Technology and Health Care - Volume 32, issue 6

Authors: Hsiao, Min-Chien | Yen, Yu-Chun | Wang, Chun-Hsiang | Chen, Yen-Nien | Wang, Shun-Ping | Su, Kuo-Chih

Article Type: Research Article

Abstract: BACKGROUND: To avoid risks of mucosal infection from contact lenses removal, a contact lens plunger is often used. OBJECTIVE: Given various types of contact lens plungers available on the market, no study has yet been done on mechanical effects of the contact lens plunger on contact lens removal. Here, this study used finite element analysis to investigate the effects of plunger size and plunger position on the removal of soft and rigid gas permeable (RGP) contact lenses. METHODS: First, we established finite element analysis models for the plunger, contact lens, cornea, and aqueous …humor. The plunger is made of mostly silicone rubber, and the contact lenses are mainly made of soft and hard material. The part of the plunger used for removal was located either at the central or the edged position, with pulling 1 mm distance. The main parameters observation indicators of in this study were the reaction force at the fixed end of the cornea, aqueous humor, the von Mises stress of the plunger, the contact lenses, and the cornea. RESULTS: Results of this study showed that when a plunger of a larger diameter was used, the reaction force of the plunger was also larger, especially when applied to RGP lenses, which required a slightly larger force (∼ 0.27 N). Also, when removing a RGP lens from the edge, there was a greater stress at the edge of the contact lens (2.5799 MPa), and this caused a higher stress on both the cornea (0.0165 MPa) and the aqueous humor (0.00114 MPa). CONCLUSIONS: When using a plunger with a larger diameter to remove a RGP lens, although a larger force required, the relatively larger contact area likely reduced the stress on the cornea and aqueous humor, thereby reducing the risk of eye injury. In addition, when removing a RGP lens, the results of this study recommended it to be removed from the plunger edge, as that facilitated the removal of contact lens. Show more

Keywords: Plunger design, contact lenses, finite element analysis, biomechanics

DOI: 10.3233/THC-231983

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4109-4121, 2024

Authors: Chen, Changsheng | Zhang, Yu | Lin, Yuda | Shen, Chong | Zhang, Zhe | Wu, Zhouliang | Qie, Yunkai | Zhao, Gangjian | Hu, Hailong

Article Type: Research Article

Abstract: BACKGROUND: Bone morphogenetic proteins (BMPs) are a group of cancer-related proteins vital for development and progression of certain cancer types. Nevertheless, function of BMP family in pan-cancer was not detailedly researched. OBJECTIVE: Investigating expression pattern and prognostic value of the BMPs family (BMP1-8A and BMP8B) expression across multiple cancer types. METHODS: Our research integrated multi-omics data for exploring potential associations between BMPs expression and prognosis, clinicopathological characteristics, copy number or somatic mutations, immune characteristics, tumor microenvironment (TME), tumor mutation burden (TMB), microsatellite instability (MSI), immune checkpoint genes and drug sensitivity in The Cancer …Genome Atlas (TCGA) tumors. Furthermore, association of BMPs expression and immunotherapy effectiveness was investigated in some confirmatory cohorts (GSE111636, GSE78220, GSE67501, GSE176307, IMvigor210 and mRNA sequencing data from currently undergoing TRUCE01 clinical research included), and biological function and potential signaling pathways of BMPs in bladder cancer (BCa) was explored via Gene Set Enrichment Analysis (GSEA). Eventually, immune infiltration analysis was done via BMPs expression, copy number or somatic mutations in BCa, as well as validation of the expression levels by reverse transcription-quantitative PCR and western blot, and in vitro functional experiments of BMP8A. RESULTS: Discoveries displayed BMPs expression was related to prognosis, clinicopathological characteristics, mutations, TME, TMB, MSI and immune checkpoint genes of TCGA tumors. Anticancer drug sensitivity analysis displayed BMPs were associated with various drug sensitivities. What’s more, it was discovered that expression level of certain BMP family members related to objective response to immunotherapy. By GSEA, we discovered multiple immune-associated functions and pathways were enriched. Immune infiltration analysis on BCa also displayed significant associations among BMPs copy number variations, mutation status and infiltration level of diverse immune cells. Furthermore, differential expression validation and in vitro phenotypic experiment indicated that BMP8A significantly promoted BCa cell proliferation, migration and invasion. CONCLUSIONS: Current results confirmed significance of both BMPs expression and genomic alteration in the prognosis and treatment of diverse cancer types, and suggested that BMPs may be vital for BCa and can possibly be utilized as biomarkers for immunotherapy. Show more

