Technology and Health Care - Volume 32, issue 6

Authors: Alsaleh, Hadeel

Article Type: Research Article

Abstract: BACKGROUND: Schwann cell sheaths are the source of benign, slowly expanding tumours known as acoustic neuromas (AN). The diagnostic and treatment approaches for AN must be patient-centered, taking into account unique factors and preferences. OBJECTIVE: The purpose of this study is to investigate how machine learning and artificial intelligence (AI) can revolutionise AN management and diagnostic procedures. METHODS: A thorough systematic review that included peer-reviewed material from public databases was carried out. Publications on AN, AI, and deep learning up until December 2023 were included in the review’s purview. RESULTS: …Based on our analysis, AI models for volume estimation, segmentation, tumour type differentiation, and separation from healthy tissues have been developed successfully. Developments in computational biology imply that AI can be used effectively in a variety of fields, including quality of life evaluations, monitoring, robotic-assisted surgery, feature extraction, radiomics, image analysis, clinical decision support systems, and treatment planning. CONCLUSION: For better AN diagnosis and treatment, a variety of imaging modalities require the development of strong, flexible AI models that can handle heterogeneous imaging data. Subsequent investigations ought to concentrate on reproducing findings in order to standardise AI approaches, which could transform their use in medical environments. Show more

Keywords: Artificial intelligence, diagnosis, acoustic neuroma, impact, management

DOI: 10.3233/THC-232043

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3801-3813, 2024

Authors: Wu, Qian | Zang, Ruiqi | Zhang, Yong

Article Type: Research Article

Abstract: BACKGROUND: Pregnancy is an important process in women’s life, which is widely concerned by women. In recent years, the incidence of premature delivery (PTD) becomes more and more higher due to the development of auxiliary reproduction and ovulation induction technologies and the changes of pregnant women’s lifestyle and physical quality. PTD not only affects postpartum recovery and causes great physical pains, but it also has adverse effects on the birth state of neonates and even leads to neonatal death OBJECTIVE: The predictive values of cervix length (CL) measurement based on transvaginal ultrasonography (TVUS) and pathological examination …of placenta for premature delivery (PTD) were investigated and the correlation between PTD and infection was analyzed. METHODS: 120 pregnant women with PTD or high-risk factors for PTD admitted to The Affiliated Hospital of Southwest Medical University between February 2020 and March 2022 were included as the subjects and underwent pathological examination of placenta and TVUS for CL measurement. The final gestational age was set as the standard for the evaluation on the predictive values of pathological examination of placenta and TVUS. What’s more, 36 subjects in PTD group and 84 in normal delivery group (control group) underwent pathological examination of placenta for the analysis of the correlation between PTD and infection. RESULTS: The joint inspection method showed significantly better sensitivity, specificity, PPV, and NPV compared to single CL or pathological examination of the placenta (P < 0.05). Among pregnant women, those with CL ⩽ 30 mm and positive placental pathology had a higher proportion compared to those with CL > 30 mm and negative placental pathology (P < 0.05). Furthermore, the incidence of Ureaplasma Urealyticum (UU), Chlamydia Trachomatis (CT), and Chorioamnionitis (CA) in vaginal discharge of the preterm delivery (PTD) group was significantly higher than that of the control group (P < 0.05). CONCLUSION: The combination of CL ⩽ 30 mm and positive placental pathology could effectively predict PTD and placental infection was notably correlated with the occurrence of PTD. Show more

Keywords: Transvaginal ultrasonography, cervix length, pathological examination of placenta, premature delivery, infection

DOI: 10.3233/THC-230079

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3815-3827, 2024

Authors: MA, Sreema | A, Jayachandran | Perumal T, Sudarson Rama

Article Type: Research Article

Abstract: BACKGROUND: Segmentation of retinal fragments like blood vessels, Optic Disc (OD), and Optic Cup (OC) enables the early detection of different retinal pathologies like Diabetic Retinopathy (DR), Glaucoma, etc. OBJECTIVE: Accurate segmentation of OD remains challenging due to blurred boundaries, vessel occlusion, and other distractions and limitations. These days, deep learning is rapidly progressing in the segmentation of image pixels, and a number of network models have been proposed for end-to-end image segmentation. However, there are still certain limitations, such as limited ability to represent context, inadequate feature processing, limited receptive field, etc., which lead to …the loss of local details and blurred boundaries. METHODS: A multi-dimensional dense attention network, or MDDA-Net, is proposed for pixel-wise segmentation of OD in retinal images in order to address the aforementioned issues and produce more thorough and accurate segmentation results. In order to acquire powerful contexts when faced with limited context representation capabilities, a dense attention block is recommended. A triple-attention (TA) block is introduced in order to better extract the relationship between pixels and obtain more comprehensive information, with the goal of addressing the insufficient feature processing. In the meantime, a multi-scale context fusion (MCF) is suggested for acquiring the multi-scale contexts through context improvement. RESULTS: Specifically, we provide a thorough assessment of the suggested approach on three difficult datasets. In the MESSIDOR and ORIGA data sets, the suggested MDDA-NET approach obtains accuracy levels of 99.28% and 98.95%, respectively. CONCLUSION: The experimental results show that the MDDA-Net can obtain better performance than state-of-the-art deep learning models under the same environmental conditions. Show more

Keywords: Deep learning, dense prediction networks, fundus images, segmentation

DOI: 10.3233/THC-230310

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3829-3846, 2024

Authors: Mujahid, Muhammad | Rustam, Furqan | Chakrabarti, Prasun | Mallampati, Bhargav | de la Torre Diez, Isabel | Gali, Pradeep | Chunduri, Venkata | Ashraf, Imran

