Technology and Health Care - Volume 32, issue 4

Authors: Zhou, Xuan | Li, Zhen-Fei | Guo, Xuan-Zhu | Wei, Qiao | Niu, Ya-Nan | Li, Meng | Xia, Jia-Ning | Chen, Li-Ping

Article Type: Research Article

Abstract: BACKGROUND: The first-line treatment for cervical dystonia (CD) consists of repeated intramuscular injections of botulinum toxin (BoNT). However, the efficacy in some patients may be unsatisfactory and they may discontinue treatment. OBJECTIVE: To examine the factors associated with the maximum rate of remission in patients with CD after initial botulinum neurotoxin type A (or botulinum toxin type A abbreviated as BTX-A or BoNT-A) treatment. METHODS: Patients with CD who received BoNT-A injections were evaluated using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Tsui scale, with follow-up endpoints lasting until the …start of the second injection. Patients who did not receive a second injection of BoNT-A were followed up for at least 5 months. The maximum remission rates were determined using the lowest Tsui and TWSTRS total scores during the follow-up period. We obtained basic information about these patients such as age, gender, duration of disease, presence of additional disease, types of torticollis, presence of anxiety, depression, tremors, single-photon emission computed tomography (SPECT) findings, injected dose, and so on from their medical records. RESULTS: A total of 70 patients with CD participated in this study, with males comprising 35.7% (25 individuals) with an average age of 45 ± 14 years old. The duration of disease was an independent risk factor for determining whether a complete remission has been attained using the Tsui scale (odds ratio [OR] = 0.978, 95% confidence interval [CI]: 0.959–0.997, P = 0.026). The optimal cut-off point for predicting patients who were unable to achieve complete remission based on duration of disease was 7.5 months (AUG = 0.711). Patients with CD with additional disease had greater difficulty achieving complete remission than those with CD alone based on TWSTRS assessments (P = 0.049). During the study, approximately 17% of all participants reported experiencing adverse reactions that lasted between 1 to 3 weeks before disappearing. CONCLUSION: BoNT is an effective and safe method for treating CD. The maximum remission rates of patients after their first injections are influenced by the duration of their disease. Thus, treatment using BoNT injections must be administered as soon as possible. Show more

Keywords: Botulinum neurotoxin (BoNT), cervical dystonia, efficacy, maximum remission rate, spasmodic torticollis

DOI: 10.3233/THC-231182

Citation: Technology and Health Care, vol. 32, no. 4, pp. 2421-2430, 2024

Authors: Darshan, B.S. Dhruva | Sampathila, Niranjana | Bairy, Muralidhar G. | Belurkar, Sushma | Prabhu, Srikanth | Chadaga, Krishnaraj

Article Type: Research Article

Abstract: BACKGROUND: Anaemia is a commonly known blood illness worldwide. Red blood cell (RBC) count or oxygen carrying capability being insufficient are two ways to describe anaemia. This disorder has an impact on the quality of life. If anaemia is detected in the initial stage, appropriate care can be taken to prevent further harm. OBJECTIVE: This study proposes a machine learning approach to identify anaemia from clinical markers, which will help further in clinical practice. METHODS: The models are designed with a dataset of 364 samples and 12 blood test attributes. The developed algorithm …is expected to provide decision support to the clinicians based on blood markers. Each model is trained and validated on several performance metrics. RESULTS: The accuracy obtained by the random forest, K nearest neighbour, support vector machine, Naive Bayes, xgboost, and catboost are 97%, 98%, 95%, 95%, 98% and 97% respectively. Four explainers such as Shapley Additive Values (SHAP), QLattice, Eli5 and local interpretable model-agnostic explanations (LIME) are explored for interpreting the model predictions. CONCLUSION: The study provides insights into the potential of machine learning algorithms for classification and may help in the development of automated and accurate diagnostic tools for anaemia. Show more

Keywords: Clinical markers, decision support, explainable artificial intelligence, machine learning

