Technology and Health Care - Volume 32, issue 5

Authors: Yaqoob, Ashfaq | Chaturvedi, Saurabh | Khader, Mohasin Abdul | Kamran, Muhammad Abdullah | Alam, Tanveer | Elmahdi, Asim Elsir | Suleman, Ghazala

Article Type: Research Article

Abstract: BACKGROUND: Any manipulation of the surface of natural teeth may result in a variation of their colour. The fixed orthodontic treatment (FOT) is one such procedure which alters the enamel surface during the procedure. OBJECTIVE: To clinically evaluate the colour changes in teeth associated with comprehensive FOT (to compare the changes in test and control groups) and to determine the relationship of age and gender on enamel colour due to FOT by using an advanced spectrophotometer. METHODS: The selection of sixty patients for the study was done randomly and among these thirty patients …who underwent the FOT as the case group, the other thirty patients who did not need FOT, were the control group. The recordings of spectrophotometric data were done in a standardized manner for all patients in the labial circular region of every anterior tooth, following debonding and cleaning operations, and before bracket bonding. The Commission Internationale de l’Eclairage’s L*, a*, and b* (lightness, red/green, and blue/yellow) tooth-type characteristics were used to measure color, and the associated color differences (DE) between the groups were computed. One-way ANOVA (a < 0.05) and the paired t -test were used to evaluate any changes in these color characteristics. RESULTS: Fixed orthodontic treatment is associated with changes in colour parameters. L* values decreased (P < 0.001), while a* and b* values increased (P < 0.001) at the end of treatment. All measured tooth types showed significant colour change (DE); their mean differences ranged from 1.64 to 2.96 DE units. CONCLUSIONS: Fixed orthodontics can change the natural colour of teeth. The CIE colour parameters L*, a*, and b* of natural teeth showed statistically significant differences after debonding the orthodontic appliances. The L* values decreased making the teeth look darker. The adolescent and male patients had more tooth colour changes than the adult and female groups. Show more

Keywords: Fixed appliance orthodontic treatment, colour changes in enamel, spectrophotometer, CIE

DOI: 10.3233/THC-231756

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3097-3108, 2024

Authors: Mittal, Priya | Jadhav, Ganesh Ranganath | Abdul Kader M, Mohammed | Al-Qarni, Mohammed A. | Sindi, Abdulelah Sameer | Cicciù, Marco | Minervini, Giuseppe

Article Type: Research Article

Abstract: BACKGROUND: Dental education is considered as a complex, challenging and often stressful educational procedure. Acquisition of psychomotor skills by undergraduate students is an important step in many health professions to become a successful professional. During under graduation, class II cavity preparation exercise is of utmost important in dentistry. OBJECTIVE: To compare class II cavities prepared by students after hands-on live demonstration and pre-recorded video demonstration using well-organised evaluation rubrics. METHOD: Preclinical dental students (n = 50) were divided into two groups. The students in group I (n = …25) attended a hands-on live demonstration performed by one faculty while students in group II (n = 25) watched a 15-minute pre-recorded procedural video on the projector. Both groups were appealed to prepare class II cavity for amalgam involving disto-occlusal surface of mandibular second molar articulated on jaw model (TRU LON study model, Jayna industries, Ghaziabad U.P., India). Following completion of the preparations, all teeth were collected, and labelled grades of prepared cavities were given according to prespecified rubrics. The data of scores were presented as means and standard deviation. Statistical analysis of data was executed using SPSS software. A paired t-test was used to compare scores between groups. RESULTS: The study shows that the video-supported demonstration of a cavity preparation was better than the live hands-on demonstration. A higher mean response for the procedural video group was found compared to the live demonstration group (p = 0.000133). CONCLUSION: Pre-recorded video-supported demonstration along with guidance by a tutor may be a viable alternative to hands-on live demonstration in cavity preparation procedures during undergraduate dental training. Moreover, rubric methods can be implemented in the teaching of various preclinical exercises for conservative dentistry and endodontics. Show more

Keywords: Dental undergraduates, educational measurement, education, dental, hands-on demonstration, video recording

DOI: 10.3233/THC-231757

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3109-3117, 2024

Authors: Li, Chao | He, Gang | Mi, Zeyu | Huang, Daxin | Hu, Yulin

Article Type: Research Article

Abstract: BACKGROUND: Currently, surgery is the mainstay of the clinical treatment of vestibular migraine. OBJECTIVE: To investigate the clinical efficacy and safety of using transesophageal echocardiography-guided interventional closure of the patent foramen ovale (PFO) in the treatment of vestibular migraine. METHODS: The study included 52 patients with vestibular migraine who were admitted to our hospital between June 2019 and June 2021. All selected patients underwent a transesophageal echocardiography-guided interventional closure of the PFO and were followed up for one year after surgery. We observed the clinical efficacy and surgical success rate one year after …surgery and compared the improvement in clinical symptoms and perioperative safety at different time points. RESULTS: The overall remission rate and the surgical success rate for the 52 patients with vestibular migraine one year after surgery were 86.54% and 96.15%, respectively. Compared to the pre-surgery levels, there was a significant progressively decreasing trend in the scores on the Headache Impact Test-6 (HIT-6), Visual Analogue Scale (VAS), Migraine Disability Assessment (MIDAS) questionnaire, frequency of headaches, and duration of headaches in patients with vestibular migraine at 1, 3, and 6 months after surgery (P < 0.05). Among the 52 patients, one developed atrial fibrillation three hours after surgery, which then spontaneously converted to sinus rhythm, and none of the other patients had adverse outcomes such as hematoma at the puncture site during the perioperative period. CONCLUSION: Transesophageal echocardiography-guided interventional closure of the PFO for treating vestibular migraine significantly improved the symptoms of migraine in patients, with a high surgical success rate, significant clinical efficacy, and favorable safety. Show more

Keywords: Efficacy, interventional closure, patent foramen ovale, safety, transesophageal echocardiography, vestibular migraine

DOI: 10.3233/THC-231815

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3119-3125, 2024

Authors: Li, Bangju

Article Type: Research Article

Abstract: BACKGROUND: Standardised management of day surgery for haemorrhoids and achieving standardised nursing in the painless ward of colorectal surgery are important. OBJECTIVE: To explore the role of segmented nursing pathways in patients undergoing day surgery for anorectal procedures and to provide theoretical and practical guidance for day surgery nursing. METHODS: A total of 146 patients undergoing anorectal surgery in our day surgery ward between April 2023 and July 2023 were selected as the study participants, with 74 patients in the control group receiving routine nursing and 72 patients in the experimental group receiving …segmented nursing. The preoperative preparedness, preoperative anxiety, complication rate, discharge preparedness and nursing satisfaction were compared between the two groups. RESULTS: The experimental group had higher rates of admission before 8:30 am (77.78% vs 45.95%), awareness of the day surgery process (63.89% vs 24.32%), completion rate of preoperative preparation (81.94% vs 59.46%), satisfaction with preoperative preparation (94.44% vs 74.32%), discharge preparedness (112.42 ± 3.28 vs 95.82 ± 3.41) and nursing satisfaction (97.22% vs 70.27%) compared with the control group (P < 0.05). After the intervention, the self-rating anxiety scale score (43.14 ± 12.44 vs 52.51 ± 13.21) and the self-rating depression scale score (45.03 ± 11.37 vs 55.37 ± 10.14) were lower in the experimental group than in the control group (P < 0.05). CONCLUSION: Segmented nursing pathways can improve the preoperative preparedness of patients undergoing day surgery for anorectal procedures, alleviate patient anxiety, enhance discharge preparedness, improve the quality of nursing care and increase nursing satisfaction. Show more

Keywords: Segmented nursing, daytime anorectal surgery, preoperative preparedness, preoperative anxiety, discharge preparedness, nursing satisfaction

DOI: 10.3233/THC-231823

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3127-3137, 2024

Authors: Liu, Lei | Guo, Jing | Ding, Kun | Zhou, Guang-Nao | Feng, Yin-Ping | Zhang, Na-Na

Article Type: Research Article

Abstract: BACKGROUND: Globally, pulmonary tuberculosis is a significant public health and social problem. OBJECTIVE: We investigated the factors influencing the hospitalization cost of patients with pulmonary tuberculosis and grouped cases based on a decision tree model to provide a reference for enhancing the management of diagnosis-related groups (DRGs) of this disease. METHODS: The data on the first page of the medical records of patients with the primary diagnosis of pulmonary tuberculosis were extracted from the designated tuberculosis hospital. The influencing factors of hospitalization cost were determined using the Wilcoxon rank sum test and multiple …linear stepwise regression analysis, and the included cases were grouped using the chi-squared automated interaction test decision tree model, with these influential factors used as classification nodes. In addition, the included cases were grouped according to the ZJ-DRG grouping scheme piloted in Zhejiang Province, and the differences between the two grouping methods were compared. RESULTS: The length of hospital stay, respiratory failure, sex, and age were the determining factors of the hospitalization cost of patients with pulmonary tuberculosis, and these factors were incorporated into the decision tree model to form eight case combinations. The reduction in variance (RIV) using this grouping method was 60.60%, the heterogeneity between groups was high, the coefficients of variance ranged from 0.29 to 0.47, and the intra-group difference was small. The patients were also divided into four groups based on the ZJ-DRG grouping scheme piloted in Zhejiang Province. The RIV using this grouping method was 55.24, the differences between groups were acceptable, the coefficients of variance were 1.00, 0.61, 0.77, and 0.87, respectively, and the intra-group difference was significant. CONCLUSION: When the pulmonary tuberculosis cases were grouped according to the duration of hospital stay, respiratory failure, and age, the results were rather reasonable, providing a reference for DRG management and cost control of this disease. Show more

Keywords: Decision tree model, disease-related diagnostic grouping, hospitalization costs, influencing factors, pulmonary, tuberculosis

DOI: 10.3233/THC-231827

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3139-3152, 2024

Authors: Wang, Tong-Yue | Guo, Jin-Yuan | Zhou, Zhen | Li, Shi-Yi | Li, Shao-Bing | Xu, Shu-Lan

Article Type: Research Article

Abstract: BACKGROUND: The substitution of missing teeth with implants is a dependable and anticipated therapeutic approach. Despite numerous studies affirming long-term success rates, there exists a spectrum of potential biological and aesthetic complications. OBJECTIVE: The primary objective of this study was to assess patient responses subsequent to surgical interventions, with a specific emphasis on the utilization of xenogenic collagen matrix (XCM), both with and without the application of a stent secured over healing abutments, in the context of keratinized gingival mucosa augmentation. The principal aim was to evaluate and draw comparisons between the clinical outcomes resulting from these …two procedural approaches, with a particular focus on critical parameters encompassing post-operative complications, patient comfort, and the overall efficacy in achieving successful keratinized tissue augmentation. METHODS: Sixty patients were selected for this study. The patients were divided into three groups: A, B, and a control group, with each group comprising 20 participants. We used XCM in experimental group A, XCM covered with surgical stent in experimental group B, and free gingival graft (FGG) in the control group. After the surgical procedure, patients were required to complete a visual analogue scale (VAS) questionnaire for post-operative complications, and a quality of life (QOL) questionnaire on days 1, 3, and 7. RESULTS: Patients in the experimental groups A and B demonstrated markedly improved outcomes when compared with the control group. Assessments conducted on days 1, 3, and 7 demonstrated diminished levels of pain, bleeding, and swelling in both experimental groups, with experimental group B showing the least discomfort. The incorporation of XCM, either with or without stents, was associated with a reduction in analgesic consumption, underscoring its favorable influence on post-operative comfort, notwithstanding the exception of halitosis in experimental group B. CONCLUSION: Using XCM with or without a stent for keratinized tissue augmentation has better post-operative outcomes associated with reduced swelling, bleeding, and pain based on the QOL survey. This study provides data to support the clinical application of XCM and stents. Show more

