Technology and Health Care - Volume 31, issue 4

Authors: Lin, Xiaoxiao | Sun, Haoyue | Lin, Xizhou | Liu, Ya | Hu, Sisi | Yu, Yingcong | Song, Caiyun

Article Type: Research Article

Abstract: BACKGROUND: Studies have reported that certain adverse reactions can occur during painless gastroscopy examination. Knowing how to decrease the risks and incidence of adverse reactions is of great importance. OBJECTIVE: To investigate whether topical pharyngeal anesthesia combined with intravenous anesthesia is superior to intravenous anesthesia alone in patients undergoing painless gastroscopy and to determine whether this combined approach had any additional benefits. METHODS: Three hundred patients undergoing painless gastroscopy were randomly assigned to either the control group or the experimental group. In the control group, patients were anesthetized with propofol, while patients in …the experimental group received propofol combined with 2% lidocaine spray for topical pharyngeal anesthesia. Hemodynamic parameters before and after the procedure, including the heart rate (HR), mean arterial pressure (MAP), and pulse oxygen saturation (SPO 2 ) were recorded. Any adverse reactions experienced by the patient, including choking and respiratory depression, and the total dosage of propofol required during each procedure were also documented. RESULTS: Compared with pre-anesthetic data, the HR, MAP, and SPO 2 were reduced after the completion of the painless gastroscopy procedure in both groups. However, the HR, MAP, and SPO 2 measurements taken after the gastroscopy were significantly lower in the control group than those of the experimental group (P < 0.05); thus, the hemodynamic parameters of the experimental group were more stable. Compared with the control group, there was significant reduction in the total amount of propofol administered in the experimental group (P < 0.05). The incidence of adverse reactions, including choking and respiratory depression, was significantly lower in the experimental group (P < 0.05). CONCLUSION: The results demonstrated that the application of topical pharyngeal anesthesia in painless gastroscopy can significantly reduce the incidence of adverse reactions. Thus, the combination of topical pharyngeal and intravenous anesthesia is worthy of clinical application and promotion. Show more

Keywords: Topical pharyngeal anesthesia, adverse reactions, painless gastroscopy, intravenous anesthesia

DOI: 10.3233/THC-220516

Citation: Technology and Health Care, vol. 31, no. 4, pp. 1245-1251, 2023

Authors: Lallement, Alex | Noblet, Vincent | Antoni, Delphine | Meyer, Philippe

Article Type: Research Article

Abstract: BACKGROUND: Adaptive radiotherapy (ART) aims to address anatomical modifications appearing during the treatment of patients by modifying the planning treatment according to the daily positioning image. Clinical implementation of ART relies on the quality of the deformable image registration (DIR) algorithms included in the ART workflow. To translate ART into clinical practice, automatic DIR assessment is needed. OBJECTIVE: This article aims to estimate spatial misalignment between two head and neck kilovoltage computed tomography (kVCT) images by using two convolutional neural networks (CNNs). METHODS: The first CNN quantifies misalignments between 0 mm and 15 …mm and the second CNN detects and classifies misalignments into two classes (poor alignment and good alignment). Both networks take pairs of patches of 33x33x33 mm 3 as inputs and use only the image intensity information. The training dataset was built by deforming kVCT images with basis splines (B-splines) to simulate DIR error maps. The test dataset was built using 2500 landmarks, consisting of hard and soft landmark tissues annotated by 6 clinicians at 10 locations. RESULTS: The quantification CNN reaches a mean error of 1.26 mm (± 1.75 mm) on the landmark set which, depending on the location, has annotation errors between 1 mm and 2 mm. The errors obtained for the quantification network fit the computed interoperator error. The classification network achieves an overall accuracy of 79.32%, and although the classification network overdetects poor alignments, it performs well (i.e., it achieves a rate of 90.4%) in detecting poor alignments when given one. CONCLUSION: The performances of the networks indicate the feasibility of using CNNs for an agnostic and generic approach to misalignment quantification and detection. Show more