DOI: 10.3233/THC-231207

Citation: Technology and Health Care, vol. 32, no. 4, pp. 2431-2444, 2024

Authors: Feng, Ruigang | Huang, Wenwen | Liu, Bowen | Li, Dan | Zhao, Jinlai | Yu, Yue | Cao, Xuchen | Wang, Xin

Article Type: Research Article

Abstract: BACKGROUND: The effective treatment of breast cancer in elderly patients remains a major challenge. OBJECTIVE: To construct a nomogram affecting the overall survival of triple-negative breast cancer (TNBC) and establish a survival risk prediction model. METHODS: A total of 5317 TPBC patients with negative expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) who were diagnosed and received systematic treatment from 2010 to 2015 were collected from the American Cancer Surveillance, Epidemiology and End Results (SEER) database. They were randomly divided into training set (n = …3721) and validation set (n = 1596). Univariate and multivariate Cox regression analysis were used to identify prognostic features, and a nomogram was established to predict the probability of 1-year, 3-year and 5-year OS and BCSS. We used consistency index (C-index), calibration curve, area under the curve (AUC) and decision curve analysis (DCA) to evaluate the predictive performance and clinical utility of the nomogram. RESULTS: The C-indices of the nomograms for OS and BCSS in the training cohort were 0.797 and 0.825, respectively, whereas those in the validation cohort were 0.795 and 0.818, respectively. The receiver operating characteristic (ROC) curves had higher sensitivity at all specificity values as compared with the Tumor Node Metastasis (TNM) system. The calibration plot revealed a satisfactory relationship between survival rates and predicted outcomes in both the training and validation cohorts. DCA demonstrated that the nomogram had clinical utility when compared with the TNM staging system. CONCLUSION: This study provides information on population-based clinical characteristics and prognostic factors for patients with triple-negative breast cancer, and constructs a reliable and accurate prognostic nomogram. Show more

Keywords: Triple negative breast cancer, nomogram, overall survival, breast cancer-specific survival, SEER database

DOI: 10.3233/THC-231240

Citation: Technology and Health Care, vol. 32, no. 4, pp. 2445-2461, 2024

Authors: Mu, Shangdong | Tian, Qiusi | Shen, Liangyu

Article Type: Research Article

Abstract: BACKGROUND: Nucleolar protein 16 (NOP16) is present in the protein complex of the nucleolus. The NOP16 promoter contains a c-Myc binding site, and the transcriptional regulation by c-Myc directly regulates NOP16 expression levels. OBJECTIVE: Dysregulation of NOP 16 is currently reported in only a small number of cancers. In this study, the expression profile of NOP 16 in hepatocellular carcinoma (LIHC) and its clinical significance were analyzed. METHODS: NOP16 expression in hepatocellular carcinoma (LIHC) and its relationship with the clinical characters of LIHC were examined using the Cancer Genome Atlas (TCGA), the Gene …Expression comprehensive database (GEO), Kaplan-Meier survival analysis, univariate Cox analysis, multivariate Cox analysis, ROC curve analysis of KEGG enrichment, GSEA enrichment, in vitro experiments (e.g., siRNA interference of NOP16 expression in hepatoma cells, Keap1-Nrf2 pathway, cell cycle, cell apoptosis and Transwell assays), and LIHC single-cell sequencing (scRNA). RESULTS: Pan-cancer analysis revealed that NOP16 was highly expressed in 20 cancer types, including LIHC, and high NOP16 expression was an independent adverse prognostic factor in LIHC patients. The expression levels of NOP16 mRNA and protein were significantly increased in tumour tissues of LIHC patients compared to normal tissues. The functions of co-expressed genes were primarily enriched in the cell cycle and reactive oxygen species metabolism. The experimental results showed that knockdown of NOP16 activated the Keap/Nrf2 signalling pathway and inhibited the invasion, migration, and EMT progression of LIHC cells. LIHC scRNA-seq data showed that NOP16 was primarily expressed in T lymphocytes. CONCLUSIONS: NOP16 promoted cancer development in LIHC and caused an imbalance in Keap/Nrf2 signalling, which subsequently caused the aberrant expression of genes typical for EMT, cell cycle progression and apoptosis. NOP16 is a potential prognostic marker and therapeutic target for hepatocellular carcinoma progression. Show more