Keywords: Collagen matrix, dental implants, keratinized mucosa, stents

DOI: 10.3233/THC-231863

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3153-3166, 2024

Authors: Jin, Ning | Zhan, Xiao

Article Type: Research Article

Abstract: BACKGROUND: Visualization of sports has a lot of potential for future development in data sports because of how quickly things are changing and how much sports depend on data. Presently, conventional systems fail to accurately address sports persons’ dynamic health data change with less error rate. Further, those systems are unable to distinguish players’ health data and their visualization in a precise manner. An excellent starting point for building fitness solutions based on computer vision technology is the data visualization technology that arose in the age of big data analytics. OBJECTIVE: This research presents a Big …Data Analytic assisted Computer Vision Model (BD-CVM) for effective sports persons healthcare data management with improved accuracy and precision. METHODS: The fitness and health of professional athletes are analyzed using information from a publicly available sports visualization dataset. Machine learning-assisted computer vision dynamic algorithm has been used for an effective image featuring and classification by categorizing sports videos through temporal and geographical data. RESULTS: The significance of big data’s great potential in screening data during a sporting event can be reasonably analyzed and processed effectively with less error rate. The proposed BD-CVM utilized an error analysis module which can be embedded in the design further to ensure the accuracy requirements in the data processing from sports videos. CONCLUSION: The research findings of this paper demonstrate that the strategy presented here can potentially improve accuracy and precision and optimize mean square error in sports data classification and visualization. Show more

Keywords: Big data, computer vision, data processing, sports visualization, recurrent neural network (RNN)

DOI: 10.3233/THC-231875

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3167-3187, 2024

Authors: Si, Tongguo | Guo, Yongfei | Yang, Mao

Article Type: Research Article

Abstract: BACKGROUND: The most effective clinical treatment for hepatocellular carcinoma (HCC) is surgery, but most patients are diagnosed when the disease has progressed. OBJECTIVE: To examine the long-term prognosis and clinical effectiveness of PD-L1 inhibitor-targeted therapy for patients suffering from HCC. METHODS: Ninety-six patients with advanced HCC who were admitted to our hospital between December 2019 and April 2022 were split into two groups based on the treatment plan after a retrospective analysis: 43 patients in the control group underwent sorafenib-based targeted therapy, while dulvalizumab was used to treat 53 patients in the observation …group. Observation indexes were used to assess the clinical effectiveness and long-term prognosis of HCC patients receiving targeted therapy with dulvalizumab, which included the disease control rate, tumor markers, immune function, survival, quality of survival, and the occurrence of unfavorable side effects such as thrombocytopenia, leukopenia, vomiting, and rash. RESULTS: The initial KPS scores, CEA, CA199, AFP, CD3+ , CD4+ , CD4+ /CD8+ , IgG, IgM, and IgA levels did not differ significantly between the two groups (P > 0.05). After treatment, the observation group showed a significantly higher disease control rate (92.45% vs. 74.42%) and improved KPS score, OS, PFS, CD3+ , CD4+ , CD4+ /CD8+ , IgG, IgM, and IgA levels compared to the control group. Additionally, the observation group exhibited significantly reduced CEA, CA199, and AFP levels, and a lower overall incidence of adverse reactions (16.98% vs. 51.16%) compared to the control group (P < 0.05). CONCLUSION: The clinical efficacy of dulvalizumab-targeted treatment of HCC among PD-L1 inhibitors is better, enhancing the disease’s ability to be controlled considerably lowering patients’ levels of tumor markers. This greatly boosts patients’ immune systems, extends their lives and improves the quality of their survival. The frequency of negative reactions is minimal and safe. Show more

Keywords: PD-L1 inhibitor, dulvalizumab, hepatocellular carcinoma, clinical efficacy, long-term prognosis

DOI: 10.3233/THC-231876

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3189-3200, 2024

Authors: Cheng, Weigen | Xu, Cheng | Wang, Fen | Ding, Yongmin | Tu, Jianglong | Xia, Linglin

Article Type: Research Article

Abstract: BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disordered breathing disorder, which can cause serious damage to multiple human systems. Although polysomnography (PSG) is the current gold standard for diagnosis, it is complex and expensive. Therefore, it is of great significance to find a simple, economical and rapid primary screening and diagnosis method to replace PSG for the diagnosis of OSA. OBJECTIVE: The purpose of this study is to propose a new method for the diagnosis and classification of OSA, which is used to automatically detect the duration of sleep apnea hypopnea events (AHE), so …as to estimate the ratio(S) of the total duration of all-night AHE to the total sleep time only based on the sound signal of sleep respiration, and to identify OSA. METHODS: We performed PSG tests on participants and extracted relevant sleep breathing sound signal data. This study is carried out in two stages. In the first stage, the relevant PSG report data of eligible subjects were recorded, the total duration of AHE in each subject’s data was extracted, and the S value was calculated to evaluate the severity of OSA. In the second stage, only the sleep breath sound signal data of the same batch of subjects were used for automatic detection, and the S value in the sleep breath sound signal was extracted, and the S value was compared with the PSG diagnosis results to calculate the accuracy of the experimental method. RESULTS: Among 225 subjects. Using PSG as the reference standard, the S value extracted from the PSG diagnostic data report can accurately diagnose OSA(accuracy rate 99.56%) and distinguish its severity (accuracy rate 95.11%). The accuracy of the S value detected in the sleep breathing sound signal in the diagnosis of severe OSA reached 100%. CONCLUSION: The results show that the experimental parameter S value is feasible in OSA diagnosis and classification. OSA can be identified and evaluated only by sleep breathing sounds. This method helps to simplify the diagnostic grading of traditional OSA and lays a foundation for the subsequent development of simple diagnostic grading equipment. Show more

Keywords: Obstructive sleep apnea, sound, Duration, diagnosis and classification

DOI: 10.3233/THC-231900

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3201-3215, 2024

Authors: Fujimura, Soichiro | Yamanaka, Yuma | Kan, Issei | Nagao, Masahiro | Otani, Katharina | Karagiozov, Kostadin | Fukudome, Koji | Ishibashi, Toshihiro | Takao, Hiroyuki | Motosuke, Masahiro | Yamamoto, Makoto | Murayama, Yuichi

Article Type: Research Article

Abstract: BACKGROUND: The current 3D-iFlow application can only measure the arrival time of contrast media through intensity values. If the flow rate could be estimated by 3D-iFlow, patient-specific hemodynamics could be determined within the scope of normal diagnostic management, eliminating the need for additional resources for blood flow rate estimation. OBJECTIVE: The aim of this study is to develop and validate a method for measuring the flow rate by data obtained from 3D-iFlow images – a prototype application in Four-dimensional digital subtraction angiography (4D-DSA). METHODS: Using phantom model and experimental circuit with circulating glycerin …solution, an equation for the relationship between contrast media intensity and flow rate was developed. Applying the equation to the aneurysm phantom models, the derived flow rate was evaluated. RESULTS: The average errors between the derived flow rate and setting flow rate became larger when the glycerin flow and the X-rays from the X-ray tube of the angiography system were parallel to each other or when the measurement point included overlaps with other contrast enhanced areas. CONCLUSION: Although the error increases dependent on the imaging direction and overlap of contrast enhanced area, the developed equation can estimate the flow rate using the image intensity value measured on 3D-iFlow based on 4D-DSA. Show more

Keywords: Aneurysm, four-dimensional digital subtraction angiography, hemodynamics

DOI: 10.3233/THC-231906

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3217-3230, 2024

Authors: Selvakumar, K. | Lokesh, S.

Article Type: Research Article

Abstract: BACKGROUND: Medical imaging techniques have improved to the point where security has become a basic requirement for all applications to ensure data security and data transmission over the internet. However, clinical images hold personal and sensitive data related to the patients and their disclosure has a negative impact on their right to privacy as well as legal ramifications for hospitals. OBJECTIVE: In this research, a novel deep learning-based key generation network (Deep-KEDI) is designed to produce the secure key used for decrypting and encrypting medical images. METHODS: Initially, medical images are pre-processed by …adding the speckle noise using discrete ripplet transform before encryption and are removed after decryption for more security. In the Deep-KEDI model, the zigzag generative adversarial network (ZZ-GAN) is used as the learning network to generate the secret key. RESULTS: The proposed ZZ-GAN is used for secure encryption by generating three different zigzag patterns (vertical, horizontal, diagonal) of encrypted images with its key. The zigzag cipher uses an XOR operation in both encryption and decryption using the proposed ZZ-GAN. Encrypting the original image requires a secret key generated during encryption. After identification, the encrypted image is decrypted using the generated key to reverse the encryption process. Finally, speckle noise is removed from the encrypted image in order to reconstruct the original image. CONCLUSION: According to the experiments, the Deep-KEDI model generates secret keys with an information entropy of 7.45 that is particularly suitable for securing medical images. Show more

Keywords: Medical image encryption, speckle noise, deep learning, zigzag pattern, generative adversarial network

DOI: 10.3233/THC-231927

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3231-3251, 2024

Authors: Oh, Sungyeon | Ko, Chang-Yong | Lee, Jaewon | Nekar, Daekook M. | Kang, Hyeyoon | Kim, Hansung | Yu, Jaeho

Article Type: Research Article

Abstract: BACKGROUND: Delayed onset muscle soreness (DOMS) is one of the most prevalent musculoskeletal symptoms in individuals engaged in strenuous exercise programs. OBJECTIVE: This study investigated the effects of wearable low-intensity continuous ultrasound on muscle biomechanical properties during DOMS. METHODS: Twenty volunteers were distributed into a wearable ultrasound stimulation group (WUG) (n = 10) and medical ultrasound stimulation group (MUG) (n = 10). All subjects performed wrist extensor muscle strength exercises to induce DOMS. At the site of pain, ultrasound of frequency 3 MHz …was applied for 1 h or 5 min in each subject of the WUG or MUG, respectively. Before and after ultrasound stimulation, muscle biomechanical properties (tone, stiffness, elasticity, stress relaxation time, and creep) and body temperature were measured, and pain was evaluated. RESULTS: A significant decrease was found in the tone, stiffness, stress relaxation time, and creep in both groups after ultrasound stimulation (all p < 0.05). A significant decrease in the pain and increases in temperature were observed in both groups (all p < 0.05). No significant differences were observed between the groups in most evaluations. CONCLUSION: The stiffness and pain caused by DOMS were alleviated using a wearable ultrasound stimulator. Furthermore, the effects of the wearable ultrasound stimulator were like those of a medical ultrasound stimulator. Show more

Keywords: Wearable low-intensity continuous ultrasound, muscle biomechanical properties, delayed onset muscle soreness, biomechanics, medical devices

