Technology and Health Care - Volume 31, issue 6

Authors: Ertuğrul, Duygu Çelik | Akcan, Neşe | Bitirim, Yiltan | Koru, Begum | Sevince, Mahmut

Article Type: Research Article

Abstract: BACKGROUND: Diabetes Mellitus (DM) is a significant risk, mostly causing blindness, kidney failure, heart attack, stroke, and lower limb amputation. A Clinical Decision Support System (CDSS) can assist healthcare practitioners in their daily effort and can improve the quality of healthcare provided to DM patients and save time. OBJECTIVE: In this study, a CDSS that can predict DM risk at an early stage has been developed for use by health professionals, general practitioners, hospital clinicians, health educators, and other primary care clinicians. The CDSS infers a set of personalized and suitable supportive treatment suggestions for patients. …METHODS: Demographic data (e.g., age, gender, habits), body measurements (e.g., weight, height, waist circumference), comorbid conditions (e.g., autoimmune disease, heart failure), and laboratory data (e.g., IFG, IGT, OGTT, HbA1c) were collected from patients during clinical examinations and used to deduce a DM risk score and a set of personalized and suitable suggestions for the patients with the ontology reasoning ability of the tool. In this study, OWL ontology language, SWRL rule language, Java programming, Protégé ontology editor, SWRL API and OWL API tools, which are well known Semantic Web and ontology engineering tools, are used to develop the ontology reasoning module that provides to deduce a set of appropriate suggestions for a patient evaluated. RESULTS: After our first-round of tests, the consistency of the tool was obtained as 96.5%. At the end of our second-round of tests, the performance was obtained as 100.0% after some necessary rule changes and ontology revisions were done. While the developed semantic medical rules can predict only Type 1 and Type 2 DM in adults, the rules do not yet make DM risk assessments and deduce suggestions for pediatric patients. CONCLUSION: The results obtained are promising in demonstrating the applicability, effectiveness, and efficiency of the tool. It can ensure that necessary precautions are taken in advance by raising awareness of society against the DM risk. Show more

Keywords: Health informatics, diabetes mellitus, knowledge bases, clinical decision support systems, smart healthcare

DOI: 10.3233/THC-230237

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2279-2302, 2023

Authors: Meng, Yinghui | Du, Zhenglong | Zhao, Chen | Dong, Minghao | Pienta, Drew | Tang, Jinshan | Zhou, Weihua

Article Type: Research Article

Abstract: BACKGROUND: Accurate extraction of coronary arteries from invasive coronary angiography (ICA) images is essential for the diagnosis and risk stratification of coronary artery disease (CAD). OBJECTIVE: In this study, a novel deep learning (DL) method is proposed for automatically extracting coronary arteries from ICA images. METHODS: A convolutional neural network (CNN) was developed with full-scale skip connections and full-scale deep supervisions. The encoder architecture was based on the residual and inception modules to obtain multi-scale features from multiple convolutional layers with different window shapes. Transfer learning was utilized to improve both the initial …performance and learning efficiency. A hybrid loss function was employed to further optimize the segmentation model. RESULTS: The model was tested on a data set of 616 ICAs obtained from 210 patients, composed of 437 images for training, 49 images for validation, and 130 images for testing. The segmentation model achieved a Dice score of 0.8942, a sensitivity of 0.8735, a specificity of 0.9954, and a Hausdorff distance of 6.0794 mm; it could predict arteries for a single ICA frame in 0.2114 seconds. CONCLUSIONS: The results showed that our model outperformed the state-of-the-art deep-learning models. Our new method has great potential for clinical use. Show more

Keywords: Coronary artery disease, invasive coronary angiography, image segmentation, deep learning, convolutional neural network

DOI: 10.3233/THC-230278

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2303-2317, 2023

Authors: Tang, Hui-Wen | Wang, Zha-Gen | Huang, Jia-Hu | Zhang, Guo-Qin | Xu, Yun-Feng | Zheng, Lu-Lu | Li, Ting-Jun