Article Type: Research Article

Abstract: Pneumonia is a dangerous disease that kills millions of children and elderly patients worldwide every year. The detection of pneumonia from a chest x-ray is perpetrated by expert radiologists. The chest x-ray is cheaper and is most often used to diagnose pneumonia. However, chest x-ray-based diagnosis requires expert radiologists which is time-consuming and laborious. Moreover, COVID-19 and pneumonia have similar symptoms which leads to false positives. Machine learning-based solutions have been proposed for the automatic prediction of pneumonia from chest X-rays, however, such approaches lack robustness and high accuracy due to data imbalance and generalization errors. This study focuses on …elevating the performance of machine learning models by dealing with data imbalanced problems using data augmentation. Contrary to traditional machine learning models that required hand-crafted features, this study uses transfer learning for automatic feature extraction using Xception and VGG-16 to train classifiers like support vector machine, logistic regression, K nearest neighbor, stochastic gradient descent, extra tree classifier, and gradient boosting machine. Experiments involve the use of hand-crafted features, as well as, transfer learning-based feature extraction for pneumonia detection. Performance comparison using Xception and VGG-16 features suggest that transfer learning-based features tend to show better performance than hand-crafted features and an accuracy of 99.23% can be obtained for pneumonia using chest X-rays. Show more

Keywords: Pneumonia prediction, COVID-19, transfer learning, automatic feature extraction, chest radiographs

DOI: 10.3233/THC-230313

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3847-3870, 2024

Authors: Ping, Yuxia

Article Type: Research Article

Abstract: BACKGROUND: In recent years, artificial intelligence (AI) technology has been continuously advancing and finding extensive applications, with one of its core technologies, machine learning, being increasingly utilized in the field of healthcare. OBJECTIVE: This research aims to explore the role of Artificial Intelligence (AI) technology in psychological counseling and utilize machine learning algorithms to predict counseling outcomes. METHODS: Firstly, by employing natural language processing techniques to analyze user conversations with AI chatbots, researchers can gain insights into the psychological states and needs of users during the counseling process. This involves detailed analysis using …text analysis, sentiment analysis, and other relevant techniques. Subsequently, machine learning algorithms are used to establish predictive models that forecast counseling outcomes and user satisfaction based on data such as user language, emotions, and behavior. These predictive results can assist counselors or AI chatbots in adjusting counseling strategies, thereby enhancing counseling effectiveness and user experience. Additionally, this study explores the potential and prospects of AI technology in the field of psychological counseling. RESULTS: The research findings indicate that the designed machine learning models achieve an accuracy rate of approximately 89% in analyzing psychological conditions. This demonstrates significant innovation and breakthroughs in AI technology. Consequently, AI technology will gradually become a highly important tool and method in the field of psychological counseling. CONCLUSION: In the future, AI chatbots will become more intelligent and personalized, providing users with precise, efficient, and convenient psychological counseling services. The results of this research provide valuable technical insights for further improving AI-supported psychological counseling, contributing positively to the application and development of AI technology. Show more

Keywords: Artificial intelligence, machine learning, natural language, psychological counseling, sentiment analysis

DOI: 10.3233/THC-230809

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3871-3888, 2024

Authors: Chen, Xiaoqun | Song, Yingliang

Article Type: Research Article

Abstract: BACKGROUND: Matrine has been reported inhibitory effects on ovarian cancer (OC) cell progression, development, and apoptosis. However, the molecular targets of matrine against OC and the underlying mechanisms of action remain elusive. OBJECTIVE: This study endeavors to unveil the potential targets of matrine against OC and to explore the intricate relationships between these targets and the pathogenesis of OC. METHODS: The effects of matrine on the OC cells (A2780 and AKOV3) viability, apoptosis, migration, and invasion was investigated through CCK-8, flow cytometry, wound healing, and Transwell analyses, respectively. Next, Matrine-related targets, OC-related genes, …and ribonucleic acid (RNA) sequence data were harnessed from publicly available databases. Differentially expressed analyses, protein-protein interaction (PPI) network, and Venn diagram were involved to unravel the core targets of matrine against OC. Leveraging the GEPIA database, we further validated the expression levels of these core targets between OC cases and controls. Mendelian randomization (MR) study was implemented to delve into potential causal associations between core targets and OC. The AutoDock software was used for molecular docking, and its results were further validated using RT-qPCR in OC cell lines. RESULTS: Matrine reduced the cell viability, migration, invasion and increased the cell apoptosis of A2780 and AKOV3 cells (P < 0.01). A PPI network with 578 interactions among 105 candidate targets was developed. Finally, six core targets (TP53, CCND1, STAT3, LI1B, VEGFA, and CCL2) were derived, among which five core targets (TP53, CCND1, LI1B, VEGFA, and CCL2) differential expressed in OC and control samples were further picked for MR analysis. The results revealed that CCND1 and TP53 were risk factors for OC. Molecular docking analysis demonstrated that matrine had good potential to bind to TP53, CCND1, and IL1B. Moreover, matrine reduced the expression of CCND1 and IL1B while elevating P53 expression in OC cell lines. CONCLUSIONS: We identified six matrine-related targets against OC, offering novel insights into the molecular mechanisms underlying the therapeutic effects of matrine against OC. These findings provide valuable guidance for developing more efficient and targeted therapeutic approaches for treating OC. Show more

Keywords: Ovarian cancer, Matrine, Mendelian randomization, target, molecular docking