DOI: 10.3233/THC-231947

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3253-3262, 2024

Authors: Zheng, Xuna | Wang, Xianglong | Zhu, Pin

Article Type: Research Article

Abstract: BACKGROUND: With the improvement of the level of science and technology, diagnosis and treatment technology of ophthalmology has continuously improved, especially with the rise of optical coherence tomography. Alternative methods have enabled clinicians to obtain more information and make greater breakthroughs in the occurrence and development of many ophthalmic diseases. OBJECTIVE: To investigate changes in retinal structure in the macular area of senile diabetic cataract patients undergoing cataract phacoemulsification. METHODS: This was a prospective cohort study. A total of 68 cataract patients (78 eyes) who voluntarily received phacoemulsification combined with intraocular lens implantation …in the Department of Ophthalmology of our hospital from December 2018 to December 2021 were selected. They were divided into A (diabetic) and B (non-diabetic) according to whether they were complicated with diabetes. There were 24 cases (28 eyes) in A and 44 cases (50 eyes) in B. Cataract patients were collected before and after surgery. Day, 1 week, and 1 month, data on the average thickness of the fovea retina and thickness of the retinal nerve fiber layer around the optic disc (average thickness, nasal thickness, topic side thickness, upper thickness, and lower thickness) were statistically analyzed analyze. RESULTS: The average retinal thickness of the macular fovea in Group A was found to be greater than that of Group B, however, there was no statistically significant difference between the two groups. At week one and week thirty, Group A’s layer of retinal nerve fibers surrounding the optic disc thickened; there was no discernible difference between the two groups. One week and one month following surgery, however, showed a one-week difference in upper thickness compared to preoperative days. There was no discernible change between the preoperative and 1-day times. CONCLUSION: Both diabetic cataract patients and simple age-related cataract patients will have different degrees of increased foveal retinal thickness after surgery. However, the foveal retinal thickness of patients with diabetes increases more. Show more

Keywords: Optical coherence tomography angiography, phacoemulsification, senile cataract, blood flow density, retinal thickness, foveal avascular area

DOI: 10.3233/THC-231966

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3263-3277, 2024

Authors: Yao, Ni | Hu, Hang | Han, Chuang | Nan, Jiaofen | Li, Yanting | Zhu, Fubao

Article Type: Research Article

Abstract: BACKGROUND: The incidence of kidney tumors is progressively increasing each year. The precision of segmentation for kidney tumors is crucial for diagnosis and treatment. OBJECTIVE: To enhance accuracy and reduce manual involvement, propose a deep learning-based method for the automatic segmentation of kidneys and kidney tumors in CT images. METHODS: The proposed method comprises two parts: object detection and segmentation. We first use a model to detect the position of the kidney, then narrow the segmentation range, and finally use an attentional recurrent residual convolutional network for segmentation. RESULTS: Our …model achieved a kidney dice score of 0.951 and a tumor dice score of 0.895 on the KiTS19 dataset. Experimental results show that our model significantly improves the accuracy of kidney and kidney tumor segmentation and outperforms other advanced methods. CONCLUSION: The proposed method provides an efficient and automatic solution for accurately segmenting kidneys and renal tumors on CT images. Additionally, this study can assist radiologists in assessing patients’ conditions and making informed treatment decisions. Show more

Keywords: Computed tomography, kidney segmentation, deep learning, medical image processing

DOI: 10.3233/THC-232009

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3279-3292, 2024

Authors: Lee, Soo Yong | Choi, Yu Sik | Kim, Min Hyuk | Chang, Woo Nam

Article Type: Research Article

Abstract: BACKGROUND: Despite the explosive increase in interest regarding Robot-Assisted Walking Training (RAWT) for stroke patients, very few studies have divided groups according to the severity levels of patients and conducted studies on the effects of RAWT. OBJECTIVE: The purpose of this study was to present a definite basis for physical therapy using the robot-assisted walking device through a more detailed comparison and analysis and to select the optimal target of RAWT. METHODS: This study was designed as a prospective and randomized controlled trial to investigate the effect of RAWT on balance, motor …function, and Activities of Daily Living (ADL) depending on severity levels in stroke patients. 100 participants were randomly divided into study and control groups in equal numbers. The study group was 49 and the control group was 47. One from the study group and three from the control group were eliminated. The study period is four weeks in total, and RAWT is performed five times a week for 40 minutes only for study group. During the same period, all group members had 30 minutes of Conventional Physiotherapy (CP) five times a week. RESULTS: The results of this study clearly confirmed that RAWT combined with CP produces more significant improvement in patients with stroke than the CP alone. And they indicated that RAWT had a more considerable effect in the poor or fair trunk control group for trunk balance and in the high fall risk group for balance. In motor function, RAWT showed its value in the severe and marked motor impairment group. The total or severe dependence group in ADL experienced more improvements for RAWT. CONCLUSION: This study can be concluded that the lower the level of physical functions, the more effective it responds to RAWT. As demonstrated in the results of this study, the potential of current robotic technology appears to be greatest at very low functional levels of stroke patients. Patients with low functional levels among stroke patients may benefit from robot rehabilitation. Show more

Keywords: ADL, balance, motor function, robot-assisted walking training, stroke

DOI: 10.3233/THC-232015

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3293-3307, 2024

Authors: von Hertzberg-Boelch, Sebastian Philipp | Rudert, Maximilian | Haker, Felix | Groll, Juergen | Ewald, Andrea

Article Type: Research Article

Abstract: BACKGROUND: The formation of biofilms, characterized by cell aggregation and extracellular polymeric substance (EPS) production, is a common feature of periprosthetic joint infections (PJI). OBJECTIVE: The current study aimed to investigate the development of biofilm features in vitro within less than 3 weeks by Staphylococcus aureus isolated from PJIs. METHODS: Biofilms were grown on sandblasted titanium discs, and fluorescence spectroscopy and microscopy were used to observe biofilm maturation for 21 days. RESULTS: DNA mass decreased initially, then increased from day 5 onwards, and decreased again after day 7. The …proportion of living to dead bacteria oscillated until day 7 and increased at day 10 for strain A and day 14 for strain B. EPS mass decreased initially and then continuously increased. Multilayer bacterial organization was observed at day 7. CONCLUSION: Cell aggregation occurred during the first week, followed by EPS production in the second week, and characteristic biofilm features were observed within 1 to 2 weeks. Show more

Keywords: Biofilm, periprosthetic, infection, staphylococcus aureus, treatment

DOI: 10.3233/THC-232041

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3309-3315, 2024

Authors: Liang, Dakai | Liang, Dandan | Liu, Jin | Zheng, Yiying | Huang, Dehua | Li, Zeliang | Huang, Xiaoyu | Chen, Jiyan

Article Type: Research Article

Abstract: BACKGROUND: Despite the considerable progress made in preventative methods, medication, and interventional therapies, it remains evident that cardiovascular events (CVEs) continue to be the primary cause of both death and morbidity among individuals diagnosed with coronary artery disease (CAD). OBJECTIVE: To compare the connection between lipoprotein a (Lp[a]), fibrinogen (Fib), and both parameters combined with all-cause mortality to detect their value as prognostic biomarkers. METHODS: This is a retrospective study. Patients diagnosed with CAD between January 2007 and December 2020 at the Guangdong Provincial People’s Hospital (China) were involved in the study. 43,367 patients …met the eligibility criteria. The Lp(a) and Fib levels were distributed into three tertile groups (low, medium, and high). All of the patients included in the study were followed up for all-cause mortality. Kaplan–Meier and Cox regression were performed to determine the relationship between Lp(a), Fib, and all-cause mortality. A concordance statistics model was developed to detect the impact of Fib and Lp(a) in terms of anticipating poor outcomes in patients with CAD. RESULTS: Throughout a median follow-up of 67.0 months, 6,883 (15.9%) patients died. Participants with high Lp(a) (above 27.60 mg/dL) levels had a significantly higher risk for all-cause mortality than individuals with low Lp(a) levels (below 11.13 mg/dL; adjusted hazard ratio [aHR] 1.219, 95% confidence interval [CI]: 1.141–1.304, p < 0.001). Similarly, patients with high Fib levels (above 4.32 g/L) had a significantly greater risk of developing all-cause mortality compared with those with reduced Fib levels (below 3.41 g/L; aHR 1.415, 95% CI: 1.323–1.514, p < 0.001). Patients with raised Lp(a) and Fib levels had the maximum risk for all-cause mortality (aHR 1.702; 95% CI: 1.558–1.859, p < 0.001). When considered together, Lp(a) and Fib caused a significant elevation of the concordance statistic by 0.009 (p < 0.05), suggesting a higher value for predicting mortality when combining the two indicators. CONCLUSION: High Lp(a) and Fib levels could be used as predictive biomarkers for all-cause mortality in individuals with CAD. The prediction accuracy for all-cause mortality improved after combining the two parameters. Show more

Keywords: Lipoprotein(a), fibrinogen, coronary artery disease, all-cause mortality

DOI: 10.3233/THC-240005

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3317-3328, 2024

Authors: Azmy, Mohamed Moustafa

Article Type: Research Article

Abstract: BACKGROUND: Melanoma is a malignant skin cancer that causes high mortality. Early detection of melanoma can save patients’ lives. The features of the skin lesion images can be extracted using computer techniques to differentiate early between melanoma and benign skin lesions. OBJECTIVE: A new model of empirical wavelet decomposition (EWD) based on tan hyperbolic modulated filter banks (THMFBs) (EWD-THMFBs) was used to obtain the features of skin lesion images by MATLAB software. METHODS: The EWD-THMFBs model was compared with the empirical short-time Fourier decomposition method based on THMFBs (ESTFD-THMFBs) and the empirical Fourier …decomposition method based on THMFBs (EFD-THMFBs). RESULTS: The accuracy rates obtained for EWD-THMFBs, ESTFD-THMFBs, and EFD-THMFBs models were 100%, 98.89%, and 83.33%, respectively. The area under the curve (AUC) was 1, 0.97, and 0.91, respectively. CONCLUSION: The EWD-THMFBs model performed best in extracting features from skin lesion images. This model can be programmed on a mobile to detect skin lesions in rural areas by a nurse before consulting a dermatologist. Show more

Keywords: EFD, ESTFD, EWD, THMFBs, CMFBs, BILSTM, RNN

DOI: 10.3233/THC-240020

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3329-3339, 2024

Authors: Nanda, Ashok Kumar | Thilagavathy, R. | Gayatri Devi, G.S.K. | Chaturvedi, Abhay | Jalda, Chaitra Sai | Inthiyaz, Syed

Article Type: Research Article

Abstract: BACKGROUND: Dengue fever is rapidly becoming Malaysia’s most pressing health concern, as the reported cases have nearly doubled over the past decade. Without efficacious antiviral medications, vector control remains the primary strategy for battling dengue, while the recently introduced tetravalent immunization is being evaluated. The most significant and dangerous risk increasing recently is vector-borne illnesses. These illnesses induce significant human sickness and are transmitted by blood-feeding arthropods such as fleas, parasites, and mosquitos. A thorough grasp of various factors is necessary to improve prediction accuracy and typically generate inaccurate and unstable predictions, as well as machine learning (ML) models, …weather-driven mechanisms, and numerical time series. OBJECTIVE: In this research, we propose a novel method for forecasting vector-borne disease risk using Radial Basis Function Networks (RBFNs) and the Darts Game Optimizer (DGO) algorithm. METHODS: The proposed approach entails training the RBFNs with historical disease data and enhancing their parameters with the DGO algorithm. To prepare the RBFNs, we used a massive dataset of vector-borne disease incidences, climate variables, and geographical data. The DGO algorithm proficiently searches the RBFN parameter space, fine-tuning the model’s architecture to increase forecast accuracy. RESULTS: RBFN-DGO provides a potential method for predicting vector-borne disease risk. This study advances predictive demonstrating in public health by shedding light on effectively controlling vector-borne diseases to protect human populations. We conducted extensive testing to evaluate the performance of the proposed method to standard optimization methods and alternative forecasting methods. CONCLUSION: According to the findings, the RBFN-DGO model beats others in terms of accuracy and robustness in predicting the likelihood of vector-borne illness occurrences. Show more

Keywords: Deep learning (DL), dengue fever, radial basis function networks, darts game optimizer, vector-borne disease

