. OBJECTIVE: This study compares the biomechanical effects of three different RME appliances, especially the effects on the midline, and evaluates the usability of the modified asymmetric RME (ARME) appliance for treating unilateral crossbites. …METHODS: Three scenarios were created with skull models using three different appliances: (1) conventional-bonded RME appliance; (2) full-cap splint RME appliance, with all teeth covered with acrylic; and (3) ARME, with all teeth on the right side and premolars and molars on the left side covered with acrylic. The finite element method was used to assess stress levels and displacements in all models after applying a 5-mm horizontal displacement to the RME screw. RESULTS: The lateral transverse movement of the first molars was greater with the conventional RME appliance than with the full-cap splint RME appliance. The lateral transverse movement of the first molar was greater on the left than on the right side with the ARME. The lateral transverse movement of the central incisors was greater with the full-cap splint RME appliance than with the conventional RME appliance. The lateral transverse movement of the central incisor was greater on the right than on the left side with the ARME. CONCLUSION: Asymmetrical RME appliance increases unilateral expansion compared to other appliances. Therefore, it should be used in cases of unilateral posterior crossbite. This appliance can also successfully treat posterior crossbite with upper midline deviation, since it corrects the shifted midline. Show more

Keywords: Asymmetrical RME appliance, finite element method, rapid maxillary expansion

DOI: 10.3233/THC-220538

Citation: Technology and Health Care, vol. 31, no. 3, pp. 1039-1050, 2023

Authors: Elagib, Mohamed Fadul A. | Alqaysi, Moayad Abdullah H. | Almushayt, Mussab Omar S. | Nagate, Raghavendra Reddy | Gokhale, Shankar T. | Chaturvedi, Saurabh

Article Type: Review Article

Abstract: BACKGROUND: Dental implants provide a suitable and reliable treatment for the replacement of missing teeth. Very few studies have been reported in the literature regarding the application of dental implants in growing and developing patients. OBJECTIVE: This systematic review with meta-analysis aimed to systematically review the available literature regarding the application of dental implants in growing and developing patients. METHODS: A detailed search in the literature was performed with the help of keywords such as dental implants, treatment planning, children, adolescents, growing patients, and developing jaws. PubMed, Scopus, Web of Sciences, and Ovidsp …databases were searched for papers published between 1980 and 2021. The papers focused on children, adolescents, developing jaws, and implants. In this systemic review, the dataset concerned with the type of study, aim, number of patients and specimens included, age of patients, total number of implants placed, total number of implants evaluated, medical history of developmental disorders of teeth such as ectodermal dysplasia, congenital absence of teeth, were evaluated. RESULTS: Out of the total literature searched, 33.45% of studies and case reports documented no complications in any implant treatment. In 47.21% of studies and case reports, there was both success and failure of implants while in 13.21% of studies and case reports there was a complete failure of implants. The most common cause for loss of permanent teeth in growing children and adolescent patients was dental trauma (73.13%) followed by congenital developmental disturbance of teeth (18.19%). CONCLUSION: It can be concluded from this systematic review that the use of implants in edentulous growing patients is determined by several parameters, including the patient’s overall health, the stage of jaw growth, the number of teeth to be replaced, and soft and hard tissue anatomic features. Still, the use of a conservative treatment strategy for missing teeth management in patients with developing jaws is common and recommended until the patient’s growth is completed, as there are chances of changes in the position of dental implants placed in the developing and growing jaws due to the continuous changes taking place in their body. However, placement of implants can be done in these patients successfully with proper treatment planning and taking into account the phase of growth with proper follow-up. Show more

Keywords: Dental implants, growing patients, systematic review, meta-analysis, health care

DOI: 10.3233/THC-220581

Citation: Technology and Health Care, vol. 31, no. 3, pp. 1051-1064, 2023

Authors: Wang, Fan | Zhang, Liping | Jiao, Junxia

Article Type: Research Article

Abstract: BACKGROUND: The early diagnosis of thyroid cancer depends on the popularisation and development of diagnostic imaging techniques and the continuous improvement of physician diagnosis. OBJECTIVE: To investigate the clinical value of multi-parameter magnetic resonance imaging (MRI) and colour B-ultrasound elastography in thyroid nodules. METHODS: The clinical and imaging data of 252 patients with thyroid nodules who were admitted to our hospital were collected. All patients underwent preoperative colour B-ultrasound elastography and MRI. The postoperative pathological results were the gold standard for diagnosing benign and malignant thyroid nodules. The accuracy, sensitivity and specificity of …MRI, colour B-ultrasound elastography and their combination for diagnosing benign and malignant thyroid nodules were compared. RESULTS: This study included 252 patients with 388 nodules. There were 169 patients with solitary nodules and 83 patients with multiple nodules. The maximum diameter of the thyroid nodules was 0.32–1.00 (0.75 ± 0.20) cm. The accuracy of MRI diagnosis (348/388) was 89.69%, the sensitivity was 92.98%, and the specificity was 65.22%. The diagnostic accuracy, sensitivity and specificity of colour B-ultrasound elastography (332/388) were 85.57%, 88.30% and 65.22%, respectively. The accuracy rate of combined diagnosis (376/388) was 96.91%, the sensitivity was 98.25%, and the specificity was 86.96%, which was significantly higher than MRI and colour B-ultrasound elastography alone. The area under the curve (AUC) of MRI, colour B-ultrasound elastography and combined diagnosis were 0.768, 0.791 and 0.926, respectively. The AUC of the three diagnostic methods was > 0.7, indicating that the three diagnostic methods had good diagnostic value. The AUC for combined diagnosis was significantly higher than that of MRI and colour B-mode ultrasound elastography alone. CONCLUSION: Combined ultrasound and MRI have high diagnostic accuracy and specificity for benign and malignant thyroid nodules. This diagnostic method can be applied in clinical practice. Show more