DOI: 10.3233/THC-231051

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3889-3902, 2024

Authors: Gao, Wenlong | Zeng, Zhimei | Ma, Xiaojie | Ke, Yongsong | Zhi, Minqian

Article Type: Research Article

Abstract: BACKGROUND: The morbidity and mortality of heart disease are increasing in middle-aged and elderly people in China. It is necessary to explore relationships and interactive associations between heart disease and its risk factors in order to prevent heart disease. OBJECTIVE: To establish a Bayesian network model of heart disease and its influencing factors in middle-aged and elderly people in China, and explore the applicability of the elite-based structure learner using genetic algorithm based on ensemble learning (EN-ESL-GA) algorithm in etiology analysis and disease prediction. METHODS: Based on the 2013 national tracking survey data …from China Health and Retirement Longitudinal Study (CHARLS) database, EN-ESL-GA algorithm was used to learn the Bayesian network structure. Then we input the data and the learned network structure into the Netica software for parameter learning and inference analysis. RESULTS: The Bayesian network model based on the EN-ESL-GAalgorithm can effectively excavate the complex network relationships and interactive associations between heart disease and its risk factors in middle-aged and elderly people in China. CONCLUSIONS: The Bayesian network model based on the EN-ESL-GA algorithm has good applicability and application prospect in the prediction of diseases prevalence risk. Show more

Keywords: Bayesian networks, heart disease, influence factors, middle-aged and elderly people

DOI: 10.3233/THC-231215

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3903-3912, 2024

Authors: Leinum, Lisbeth R. | Baandrup, Anders O. | Gögenur, Ismail | Krogsgaard, Marianne | Azawi, Nessn

Article Type: Research Article

Abstract: BACKGROUND: Innovations in healthcare technologies have the potential to address challenges, including the monitoring of fluid balance. OBJECTIVE: This study aims to evaluate the functionality and accuracy of a digital technology compared to standard manual documentation in a real-life setting. METHODS: The digital technology, LICENSE, was designed to calculate fluid balance using data collected from devices measuring urine, oral and intravenous fluids. Participating patients were connected to the LICENSE system, which transmitted data wirelessly to a database. These data were compared to the nursing staff’s manual measurements documented in the electronic patient record …according to their usual practice. RESULTS: We included 55 patients in the Urology Department needing fluid balance charting and observed them for an average of 22.9 hours. We found a mean difference of - 44.2 ml in total fluid balance between the two methods. Differences ranged from - 2230 ml to 2695 ml, with a divergence exceeding 500 ml in 57.4% of cases. The primary source of error was inaccurate or omitted manual documentation. However, errors were also identified in the oral LICENSE device. CONCLUSIONS: When used correctly, the LICENSE system performs satisfactorily in measuring urine and intravenous fluids, although the oral device requires revision due to identified errors. Show more

Keywords: Water-electrolyte balance, monitoring, physiologic, digital technology, automation, equipment design

DOI: 10.3233/THC-231303

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3913-3924, 2024

Authors: Wu, Cuiying | Li, Yunjun | Luo, Yongchun | Dai, Yiwu | Qin, Jiazhen | Liu, Ning | Xu, Ruxiang | Li, Xuezhen | Zhang, Peng

Article Type: Research Article

Abstract: BACKGROUND: Low-grade gliomas (LGG) are a variety of brain tumors that show different clinical outcomes. The methylation of the GSTM5 gene has been noted in the development of LGG, however, its prognostic importance remains uncertain. OBJECTIVE: The objective of this study was to examine the correlation between GSTM5 DNA methylation and clinical outcomes in individuals diagnosed with LGG. METHODS: Analysis of GSTM5 methylation levels in LGG samples was conducted using data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets. The overall survival based on GSTM5 methylation status was evaluated …using Kaplan-Meier curves. The DNA methylation heatmap for particular CpG sites in the GSTM5 gene was visualized using the “pheatmap” R package. RESULTS: The study analyzed that LGG tumors had higher levels of GSTM5 methylation than normal tissues. There was an inverse relationship discovered between GSTM5 expression and methylation. LGG patients with hypermethylation of GSTM5 promoter experienced a positive outcome. Age, grade, and GSTM5 methylation were determined as independent prognostic factors in LGG through both univariate and multivariate Cox regression analyses. CONCLUSION: Methylation of GSTM5 DNA, specifically at certain CpG sites, is linked to a positive outlook in patients with LGG. Utilizing the “pheatmap” R package to visualize GSTM5 methylation patterns offers important information for identifying prognostic markers and therapeutic targets in low-grade gliomas. Show more

Keywords: Low-grade glioma, glutathione S-transferase mu class 5 (GSTM5), prognosist, methylaion, immune cells

DOI: 10.3233/THC-231316

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3925-3942, 2024

Authors: Yin, Huimin | Yan, Zhanjie | Zhao, Fangcheng

Article Type: Research Article

Abstract: BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is currently an important chronic liver disease threatening human life and health. OBJECTIVE: To investigate the risk factors of hepatocellular carcinoma (HCC) associated with nonalcoholic fatty liver disease (NAFLD) by systematic review. METHODS: We conducted a systematic review and meta-analysis. A systematic search of Chinese and English databases (PubMed, Web of Science, Cochrane Library, China national knowledge infrastructure (CNKI), Wanfang database, and VIP database) was performed until June 30, 2023. Studies were included to investigate the risk factors for HCC in patients with NAFLD. Quality evaluation was …performed using the Newcastle-Ottawa Literature Quality Evaluation Scale, and then hazard ratios (HRs) for different influencing factors were combined. RESULTS: We reviewed the results of 12 high-quality cohort studies involving 738,934 patients with NAFLD and 1,480 developed HCC. A meta-analysis based on a random-effects model showed that advanced age (HR = 1.81, 95% CI: 1.51–2.17), male gender (HR = 2.51, 95% CI: 1.67–3.78), hypertension (HR = 1.87, 95% CI: 1.05–3.33), and diabetes (HR = 2.27, 95% CI: 1.63–3.16) were risk factors for HCC in NAFLD, and the differences were statistically significant. However, there was no statistically significant effect of current smoking (HR = 1.45, 95% CI: 0.72–2.92) and dyslipidemia (HR = 1.03, 95% CI: 0.72–1.47) on HCC incidence in this study. CONCLUSION: Age, sex, hypertension and diabetes are risk factors for HCC in NAFLD patients. Diabetic NAFLD patients have a 2.27-fold increased risk of HCC, and health education and intervention for elderly, male, NAFLD patients with diabetes and hypertension need to be strengthened to promote a reduction in the risk of HCC. Show more