DOI: 10.3233/THC-240046

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3341-3361, 2024

Authors: Liao, Liangchuang | Zhang, Guoan | Hu, Mingwei

Article Type: Research Article

Abstract: BACKGROUND: Human gait pattern recognition and compliance control are key technologies for achieving high coordination and assistance between exoskeleton robots and human movements. OBJECTIVE: In order to improve the adaptability of exoskeleton robots to the human body, this paper proposes an exoskeleton compliance control strategy based on dual interaction torque phase separation control method. METHODS: A support phase swing phase split control strategy based on dual interaction torque is proposed. Utilize the interaction force of human joints and adopt a model-based method to control the support phase. By utilizing the interaction force of exoskeleton …joints and using a torque closed-loop method to control the swing phase, a multi-state control method of motion is achieved. RESULTS: A lower limb exoskeleton knee joint testing platform is built to verify the proposed human gait recognition The effectiveness of human-machine interaction force identification and human-machine coupling system compliance control technology. CONCLUSION: The proposed control method can effectively adjust joint torque, enabling the exoskeleton robot to maintain balance and stability during the entire walking phase. Show more

Keywords: Exoskeleton robots, compliance control, pattern recognition

DOI: 10.3233/THC-240050

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3363-3381, 2024

Authors: Wu, Jianlei | Guo, Jing | Luo, Yong | Sun, Jianfeng | Xu, Liangwei | Zhang, Jianxing | Liu, Yunfeng

Article Type: Research Article

Abstract: BACKGROUND: As a new intelligent polymer material, shape memory polymer (SMP) was a potential orthodontic appliance material. OBJECTIVE: This study aimed to investigate the thermodynamic responses of SMP under different loads via finite element analysis (FEA). METHODS: FEA specimens with a specification of 0.1 × 0.1 × 1 mm were designed. One end of the specimen was fixed, and the other was subjected to displacement load. Different loading, cooling, and heating rates were separately exerted on the specimen in its shape recovery process and used to observe …the responses of the SMP constitutive model. Furthermore, specimens with various tensile elongation and sectional areas were simulated and used to elucidate their effect on shape recovering force. RESULTS: The specimens obtained a similar stress of 0.5, 0.44, and 1.07 Mpa for different loading, cooling, and heating rates after a long time. The shape recovering force of specimen increased from 0.0102 to 0.0315 N when the elongation improved from 10% to 40% and to 0.0408 N when the sectional areas were expanded to 0.2 × 0.2 mm. CONCLUSION: The stiffness of SMP was small at a high temperature but large at a low temperature. The effects of the loading, cooling, and heating rates on SMP can be eliminated after a long time. Furthermore, it was possible to increase the recovering force by increasing the elongation or expanding the sectional area of the specimen. The force was quadratically dependent on the elongation ratio. Show more

Keywords: Shape memory polymer, constitutive model, thermodynamic response, finite element analysis

DOI: 10.3233/THC-240078

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3383-3391, 2024

Authors: Zhao, Mei | Zhou, Hengyu | Wang, Jing | Liu, Yongyue | Zhang, Xiaoqing

Article Type: Research Article

Abstract: BACKGROUND: The theory of Chinese medicine (TCM) constitution contributes to the optimisation of individualised healthcare programmes. However, at present, TCM constitution identification mainly relies on inefficient questionnaires with subjective bias. Efficient and accurate TCM constitution identification can play an important role in individualised medicine and healthcare. OBJECTIVE: Building an efficient model for identifying traditional Chinese medicine constitutions using objective tongue features and machine learning techniques. METHODS: The DS01-A device was applied to collect tongue images and extract features. We trained and evaluated five machine learning models: Support Vector Machine (SVM), Decision Tree (DT), …Random Forest (RF), LightGBM (LGBM), and CatBoost (CB). Among these, we selected the model with the best performance as the base classifier for constructing our heterogeneous ensemble learning model. Using various performance metrics, including classification accuracy, precision, recall, F1 score, and area under curve (AUC), to comprehensively evaluate model performance. RESULTS: A total of 1149 tongue images were obtained and 45 features were extracted, forming dataset 1. RF, LGBM, and CB were selected as the base learners for the RLC-Stacking. On dataset 1, RLC-Stacking1 achieved an accuracy of 0.8122, outperforming individual classifiers. After feature selection, the classification accuracy of RLC-Stacking2 improved to 0.8287, an improvement of 0.00165 compared to RLC-Stacking1. RLC-Stacking2 achieved an accuracy exceeding 0.85 for identifying each TCM constitution type, indicating excellent identification performance. CONCLUSION: The study provides a reliable method for the accurate and rapid identification of TCM constitutions and can assist clinicians in tailoring individualized medical treatments based on personal constitution types and guide daily health care. The information extracted from tongue images serves as an effective marker for objective TCM constitution identification. Show more

Keywords: Traditional Chinese Medicine Constitution, constitution identification, tongue features, machine learning, ensemble learning

DOI: 10.3233/THC-240128

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3393-3408, 2024

Authors: Chen, Ruijuan | Wang, Rui | Fei, Jieying | Huang, Lengjie | Bi, Xun | Wang, Jinhai

Article Type: Research Article

Abstract: BACKGROUND: Mental fatigue has become a non-negligible health problem in modern life, as well as one of the important causes of social transportation, production and life accidents. OBJECTIVE: Fatigue detection based on traditional machine learning requires manual and tedious feature extraction and feature selection engineering, which is inefficient, poor in real-time, and the recognition accuracy needs to be improved. In order to recognize daily mental fatigue level more accurately and in real time, this paper proposes a mental fatigue recognition model based on 1D Convolutional Neural Network (1D-CNN), which inputs 1D raw ECG sequences of 5 s duration …into the model, and can directly output the predicted fatigue level labels. METHODS: The fatigue dataset was constructed by collecting the ECG signals of 22 subjects at three time periods: 9:00–11:00 a.m., 14:00–16:00 p.m., and 19:00–21:00 p.m., and then inputted into the 19-layer 1D-CNN model constructed in the present study for the classification of mental fatigue in three grades. RESULTS: The results showed that the model was able to recognize the fatigue levels effectively, and its accuracy, precision, recall, and F1 score reached 98.44%, 98.47%, 98.41%, and 98.44%, respectively. CONCLUSION: This study further improves the accuracy and real-time performance of recognizing multi-level mental fatigue based on electrocardiography, and provides theoretical support for real-time fatigue monitoring in daily life. Show more

Keywords: Mental fatigue, short-time electrocardiographic sequence, deep learning, 1D convolutional neural network

DOI: 10.3233/THC-240129

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3409-3422, 2024

Authors: Ji, Jiajia | Zhu, Min | Bao, Mengqian | Xu, Lamei | Yuan, Hui

Article Type: Research Article

Abstract: BACKGROUND: To enhance the self-management ability of elderly diabetes mellitus (DM) patients, priority should be given to the accurate evaluation of their current self-management ability, and then provide corresponding guidance. OBJECTIVE: To explore the application value of Diabetes Self-Management Behaviors among Older Koreans (DSMB-O) in self-management of elderly patients with type 2 diabetes mellitus (T2DM). METHODS: Using convenient sampling, this study retrospectively collected the clinical data of 215 elderly patients with T2DM who were admitted to our hospital from June 2020 to June 2022. Enrolled patients were divided into an effective-control group (n …= 80) and an ineffective-control group (n = 135) based on whether the glycated hemoglobin (HbA1C) was < 7.5% for further comparison of the collected data. RESULTS: There were statistically significant differences in the comparison of the proportion of diabetes mellitus (DM) course (χ 2 = 26.000, P < 0.001), DSMB-O score (17.67 ± 4.07 VS 14.67 ± 4.70 points, t = 4.582, P < 0.001), and Summary Diabetes Self Care Activity (SDSCA) score (43.16 ± 11.17 VS 37.58 ± 12.47 points, t = 5.492, P < 0.001) between the two groups. The total score of DSMB-O was negatively correlated with both HbA1c (r = - 0.281, P < 0.001) and complications (r = - 0.193, P = 0.004); moreover, the total score of SDSCA was also negatively correlated with both HbA1c (r = - 0.234, P < 0.001) and complications (r = - 0.153, P = 0.025). Among various dimensions of DSMB-O, active exercise (OR = 0.699, 95%CI: 0.541 ∼ 0.902) and blood glucose monitoring (OR = 0.603, 95%CI: 0.431 ∼ 0.817) were protective factors for T2DM patients with HbA1c levels < 7.5%. The area under the curve (AUC) of SDSCA score and DSMB-O score predicting self-management level in elderly T2DM patients was 0.643 (95%CI: 0.611 ∼ 0.756) and 0.716 (95%CI: 0.689∼ 0.774), respectively. CONCLUSION: DSMB-O exhibits a higher accuracy in predicting the self-management level of elderly patients with T2DM than that of SDSCA. Regular exercise, medication, blood glucose monitoring, and reducing the risk of complications are all intimately associated with the control of blood glucose. Show more

Keywords: Elderly, Type 2 diabetes, self-management behavior, influencing factors, health effects

DOI: 10.3233/THC-240138

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3423-3432, 2024

Authors: Auer, Simon | Süß, Franz | Dendorfer, Sebastian

Article Type: Research Article

Abstract: BACKGROUND: This study presents a comprehensive comparison between a marker-based motion capture system (MMC) and a video-based motion capture system (VMC) in the context of kinematic analysis using musculoskeletal models. OBJECTIVE: Focusing on joint angles, the study aimed to evaluate the accuracy of VMC as a viable alternative for biomechanical research. METHODS: Eighteen healthy subjects performed isolated movements with 17 joint degrees of freedom, and their kinematic data were collected using both an MMC and a VMC setup. The kinematic data were entered into the AnyBody Modelling System, which enables the calculation of …joint angles. The mean absolute error (MAE) was calculated to quantify the deviations between the two systems. RESULTS: The results showed good agreement between VMC and MMC at several joint angles. In particular, the shoulder, hip and knee joints showed small deviations in kinematics with MAE values of 4.8∘ , 6.8∘ and 3.5∘ , respectively. However, the study revealed problems in tracking hand and elbow movements, resulting in higher MAE values of 13.7∘ and 27.7∘ . Deviations were also higher for head and thoracic movements. CONCLUSION: Overall, VMC showed promising results for lower body and shoulder kinematics. However, the tracking of the wrist and pelvis still needs to be refined. The research results provide a basis for further investigations that promote the fusion of VMC and musculoskeletal models. Show more

Keywords: Biomechanics, range of motion, musculoskeletal system, optical motion capture

DOI: 10.3233/THC-240202

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3433-3442, 2024

Authors: Njezic, Sasa | Zivic, Fatima | Savic, Slobodan | Petrovic, Nenad | Pesic, Zivana Jovanovic | Stefanovic, Anja | Milenkovic, Strahinja | Grujovic, Nenad