Keywords: Registration error, DIR validation, DIR in radiotherapy, adaptive radiotherapy, supervised learning, convolutional neural networks, deep learning

DOI: 10.3233/THC-220519

Citation: Technology and Health Care, vol. 31, no. 4, pp. 1253-1266, 2023

Authors: Li, Zhennan | Liu, Chunbao | Han, Yang | Wang, Tongjian | Lei, Ren

Article Type: Research Article

Abstract: BACKGROUND: Due to low friction, passive mechanical prostheses move compliantly followed by the stump and are used widely. Advanced semi-active prostheses can both move passively like passive prostheses and provide active torque under specific conditions. However, the current mechanical-hydraulic coupling driven semi-active prostheses, in order to meet the low passive friction requirements with a low active transmission ratio, lead to a significant problem of insufficient active torque. OBJECTIVE: A hybrid active and passive prosthesis was developed to solve the incompatibility problem of low passive friction and high active driving torque of semi-active prostheses. METHODS: …The mechanical structure and control strategy of the prosthesis were demonstrated. The performance of the prosthesis was tested by bench and human tests. RESULTS: Passive subsystem damping adjustment ranges from 0.4 N⋅ (mm/s) - 1 to 300 N⋅ (mm/s) - 1 . The switching time between the damping and the active subsystem is 32 ± 2 ms. The continuous active torque output is more than 24 Nm. In level walking, the peak torque is about 28 Nm. CONCLUSION: The proposed active-passive hybrid hydraulic prosthesis could satisfy both low passive friction and high active actuation. Show more

Keywords: Knee prosthesis, hydraulic, active-passive hybrid drive, low passive friction, high transmission ratio

DOI: 10.3233/THC-220522

Citation: Technology and Health Care, vol. 31, no. 4, pp. 1267-1277, 2023

Authors: Shimpi, Neel | Glurich, Ingrid | Hegde, Harshad | Steinmetz, Annie | Kuester, Robbyn | Crespin, Matthew | Acharya, Amit

Article Type: Research Article

Abstract: BACKGROUND: The evidence base supports effectiveness of dental sealants for prevention of childhood caries in school-aged children. OBJECTIVE: This study describes planning, development, usability testing and outcomes following implementation of DentaSeal, a web-based application designed to accurately track unique student data and generate reports for all Wisconsin school-based sealant placement (SP) programs. METHODS: Application software development was informed by a steering committee of representative stakeholders who were interviewed to inform design and provide feedback for design of DentaSeal during development and evaluation. Software development proceeded based on wireframes developed to build architectural design. …Usability testing followed and informed any required adjustments to the application. The DentaSeal prototype was beta tested and fully implemented subsequently in the public health sector. RESULTS: The DentaSeal application demonstrated capacity to: 1) track unique student SP data and longitudinal encounter history, 2) generate reports and 3) support administrative tracking. In 2019, DentaSeal captured SP data of 47 school-based programs in Wisconsin that sponsored > 7,000 program visits for 184,000 children from 62 counties. Delivery of > 548,000 SP services were catalogued. CONCLUSIONS: For public health initiatives targeting reduction in caries incidence, web-based applications such as DentaSeal represent useful longitudinal tracking tools for cataloguing SP in school-based program participants. Show more

Keywords: Dental sealants, school health services, registries, user-computer interface, computer software, dental caries resistance

DOI: 10.3233/THC-220568

Citation: Technology and Health Care, vol. 31, no. 4, pp. 1279-1291, 2023

Authors: Li, Ling | Mkangala, Abdala | Geng, Zhiqi | Fan, Wenliang | Ren, Yanqiao | Wang, Zhongmin | Zheng, Chuansheng | Xiao, Shuping