Keywords: Bone morphogenetic proteins, pan-cancer analysis, bladder cancer, tumor microenvironment, prognosis

DOI: 10.3233/THC-232004

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4123-4175, 2024

Authors: Tu, Jin-Peng | Shi, Xiao-Feng | Wang, Hui | Zhao, Jie | Wang, Xin | Mo, Chun-Bai | Song, Wen-Li

Article Type: Research Article

Abstract: BACKGROUND: Renal failure is one of the most common chronic complications of diabetes. Simultaneous pancreas-kidney transplantation (SPK) is considered the preferred treatment for individuals with diabetes and chronic renal failure. This procedure has demonstrated efficacy in enhancing the quality of life for patients and minimizing the complications associated with diabetes. OBJECTIVE: In this study, we analyzed the incidence and safety of complications in different thrombosis prevention techniques post simultaneous pancreas-kidney transplantation (SPK). METHODS: Patients who underwent SPK between January 2019 and December 2022 were selectively categorized into two groups: the heparin group and the …non-heparin group depending on the utilization of low molecular weight heparin. The occurrence of complications and clinical outcomes were subsequently calculated in each group. RESULTS: In this study, we included a total of 58 recipients who underwent SPK, with 36 in the heparin group and 22 in the non-heparin group. Among the 58 participants, there were 3 cases of pancreatic thrombosis complications, with 2 cases (5.6%) in the heparin group and 1 case (4.6%) in the non-heparin group, and the differences were not statistically significant (P > 0.05). Regarding gastrointestinal bleeding, there were 17 cases out of the total 58 patients, with 14 cases (38.9%) in the heparin group and 3 cases (13.6%) in the non-heparin group, and the difference was statistically significant (P < 0.05). CONCLUSION: After surgery, the use of low molecular weight heparin anticoagulation may increase the likelihood of experiencing gastrointestinal bleeding. Prior to the surgery, a comprehensive evaluation of the coagulation status and medical history of the patient should be performed, enabling stratification of risks involved. Based on this assessment, either low-molecular-weight heparin or aspirin should be selected as a preventive measure against thrombosis. Show more

Keywords: Heparin, simultaneous pancreas-kidney transplantation (SPK), thrombosis

DOI: 10.3233/THC-232037

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4177-4185, 2024

Authors: Fragidis, Leonidas | Tsamoglou, Sofia | Kosmidis, Kosmas | Aggelidis, Vassilios

Article Type: Research Article

Abstract: BACKGROUND: The global implementation of Electronic Health Records has significantly enhanced the quality of medical care and the overall delivery of public health services. The incorporation of Evidence-Based Medicine offers numerous benefits and enhances the efficacy of decision-making in areas such as prevention, prognosis, diagnosis, and therapeutic approaches. OBJECTIVE: The objective of this paper is to propose an architectural design of an Evidence-Based Medicine information system based on the Electronic Health Record, taking into account the existing and future level of interoperability of health information systems in Greece. METHODS: A study of the …suggested evidence-based medicine architectures found in the existing literature was conducted. Moreover, the interoperability architecture of health information systems in Greece was analyzed. The architecture design reviewed by specialized personnel and their recommendations were incorporated into the final design of the proposed architecture. RESULTS: The proposed integrated architecture of an Evidence-Based Medicine system based on the Electronic Health Record integrates and utilizes citizens’ health data while leveraging the existing knowledge available in the literature. CONCLUSIONS: Taking into consideration the recently established National Interoperability Framework, which aligns with the European Interoperability Framework, the proposed realistic architectural approach contributes to improving the quality of healthcare provided through the ability to make safe, timely and accurate decisions by physicians. Show more