Article Type: Research Article

Abstract: BACKGROUND: The biological properties of silicone elastomers such as polydimethylsiloxane (PDMS) have widespread use in biomedicine for soft tissue implants, contact lenses, soft robots, and many other small medical devices, due to its exceptional biocompatibility. Additive manufacturing of soft materials still has significant challenges even with major advancements that have occurred in development of these technologies for customized medical devices and tissue engineering. OBJECTIVE: The aim of this study was to develop a mathematical model of tangential stress in relation to shear stress, shear rate, 3D printing pressure and velocity, for non-Newtonian gels and fluids that …are used as materials for 3D printing. METHOD: This study used FENE (finitely extensible nonlinear elastic model) model, for non-Newtonian gels and fluids to define the dependences between tangential stress, velocity, and pressure, considering viscosity, shear stress and shear rates as governing factors in soft materials friction and adhesion. Experimental samples were fabricated as showcases, by SLA and FDM 3D printing technologies: elastic polymer samples with properties resembling elastic properties of PDMS and thermoplastic polyurethane (TPU) samples. Experimental 3D printing parameters were used in the developed analytical solution to analyse the relationships between governing influential factors (tangential stress, printing pressure, printing speed, shear rate and friction coefficient). Maple software was used for numerical modelling. RESULTS: Analytical model applied on a printed elastic polymer, at low shear rates, exhibited numerical values of tangential stress of 0.208–0.216 N m - 2 at printing velocities of 0.9 to 1.2 mm s - 1 , while the coefficient of friction was as low as 0.09–0.16. These values were in accordance with experimental data in literature. Printing pressure did not significantly influence tangential stress, whereas it was slightly influenced by shear rate changes. Friction coefficient linearly increased with tangential stress. CONCLUSION: Simple analytical model of friction for elastic polymer in SLA 3D printing showed good correspondence with experimental literature data for low shear rates, thus indicating possibility to use it for prediction of printing parameters towards desired dimensional accuracy of printed objects. Further development of this analytical model should enable other shear rate regimes, as well as additional soft materials and printing parameters. Show more

Keywords: Soft materials, tangential stress model, shear rate, friction coefficient, FENE (finitely extensible nonlinear elastic model), 3D printing

DOI: 10.3233/THC-240209

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3443-3462, 2024

Authors: Miura, Takanori | Takahashi, Tsuneari | Ae, Ryusuke | Takeshita, Katsushi | Miyakoshi, Naohisa

Article Type: Research Article

Abstract: BACKGROUND: A gradually reducing radius (GRADIUS) design implant can facilitate a smooth transition from stability through full range of motion in total knee arthroplasty (TKA). Nonetheless, patient-specific factors associated with good knee flexion remain unclear. OBJECTIVE: This study aimed to determine the factors associated with good knee flexion after cruciate-retaining TKA with a GRADIUS prosthesis in an Asian population. METHODS: This retrospective study included 135 patients that were stratified according to postoperative knee flexion angle (KFA) into Group F (⩾ 120∘ ; 85 patients [63.2%]) and Group NF (< …120∘ ; 50 patients [36.8%]). RESULTS: Patients in Group F were taller and had a lower body mass index (BMI) smaller preoperative hipkneeankle angle and better preoperative extension and flexion angle than Group NF patients. The multivariable analysis revealed that patients’ height (odds ratio [OR]: 1.07, P = 0.0150), BMI (OR: 0.85, P = 0.0049), and preoperative flexion angle (OR: 1.06, P = 0.0008) predicted good KFA. The ROC curve analysis showed that the cutoff values of a good KFA were height 155.1 cm, BMI 22.1 kg/m2 , and preoperative KFA 120∘ . CONCLUSIONS: Patient height, BMI, and preoperative KFA were independent factors affecting good postoperative KFA in patients of Asian descent who underwent cruciate-retaining TKA with a GRADIUS design. Show more

Keywords: Total knee arthroplasty, posterior cruciate ligament retaining, knee flexion, body mass index, height, knee implant

DOI: 10.3233/THC-240212

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3463-3471, 2024

Authors: Sun, Yuyan | Li, Qian

Article Type: Research Article

Abstract: BACKGROUND: Dental extraction or tooth extraction is a common clinical radical treatment surgery. OBJECTIVE: To explore the efficacy and safety of remimazolam in tooth extraction surgery in a randomized, single-blind, multi-center clinical trial. METHOD: Patients who underwent tooth extraction surgery at Jinan Stomatological Hospital from April 2022 to March 2023 were selected as the research subjects, and they were divided into a control group and an observation group using the random arrangement table method. The patients in the control group were anesthetized with midazolam, and the patients in the observation group were anesthetized …with remimazolam. Collect the general demographic data of the patients, use the propensity score matching method (PSM) to balance the baseline data of the two groups, and use t -test, chi-square test, and analysis of variance to compare the hemodynamics, anesthesia maintenance period indicators, and alertness/Sedation scores and occurrence of adverse reactions. RESULT: PSM matching was performed according to a 1:1 ratio, and 40 patients were included in the observation and control groups. There was no statistical significance in the baseline data of the two groups. Compared with T0 , the hemodynamic indexes of both groups of patients increased at T1 , T2 , T3 , T4 , and T5 (P < 0.05), but the indexes at T0 and T2 were the same. The same (P > 0.05), and the indicators of the observation group at T1 , T3 , T4 , and T5 were higher than those of the control group (P < 0.05); the administration time of the two groups of patients was the same (P > 0.05), but the observation group The recovery time and onset of effect were shorter than those in the control group (P < 0.05); at T0 , the clinical behavior scores of the two groups of patients were the same (P > 0.05), and at T1 , the scores of the observation group were lower than those of the control group (P < 0.05); at T0 and T1 , the alertness/sedation scores of the patients in the observation group were lower than those in the control group, but at T2 , the scores of the patients in the observation group were higher than those in the control group (P < 0.05); the total clinical adverse reactions of the patients in the observation group were The incidence rate (5.00%) was lower than that of the control group (30.00%) (P < 0.05). CONCLUSION: The use of remimazolam during tooth extraction can stabilize the patient’s hemodynamics, shorten the recovery and onset time, stabilize the patient’s behavior, have an excellent soothing effect, have fewer adverse reactions, and be safer, so it is worthy of use. Show more

Keywords: Remazolam, tooth extraction, sedation, safety, single-masked, multi-center

DOI: 10.3233/THC-240237

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3473-3484, 2024

Authors: Zhao, Tingting | Lv, Tian

Article Type: Research Article

Abstract: BACKGROUND: A significant proportion of interstitial lung disease (ILD) patients experience two or more comorbidities, leading to an increasing burden of disease, frequent hospitalizations, and premature death. OBJECTIVE: To investigate the causal relationship between serum metabolites and ILD in humans using Mendelian randomization. METHODS: Genetic loci closely related to human serum metabolites were selected as instrumental variables (IVs), with the inverse-variance weighted method (IVW) as the primary method and the weighted median method (WME) and MR-Egger regression as auxiliary methods for Mendelian randomization analysis of the data. Meanwhile, the causal relationship between human …serum metabolites and ILD was evaluated by OR, along with the assessment of the stability and reliability of the results via 3 methods, i.e., heterogeneity testing, gene pleiotropy testing, and sensitivity analysis. RESULTS: 8,234 single nucleotide polymorphism (SNP) loci were included as IV, among which 23 SNP loci were selected as IV. Specifically, IVW estimated that the risk of ILD in the anti-Jo-1 antibody-positive population was 4.122 times higher than that in the negative population (95% CI: 2.311–5.954, P < 0.001). IVW also supported a causal effect between anti-SSA antibody positivity and ILD (OR = 2.781, 95% CI: 1.413–4.350, P < 0.001). At the same time, MR-Egger fitted a linear relationship between erythrocyte sedimentation rate (ESR) (95% CI: 1.257–5.894, P = 0.002), C-reactive protein (CRP) (95% CI: 2.433–6.935, P = 0.001), and ILD. Additionally, heterogeneity testing with IVW and MR-Egger regression indicated no heterogeneity, and MR-Egger regression intercept and MR-PRESSO testing suggested minimal influence of gene pleiotropy on the results, without non-specific SNPs identified in the leave-one-out analysis. CONCLUSION: A positive causal relationship may exist between anti-Jo-1 antibody positivity, anti-SSA antibody positivity, elevated ESR, elevated CRP, and ILD. Show more

Keywords: Serum metabolites, interstitial lung disease, mendelian randomization, causal relationship

DOI: 10.3233/THC-240285

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3485-3496, 2024

Authors: Weber, Maximilian | Lenz, Maximilian | Wassenberg, Lena | Perera, Akanksha | Eysel, Peer | Scheyerer, Max Joseph

Article Type: Research Article

Abstract: BACKGROUND: Wound complications after lumbar spine surgery may result in prolonged hospitalization and increased morbidity. Early identification can trigger appropriate management. OBJECTIVE: The aim of this study was to investigate the efficacy of infrared-based wound assessment (FLIR) after lumbar spine surgery in the context of identifying wound healing disorders. METHODS: 62 individuals who underwent lumbar spine surgery were included. The immediate postoperative course was studied, and the patient’s sex, age, body mass index (BMI), heart rate, blood pressure, body temperature, numeric rating scale for pain (NRS), C-reactive protein (CRP), leukocyte, and hemoglobin levels …were noted and compared to thermographic measurement of local surface temperature in the wound area. RESULTS: Measurement of local surface temperature in the wound area showed a consistent temperature distribution while it was uneven in case of wound healing disorder. In this instance, the region of the wound where the wound healing disorder occured had a lower temperature than the surrounding tissue (p > 0.05). CONCLUSIONS: This study demonstrates the ongoing importance of clinical wound assessment for early detection of complications. While laboratory parameter measurement is crucial, FLIR may serve as a cost-effective supplemental tool in clinical wound evaluation. Patient safety risks appear minimal since local ST is measured without touch. Show more

Keywords: Infrared thermography, surgical site infection, spine surgery, skin, temperature

DOI: 10.3233/THC-240344

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3497-3504, 2024

Authors: Vater, Adrian Matthias | Lamby, Philipp | Moncher, Johanna | Schmidt, Karsten | Jordan, Martin | Jakubietz, Michael | Meffert, Rainer | Jakubietz, Rafael

Article Type: Research Article

Abstract: BACKGROUND: Coverage of soft tissue defects following surgery at the trochanteric area is challenging. Revision surgery in case of compromised wound healing may lead to soft tissue defects requiring reconstruction with pedicled or free flaps. Previous access to the hip joint may jeopardize neurovascular structures relevant to the flap. OBJECTIVE: In this study, we evaluated if the use of a pedicled anterior lateral thigh (ALT) flap is a valuable option for soft tissue reconstruction. METHODS: In this retrospective study, seven patients were included. Defect etiology was tumor resection in one case, screw osteosynthesis …in another case and total hip arthroplasty in three cases. All patients underwent reconstruction by proximal pedicled anterior lateral thigh (ALT) flap. RESULTS: Pedicled ALT flap was a safe procedure in all cases. One patient showed delayed wound healing with need for additional surgery. No further complications were observed. CONCLUSIONS: Pedicled ALT flap transfer represents a reliable option for soft tissue coverage in the trochanteric area after primary surgery such as hip arthroplasty, osteosynthesis or tumor resection. Show more

Keywords: ALT flap, trochanteric defect, reconstructive surgery, revision surgery, hip arthroplasty, plastic surgery

DOI: 10.3233/THC-240381

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3505-3512, 2024

Authors: Wu, Jing | Yang, Xiaoyan | Liu, Yun | Xi, Fang | Lei, Ping

Article Type: Research Article

Abstract: BACKGROUND: Deep vein thrombosis (DVT) of the lower limbs is a venous reflux disorder caused by abnormal coagulation of blood components, primarily characterised by swelling and pain in the lower limbs. Key risk factors include prolonged immobility due to bed rest, pregnancy, postpartum or postoperative states, traumas, malignant tumours and long-term contraceptive use. OBJECTIVE: To investigate the application of real-time shear wave elastography (SWE) in diagnosing lower-limb deep vein thrombosis (DVT). METHODS: A total of 91 patients with DVT were selected and divided into three groups: acute phase (n = …29), subacute phase (n = 30) and chronic phase (n = 32). The Young’s modulus of the patients was measured using real-time SWE. The diagnostic efficacy of Young’s modulus was evaluated by ROC curves. The hardness differences in Young’s modulus across different parts of the same thrombus (head, body and tail) were measured using SWE. RESULTS: Before treatment, significant differences were observed in Young’s modulus among patients with DVT (P < 0.001). Following anticoagulant therapy, catheter-directed thrombolysis and systemic thrombolysis, significant differences were noted in Young’s modulus among patients at the same stage but receiving different treatments (acute phase: P = 0.003; subacute phase: P = 0.014; chronic phase: P = 0.004). Catheter-directed thrombolysis had greater efficacy than anticoagulant therapy. The area under the curve for SWE in staging patients was 0.917, with a sensitivity of 92.36% and specificity of 93.81%. Significant differences in Young’s modulus were found between the thrombus head and thrombus body and tail but not between the thrombus body and thrombus tail. CONCLUSION: Measurement of Young’s modulus using SWE can serve as an auxiliary means of evaluating staging, predicting pulmonary embolism and selecting treatment in patients with DVT. Show more