Keywords: NOP16, Keap1-Nrf2 pathway, hepatic cell liver cancer, bioinformatics

DOI: 10.3233/THC-231256

Citation: Technology and Health Care, vol. 32, no. 4, pp. 2463-2483, 2024

Authors: Wang, Zhen | Zhu, Darong | Hu, Guangzhu | Shi, Xiaobei

Article Type: Research Article

Abstract: BACKGROUND: The study of coronary artery calcification (CAC) may assist in identifying additional coronary artery problem protective factors. On the contrary side, due to the wide variety of CAC as individuals, CAC research is difficult. Due to this, evaluating data for investigation is becoming complicated. OBJECTIVE: To use a multi-layer perceptron, we investigated the accuracy and reliability of synthetic CAC coursework or hazard classification in pre or alors chest computerized tomography (CT) of arrangements resolutions in this analysis. method: Photographs of the chest from similar individuals as well as calcium-just and non-gated pictures …were incorporated. This cut thickness ordered CT pictures (bunch A: 1 mm; bunch B: 3 mm). The CAC rating was determined utilizing calcification score picture information, and became standard for tests. While the control treatment’s machine learning program was created using 170 computed tomography pictures and evaluated using 144 scans, group A’s machine learning algorithm was created using 150 chest CT diagnostic tests. RESULTS: 334 external related pictures (100 μ m: 117; 0.5 mm x: 117) of 117 individuals and 612 inside design organizing (1 mm: 294; mm3: 314) of 406 patients were surveyed. Pack B had 0.94, however, tests An and b had 0.90 (95% CI: 0.85–0.93) ICCs between significant learning and gold expenses (0.92–0.96). Dull Altman plots agreed well. A machine teaching approach successfully identified 71% of cases in category A is 81% of patients in section B again for cardiac risk class. CONCLUSION: Regression risk evaluation algorithms could assist in categorizing cardiorespiratory individuals into distinct risk groups and conveniently personalize the treatments to the patient’s circumstances. The models would be based on information gathered through CAC. On both 1 and 3-mm scanners, the automatic determination of a CAC value and cardiovascular events categorization that used a depth teaching approach was reliable and precise. The layer thickness of 0.5 mm on chest CT was slightly less accurate in CAC detection and risk evaluation. Show more

Keywords: Coronary artery calcification (CAC), CT images, CT diagnostic tests, artificial neural network, calcification score image data

DOI: 10.3233/THC-231273

Citation: Technology and Health Care, vol. 32, no. 4, pp. 2485-2507, 2024

Authors: Lu, Cancan | Shi, Jimin | Tan, Yamin | Hu, Huixian

Article Type: Research Article

Abstract: BACKGROUND: There is no specificity in the clinical presentation of hemophagocytic lymphohistiocytosis (HLH). OBJECTIVE: To study some clinical, etiological, and prognostic features of HLH to improve the clinical understanding of the disease. METHODS: Retrospective analysis of the clinical data of 125 patients with HLH admitted to our hospital from June 2015 to August 2021, including clinical characteristics, laboratory indicators, and survival period. Statistical analysis was performed from the overall group of study indicators, which included population, children, and adults. RESULTS: In the whole population, sex, age, blood myoglobin, and NK …cell ratio of M-HLH and non-M-HLH patients (P < 0.05), serum albumin, and direct bilirubin were independent correlates of M-HLH. In the pediatric group, age and the proportion of NK cells were significantly different between M-HLH and non-M-HLH patients (P < 0.05). Multivariate Logistic regression analysis showed that all factors were not significantly associated with M-HLH. The associated regression analysis showed that all factors were not significantly associated with M-HLH. ROC curve analysis showed that the best predictive value of NK cell percentage for M-HLH diagnosis in the overall population was 4.96% in the pediatric group and 4.96% in the adult group. The best predictive value for M-HLH diagnosis was 2.08%. The univariate analysis showed that platelet count, alanine aminotransferase, aspartate aminotransferase, serum albumin, direct bilirubin and indirect bilirubin affected prognosis; COX regression showed that none of these factors had a significant relationship. The overall median survival time was 20.7 months in the adult group, 44.3 months in non-M-HLH patients, and 7.73 months in M-HLH patients (p = 0.011); univariate analysis showed that platelet count and serum albumin level affected prognosis; COX regression results in serum albumin level was an independent risk factor for prognosis. CONCLUSION: The survival rate of non-M-HLH was significantly better than that of M-HLH; the proportion of NK cells had predictive value for the diagnosis of M-HLH; in the general population, non-M-HLH was more likely to have abnormal liver function than M-HLH: lower platelet count and serum albumin level were associated with poor prognosis, and the lower the platelet count and serum albumin level, the worse the prognosis: in addition, adults with lower serum albumin levels are also associated with poor prognosis. Show more