Keywords: Thyroid nodules, benign and malignant, diagnostic value, multi-parameter MRI, colour B-ultrasound elastography

DOI: 10.3233/THC-220593

Citation: Technology and Health Care, vol. 31, no. 3, pp. 1065-1075, 2023

Authors: Xu, Site | Zhang, Tiantian | Sheng, Tao | Liu, Jiaxing | Sun, Mu | Luo, Li

Article Type: Research Article

Abstract: BACKGROUND: To effectively monitor medical insurance funds in the era of big data, the study tries to construct an inpatient cost rationality judgement model by designing a virtuous cycle of inpatient cost supervision information system and exploring a complete set of inpatient cost supervision methods. OBJECTIVE: To lay the foundation for applying artificial intelligence (AI) technology in medical insurance cost control supervision and provide feasible paths and available tools for medical insurance cost control managers. METHODS: By way of collecting and cleaning electronic medical record (EMR) data from 2016 to 2018 of a …city in East China, focusing on basic patient information and cost information, and using a combination of machine learning modeling and information system construction, the study tries to form a feasible inpatient cost supervision method and operation path. RESULTS: The set of the regulatory method, applied in nursing homes of a city in East China, is compelling. The accuracy rates of rationality judgement in different main diseases are stable up to 80%, the false positive rate is steady within 10%, and rehabilitation fee days of hospitalization, and the number of complications are important factors affecting the rationality of the inpatient cost. CONCLUSION: The model construction and optimization method combining machine learning and information system can make practical cost rationality judgement on medical institution’s inpatient cost data, which can directly reflect the key influencing factors of relevant inpatient costs, and achieve the effect of guiding medical behavior and improving the efficiency of medical insurance fund use. Show more

Keywords: EMR, cost supervision, medical insurance fund, machine learning, information system

DOI: 10.3233/THC-220608

Citation: Technology and Health Care, vol. 31, no. 3, pp. 1077-1091, 2023

Authors: Xu, Yi-Jun | Yang, Peng-Jie | Chen, Zhi-Qiang | Liu, Peng | Wen, Wen | Li, Xiao-Wei | Guo, Jia-Qi | Deng, Yong-Zhi

Article Type: Research Article

Abstract: BACKGROUND: Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) are the main treatment methods for left main artery disease (LMAD) and triple-vessel coronary artery disease (TVCAD). OBJECTIVE: This study aimed to evaluate the five-year post-treatment effects of CABG and PCI in patients with severe coronary vasculopathy. METHODS: A total of 430 patients with LMAD and/or triple-vessel coronary artery disease from November 2014 to July 2015 were enrolled retrospectively in the affiliated cardiovascular hospital of Shanxi Medical University and divided into the CABG group and PCI group. The living conditions of the …patients were obtained through medical records and telephonic follow-ups five years after the surgery date. The independent risk factors for major adverse cardiovascular and cerebrovascular events (MACCE) were analyzed using logistic regression analysis. The effects of the two treatment methods were followed up and evaluated to measure the predictive ability of the Global Risk Classification (GRC) scoring system for MACCE after five years. RESULTS: There were 212 cases in the CABG group and 218 cases in the PCI group. Smoking (P = 0.047), diabetes (P = 0.031), LVEF (P = 0.020), LMAD (P = 0.008), and anterior descending branch lesions (P = 0.038) were significantly correlated with MACCE. The prevalence of MACCE in the CABG group and PCI group had no significant difference (P = 0.549). The GRC scoring system received an AUC of 0.701 for predicting MACCE. CONCLUSION: For patients with severe coronary artery disease, there was no significant difference in the prevalence of MACCE between the CABG and the PCI groups. Several independent risk factors for MACCE were found. The GRC scoring system showed a strong predictive ability for MACCE after five years of revascularization. Show more

Keywords: Coronary heart disease, CABG, PCI, MACCE, GRC

DOI: 10.3233/THC-220629

Citation: Technology and Health Care, vol. 31, no. 3, pp. 1093-1103, 2023