Keywords: Real-time shear wave elastography, lower-limb deep vein thrombosis, diagnosis, treatment plan

DOI: 10.3233/THC-240386

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3513-3523, 2024

Authors: Begic, Zijo | Djukic, Milan | Begic, Edin | Aziri, Buena | Gojak, Refet | Mladenovic, Zorica | Begic, Nedim | Badnjevic, Almir

Article Type: Research Article

Abstract: BACKGROUND: Left atrial stiffness index (LASI), defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e’) to peak atrial strain, reflects reduced left atrial (LA) compliance and represents an emerging marker that can be used for noninvasive measurement of fibrosis of LA in patients with mitral regurgitation (MR). OBJECTIVE: To investigate the impact of chronic MR in children and adolescents on the remodeling and function of the LA, quantified through strain parameters and diastolic function. METHODS: The study included fifty patients (n = …50) diagnosed with primary and secondary chronic MR lasting at least 5 years. The echocardiographic recordings were performed by a third party, two cardiologists actively engaged in echocardiography on a daily basis. RESULTS: Older participants had higher values of the LASI (r = 0.467, p = 0.001). Participants with higher LASI values had a smaller LA reservoir (r = 0.784, p = 0.0001) and smaller LA conduit values (r = - 0.374, p = 0.00). Participants with higher LASI values had a larger LA diameter (r = 0.444, p -value= 0.001) and higher average E/e’ ratio (r = 0.718, p = 0.0001). There was a significant difference (p = 0.04) in the LASI among participants based on the MR jet area (< 20.85% ⩾ 20.85%), LASI was higher in participants with an area greater than 20.85%. Differences in other parameters such as LA reservoir, LA conduit, LA contractile were not statistically significant. CONCLUSION: Increased LA stiffness is associated with diminished atrial compliance and reservoir capacity, and LASI has a potential to as an early marker for assessing disease severity and progression in pediatric MR. Show more

Keywords: Left atrium, mitral regurgitation, echocardiography, fibrosis

DOI: 10.3233/THC-240402

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3525-3533, 2024

Authors: Thomas, Anvin | Jose, Rejath | Syed, Faiz | Wei, Ong Chi | Toma, Milan

Article Type: Research Article

Abstract: BACKGROUND: Cardiovascular diseases remain a leading cause of global morbidity and mortality, with heart attacks and strokes representing significant health challenges. The accurate, early diagnosis and management of these conditions are paramount in improving patient outcomes. The specific disease, cardiovascular occlusions, has been chosen for the study due to the significant impact it has on public health. Cardiovascular diseases are a leading cause of mortality globally, and occlusions, which are blockages in the blood vessels, are a critical factor contributing to these conditions. OBJECTIVE: By focusing on cardiovascular occlusions, the study aims to leverage machine learning …to improve the prediction and management of these events, potentially helping to reduce the incidence of heart attacks, strokes, and other related health issues. The use of machine learning in this context offers the promise of developing more accurate and timely interventions, thus improving patient outcomes. METHODS: We analyze diverse datasets to assess the efficacy of various machine learning algorithms in predicting heart attacks and strokes, comparing their performance to pinpoint the most accurate and reliable models. Additionally, we classify individuals by their predicted risk levels and examine key features that correlate with the incidence of cardiovascular events. The PyCaret machine learning library’s Classification Module was key in developing predictive models which were evaluated with stratified cross-validation for reliable performance estimates. RESULTS: Our findings suggest that machine learning can significantly improve the prediction accuracy for heart attacks and strokes, facilitating earlier and more precise interventions. We also discuss the integration of machine learning models into clinical practice, addressing potential challenges and the need for healthcare professionals to interpret and apply these predictions effectively. CONCLUSIONS: The use of machine learning for risk stratification and the identification of modifiable factors may empower preemptive approaches to cardiovascular care, ultimately aiming to reduce the occurrence of life-threatening events and improve long-term patient health trajectories. Show more

Keywords: Machine learning, cardiovascular diseases, heart attack, stroke, predictive modeling, risk factors, clinical decision-making

DOI: 10.3233/THC-240582

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3535-3556, 2024

Authors: Zheng, Yanhua | Ren, Ruilin | Zuo, Teng | Chen, Xuan | Li, Hanxuan | Xie, Cheng | Weng, Meiling | He, Chunxiao | Xu, Min | Wang, Lili | Li, Nainong | Li, Xiaofan

Article Type: Research Article

Abstract: BACKGROUND: Diagnostic challenges exist for CMV pneumonia in post-hematopoietic stem cell transplantation (post-HSCT) patients, despite early-phase radiographic changes. OBJECTIVE: The study aims to employ a deep learning model distinguishing CMV pneumonia from COVID-19 pneumonia, community-acquired pneumonia, and normal lungs post-HSCT. METHODS: Initially, 6 neural network models were pre-trained with COVID-19 pneumonia, community-acquired pneumonia, and normal lung CT images from Kaggle’s COVID multiclass dataset (Dataset A), then Dataset A was combined with the CMV pneumonia images from our center, forming Dataset B. We use a few-shot transfer learning strategy to fine-tune the pre-trained models and evaluate …model performance in Dataset B. RESULTS: 34 cases of CMV pneumonia were found between January 2018 and December 2022 post-HSCT. Dataset A contained 1681 images of each subgroup from Kaggle. Combined with Dataset A, Dataset B was initially formed by 98 images of CMV pneumonia and normal lung. The optimal model (Xception) achieved an accuracy of 0.9034. Precision, recall, and F1-score all reached 0.9091, with an AUC of 0.9668 in the test set of Dataset B. CONCLUSIONS: This framework demonstrates the deep learning model’s ability to distinguish rare pneumonia types utilizing a small volume of CT images, facilitating early detection of CMV pneumonia post-HSCT. Show more

Keywords: Cytomegalovirus pneumonia, hematopoietic stem cell transplantation, imaging diagnosis, deep learning, transfer learning

DOI: 10.3233/THC-240597

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3557-3568, 2024

Authors: Sawan, Nozha | Ben Gassem, Afnan

Article Type: Research Article

Abstract: BACKGROUND: Esthetic orthodontic wires are preferred for their ease to fit in with natural tooth color, but their susceptibility to staining in the oral environment poses a concern. Various Coatings such as Teflon and Epoxy aim to enhance appearance and biocompatibility but may still result in discoloration. Understanding the color stability of these wires under different staining conditions is crucial for a better and enhanced treatment plan. OBJECTIVE: This study intended to assess the color stability of esthetic orthodontic wires under various staining solutions that are often used in daily life. METHOD: …Color changes of Teflon and Epoxy-coated esthetic orthodontic wires were meticulously measured at baseline, 7, 14, and 21-day intervals utilizing the precise CIE Lab* color measurement system. A total of thirty-two samples of wires from each brand were prepared (n = 8/group) and immersed in staining solutions (coffee, tea, cola, and saffron). The color change within and between the groups was statistically evaluated (p < 0.05). RESULTS: Significant variations in color stability were observed across different staining solutions. Saffron emerged as the most potent agent, inducing the most pronounced color changes, whereas cola demonstrated the least impact. Furthermore, Epoxy-coated wires consistently exhibited superior color stability compared to their Teflon-coated counterparts across all staining solutions and time intervals. CONCLUSION: This study underlines the significance for orthodontists to consider staining agents’ possible effects on orthodontic wires into account when selecting the orthodontic wires. The findings suggest that Epoxy-coated wires hold promise in mitigating discoloration issues during orthodontic therapy. Show more

Keywords: Esthetic orthodontic wire, color change, tea, coffee, cola, saffron

DOI: 10.3233/THC-240638

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3569-3578, 2024

Authors: Chen, Han | Yang, Qiaorui | Yu, Fangjie | Shen, Yunxiang | Xia, Hong | Yang, Mengfan | Yin, Riping | Shen, Yiwei | Fan, Junfen | Fan, Zhenliang

Article Type: Research Article

Abstract: BACKGROUND: It is still unknown whether unsaturated fatty acids (UFA) have the same effect on preventing cognitive impairment in chronic kidney disease (CKD) patients as in healthy people. OBJECTIVE: To investigate the protective effect of dietary UFA intake and proportion on cognitive impairment in patients with CKD. METHODS: We extracted data from the National Health and Nutrition Examination Survey (NHANES, 2011–2014) on participants with a previous diagnosis of CKD and at least one complete cognitive assessment (Consortium to Establish a Registry for Alzheimer’s Disease test, Animal Fluency Test and Digit Symbol Substitution Test). …We used the lower quartile of the total scores of these three tests as the cut-off point, and divided the participants into two groups of normal cognitive performance and low cognitive performance to extract participants’ intake of various UFA from the NHANES dietary module. The data were weighted using weighting parameters included in NHANES, and logistics regression and restricted cubic spline were used to analyze the protective effect of UFA intake on cognitive impairment in CKD participants. RESULTS: We found that participants with low cognitive performance all had significantly lower intakes of total monounsaturated fatty acids, total polyunsaturated fatty acids, ω -3 UFA, ω -6 UFA and ω -9 UFA than participants with normal cognitive performance (p < 0.05), and the ω -6 UFA and ω -9 UFA had the most significant protective effects on cognitive impairment of participants. We also discovered that oleic and linoleic acids play important roles in protecting against cognitive impairment in CKD participants. The protective effect of oleic acid, but not linoleic acid, on cognitive impairment showed a nonlinear relationship. The changes in the proportion of monounsaturated fatty acids to polyunsaturated fatty acids, ω -6 UFA to ω -3 UFA, and oleic acid to linoleic acid did not affect the risk of cognitive impairment in CKD participants. CONCLUSIONS: UFA can reduce the risk of cognitive impairment in CKD patients, especially oleic acid and linoleic acid have a more obvious protective effect on cognitive impairment in patients with CKD. Among them, the protective effect of linoleic acid on cognitive impairment was continuously enhanced with the increase of intake, indicating that linoleic acid may be the most important UFA to reduce cognitive impairment in CKD patients. Show more

Keywords: Unsaturated fatty acids, cognitive impairment, chronic kidney disease, oleic acid, linoleic acid