Keywords: Nonalcoholic fatty liver disease, hepatocellular carcinoma, risk factors, meta-analysis

DOI: 10.3233/THC-231331

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3943-3954, 2024

Authors: Quan, Wentao | Guo, Xudong | Cui, Haipo | Luo, Linlaisheng | Li, Mengyun

Article Type: Research Article

Abstract: BACKGROUND: Multi-channel acquisition systems of brain neural signals can provide a powerful tool with a wide range of information for the clinical application of brain computer interfaces. High-throughput implantable systems are limited by size and power consumption, posing challenges to system design. OBJECTIVE: To acquire more comprehensive neural signals and wirelessly transmit high-throughput brain neural signals, a FPGA-based acquisition system for multi-channel brain nerve signals has been developed. And the Bluetooth transmission with low-power technology are utilized. METHODS: To wirelessly transmit large amount of data with limited Bluetooth bandwidth and improve the accuracy …of neural signal decoding, an improved sharing run length encoding (SRLE) is proposed to compress the spike data of brain neural signal to improve the transmission efficiency of the system. The functional prototype has been developed, which consists of multi-channel data acquisition chips, FPGA main control module with the improved SRLE, a wireless data transmitter, a wireless data receiver and an upper computer. And the developed functional prototype was tested for spike detection of brain neural signal by animal experiments. RESULTS: From the animal experiments, it shows that the system can successfully collect and transmit brain nerve signals. And the improved SRLE algorithm has an excellent compression effect with the average compression rate of 5.94%, compared to the double run-length encoding, the FDR encoding, and the traditional run-length encoding. CONCLUSION: The developed system, incorporating the improved SRLE algorithm, is capable of wirelessly capturing spike signals with 1024 channels, thereby realizing the implantable systems of High-throughput brain neural signals. Show more

Keywords: Brain nerve signal, wireless transmission, multi-channel system, improved SRLE, compression ratio

DOI: 10.3233/THC-231401

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3955-3966, 2024

Authors: Zheng, Chichao | Tang, Yi | Wang, Yadan | Wang, Yuanguo | Peng, Hu

Article Type: Research Article

Abstract: BACKGROUND: Ultrasound imaging has been widely used in clinical examination because of portability, safety, and low cost. However, there are still some main challenges of imaging quality that remain in conventional ultrasound systems. OBJECTIVE: Improving image quality of SA-based methods using an improved imaging mode named far-focus compound (FSC) imaging. METHODS: A far-focus compound (FSC) imaging based on full-aperture transmission and full-aperture reception is proposed in this paper. In transmission, it uses the full aperture to transmit the focused beam to ensure image resolution and emission of sound field energy. In reception, the …full aperture is used to receive the reflected beam to ensure the image quality. A lag-one coherence-based zero-cross factor (LOCZF) is then implemented in FSC for improvement of contrast ratio (CR). The LOCZF uses lag-one coherence as zero-cross factor’s adaptive coefficient. Comparisons were made with several other weighting techniques by performing simulations and experiments for performance evaluation. RESULTS: Results confirm that LOCZF applied to FSC offers a good image contrast and simultaneously the speckle pattern. For simulated cysts, CR improvement of LOCZF reaches 194.1%. For experimental cysts, CR improvement of LOCZF reaches 220%. From the in-vivo result, compared with FSC, CR improvement of LOCZF reaches 112.7%. CONCLUSION: Proved gCNR performance. In addition, the LOCZF method shows good performance in experiments. The proposed method can be used as an effective weighting technique for improvement of image quality in ultrasound imaging. Show more

Keywords: Ultrasonic imaging, far-focus compound imaging, reversal-squart zero-cross factor, lag-one coherence-based zero-cross factor

DOI: 10.3233/THC-231452

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3967-3984, 2024

Authors: Niu, Haiying | He, Huijie | Zhao, Zilong | Lu, Xuemei | Zhao, Gang

Article Type: Research Article

Abstract: BACKGROUND: Asthma is a major public health concern due to its persistent inflammation of the airways. The intricate and widely variable epidemiology of asthma among nations and populations is a result of the interplay between genetic, environmental, and socioeconomic factors. OBJECTIVE: This study aims to investigate whether VitD supplementation can reduce the frequency of exacerbations (including the frequency of exacerbations requiring systemic corticosteroids and the frequency of exacerbations necessitating trips to the hospital or emergency room, or both) and improve pulmonary function (clinical indicators such as the FEV1% predicted value). METHODS: Computers were …used to search Pubmed, Medline, ISI Web of Science, Embase, Cachrane Library, CNKI, CBM, VIP, and the Wanfang Database. Asthma/asthma, VitD/VitD, lung function/lung function, retrieval time is from database setup to October 8, 2021, to search all randomized controlled trials (RCTs) on the effect of VitD on human asthma and to retroactively incorporate references to literature were all included in the search criteria. After rigorous screening, quality evaluation, and data extraction of the included literature by two reviewers independently, heterogeneity tests and sensitivity analyses were performed. RESULTS: The findings show that a total of 12 relevant studies meeting the inclusion criteria were finally included, including 649 cases in the experimental group and 646 cases in the control group. VitD intervention reduced the number of asthma exacerbations, including the rate of exacerbations requiring systemic corticosteroid therapy and the rate of acute exacerbations requiring emergency department or hospital visits or both. CONCLUSIONS: In the outcome of lung function (FEV1% predicted value), it was shown that VitD supplementation improved lung function; in the outcome of serum 25-hydroxyVitD levels, it was shown that VitD supplementation increased serum 25-hydroxyVitD levels. Show more