Keywords: Electronic health records, evidence-based medicine, clinical decision support systems, health information systems

DOI: 10.3233/THC-232042

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4187-4201, 2024

Authors: Gao, Peng | Chen, Lijun | He, Linbo | Lei, Jiang | Luo, Menglu | Gu, Li

Article Type: Research Article

Abstract: BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common respiratory disease globally, characterized by obstructive ventilatory disorder under pulmonary function tests. Recent years have witnessed a yearly increase in the prevalence of COPD. OBJECTIVE: To investigate the impact of respiratory virus infections on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to perform sequencing typing and mutation analysis of viruses with high detection rate. METHODS: A total of 1523 inpatients with AECOPD admitted to our hospital from April 1,2020 to March 30,2022 were collected and divided into two groups: the …infected group (n = 532) and the non-infected group (n = 991). The related indexes between the two groups were collected and compared (including clinical characteristics and laboratory tests that blood cell count, PCT, CRP, adenovirus, respiratory syncytial virus, rhinovirus, influenza A virus, influenza B virus, etc.). RESULTS: In the infected group, the proportion of patients with palpitations (49.44% VS 8.07%, P < 0.001), lipid metabolism abnormalities (18.42% VS 39.96%, P < 0.001), heart failure (39.85% VS 29.87%, P < 0.001), disease duration (17.48 ± 7.47 VS 12.45 ± 11.43 d, P < 0.001), and poor prognosis (69.55% VS 17.15%, P < 0.001) were higher than those in the non-infected group; Adenovirus (ADV) accounted for 75.94% (404/532) of all infected viruses. 31 virus strains could be categorized into 16 ADV-C1, one ADV-C5, two ADV-B3, three ADV-B7, two ADV-D17, two ADV-D19, and five ADV-D27, which were similar to the serotypes reported in severe pneumonia. Furthermore, three strains of C1 adenovirus were found to be highly homologous to the original strain AF534906 by sequencing, and the phylogenetic trees of the three main structural genes were all on the same branch as the original strain. Base mutations and amino acid variants were found in each structural gene segment. In clinical data, it’s found that patients with mutations are worse than those without mutations. CONCLUSION: Respiratory viruses are common in patients with poor prognosis of AECOPD, especially adenovirus, respiratory syncytial virus. Respiratory virus infections will lead to the deterioration of patients with AECOPD, accompanied by longer treatment cycles and poor prognosis. Show more

Keywords: Chronic obstructive pulmonary disease, respiratory virus infections, genotyping

DOI: 10.3233/THC-240010

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4203-4221, 2024

Authors: R, Seethalakshmi | S, Hariharan | Karnan, Hemalatha | V, Keerthana | V, Akshara

Article Type: Research Article

Abstract: BACKGROUND: Atherosclerosis is a condition which disrupts blood flow due to plaque build-up inside the arteries. Under conditions where consecutive plaques are prevailing blood hammer principle is exhibited. OBJECTIVE: The pressure and shear stress produced at an infinitesimal area act as the governing equation for stent modeling. The leading order pressure lays the foundation for the design of cardiac stents with definite dimensions. METHOD: The designed stent was encapsulated inside a crimper validated through ANSYS-static and transient structural simulation to derive the total deformation, equivalent strain, and stress exerted on the stent. Five …different biomaterials stainless steel 316, cobalt, chromium, platinum, and Poly lactic acid were selected for the material assessment. RESULT: Static and Transient structural analysis for a period of 1 and 10 secs was implemented for a stent with and without a crimper. The material performance in terms of total deformation, equivalent stress, and strain are analyzed. CONCLUSION: The paper envisions the dynamics of blood hammer in atherosclerosis that provides the changes in the pressure and clotting process. It shows the promising results of the stent behavior in varied forces which gives valuable insights for future improvement in stent design and material selection. Show more