Article Type: Research Article

Abstract: BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is an accepted minimal invasive procedure for the management of complications of portal hypertension. OBJECTIVE: This study aims to investigate the value of the preemptive administration of morphine, when compared with on-demand morphine, during TIPS. METHODS: The present study was a randomized control trial. A total of 49 patients were selected to receive 10 mg of morphine either before the TIPS procedure (group B, n = 26), or on demand when needed during the TIPS procedure (group A, n = …23). The patient’s pain was scored using the visual analog scale (VAS) during the procedure. VAS, pain performance, HR, systolic pressure, diastolic pressure and SPO 2 were recorded at four-time points: before the operation (T0), during the trans-hepatic puncture of the portal vein (T1), during the intrahepatic channel expansion (T2), and when the operation was finished (T3). The duration of the operation was also recorded. RESULTS: In group A, the proportion of severe pain at T1 was 4.3% (one case), two cases were combined with vagus reflex, and the proportion of severe pain at T2 was 65.2% (15 cases). No severe pain occurred in group B. The VAS score significantly decreased at T1, T2 and T3 in group B, when compared to group A (P < 0.05). HR, systolic pressure and diastolic pressure significantly decreased at T2 and T3 in group B, when compared to group A (P < 0.05). There was no significant difference between the two groups in terms of SPO 2 (P > 0.05). CONCLUSION: Preemptive analgesia can effectively relieve severe pain during TIPS, improve patient comfort and compliance, ensure a routine procedure, and offer excellent safety, and is simple and effective. Show more

Keywords: Preemptive analgesia, morphine, TIPS, pain, visual analogue scale

DOI: 10.3233/THC-220572

Citation: Technology and Health Care, vol. 31, no. 4, pp. 1293-1300, 2023

Authors: Tian, Qiu-Si | Zhang, Qun | Huang, Wei

Article Type: Research Article

Abstract: BACKGROUND: Gliomas are one of the most common malignancies in the central nervous system (CNS). Members of the minichromosomal maintenance protein (MCM) family play an essential role in diagnosing and prognosis of malignant tumors. MCM10 is found in gliomas, but the prognosis and immune infiltration of gliomas has not been elucidated. OBJECTIVE: To explore the biological function and immune infiltration of MCM10 in gliomas and provide a reference for the diagnosis, treatment, and prognostic evaluation. METHODS: The MCM10 expression profile and the clinical information database of glioma patients were obtained from the China …Glioma Genome Atlas (CGGA) and Cancer Genome Atlas (TCGA) glioma data. We analyzed the MCM10 expression levels in various cancers from The TCGA.RNA sequencing data were analyzed using the R packages to determine differentially expressed genes (DEGs) between high- and low MCM10 expressing GBM tissues from the TCGA-GBM database. The Wilcoxon rank sum test was used to compare MCM10 expression levels in glioma and normal brain tissue. To evaluate the value of MCM10 expressions in the prognosis of glioma patients by the Kaplan-Meier survival analysis, a univariate Cox analysis, multivariate Cox analysis, and a ROC curve analysis were used to analyze the correlation of MCM10 expression and the clinicopathological features of glioma patients using the TCGA database data. Subsequently, a functional enrichment analysis was performed to explore its potential signaling pathways and biological functions. Moreover, a single-sample gene set enrichment analysis was used to assess the extent of immune cell infiltration. Lastly, the authors constructed a nomogram to predict the overall survival rate (OS) of gliomas at 1, 3 and 5 years after diagnosis. RESULTS: MCM10 is highly expressed in 20 cancer types including gliomas, and MCM10 expression was an independent adverse prognostic factor in glioma patients. Similarly, high expression of MCM10 was associated with advanced age (60 years), increased tumor grade, tumor recurrence or development of a secondary tumor, IDH wild-type, and non-codeletion of 1p19q (p < 0.01). The OS nomogram generated a consistency index of 0.821. The results of Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment and Gene Ontology (GO) functional analysis showed that the cell-cycle-related and tumor-related signaling pathways were significantly enriched in the MCM10 high expression phenotype. Moreover, signaling pathways were significantly enriched in Gene Set Enrichment Analysis (GSEA), including Rho GTPases, M phase, DNA repair, extracellular matrix organization, and nuclear receptors. Furthermore, MCM10 over expression was negatively correlated with the level of immune cell infiltration in natural killer CD56 bright cells, follicular helper T cells, plasmacytoma dendritic cells, and dendritic cells. CONCLUSION: MCM10 is an independent prognostic index of glioma patients, and the high expression of MCM10 suggests a poor prognosis; MCM10 expression is closely related to the immune cell infiltration of gliomas, and MCM10 may be related to drug resistance and development of gliomas. Show more