Keywords: Asthma, VitD, FEV, lung function, 25-hydroxyVitD

DOI: 10.3233/THC-231462

Citation: Technology and Health Care, vol. 32, no. 6, pp. 3985-4008, 2024

Authors: Hong, Haisen | Sha, Mo | Chen, Zhangxin | Li, Yanwei | Kang, Liangqi

Article Type: Research Article

Abstract: BACKGROUND: Femoral neck fractures, which are fractures occurring from the femoral head to the base of the femoral neck, are prevalent in the elderly population. With the progression of societal aging, the incidence of femoral neck fractures has been steadily increasing, making it a significant global issue that urgently needs to be addressed. OBJECTIVE: To compare the efficacy and safety of dynamic hip screw (DHS) with anti-rotation screw and femoral neck system (FNS) internal fixation for the treatment of Garden II–IV type femoral neck fractures. METHODS: A total of 90 patients with Garden …II–IV type femoral neck fractures were randomly assigned to either the control group (n = 45) treated with DHS and anti-rotation screw or the experimental group (n = 45) treated with FNS. Surgical outcomes, including incision size, blood loss, operation time, fluoroscopy frequency, and fracture healing time, were compared. Postoperative complication rates, reoperation rates, Harris scores, and visual analogue scale (VAS) scores were also assessed. RESULTS: The experimental group demonstrated significantly reduced incision length, blood loss, operation time, and fluoroscopy frequency compared to the control group (P < 0.01). No significant differences were observed in fracture healing time, Garden classification, or fracture reduction outcomes between the two groups (P > 0.05). At 6 months post-treatment, both groups showed significant improvements in Harris scores and VAS scores compared to pre-treatment (P < 0.05), with no significant differences between the groups (P > 0.05). The rates of internal fixation failure, nonunion, and avascular necrosis of the femoral head, as well as overall incidence of postoperative complications and reoperation rates, showed no significant differences between the two groups (P > 0.05). CONCLUSIONS: Both DHS with anti-rotation screw and FNS internal fixation demonstrated comparable efficacy and safety profiles in the treatment of Garden II–IV type femoral neck fractures. The experimental group showed advantages in terms of reduced incision length, blood loss, operation time, and fluoroscopy frequency, while maintaining similar clinical outcomes and complication rates. Show more

Keywords: Femoral neck fractures, Garden II–IV classification, dynamic hip screw (DHS), anti-rotation screw, femoral neck system (FNS), internal fixation

DOI: 10.3233/THC-231547

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4009-4017, 2024

Authors: Abu-Izneid, Tareq | Rauf, Abdur | Naz, Saima | Ibrahim, Muhammad | Muhammad, Naveed | Wadood, Abdul | Ajmal, Amar | Hemeg, Hassan A. | Fahad, Shah | Thiruvengadam, Muthu | Venkidasamy, Baskar

Article Type: Research Article

Abstract: BACKGROUND: Ficus benghalensis has been used by local health care practitioners to treat pain, inflammation, rheumatism, and other health issues. OBJECTIVE: In this study, the crude extract and diverse fractions, along with the isolated compound of F. benghalensis were examined for their roles as muscle relaxants, analgesics, and sedatives. METHODS: The extract and isolated compound 1 were screened for muscle-relaxant, analgesic, and sedative actions. The acetic acid-mediated writhing model was utilized for analgesic assessment, the muscle relaxant potential was quantified through traction and inclined plan tests, and the open field test was …applied for sedative effects. RESULTS: The extract/fractions (25, 50, and 100 mg/kg) and isolated compounds (2.5, 5, 10, and 20 mg/kg) were tested at various doses. A profound (p < 0.001) reduce in the acetic acid-mediated writhing model was observed against carpachromene (64.44%), followed by ethyl acetate (60.67%) and methanol (58.42%) fractions. A marked (p < 0.001) muscle relaxant activity was noticed against the isolated compound (71.09%), followed by ethyl acetate (66.98%) and methanol (67.10%) fractions. Regarding the sedative effect, a significant action was noted against the isolated compound (71.09%), followed by ethyl acetate (66.98%) and methanol (67.10%) fractions. Furthermore, the binding modes of the isolated compounds were explored using molecular docking. The molecular docking study revealed that the isolated compound possessed good binding affinity for COX2 and GABA. Our isolated compound may possess inhibitory activity against COX2 and GABA receptors. CONCLUSION: The extract and isolated compounds of Ficus benghalensis can be used as analgesics, muscle relaxants, and sedatives. However, detailed molecular and functional analyses are essential to ascertain their function as muscle relaxants, analgesics, and sedatives. Show more

Keywords: Ficus benghalensis, Moraceae, carpachromene, analgesic, muscle relaxant, sedative, molecular docking