DOI: 10.3233/THC-240671

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3579-3593, 2024

Authors: Dou, Fengjiao | Tian, Qingxiu | Zhang, Ran

Article Type: Research Article

Abstract: BACKGROUND: Gestational diabetes, a frequent pregnancy complication marked by elevated maternal blood glucose, can cause serious adverse effects for both mother and fetus, including increased amniotic fluid and risks of fetal asphyxia, hypoxia, and premature birth. OBJECTIVE: To construct a predictive model to analyze the risk factors for macrosomia in deliveries with gestational diabetes. METHODS: From January 2021 to February 2023, 362 pregnant women with gestational diabetes were selected for the study. They were followed up until delivery. Based on newborn birth weight, the participants were divided into the macrosomia group (birth weight ⩾ …4000 g) and the non-macrosomia group (birth weight < 4000 g). The data of the two groups of pregnant women were compared. ROC curves were plotted to analyze the predictive value of multiple factors for the delivery of macrosomic infants among pregnant women with gestational diabetes. A logistic regression model was constructed to identify the risk factors for delivering macrosomic infants and the model was tested. RESULTS: A total of 362 pregnant women with gestational diabetes were included, of which 58 (16.02%) had babies with macrosomia. The macrosomia group exhibited higher metrics in several areas compared to those without: pre-pregnancy BMI, fasting glucose, 1 h and 2 h OGTT sugar levels, weight gain during pregnancy, and levels of triglycerides, LDL-C, and HDL-C, all with significant differences (P < 0.05). ROC analysis revealed predictive value for macrosomia with AUCs of 0.761 (pre-pregnancy BMI), 0.710 (fasting glucose), 0.671 (1 h OGTT), 0.634 (2 h OGTT), 0.850 (weight gain), 0.837 (triglycerides), 0.742 (LDL-C), and 0.776 (HDL-C), indicating statistical significance (P < 0.05). Logistic regression identified high pre-pregnancy BMI, fasting glucose, weight gain, triglycerides, and LDL-C levels as independent risk factors for macrosomia, with odds ratios of 2.448, 2.730, 1.884, 16.919, and 5.667, respectively, and all were statistically significant (P < 0.05). The model’s AUC of 0.980 (P < 0.05) attests to its reliability and stability. CONCLUSION: The delivery of macrosomic infants in gestational diabetes may be related to factors such as body mass index before pregnancy, blood-glucose levels, gain weight during pregnancy, and lipid levels. Clinical interventions targeting these factors should be implemented to reduce the incidence of macrosomia. Show more

Keywords: Gestational diabetes, delivery, macrosomia, risk factors, predictive model

DOI: 10.3233/THC-240679

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3595-3604, 2024

Authors: Begic, Zijo | Djukic, Milan | Begic, Edin | Aziri, Buena | Begic, Nedim | Badnjevic, Almir

Article Type: Research Article

Abstract: BACKGROUND: Left atrial strain (LAS) analysis represents a newer non-invasive, sensitive and specific technique for assessing left atrial (LA) function and early detection of its deformation and dysfunction. However, its applicability in mitral regurgitation (MR) in pediatric population remains unexplored, raising pertinent questions regarding its potential role in evaluating the severity and progression of the disease. OBJECTIVE: To investigate the impact of chronic MR in children and adolescents on LA remodeling and function. METHODS: The study included 100 participants. Patients with primary and secondary chronic MR lasting at least 5 years fit our …inclusion criteria. The exclusion criteria from the study were: patients with functional mitral regurgitation due to primary cardiomyopathies, patients with artificial mitral valve, patients with MR who had previously undergone surgery due to obstructive lesions of the left heart (aortic stenosis, coarctation of the aorta), patients with significant atrial rhythm disorders (atrial fibrillation, atrial flutter). The echocardiographic recordings were conducted by two different cardiologists. Outcome data was reported as mean and standard deviation (SD) or median and interquartile range (Q1–Q3). RESULTS: The study included 100 participants, of whom 50 had MR and the remaining 50 were without MR. The average age of all participants was 15.8 ± 1.2 years, with a gender distribution of 37 males and 63 females. There was a significant difference in the values of LA volume index (LAVI), which were higher in patients with MR (p = 0.0001), S/D ratio (and parameters S and D; p = 0.001, p = 0.0001, p = 0.013), mitral annulus radius (p = 0.0001), E/A ratio (p = 0.0001), as well as septal e’ (m/s), lateral e’ (m/s), and average E/e’ ratio, along with the values of TV peak gradient and LV global longitudinal strain (%). There was no significant difference in LA strain parameters, nor in LA stiffness index (LASI). CONCLUSION: Our findings revealed significant differences in several echocardiographic parameters in pediatric patients with MR relative to those without MR, providing insight into the multifaceted cardiac structural and functional effects of MR in this vulnerable population. Show more

Keywords: Left atrium, mitral regurgitation, echocardiography, fibrosis

DOI: 10.3233/THC-240768

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3605-3612, 2024

Authors: Schuh, Alexander | Feyrer, Matthias | Benditz, Achim | Sesselmann, Stefan | Koehl, Philipp

Article Type: Case Report

Abstract: BACKGROUND: Uncemented acetabular components are widely used in modern total hip arthroplasty (THA). Modularity has numerous advantages including the ability to use supplementary screw fixation for the shell, and allow to switch from ceramic to polyethylene (PE) bearings and vice versa, and the use of lipped and face-changing liners. OBJECTIVE: Despite these advantages, a problem with modular PE liners is dissociation. This is a rare complication in modern implants. The rate of liner dissociation is reported to be very low between 0.17% and 0.8%. Typical symptoms are sudden onset of groin pain in a previously well-functioning …hip joint, followed by grinding or clicking sensations during hip joint motions indicating, that the femoral head is articulating with the metal acetabular shell rather than with the PE liner. Any newly observed noise or squeaking from a THA should undergo radiographic investigation to exclude liner dissociation. CASE PRESENTATION: We present the case of an 88-yearold male patient who developed PE liner dissociation in a cementless THA with a Pinnacle acetabular component six years after the index operation. We recommended revision of the left hip, which was performed two days later. In the interim, the patient was advised to use a pair of crutches. During revision surgery, it was observed that the metal head made contact with the cementless cup shell without damaging it from a macroscopic standpoint. Consequently, a simple exchange of the PE liner was conducted, and a 36 mm metal head was implanted due to scratches on the original head. CONCLUSION: Early diagnosis facilitates a straightforward exchange of the liner along with the head, potentially preserving the osseous integrated cup shell and stem integrity. Routine radiologic follow-up allows to distinguish between PE liner dissociation and severe PE wear. Show more

Keywords: Polyethylene, PE, liner, dissociation, THR, THA, pinnacle cup

DOI: 10.3233/THC-240016

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3613-3619, 2024

Authors: Citak, Mustafa

Article Type: Editorial

DOI: 10.3233/THC-248051

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3623-3624, 2024

Authors: Hoveidaei, Amir Human | Esmaeili, Sina | Ghaseminejad-Raeini, Amirhossein | Pirahesh, Seyed Kasra | Hoveidaei, Armin | Sandiford, Nemandra A. | Lahner, Nina | Citak, Mustafa

Article Type: Review Article

Abstract: BACKGROUND: Unicompartmental knee arthroplasty (UKA) is a viable alternative to total knee arthroplasty (TKA) for osteoarthritis patients with single-compartment involvement, with advantages including accelerated recovery, reduced pain, and improved function. Robotic-assisted UKA (rUKA) is a promising development that ensures precise implant positioning and limb alignment. However, concerns about complications remain. OBJECTIVE: This study looks at patient satisfaction as a key metric for determining the efficacy of rUKA versus manual UKA (mUKA). METHODS: The search strategy for this study followed PRISMA. Using precise keywords, PubMed, Scopus, Web of Science, and the Cochrane library were …searched. English articles were searched until August 2, 2023. Selection criteria included mUKA and rUKA patient satisfaction studies. The NOS scale evaluated study quality. Meta-analysis was done with R and heterogeneity analysis. RESULTS: This systematic review examined 5 studies with 1060 UKAs (532 robotic-assisted and 528 manual). Variable satisfaction assessment methods were used. Three studies found no difference in patient satisfaction after robotic-assisted UKA, but two found a higher satisfaction. Meta-analysis showed robotic-assisted UKA improved patient satisfaction (OR = 1.72 [1.25–2.37]). Overall, most studies showed low risk of bias, except one with higher bias. CONCLUSION: This review suggests that robotic assistance may enhance patient satisfaction in UKA procedures. Show more

Keywords: Arthroplasty, replacement, knee, medical device, patient satisfaction, robotic surgical procedures

DOI: 10.3233/THC-231216

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3625-3634, 2024

Authors: De Mauro, Domenico | Salber, Jochen | Stimolo, Davide | Florian, Ende | Citak, Mustafa

Article Type: Review Article

Abstract: BACKGROUND: In periprosthetic joint infections (PJIs), the surgeon’s role becomes pivotal in addressing the infection locally, necessitating the surgical removal of infected and necrotic tissue. Opportunity to enhance the visualization of infected tissue during surgery could represent a game-changing innovation. OBJECTIVE: The aim of this narrative review is to delineate the application of intraoperative fluorescence imaging for targeting infected tissues in PJIs. METHODS: A systematic review, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, was carried out. The search included multiple online database; MEDLINE, Scopus, and Web of …Science. For data extraction the following were evaluated: (i) diagnosis of musculoskeletal infection; (ii) use of intraoperative fluorescence imaging; (iii) infected or necrotic tissues as target. RESULTS: Initially, 116 studies were identified through online database searches and reference investigations. The search was narrowed down to a final list of 5 papers for in-depth analysis at the full-text level. Subsequently, 2 studies were included in the review. The study included a total of 13 patients, focusing on cases of fracture-related infections of the lower limbs. CONCLUSION: The primary and crucial role for orthopedic surgeons in PJIs is the surgical debridement and precise removal of necrotic and infected tissue. Technologies that enable clear and accurate visualization of the tissue to be removed can enhance the eradication of infections, thereby promoting healing. A promising avenue for the future involves the potential application of intraoperative fluorescence imaging in pursuit of this objective. Show more

Keywords: Intraoperative fluorescence imaging, periprosthetic joint infections, total joint arthroplasty, necrotic tissue, 5-aminolevulinic acid

DOI: 10.3233/THC-240479

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3635-3641, 2024

Authors: Kara, Seher | Nokay, Aziz Emre

Article Type: Review Article

Abstract: BACKGROUND: Total knee arthroplasty (TKA) is a common procedure for treating end-stage degenerative knee osteoarthritis (OA). Despite the generally excellent outcomes, postoperative complications such as loss of muscle strength and joint limitation can occur. Therefore, postoperative physical rehabilitation is crucial for regaining strength, functionality, and managing pain. Various rehabilitation strategies employ different methods to reduce pain severity, regain muscle strength, assist patients in returning to daily activities, and increase functionality. In recent years, technological advancements have transformed rehabilitation methods. In addition to traditional applications, new methods have been incorporated into treatment plans. OBJECTIVE: This study aimed …to evaluate novel physical rehabilitation methods and options following OA. METHODS: A literature review was conducted to identify and investigate recent and commonly used novel rehabilitation methods. The search terms “Total Knee Arthroplasty,” “New Rehabilitation TKA,” “Novel Rehabilitation” “Novel Rehabilitation in Arthroplasty” and “Technology Knee Rehabilitation” were searched across PubMed and Google Scholar databases, covering literature from the past 15 years. Studies on telerehabilitation, functional electric stimulation, virtual reality, yoga, and their reported outcomes were evaluated using specific keywords. The results of various studies on novel rehabilitation methods were gathered and compared to traditional treatment plans based on functionality and applicability. RESULTS: Several studies reported that telerehabilitation was not inferior to traditional rehabilitation, with some showing positive outcomes. Telerehabilitation following TKA demonstrated positive effects on functionality and patient satisfaction. Functional electric stimulation showed significant improvements in muscle strength and pain reduction. Virtual reality demonstrated superior effects on proprioception and posture outcomes. The use of yoga in rehabilitation also resulted in improved proprioception and pain reduction. CONCLUSION: In addition to traditional rehabilitation methods, new approaches have shown significant positive outcomes for patients who have received TKA. We are in an era of digital development, and as such, new rehabilitation techniques, particularly those involving digital advancements, will continue to emerge. With the trend toward personalized approaches in medicine, more new techniques or methods will be incorporated into rehabilitation plans, leading to better recovery outcomes from TKA. Show more