Article Type: Research Article

Abstract: BACKGROUND: Acute appendicitis in children refers to the acute inflammation of the appendix, which accounts for 20% ∼ 30% of cases of acute abdomen in pediatric surgery. OBJECTIVE: This study aimed to establish a decision tree model of complicated appendicitis in children using appendiceal ultrasound combined with an inflammatory index and evaluated its clinical efficacy in pediatric patients. METHODS: A total of 395 children admitted to the Emergency Department of the Shanghai Children’s Hospital from January 2018 to December 2021 and diagnosed with appendicitis by postoperative pathology were retrospectively analyzed. …According to the postoperative pathology, the children were divided into a complicated and non-complicated appendicitis group, respectively. Routine laboratory inflammatory indicators, including white blood cell count, N(%), neutrophil (Neu) count, Neu/lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin were collected from the two groups. Collecting data on ultrasound examination of the appendix includes whether the appendix diameter is thickened, whether the echogenicity of the mesenteric rim surrounding the appendix is enhanced, whether there is rich blood supply in the appendix, and whether there are fecaliths in the appendix lumen. The risk factors for complicated appendicitis were screened out by univariate and multivariate logistic regression analyses, the binary logistic regression prediction and decision tree models were established, respectively, and the receiver operating characteristic (ROC) curve was used to verify the accuracy of the two prediction models. RESULTS: Binary logistic regression analysis showed that CRP, NLR, the presence of an appendicolith, and peripheral retina echo enhancement were independent risk factors for complicated appendicitis in children (P < 0.05). The decision tree model had an overall accuracy of 79%, an area under the ROC curve (AUC) of 0.809 (95% confidence interval [CI] 0.780–0.865), and sensitivity and specificity of 71.3% and 77.7%, respectively. The logistic regression model had an overall accuracy of 74.9%, an AUC value of 0.823 (95% CI, 0.765–0.853), a sensitivity value of 80.3%, and a specificity of 71.8%. CONCLUSION: This predictive model, based on ultrasound of the appendix combined with inflammatory markers, provides a useful method to assist pediatric emergency physicians in diagnosing childhood appendicitis. The decision tree model reflected the interaction of various indexes, and the model was simple, intuitive, and effective. Show more

Keywords: Complicated appendicitis, appendiceal ultrasound, inflammatory index, decision tree model, children

DOI: 10.3233/THC-230285

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2319-2329, 2023

Authors: Tan, Pei-Ze | Li, Shang-Lun | Zhang, Qing | Liu, Xiang | Tang, Feng | Liu, Chang-Le

Article Type: Research Article

Abstract: BACKGROUND: Myocardial infarction (MI) is a series of clinical syndromes caused by ischemic necrosis of myocardial cells that results from severe and persistent acute ischemia of the myocardium due to a dramatic reduction or interruption of coronary blood supply. OBJECTIVE: In this study, we analyzed the role of pre-hospital emergency services in the rescue of patients suffering from ST-elevation myocardial infarction (STEMI). METHODS: We enrolled 229 patients with STEMI who were transported to the Second Hospital of Tianjin Medical University by Tianjin Emergency Center from January 2017 to June 2021. With the development …of the pre-hospital emergency medical system in Tianjin (2019) as the time node, the patients were divided into three groups: A (87 cases), B (68 cases), and C (74 cases). The onset-to-call time, emergency response time, door-to-balloon (D-B) time, first medical contact to balloon dilation (FMC-B) time, symptom onset-to-balloon dilation (S-B) time, proportion of patients receiving prehospital administration of bispecific antibodies, number of days hospitalized, total hospitalization expenses, and in-hospital incidence and mortality of heart failure were compared between the three groups. RESULTS: Group C differed significantly from group A and group B in terms of emergency response time, D-B time, FMC-B time, S-B time, the proportion of patients who received prehospital administration of bispecific antibodies, and the number of days of hospitalization (P < 0.05), but there was no significant difference in the onset-to-call time (P > 0.05) and the decreasing trends in the in-hospital incidence and mortality of heart failure were not statistically significant (incidence: 9.50% vs. 13.23%, 12.64%; mortality: 4.10% vs. 5.90%, 4.60%). CONCLUSION: A reasonable pre-hospital emergency medical network layout and resource investment, as well as the strengthening of the interface between pre-hospital and in-hospital medical emergencies and pre-hospital standardized rescue, can shorten the emergency response time and the total ischemic time in patients with chest pain, which can improve patient prognosis to a certain extent. Show more

Keywords: Chest pain center, door-to-balloon time, emergency response time, pre-hospital medical emergency, ST-elevation myocardial infarction