DOI: 10.3233/THC-231703

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4019-4030, 2024

Authors: Li, Zhaoxi | Guo, Xiaohui | Shi, Wei | He, Rongxia | Zhong, Hua

Article Type: Research Article

Abstract: BACKGROUND: Electronic foetal monitoring (EFM), a method to monitor foetal intrauterine conditions and foetal reserve capacity, is the most extensively used intrauterine monitoring technology in obstetrics. OBJECTIVE: This study aims to compare the Thoth wearable foetal electrocardiogram (foetal ECG [FECG]) monitoring system with a traditional Doppler foetal heart monitoring system before labour to investigate their respective values in clinical application. METHODS: A total of 393 pregnant women admitted to our hospital between 2020 and 2022 participated in this study. They were recruited using the convenience sampling method. We employed a paired design to …assess the confusion rate, trend overlap, and foetal heart rate/ECG monitoring consistency, whereas a completely randomised design was used to measure pregnancy outcome indicators. The participants were divided into two groups using a random number table: the Thoth group (n = 196) and the traditional Doppler group (n = 197). Each group was monitored using the corresponding system. RESULTS: The Thoth monitor demonstrated a lower confusion rate compared with the traditional Doppler monitor (0.25% vs 2.04%; χ 2 = 5.508, P = 0.019). The trend overlap in foetal heart rates was consistently 100%, with 91.2% of readings showing a consistency rate of ⩾ 95%. Additionally, the Thoth monitor recorded a higher cumulative interruption time in the foetal heart rate curve (12.13 ± 2.22 vs 21.02 ± 2.34; t = 18.471, P < 0.001) and more abnormal ECGs (21.21 ± 4.32 vs 18.21 ± 2.91; t = 7.582, P < 0.001) than the traditional Doppler system. CONCLUSION: The Thoth wearable FECG monitor offers several advantages over the traditional Doppler foetal heart monitoring system. These include a reduced confusion rate, more accurate data collection, a lower rate of clinical misjudgement, reduced workload for medical staff, and enhanced comfort during vaginal delivery. The rates of emergency caesarean sections and neonatal asphyxia in the Thoth group were marginally lower than those in the Doppler group, which may be attributed to issues such as ECG disconnection or interference from the maternal heart rate. Show more

Keywords: Foetal heart monitoring, foetal ECG monitor, Thoth wearable device, Doppler device, heart rates

DOI: 10.3233/THC-231752

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4031-4040, 2024

Authors: Wang, Zuoshan | Wang, Shilin | Wang, Manya | Sun, Yan

Article Type: Research Article

Abstract: BACKGROUND: Healthcare is crucial to patient care because it provides vital services for maintaining and restoring health. As healthcare technology evolves, cutting-edge tools facilitate faster diagnosis and more effective patient treatment. In the present age of pandemics, the Internet of Things (IoT) offers a potential solution to the problem of patient safety monitoring by creating a massive quantity of data about the patient through the linked devices around them and then analyzing it to estimate the patient’s current status. Utilizing the IoT-based meta-heuristic algorithm allows patients to be remotely monitored, resulting in timely diagnosis and improved care. Meta-heuristic algorithms …are successful, resilient, and effective in solving real-world enhancement, clustering, predicting, and grouping. Healthcare organizations need an efficient method for dealing with big data since the prevalence of such data makes it challenging to analyze for diagnosis. The current techniques used in medical diagnostics have limitations due to imbalanced data and the overfitting issue. OBJECTIVE: This study introduces the particle swarm optimization and convolutional neural network to be used as a meta-heuristic optimization method for extensive data analysis in the IoT to monitor patients’ health conditions. METHOD: Particle Swarm Optimization is used to optimize the data used in the study. Information for a diabetes diagnosis model that includes cardiac risk forecasting is collected. Particle Swarm Optimization and Convolutional Neural Networks (PSO-CNN) results effectively make illness predictions. Support Vector Machine has been used to predict the possibility of a heart attack based on the classification of the collected data into projected abnormal and normal ranges for diabetes. RESULTS: The results of the simulations reveal that the PSO-CNN model used to predict diabetic disease increased in accuracy by 92.6%, precision by 92.5%, recall by 93.2%, F1-score by 94.2%, and quantization error by 4.1%. CONCLUSION: The suggested approach could be applied to identify cancer cells. Show more

Keywords: Healthcare, disease diagnosis, meta-heuristic algorithm, IoT, patient monitoring, Particle Swarm Optimization, convolutional neural network, diabetes, cardiac risk forecasting, support vector machine, cancer cells

DOI: 10.3233/THC-231755

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4041-4061, 2024

Authors: Jiang, Yangzheng | Yang, Jiantao | Tian, Hui | Jiang, Chuan | Wang, Hongzhu

Article Type: Research Article

Abstract: BACKGROUND: Flatfoot (pes planus) is a common foot deformity, and its causes are mainly related to age, gender, weight, and genetics. Previous studies have shown that custom-made insoles could have a positive effect in improving plantar pressure and symptoms in individuals with flexible flatfeet, but it remains to be explored whether they can still show benefits in daily walking on different slopes. OBJECTIVE: This study aims to investigate a custom-made insole based on plantar pressure redistribution and to verify its effectiveness by gait analysis on different slopes. METHODS: We recruited 10 subjects and …compared the peak pressure and impulse in each area between custom-made insole (CI) and ordinary insole (OI) groups. RESULTS: The results illustrate that CI raises the pressure in T area, improves the ability of the subjects to move forward in the slope walking, which was beneficial to gait stability. CONCLUSION: The redistribution of pressure in MF and MH area is promoted to provide active protection for subjects. Meanwhile, CI could decrease the impulse in MF area during uphill and level walking, which effectively reduces the accumulation of fatigue during gait. Moreover, avoiding downhill walking could be able to protect foot from injury in daily life. Show more

Keywords: Flatfoot, custom-made insole, slope, pressure, impulse

DOI: 10.3233/THC-231785

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4063-4075, 2024

Authors: Yang, Ping | Wu, Xiaoneng

Article Type: Research Article

Abstract: BACKGROUND: The objective performance evaluation of an athlete is essential to allow detailed research into elite sports. The automatic identification and classification of football teaching and training exercises overcome the shortcomings of manual analytical approaches. Video monitoring is vital in detecting human conduct acts and preventing or reducing inappropriate actions in time. The video’s digital material is classified by relevance depending on those individual actions. OBJECTIVE: The research goal is to systematically use the data from an inertial measurement unit (IMU) and data from computer vision analysis for the deep Learning of football teaching motion recognition …(DL-FTMR). There has been a search for many libraries. The studies included have examined and analyzed training through profound model construction learning methods. Investigations show the ability to distinguish the efficiency of qualified and less qualified officers for sport-specific video-based decision-making assessments. METHODS: Video-based research is an effective way of assessing decision-making due to the potential to present changing in-game decision-making scenarios more environmentally friendly than static picture printing. The data showed that the filtering accuracy of responses is improved without losing response time. This observation indicates that practicing with a video monitoring system offers a play view close to that seen in a game scenario. It can be an essential way to improve the perception of selection precision. This study discusses publicly accessible training datasets for Human Activity Recognition (HAR) and presents a dataset that combines various components. The study also used the UT-Interaction dataset to identify complex events. RESULTS: Thus, the experimental results of DL-FTMR give a performance ratio of 94.5%, behavior processing ratio of 92.4%, athletes energy level ratio of 92.5%, interaction ratio of 91.8%, prediction ratio of 92.5%, sensitivity ratio of 93.7%, and the precision ratio of 94.86% compared to the optimized convolutional neural network (OCNN), Gaussian Mixture Model (GMM), you only look once (YOLO), Human Activity Recognition- state-of-the-art methodologies (HAR-SAM). CONCLUSION: This finding proves that exercising a video monitoring system that provides a play view similar to that seen in a game scenario can be a valuable technique to increase selection accuracy perception. Show more