Keywords: Gliomas, minichromosomal maintenance protein 10, immune infiltration, biomarker, prognosis

DOI: 10.3233/THC-220576

Citation: Technology and Health Care, vol. 31, no. 4, pp. 1301-1317, 2023

Authors: Chen, Huan | Zhao, Dechun | Luo, Zixin | Shen, Lihao | Shu, Yang | Li, Ling

Article Type: Research Article

Abstract: BACKGROUND: Closed-loop deep brain stimulation (DBS) is a research hotspot in the treatment of Parkinson’s disease. However, a variety of stimulation strategies will increase the selection time and cost in animal experiments and clinical studies. Moreover, the stimulation effect is little difference between similar strategies, so the selection process will be redundant. OBJECTIVE: The objective was to propose a comprehensive evaluation model based on analytic hierarchy process (AHP) to select the best one among similar strategies. METHODS: Two similar strategies, namely, threshold stimulation (CDBS) and threshold stimulus after EMD feature extraction (EDBS), were …used for analysis and screening. The values of Similar to Unified Parkinson’s Disease Rating Scale estimates (SUE), β power and energy consumption were calculated and analysed. The stimulation threshold with the best improvement effect was selected. The weights of the indices were allocated by AHP. Finally, the weights and index values were combined, and the comprehensive scores of the two strategies were calculated using the evaluation model. RESULTS: The optimal stimulation threshold for CDBS was 52% and for EDBS was 62%. The weights of the indices were 0.45, 0.45 and 0.1, respectively. According to comprehensive scores, different from the situation where either EDBS or CDBS can be called optimal stimulation strategies. But under the same threshold stimulation, the EDBS was better than the CDBS under the optimal level. CONCLUSION: The evaluation model based on AHP under the optimal stimulation conditions satisfied the screening conditions between the two strategies. Show more

Keywords: Optimal level, comprehensive evaluation model, closed-loop deep brain stimulation strategy, analytic hierarchy process, Parkinson’s disease

DOI: 10.3233/THC-220587

Citation: Technology and Health Care, vol. 31, no. 4, pp. 1319-1331, 2023

Authors: Wang, Ping | Song, Guo-Dong | Xie, Wang-Cheng | Song, Zhen-Shun

Article Type: Research Article

Abstract: BACKGROUND: There are two minimally invasive ways of treating cholecystolithiasis combined with choledocholithiasis, but there remains some controversy regarding which technique is better, since they both have advantages and disadvantages. The one-step method involves laparoscopic cholecystectomy, laparoscopic common bile duct exploration, and primary close (LC + LCBDE + PC), while the two-step procedure consists of endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy, and laparoscopic cholecystectomy (ERCP + EST + LC). OBJECTIVE: This multicenter retrospective study aimed to analyze and compare the effects of the two techniques. …METHODS: The data of patients who underwent either one-step LCBDE + LC + PC or two-step ERCP + EST + LC treatment for gallstones in the gallbladder and bile duct at the Shanghai Tenth People’s Hospital, Shanghai Tongren Hospital, and Taizhou Fourth People’s Hospital between January 1, 2015 and December 31, 2019 were collected, and the preoperative indicators of the two groups were compared. RESULTS: The surgical success rate of the one-step laparoscopic group was 96.23% (664/690), the transit abdominal opening rate was 2.03% (14/690), and there were 21 cases of postoperative bile leakage. The success rate of the two-step endolaparoscopic surgery was 78.95% (225/285), the transit opening rate was 2.46% (7/285), and there were 43 postoperative cases of pancreatitis and five of cholangitis. Postoperative cholangitis, pancreatitis, postoperative stone recurrence, postoperative hospitalization, and treatment costs were significantly lower (P < 0.05) in the one-step laparoscopic group than in the two-step endolaparoscopic group. However, the amount of intraoperative bleeding, the postoperative extraction time of the abdominal drainage tube, and the incidence of bile leakage were higher (P < 0.05) in the one-step laparoscopic group than in the two-step endolaparoscopic group. CONCLUSION: The two methods of treating choledocholithiasis combined with choledocholithiasis that were analyzed in this study were safe and effective, and each method had its own advantages. Show more