DOI: 10.3233/THC-230353

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2331-2338, 2023

Authors: Peng, Jigui | He, Changjin | Yan, Haiqiang | Zhou, Wang

Article Type: Research Article

Abstract: BACKGROUND: Although it has been established that cancer-associated fibroblasts (CAFs) facilitate tumor development, the relationship between CAFs and the prognosis of patients with lung adenocarcinoma (LUAD) has not been extensively explored. OBJECTIVE: This study was formulated to investigate the prognostic value of CAF-related genes in LUAD. METHODS: Differential analysis was carried out with TCGA-LUAD dataset as the training set. By overlapping differentially expressed genes (DEGs) with genes associated with CAF, CAF-related DEGs specific to LUAD were obtained. A prognostic risk model was constructed by Lasso and Cox regression analysis, and samples were grouped …according to median risk score. The efficacy of the model was accessed through survival curve and receiver operating characteristic curve (ROC) analyses, with the validation set for verification. Risk score combined with clinical factors was utilized for Cox analysis to verify the independence of the model, and a nomogram was drawn. GSEA was performed on different risk groups. Immunologic infiltration and tumor mutational burden were assessed in different risk groups. RESULTS: Eleven feature genes including DLGAP5, KCNE2, UPK2, NPAS2, ARHGAP11A, ANGPTL4, ANLN, DKK1, SMUG1, C16orf74, and ACAD8 were identified, based on which a prognostic model was constructed. Risk score could predict the prognosis of LUAD patients and could be an independent prognostic factor for LUAD patients. GSEA outcomes displayed significant enrichment of genes in the high-risk group in the P53 SIGNALING PATHWAY. In comparison to the low-risk group, the high-risk group exhibited a decreased degree of immune infiltration and an elevated level of tumor mutational burden. CONCLUSION: An 11-gene model was constructed based on CAF-related genes to predict LUAD prognosis. This model represented an independent prognostic factor for LUAD. Show more

Keywords: Lung adenocarcinoma, fibroblasts, prognostic risk model, immune infiltration, tumor mutational burden

DOI: 10.3233/THC-230453

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2339-2354, 2023

Authors: Zhang, Xiao-Hua | Zhang, Xin | Feng, Hong-Ye | Cao, Chang-Chun | Lv, Hui-Lan | Wang, Yu-Long | Ren, Li-Jie

Article Type: Research Article

Abstract: BACKGROUND: At present, the pathogenesis of post-stroke insomnia (PSI) is still inconclusive. OBJECTIVE: To explore the changes and significance of serum cholecystokinin-8 (CCK-8), substance P (SP), and 5-hydroxytryptamine (5-HT) in patients with PSI. METHODS: Ninety-one patients with stroke were selected as the research subjects, and according to the score of the Athens Insomnia Scale (AIS), they were divided into the insomnia group and the non-insomnia group. The serum levels of CCK-8, SP, and 5-HT in the two groups were compared to explore their relationships with PSI. RESULTS: Among the 91 …patients, 56 were in the insomnia group and 35 were in the non-insomnia group, and the incidence of insomnia was 61.5%. There was no significant difference in the serum levels of CCK-8, SP, and 5-HT between the two groups (P = 0.696, 0.980, and 0.809, respectively). One-way analysis of variance showed that there was no significant correlation between the serum levels of CCK-8, SP, 5-HT, and the AIS score (P = 0.7393, 0.9581, and 0.5952, respectively). CONCLUSION: The incidence of PSI was relatively high, but it could not be proved that CCK-8, SP, and 5-HT were involved in the pathogenesis of PSI. There might exist other neurotransmitters involved in the pathophysiological process of PSI, which should be further explored. Show more

Keywords: Stroke, insomnia, cholecystokinin-8, serum substance P, 5-hydroxytryptamine

DOI: 10.3233/THC-230506

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2355-2361, 2023

Authors: Xia, Yunqing | Tang, Liang | Hu, Yu

Article Type: Review Article

Abstract: BACKGROUND: Currently, the frequency of coagulation dysfunction associated with chimeric antigen receptor-T cell (Car-T) therapy cannot yet be determined. OBJECTIVE: We performed a systematic review and meta-analysis to examine the prevalence of abnormal laboratory tests related to coagulation disorders in patients receiving Car-T therapy and provide a reference for future risk assessment mechanisms. METHODS: We searched PubMed, Embase, and Web of Science for relevant studies and evaluated their quality using the methodology index of non-random research (MINORS). 2672 quotations were retrieved via systematic searches. After screening of titles, abstracts and full-text, 45 trials …involving 2541 patients were ultimately included. 41 studies reported the incidence of thrombocytopenia, 8 studies reported the rate of low fibrin, 4 trials reported the rate of APTT or PT abnormalities and only 3 trials reported the incidence of venous thromboembolism (VTE). We performed a quantitative meta-analysis to explore the incidence of thrombocytopenia following Car-T treatment. The incidence of hypofibrinogenemia, VTE, and abnormal APTT or PT was only qualitatively assessed, as fewer reports were included in this study. RESULTS: The overall incidence of thrombocytopenia associated with Car-T therapy was 45.8% (95%[CI], 0.384–0.533). The highest rates of thrombocytopenia occurred in patients with multiple myeloma (60.1%, 95%[CI], 0.507–0.688) and aged between 18 to 60 (50%, 95%[CI], 0.367–0.633). There was greater prevalence of thrombocytopenia in BCMA-Car-T therapy of 58.7% (95%[CI], 0.482–0.685). Thrombocytopenia occurred most frequently in Car-T patients treated with a dosage of 1 × 10 5 –1 × 10 6  cell/kg, at a rate of 66.2% (95%[CI], 0.561–0.749). CONCLUSION: Overall, 45.8 percent of patients receiving Car-T treatment suffered from thrombocytopenia. Multiple myeloma patients, ages between 18–60, a dose of 1 × 10 5 –1 × 10 6  cell/kg and BCMA-Car-T therapy are all considered high-risk factors. Show more