Keywords: Football, training, deep learning, video surveillance, skills, detection

DOI: 10.3233/THC-231860

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4077-4096, 2024

Authors: Zhao, Dechun | Luo, Zixin | Yao, Mingcai | Wei, Li | Qin, Lu | Wang, Ziqiong

Article Type: Research Article

Abstract: BACKGROUND: The local field potential (LFP) signals are a vital signal for studying the mechanisms of deep brain stimulation (DBS) and constructing adaptive DBS containing information related to the motor symptoms of Parkinson’s disease (PD). OBJECTIVE: A Parkinson’s disease state identification algorithm based on the feature extraction strategy of transfer learning was proposed. METHODS: The algorithm uses continuous wavelet transform (CWT) to convert one-dimensional LFP signals into two-dimensional gray-scalogram images and color images respectively, and designs a Bayesian optimized random forest (RF) classifier to replace the three fully connected layers for the classification …task in the VGG16 model, to realize automatic identification of the pathological state of PD patients. RESULTS: It was found that consistently superior performance of gray-scalogram images over color images. The proposed algorithm achieved an accuracy of 97.76%, precision of 99.01%, recall of 96.47%, and F1-score of 97.73%, outperforming feature extractors such as VGG19, InceptionV3, ResNet50, and the lightweight network MobileNet. CONCLUSIONS: This algorithm has high accuracy and can distinguish the disease states of PD patients without manual feature extraction, effectively assisting the working of doctors. Show more

Keywords: Parkinson’s disease, deep brain stimulation, local field potential, transfer learning, state identification

DOI: 10.3233/THC-231929

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4097-4107, 2024

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

Authors: Rajeshkumar, C. | Soundar, K. Ruba

Article Type: Research Article

Abstract: BACKGROUND: Due to the increasing prevalence of respiratory diseases and the importance of early diagnosis. The need for non-invasive and touchless medical diagnostic solutions has become increasingly crucial in modern healthcare to detect lung abnormalities. OBJECTIVE: Existing methods for lung abnormality detection often rely on invasive and time-consuming procedures limiting their effectiveness in real-time diagnosis. This work introduces a novel Touchless Lung Abnormality (TO-LAB) detection model utilizing universal software radio peripherals (USRP) and machine learning algorithms. METHODS: The TO-LAB model integrates a blood pressure meter and an RGB-D depth-sensing camera to gather individual …data without physical contact. Heart rate (HR) is analyzed through image conversion to IPPG signals, while blood pressure (BP) is obtained via analog conversion from the blood pressure meter. This touchless imaging setup facilitates the extraction of essential signal features crucial for respiratory pattern analysis. Advanced computer vision algorithms like Mel-frequency cepstral coefficients (MFCC) and Principal Component Analysis (PCA) process the acquired data to focus on breathing abnormalities. These features are then combined and inputted into a machine learning-based Multi-class SVM for breathing activity analysis. The Multi-class SVM categorizes breathing abnormalities as normal, shallow, or elevated based on the fused features. The efficiency of this TO-LAB model is evaluated with the simulated and real-time data. RESULTS: According to the findings, the proposed TO-LAB model attains the maximum accuracy of 96.15% for real time data; however, the accuracy increases to 99.54% for simulated data for the efficient classification of breathing abnormalities. CONCLUSION: From this analysis, our model attains better results in simulated data but it declines the accuracy while processing with real-time data. Moreover, this work has a significant medical impact since it presents a solution to the problem of gathering enough data during the epidemic to create a realistic model with a large dataset. Show more

Keywords: Breathing abnormality, touchless detection, universal software radio peripherals, machine learning, multi-class SVM

DOI: 10.3233/THC-240149

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4309-4330, 2024

Authors: Ni, Boye | Jin, Huaping | Wu, Wei

Article Type: Research Article

Abstract: BACKGROUND: According to the Global Burden of Disease Study the prevalence of stroke worldwide has significantly increased from 1990 to 2019, making it the second leading cause of death worldwide. Approximately 70%–80% of stroke patients are unable to live independently due to disability. OBJECTIVE: To explore the therapeutic effect of proprioceptive neuromuscular facilitation (PNF) combined with muscle energy technique (MET) on post-stroke dysphagia. METHODS: A total of 122 stroke patients with dysphagia admitted to our hospital from January 2017 to December 2020 were divided into the control group (n = …61) and the study group (n = 61). Patients in the control group received conventional rehabilitation plans, while those in the study group were given a combined therapy of MET and PNF. Standard Swallowing Function Assessment Scale (SSA), Videofluoroscopic Swallow Study (VFSS), Swallowing Quality of Life (SWAL-QOL) scores, Water Swallow Test (WST) grading, and efficacy indicators were compared between two group with t -tests, Wilcoxon signed-rank test, χ 2 test or Fisher’s exact probability test. RESULTS: After treatment, the study group showed lower SSA score (P = 0.036), and VFSS, P = 0.013 than the control group. The changes in SSA score (P = 0.013) and VFSS score (P < 0.001) in the study group were greater than the control group. Furthermore, after treatment, both the study group and the control group showed a decrease in WST grading (P < 0.001); and the degree of post-treatment WST grading decline in the study group was higher (P = 0.009). Besides, after treatment, the SWAL-QOL score of the study group was higher than the control group (P < 0.001); and the effective rate of patients in the study group was higher than that in the control group (P = 0.021). CONCLUSION: Compared with traditional rehabilitative training strategies, PNF combined with MET can effectively improve swallowing function, and enhance the quality of life in patients with post-stroke dysphagia. Show more