Keywords: Atherosclerosis, blood hammer, stent, transient

DOI: 10.3233/THC-240051

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4223-4238, 2024

Authors: Bhatt, Ashish | Nigam, Vineeta Saxena

Article Type: Research Article

Abstract: BACKGROUND: Brain tumor is an extremely dangerous disease with a very high mortality rate worldwide. Detecting brain tumors accurately is crucial due to the varying appearance of tumor cells and the dimensional irregularities in their growth. This poses a significant challenge for detection algorithms. Currently, there are numerous algorithms utilized for this purpose, ranging from transform-based methods to those rooted in machine learning techniques. These algorithms aim to enhance the accuracy of detection despite the complexities involved in identifying brain tumor cells. The major limitation of these algorithms is the mapping of extracted features of a brain tumor in …the classification algorithms. OBJECTIVE: To employ a combination of transform methods to extract texture feature from brain tumor images. METHODS: This paper employs a combination of transform methods based on sub band decomposition for texture feature extraction from MRI scans, hybrid feature optimization methods using firefly and glow-worm algorithms for selection of feature, employment of MKSVM algorithm and stacking ensemble classifier for classification and application of the feature of fusion of different feature extraction methods. RESULTS: The algorithm under consideration has been put into practice using MATLAB, utilizing datasets from BRATS (Brain Tumor Segmentation) for the years 2013, 2015, and 2018. These datasets serve as the foundation for testing and validating the algorithm’s performance across different time periods, providing a comprehensive assessment of its effectiveness in detecting brain tumors. The proposed algorithm achieves maximum detection accuracy, detection sensitivity and specificity up to 98%, 99% and 99.5% respectively. The experimental outcomes showcase the efficiency of the algorithm in detection of brain tumor. CONCLUSION: The proposed work mainly contributes in brain tumor detection in the following aspects: a) use of combination of transform methods for texture feature extraction from MRI scans b) hybrid feature selection methods using firefly and glow-worm optimization algorithms for selection of feature c) employment of MKSVM algorithm and stacking ensemble classifier for classification and application of the feature of fusion of different feature extraction methods. Show more

Keywords: Brain tumor, transform function, feature fusion, optimization, machine learning algorithm

DOI: 10.3233/THC-240052

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4239-4256, 2024

Authors: Hwang, Daon | Cho, Ki Hun

Article Type: Research Article

Abstract: BACKGROUND: Traditional canes have no special functions besides weight support, and their long-term use may cause secondary damage to the musculoskeletal system and gait deviation. OBJECTIVE: This study aimed to investigate the usability of the cane-combined weight support feedback device (CWSFD) to identify areas requiring improvement and the current level of satisfaction. METHODS: As a collet-type device, the CWSFD has a structure allowing attachment and detachment at the lower end of a traditional mono cane. To assess the level of satisfaction and areas of improvement regarding the novel CWSFD, a usability test was …conducted on 10 physical therapists with ⩾ 20 years of clinical experience. The usability test comprised a satisfaction survey questionnaire to determine the level of satisfaction, and an in-depth interview to identify the points of improvement. RESULTS: The usability test demonstrated a moderate or higher level of satisfaction in all tested items, and the in-depth interview revealed that the device should have a lower weight with a greater diversity of feedback. CONCLUSIONS: We anticipate that by implementing the respective improvements, a novel device will be developed in the future; for its commercialization, studies to verify the clinical effectiveness are warranted. Show more