Keywords: HLH, EB virus infection, inclusion criteria, diagnostic criteria, demographics

DOI: 10.3233/THC-231275

Citation: Technology and Health Care, vol. 32, no. 4, pp. 2509-2526, 2024

Authors: Siegel, Danielle N. | Ogle, Melissa M. | Wilson, Christopher | Scholes, Olivia | Prow, Abby | Mannen, Erin M.

Article Type: Research Article

Abstract: BACKGROUND: Rolling is an important developmental milestone for infants where identifying the coordinated movement patterns could facilitate the early identification of motor development delays. Current methods for identifying coordinated movements of rolling are limited to a laboratory setting and not feasible for clinicians. OBJECTIVE: To develop video-based methods in which six coordinated movements, previously defined through motion capture, can be identified through video alone. METHODS: Forty-five videos of sixteen healthy infants achieving a roll were used to develop the video-based methodology and twenty-four videos had corresponding motion capture data used for validation. Four raters …comprised of researchers and a clinician identified rolling coordination using the new video-based methods. A Fleiss’ Kappa statistical test determined the inter- and intra-rater reliability of agreement for the new methodology and compared it to motion capture. RESULTS: The comparison of the motion capture and video-based methods resulted in substantial agreement. The video-based methods inter- and intra-rater reliability were substantial and almost perfect, respectively. CONCLUSIONS: We developed reliable methodology to accurately identify the coordinated movements of infant rolling using only 2D video. This methodology will allow researchers to reliably define coordinated movements of infants through video alone and may assist clinicians in identifying possible motor development delays and disorders. Show more

Keywords: Motor development, kinematics, milestones, biomechanics, experimental design

DOI: 10.3233/THC-231281

Citation: Technology and Health Care, vol. 32, no. 4, pp. 2527-2539, 2024

Authors: Lv, Chen | Guo, Qian | Peng, Shuang-Shuang | Chen, Xiao-Feng | Liu, Su-Fang | Wang, Xiu-Hua

Article Type: Research Article

Abstract: BACKGROUND: The implementation of the rotation system in the Chinese medical industry has achieved significant results. OBJECTIVES: The present study aims to 1) explore the strengths, weaknesses, opportunities and challenges of rotational nursing department implementation and 2) provide references for developing nursing staff’s competencies in leadership, performance evaluation, quality of care, communication in relationships and human resources. METHODS: A total of 16 rotational nursing department staff members from a tertiary tuberculosis specialist hospital in Beijing were interviewed, and the interview data were analysed using a strengths, weaknesses, opportunities and threats analysis and class …analysis. RESULTS: The advantages of the rotational nursing department included: (1) stimulating the nursing staff’s enthusiasm and creativity; (2) strengthening the communication and collaboration between departments; (3) improving the detailed management of nursing quality; and (4) enhancing the nursing staff’s comprehensive abilities. The disadvantages included: (1) the design of the rotation programme focusing on practice; (2) a lack of personalisation; and (3) imperfect performance assessment of the rotating staff. Opportunities included: (1) deepening the connotation of nursing job management and (2) developing the construction of nursing discipline and the need for personal career development and value realisation. Threats included the lack of a sound rotation management model to draw on. CONCLUSION: A rotational nursing department is conducive to enhancing the competence of nursing staff in management positions and providing new ideas for hospitals to select and train nursing management talents. By taking full advantage of the benefits of vertical nursing management, designing personalised rotation training programmes, building a diversified learning and training platform and developing a positive performance incentive mechanism is recommended to fully engage the role of rotation in nursing management talent training. Show more