Keywords: Car-T, thrombocytopenia, hematological tumors, meta-analysis

DOI: 10.3233/THC-220537

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2363-2380, 2023

Authors: Wu, Jiaqi | Heng, Modi | Bai, Yunyang

Article Type: Other

Abstract: BACKGROUND: The minimally invasive endodontics could retain more peri-cervical dentin (PCD) and other important dental structures, thus realizing the minimal loss of teeth structures and preserving the strength and function of the endodontically treated tooth (ETT). The search for abnormal root canals or calcified root canals could be quite time-consuming and increase the risk of perforation. OBJECTIVE: This study introduced a novel multifunctional 3D printing guided splint inspired by the dice, which can achieve the minimally invasive access cavity preparation and canal orifice identification. METHOD: Data were collected from an outpatient with dens …invaginatus. Cone-beam Computed Tomography (CBCT) revealed a type III invagination. The CBCT data of the patient were imported into a computer-aided design (CAD) software (Exocad 3.0; Exocad GmbH) for the 3D reconstruction of jaw bones and teeth. The dice-inspired 3D printing guided splint consists of the sleeve and guided splint. The sleeve with minimal invasive opening channel and orifice locating channel were designed with a reverse-engineering software (Geomagic Wrap 2021). The reconstructed models in the Standard Template Library (STL) format were imported into a CAD software. The design of the template was aided by the dental CAD software in Splint Design Mode. The sleeve and splint were exported into the STL files separately. A 3D printer (ProJet ® 3600 3D Systems) was used to separately generate the sleeve and guided splint, and was made by stereolithography and processed in a medical resin (VisiJet M3 StonePlast). RESULTS: The novel multifunctional 3D printing guided splint could be set in position. The opening side in the sleeve was selected and the sleeve was inserted in place. The minimal invasive opening was made in the crown of the tooth to access the pulp. The sleeve was draw out and turned to the orifice location side, and then inserted in place. The target orifice was located rapidly. CONCLUSION: This novel dice-inspired multifunctional 3D printing guided splint allow dental practitioners to gain accurate, conservative, and safe cavity access from teeth with anatomical malformations. Complex operations might be carried out with less reliance on the operator’s experience than with conventional access preparations. This novel dice-inspired multifunctional 3D printing guided splint would have a broad application in the dental field. Show more

Keywords: Guided endodontics, minimally invasive endodontics, CAD, 3D printing

DOI: 10.3233/THC-230002

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2381-2387, 2023

Authors: Wu, Bao-Qiang | Zhang, Xu-Dong | Zhu, Chun-Fu | Qin, Xi-Hu

Article Type: Research Article

Abstract: BACKGROUND: Ectopic replantation and regeneration of splenic tissue fragments following splenic trauma or splenectomy is known as replantation of splenic tissue. It typically takes place in the abdominal cavity, however, splenic tissue replantation in the liver is extremely rare and difficult to diagnose. It is often misdiagnosed as a liver tumor and removed. CASE PRESENTATION: We present the case of a patient with a history of traumatic splenectomy 15 years prior to the replantation of splenic tissue in the liver. A 4 cm mass in the liver was found during the most recent physical examination, and …a computed tomography scan indicated the possibility of a malignant tumor. The tumor was then removed using fluorescence laparoscopy. CONCLUSION: There is a possibility of intrahepatic replantation of splenic tissue in patients who have had a splenectomy in the past, have recently discovered an intrahepatic space-occupying lesion, and do not have any high-risk factors for liver cancer. Unnecessary surgery can be avoided if 99m Tc-labeled red blood cells imaging using mass puncture or radionuclide examination provides a clear preoperative diagnosis. Globally, there are no reports of the use of fluorescence laparoscopy in resecting replanted splenic tissue in the liver. Specifically, in the current case, there was no indocyanine green uptake in the mass, and only a small amount was found in the normally functioning liver tissue surrounding the tumor. Show more

Keywords: Fluorescence laparoscopy, hepatectomy, liver tumor, replantation of splenic tissue

DOI: 10.3233/THC-220475

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2389-2394, 2023

Article Type: Correction

DOI: 10.3233/THC-235017

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2395-2395, 2023