Keywords: TKA, rehabilitation, technology, telerehabilitation, virtual reality, functional electric stimulation, novel methods in rehabilitation

DOI: 10.3233/THC-240628

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3643-3648, 2024

Authors: Tekeli, Seçkin Özgür | Köse, Özkan | Yapar, Dilek | Tekeli, Feyza Yağmur | Asoğlu, Mehmet Melih | Kartal, Emre Mücahit

Article Type: Research Article

Abstract: BACKGROUND: The extent of the association between vitamin D deficiency and knee osteoarthritis remains inadequately understood. OBJECTIVE: This study aimed to elucidate the relationship between vitamin D levels and knee osteoarthritis through a cross-sectional analysis. METHODS: This retrospective study involved an analysis of knee radiographs and serum 25-hydroxyvitamin D3 (25-(OH) vitamin D3) levels in a cohort of 3424 individuals (2901 women and 523 men). Knee osteoarthritis severity was evaluated using the Kellgren-Lawrence radiological scoring system. RESULTS: Of the participants, 49.2% (n = 1,683) were diagnosed …with knee osteoarthritis. Among these patients, the levels of adjusted 25-(OH) vitamin D3 were significantly lower (p < 0.001). Regression analysis revealed a significant association between vitamin D deficiency and knee osteoarthritis, with an adjusted odds ratio (OR) of 1.7 (95% CI: 1.5–2.0; p < 0.001). Notably, a stronger association was observed between vitamin D deficiency and knee osteoarthritis in women under 65 compared to those aged 65 and above. CONCLUSIONS: The findings of this study indicate a higher prevalence of vitamin D deficiency in patients with knee osteoarthritis. Maintaining adequate serum 25-(OH) vitamin D3 levels may prevent knee osteoarthritis, especially in women below 65. Show more

Keywords: Vitamin D, knee, osteoarthritis, female sex, biomedical imaging, elderly healthcare, orthopedic surgery

DOI: 10.3233/THC-230802

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3649-3658, 2024

Authors: Akçaalan, Serhat | Akbulut, Batuhan | Çağlar, Ceyhun | Innocenti, Matteo | Uğurlu, Mahmut | Dogan, Metin | Akkaya, Mustafa

Article Type: Research Article

Abstract: BACKROUND: Periprosthetic joint infection (PJI) is a very important complication that occurs after total joint replacement. Diagnosing PJI is at least as difficult as this disease. There is no biomarker that alone can diagnose PJI. OBJECTIVE: This study aimed to evaluate the effectiveness of large unstained cell percentage (%LUC) in diagnosing PJI and deciding on re-implantation in two stage septic exchange arthroplasty. METHODS: Patients who underwent revision arthroplasty between 2019 and 2023 were screened retrospectively. These patients were grouped as those who underwent two-stage septic exchange and those who underwent aseptic exchange. Prosthesis …removal from the patients who underwent two-stage septic exchange, before spacer application, and on the 3rd post-operative day after spacer application, Blood parameters were collected at the 1st month and before the second stage after the spacer application, and before the revision surgery from the patients who underwent aseptic exchange. White blood cell, neutrophil percentage, %LUC, albumin, sedim and CRP values were checked and recorded one by one from all patients. RESULTS: The data of a total of 233 patients, including 133 patients in the two stage septic exchange group and 100 patients in the aseptic exchange group, were included in the study. When the predictive value of %LUC in PJI was accepted as cut-off 1.75, the sensitivity was 69.2% and the specificity was 73%. The change in %LUC over time in patients who underwent two-stage septic exchange was statistically significant (p = 0.0001). A positive correlation was found between the value of .%LUC after spacer application and the value of CRP before prosthesis protrusion/spacer application surgery, and the Spearman correlation coefficient was found to be 0.005. CONCLUSION: %LUC value can be a promising biomarker for the diagnosis of PJI by considering both sensitivity and specificity rates. Apart from this, it is an easily accessible and effective biomarker for re-implantation decision making and evaluation of response to treatment, especially in two-stage septic exchange surgeries. Show more

Keywords: Periprosthetic joint infection, %LUC, biomarker, two stage, septic exchange

DOI: 10.3233/THC-230903

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3659-3667, 2024

Authors: Fink, Bernd | Hoyka, Marius | Blersch, Benedikt Paul | Baum, Hannsjörg | Sax, Florian Hubert

Article Type: Research Article

Abstract: BACKGROUND: Graphic type differentiation of cell count data of synovial aspirates is a new method for the diagnosis of early and late periprosthetic joint infection. OBJECTIVE: The aim of the study was to analyse if the same 6 LMNE-types can be differentiated in the new Yumizen H500 cell counter as it was the case for the old cell counter ABX Pentra XL 80 of previous publications, to verify if the erythrocyte and thrombocyte curves of the new device give additional information and to calculate the difference of cell count in LMNE-type I and III (with abrasion) …in the cell counter and in the manual counting chamber (Neubauer improved). METHODS: 450 aspirates of 152 total hip arthroplasties and 298 knee arthroplasties obtained for the diagnosis of periprosthetic joint infection were analysed with the Yumizen H500. RESULTS: All LMNE-matrices of the 450 aspirates could assigned to one of the six LMNE-types. There were 76 LMNE-type I, 72 LMNE-type II, 14 LMNE-type III, 241 LMNE-type IV, 36 LMNE-type V and 12 LMNE-type VI. The erythrocyte and thrombocyte distribution curves were very helpful for differentiation of hematoma and infection. The cell count in the manual counting procedure was lower than in the cell counter: for the LMNE-type I (abrasion type) the median of the difference was 925/μ L (median) and for the LMNE-type III (combined type of infection and abrasion) 3570/μ L (median). CONCLUSION: The described graphic type differentiation is a new and helpful method for differentiation of hematoma and early PJI as well as abrasion and late PJI. Show more

Keywords: Leucocyte count, synovia, periprosthetic joint infection, cell counter

DOI: 10.3233/THC-231006

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3669-3680, 2024

Authors: Incesoy, Mustafa Alper | Yildiz, Fatih | Pulatkan, Mehmet Anil | Yesiller, Omer Faruk | Toluk, Ozlem | Erdem, Ahmet Can | Tuncay, Ibrahim

Article Type: Research Article

Abstract: BACKGROUND: With the restoration of the natural hip biomechanics, a successful total hip arthroplasty (THA) and long-term survival is pursued. Although robotic THA (rTHA) has been developed to increase accuracy of implant positioning, leg lengths and offsets, discussions about its radiological and clinical advantages over conventional THA (cTHA) continues. OBJECTIVE: The aim of this study was to compare clinical and radiological outcomes of robotic and conventional THA. METHODS: This retrospective study compares functional and radiological outcomes of 82 rTHA with a matched group of 82 cTHA in terms of age, sex, body mass …index and preoperative functional scores. The minimum follow up was 12 months for all patients. Functional outcomes were Harris Hip Score (HHS) and the Western Ontario and McMaster University Osteoarthritis index (WOMAC) evaluated pre- and postoperatively. Radiological evaluations included position of cup placement according to Lewinnek and Callanan safe zones, Canal Fill Ratio (CFR), Leg Length Discrepancy (LLD), Lateral offset (LO) and Femoral Component Alignment (FCA). Complications were also evaluated. RESULTS: In the rTHA group, 91.5% (75 out of 82) of the acetabular cups were positioned within the safe zone whereas it was 63.4% (52 out of 82) for the cTHA group (p < 0.001). According to Callanan, they were 84.1% and 50%, respectively (p < 0.001). Between the groups, no statistically significant difference was found in CFR, LLD, HO, FCA, AI, AA, WOMAC, HHS and major complication rates. CONCLUSION: rTHA is superior to cTHA in terms of accuracy and reproducibility of the cup placement, however no apparent clinical benefit was found in short term follow. Show more

Keywords: Total hip arthroplasty, robot-assisted surgery, component positioning, robotic total hip replacement

DOI: 10.3233/THC-231111

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3681-3691, 2024

Authors: Ong, Christian B. | Buchan, Graham B.J. | Hecht II, Christian J. | Homma, Yasuhiro | Harmon, Daniel J. | Kendoff, Daniel O. | Petterwood, Joshua | Kamath, Atul F.

Article Type: Research Article

Abstract: BACKGROUND: Robotic assistance in total hip arthroplasty (RA-THA) has been shown to minimize laterality-based differences in acetabular cup positioning. OBJECTIVE: To determine if the use of a novel, fluoroscopy-based RA-THA system mitigates differences in acetabular cup placement between left (L) and right (R) side hip procedures, when compared to manual, fluoroscopic-assisted technique. METHODS: We conducted a retrospective review of 106 consecutive mTHA (40 L/66 R) and 102 RA-THA (48 L/54 R) primary direct anterior approach procedures. All cases were performed by a single right-hand-dominant surgeon, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, …or rheumatoid arthritis. Outcomes included acetabular cup inclination and anteversion, and the proportion of cups within the Lewinnek safe-zone. RESULTS: The average inclination of mTHA L cases was smaller than that of mTHA R cases (41.10∘ ± 7.38 vs. 43.97∘ ± 6.27; p = 0.04). For RA-THA, L and R cup angles were similar. There were fewer overall mTHA hips within the Lewinnek safe-zone compared to RA-THA (0.59 vs. 0.78; p = 0.003), as well as fewer mTHA R cases than RA-THA R cases (0.59 vs. 0.80; p = 0.03) within safe zone. CONCLUSION: Use of a novel, fluoroscopy-based robotic system mitigates laterality-based differences in acetabular cup placement that were observed in a manual, fluoroscopic-assisted cohort. Show more

Keywords: Arthroplasty, hip, acetabulum, robotic-assisted surgery, functional laterality

DOI: 10.3233/THC-231126

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3693-3701, 2024

Authors: Ong, Christian B. | Buchan, Graham B.J. | Hecht II, Christian J. | Kendoff, Daniel O. | Homma, Yasuhiro | Kamath, Atul F.

Article Type: Research Article

Abstract: BACKGROUND: Patient obesity is a risk factor for poor acetabular cup positioning in total hip arthroplasty (THA). OBJECTIVE: To assess the impact of using a novel, fluoroscopy-based robotic THA system on acetabular cup placement in obese versus non-obese patients. METHODS: A review of 105 consecutive manual unassisted (mTHA) (47 Obese/58 Non-obese) and 102 robotic-assisted (RA-THA) (50 Obese/52 Non-obese) primary, direct anterior approach THA procedures was conducted. All cases were performed by a single surgeon, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Obesity was defined as a Body Mass Index …(BMI) ⩾ 30 kg/m2 . Outcomes included acetabular cup inclination and anteversion, and the proportion of cups within the Lewinnek safe-zone. RESULTS: Obese patients in the mTHA cohort had larger cup inclination angles on average compared to non-obese patients (44.82∘ ± 6.51 vs. 41.39∘ ± 6.75; p = 0.009). Obese mTHA patients were less likely to have cup placement within the Lewinnek zone compared to non-obese mTHA patients (0.48 vs. 0.67; p = 0.027). Obesity had no effect on the accuracy of RA-THA. CONCLUSION: Obesity affects the placement of the acetabular component in manual THA. The novel, fluoroscopy-based robotic THA system in this study demonstrated accurate cup placement regardless of obesity status. Show more

Keywords: Arthroplasty, hip, acetabulum, robotic-assisted surgery, obesity

DOI: 10.3233/THC-231127

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3703-3712, 2024