Keywords: Job rotation training, post competency, SWOT analysis, nursing management

DOI: 10.3233/THC-231282

Citation: Technology and Health Care, vol. 32, no. 4, pp. 2541-2552, 2024

Authors: Tomasevic, Smiljana | Anic, Milos | Arsic, Branko | Gakovic, Branko | Filipovic, Nenad | Djukic, Tijana

Article Type: Research Article

Abstract: BACKGROUND: Ultrasound is one of the non-invasive techniques that are used in clinical diagnostics of carotid artery disease. OBJECTIVE: This paper presents software methodology that can be used in combination with this imaging technique to provide additional information about the state of patient-specific artery. METHODS: Overall three modules are combined within the proposed methodology. A clinical dataset is used within the deep learning module to extract the contours of the carotid artery. This data is then used within the second module to perform the three-dimensional reconstruction of the geometry of the carotid bifurcation …and ultimately this geometry is used within the third module, where the hemodynamic analysis is performed. The obtained distributions of hemodynamic quantities enable a more detailed analysis of the blood flow and state of the arterial wall and could be useful to predict further progress of present abnormalities in the carotid bifurcation. RESULTS: The performance of the deep learning module was demonstrated through the high values of relevant common classification metric parameters. Also, the accuracy of the proposed methodology was shown through the validation of results for the reconstructed parameters against the clinically measured values. CONCLUSION: The presented methodology could be used in combination with standard clinical ultrasound examination to quickly provide additional quantitative and qualitative information about the state of the patient’s carotid bifurcation and thus ensure a treatment that is more adapted to the specific patient. Show more

Keywords: Convolutional neural networks, 3D reconstruction, blood flow, patient-specific geometry, validation against clinical data

DOI: 10.3233/THC-231306

Citation: Technology and Health Care, vol. 32, no. 4, pp. 2553-2574, 2024

Authors: Farid, Farzaneh | Haider, Julfikar | Shahab, Marjan Sadeghpour | Rezaeikalantari, Nika

Article Type: Research Article

Abstract: BACKGROUND: For placement of intraradicular posts the intracanal filling material has to be removed. If drills are employed for this purpose, extra widening of the canal, incomplete cracks or root perforation are probable when inappropriate size of drill is used. OBJECTIVE: This in vitro study assessed the efficacy of radiographs taken after completion of root canal therapy in selecting the appropriate-sized Peeso reamer for post space preparation. METHODS: Canals of 53 extracted maxillary and mandibular teeth of different types were cleaned and shaped. Then with acrylic resin 3-dimensional model of the intracanal …space of each tooth was fabricated. Next, all canals were filled with gutta-percha and teeth were radiographed buccolingually. Based on these radiographs two observers selected a Peeso reamer that best matched each canal’s diameter. The diameter of the selected Peeso reamer was compared to the diameter of the corresponding resin model of each canal by two independent observers and the difference was measured. The data were analyzed by paired sample t -test using SPSS version 22. RESULTS: The diameter of the selected Peeso reamers ranged from 0.21 mm smaller to 0.12 mm larger than the diameter of intracanal spaces. The difference between reamer and resin model was less than 0.1 mm in 75% of the cases. CONCLUSION: The result of this study suggests that post-operation endodontic radiographs are reliable means for selecting a size of Peeso reamer that does not encroach on dentinal wall during removal of intracanal filling material and post space preparation. Show more

Keywords: Root canal therapy, periapical radiographs, peeso reamer, post space preparation

DOI: 10.3233/THC-231410

Citation: Technology and Health Care, vol. 32, no. 4, pp. 2575-2583, 2024