Keywords: Laparoscopic cholecystectomy, laparoscopic common bile duct exploration, endoscopic sphincterotomy, secondary choledocholithiasis, multicenter retrospective clinical study

DOI: 10.3233/THC-220610

Citation: Technology and Health Care, vol. 31, no. 4, pp. 1333-1342, 2023

Authors: Popović, Tamara | Matavulj, Milica | Nežić, Lana | Radulović, Tatjana Nožica | Škrbić, Ranko

Article Type: Research Article

Abstract: BACKGROUND: The pulsed electromagnetic fields (PEMFs) seem effective in increasing bone mineral density and promoting osteogenesis and bone healing. OBJECTIVE: To examine the effect of two different modalities of PEMFs therapy in comparison with the recommended pharmacological treatment on experimental osteoporosis in rats. METHODS: The experimental model of estrogen-deficient osteoporosis induced by ovariectomy was used in this study. The animals were exposed to PEMFs of various frequencies (40 Hz and 25 Hzk), intensities (10 mT and 36.4 μ T), lengths of exposure, and the effects were compared with the standard treatment …with pamidronate, vitamin D, and calcium supplementation. RESULTS: The application of PEMF 40Hz , significantly reduced the osteoporotic bone loss in female rats that were confirmed with biochemical, biomechanical, and histological analyses. These effects were more pronounced than in osteoporotic animals treated with pamidronate, vitamin D, and calcium supplementation. On the contrary, the exposure to PEMF 25Hz did not show restorative effects but led to further progression of osteoporosis. CONCLUSION: The exposure to PEMF 40Hz , significantly restored osteoporosis and attenuated bone fragility in comparison to the rats exposed to PEMF 25Hz or those treated with pamidronate, vitamin D, and calcium supplementation. Show more

Keywords: Estrogen deficient osteoporosis, pulsed electromagnetic fields, pamidronate, vitamin D, calcium

DOI: 10.3233/THC-220642

Citation: Technology and Health Care, vol. 31, no. 4, pp. 1343-1353, 2023

Authors: Zhang, Yanhua | Teng, Libao | Wang, Chunying

Article Type: Research Article

Abstract: BACKGROUND: In order to prevent the occurrence of high-cost cases, it is necessary to know the proportion of high-rate cases and the hospitalization cost of patients. OBJECTIVE: Through the analysis of the high-rate cases of various specialties in a first-class hospital in a province, the profit and loss situation of medical institutions under the diagnosis-intervention packets (DIP) payment reform was discussed to seek a more effective way of medical insurance payment reform. METHODS: Data of 1955 inpatients who participated in DIP settlement in January 2022 were retrospectively selected. The Pareto chart was used …to analyze the distribution trend of high-cost cases and the composition of hospitalization expenses in each specialty. RESULTS: The high-cost cases are the main reason for the loss of medical institutions at the time of DIP settlement. Neurology, respiratory medicine and other specialties are the focus of high-cost cases. CONCLUSION: The cost composition of inpatients with high-cost cases is in urgent need of optimization and adjustment. DIP payment method can control the use of medical insurance funds more effectively, which is the guarantee for the refined management of medical institutions. Show more

Keywords: High-cost cases, diagnosis-intervention packet, hospitalization expenses, Pareto chart analysis

DOI: 10.3233/THC-220647

Citation: Technology and Health Care, vol. 31, no. 4, pp. 1355-1364, 2023