Keywords: Cane, gait, satisfaction, usability test, weight support

DOI: 10.3233/THC-240056

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4257-4265, 2024

Authors: K, Gayathri | N, Uma Maheswari | R, Venkatesh | B, Ganesh Prabu

Article Type: Research Article

Abstract: BACKGROUND: The left ventricle segmentation (LVS) is crucial to the assessment of cardiac function. Globally, cardiovascular disease accounts for the majority of deaths, posing a significant health threat. In recent years, LVS has gained important attention due to its ability to measure vital parameters such as myocardial mass, end-diastolic volume, and ejection fraction. Medical professionals realize that manually segmenting data to evaluate these processes takes a lot of time, effort when diagnosing heart diseases. Yet, manually segmenting these images is labour-intensive and may reduce diagnostic accuracy. OBJECTIVE/METHODS: This paper, propose a combination of different deep neural networks for …semantic segmentation of the left ventricle based on Tri-Convolutional Networks (Tri-ConvNets) to obtain highly accurate segmentation. CMRI images are initially pre-processed to remove noise artefacts and enhance image quality, then ROI-based extraction is done in three stages to accurately identify the LV. The extracted features are given as input to three different deep learning structures for segmenting the LV in an efficient way. The contour edges are processed in the standard ConvNet, the contour points are processed using Fully ConvNet and finally the noise free images are converted into patches to perform pixel-wise operations in ConvNets. RESULTS/CONCLUSIONS: The proposed Tri-ConvNets model achieves the Jaccard indices of 0.9491 ± 0.0188 for the sunny brook dataset and 0.9497 ± 0.0237 for the York dataset, and the dice index of 0.9419 ± 0.0178 for the ACDC dataset and 0.9414 ± 0.0247 for LVSC dataset respectively. The experimental results also reveal that the proposed Tri-ConvNets model is faster and requires minimal resources compared to state-of-the-art models. Show more

Keywords: Left ventricle, convolutional neural networks, deep learning, region of interest, MRI

DOI: 10.3233/THC-240062

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4267-4289, 2024

Authors: Zhang, Hongru | Wang, Chen | Yang, Ning

Article Type: Research Article

Abstract: BACKGROUND: Early identification of sepsis has been shown to significantly improve patient prognosis. OBJECTIVE: Therefore, the aim of this meta-analysis is to systematically evaluate the diagnostic efficacy of machine-learning algorithms for sepsis prediction. METHODS: Systematic searches were conducted in PubMed, Embase and Cochrane databases, covering literature up to December 2023. The keywords included machine learning, sepsis and prediction. After screening, data were extracted and analysed from studies meeting the inclusion criteria. Key evaluation metrics included sensitivity, specificity and the area under the curve (AUC) for diagnostic accuracy. RESULTS: The …meta-analysis included a total of 21 studies with a data sample size of 4,158,941. Overall, the pooled sensitivity was 0.82 (95% confidence interval [CI] = 0.70–0.90; P < 0.001; I 2 = 99.7%), the specificity was 0.91 (95% CI = 0.86–0.94; P < 0.001; I 2 = 99.9%), and the AUC was 0.94 (95% CI = 0.91–0.96). The subgroup analysis revealed that in the emergency department setting (6 studies), the pooled sensitivity was 0.79 (95% CI = 0.68–0.87; P < 0.001; I 2 = 99.6%), the specificity was 0.94 (95% CI 0.90–0.97; P < 0.001; I 2 = 99.9%), and the AUC was 0.94 (95% CI = 0.92–0.96). In the Intensive Care Unit setting (11 studies), the sensitivity was 0.91 (95% CI = 0.75–0.97; P < 0.001; I 2 = 98.3%), the specificity was 0.85 (95% CI = 0.75–0.92; P < 0.001; I 2 = 99.9%), and the AUC was 0.93 (95% CI = 0.91–0.95). Due to the limited number of studies in the in-hospital and mixed settings (n < 3), no pooled analysis was performed. CONCLUSION: Machine-learning algorithms have demonstrated excellent diagnostic accuracy in predicting the occurrence of sepsis, showing potential for clinical application. Show more

Keywords: Sepsis, machine learning, prediction, meta-analysis

DOI: 10.3233/THC-240087

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4291-4307, 2024