Keywords: Proprioceptive neuromuscular facilitation, muscle energy technique, stroke, dysphagia

DOI: 10.3233/THC-240220

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4331-4342, 2024

Authors: Lu, Jieting | Sun, Xiaoling | Zhang, Yun

Article Type: Research Article

Abstract: BACKGROUND: Nursing management considers nursing quality management at its core. Evaluation indexes of nursing quality not only control nursing quality, measure work enthusiasm, and judge the difference in nursing levels but also help nurses accurately understand the satisfaction degree of patients. OBJECTIVE: To analyze pediatric tumor nursing quality evaluation indexes and establish a scientific and rigorous index system of children’s nursing quality. METHODS:   Based on the “structure-process-result” in this study, the Delphi method was used to carry out questionnaire investigations and opinion collection for domestic experts in pediatrics, pediatric oncology internal medicine, and pediatric oncology …surgical care and clinical aspects two times. In addition, the Kendall coordination coefficient and analytic hierarchy process were used to determine the content of indicators at all levels, set the weight, and finally establish the quality index system of pediatric tumor nursing. RESULTS: The response rate of 27 experts in the first round of the questionnaire was 100%, Ca0.77, Cs,0.73, Cr0.75, and the W value of the expert coordination coefficient was 0.315. In the second round of 27 expert consultations, the reply rate was 96%, Ca0.81, Cs0.80, Cr0.805, and the specialist coordination coefficient W value was 0.369. After two rounds of consultation, the importance evaluation scores of each indicator ranged from 3.31 to 4.88 and 3.29 to 5.00, respectively, and more than 94.7% of the indicators’ importance evaluation scores were higher than 3.50. Finally, 3 Level-1 indicators, 12 Level-2 indicators, and 54 Level-3 indicators are established. CONCLUSION: This study has established a simple, comprehensive, and scientific quality index system for pediatric tumor nursing, highlighted the characteristics of pediatric tumor nursing, and provided an evaluation system for specialized nursing of pediatric tumors to more standardized pediatric tumor nursing and contribute to the sustainable and scientific development of pediatric tumor nursing. Show more

Keywords: Pediatric tumor, tumor nursing, quality indexes, Delphi method, health care, semi-structured interview method, oncology nurses

DOI: 10.3233/THC-240252

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4343-4351, 2024

Authors: Tian, Wei | Zhang, Sheng | Gao, Yuan | Wang, Yan | Cui, Qianqian

Article Type: Research Article

Abstract: BACKGROUND: Irrational pharmacotherapy and increasing pharmacy costs remain major concerns in healthcare systems. Pharmacists are expected to employ diagnosis-related group (DRG) data to analyse inpatient pharmacy utilization. OBJECTIVE: This project aimed to pilot an efficient pharmacist-led programme to analyse factors related to pharmacy expenses, evaluate the rational use of drugs in batch processing, and make further interventions based on DRG data. METHODS: Patients from the OB25 (caesarean section without comorbidities or complications) DRG were selected in 2018, and the most relevant factors were identified through statistical analysis. Interventions were implemented by sending monthly …reports on prescribing data and drug review results for the same DRGs to the department starting in 2019. Pre–post comparisons were conducted to demonstrate changes in pharmacy costs and appropriateness at a tertiary teaching hospital with 2,300 beds in China. RESULTS: A total of 1,110 patients were identified from the OB25 DRG data in 2018. Multivariate linear analysis indicated that the number of items prescribed and wards substantially influenced pharmacy expenditure. Drugs labelled as vital, essential, and non-essential revealed that 46.6% of total pharmacy costs were spent on non-essential drugs, whereas 38.7% were spent on vital drugs. The use of inappropriate pharmaceuticals and drug items was substantially reduced, and the average pharmacy cost after intervention was 336.7 RMB in 2020. The benefit–cost ratio of the programme was 9.86. CONCLUSION: Interventions based on DRG data are highly efficient and feasible for reducing inpatient pharmacy costs and non-essential drug use. Show more

Keywords: Diagnosis-related groups, rational use of drugs, cost savings, prescribing behaviour, pharmacist intervention

DOI: 10.3233/THC-240284

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4353-4363, 2024

Authors: Pélissier, Léna | Beraud, Duane | Pereira, Bruno | Couret, Alexis | Isacco, Laurie | Thivel, David

Article Type: Research Article

Abstract: BACKGROUND: Exploring the independent effect of mechanical discharge in response to weight loss (WL) seems necessary but remains highly challenging from a methodological point. Anti-gravity treadmills could be relevant to simulate a mechanical WL by body weight support (BWS), but their reliability remains unclear to properly explore exercise energy metabolism, especially at low degrees of alleviations. OBJECTIVE: The study aimed to evaluate the accuracy and reproducibility of an anti-gravity treadmill to generate BWS, and the reproducibility of cardiometabolic responses to an exercise performed at low degrees of BWS on this device. METHODS: Observed …BWS of 18 normal-weight males was obtained twice at seven degrees of target BWS (i.e., 0, 3, 6, 9, 12, 15, 18%) using a digital scale inside the anti-gravity treadmill, and was compared to the expected BWS. Then, 15 of them performed 5-min bout of low-intensity walking exercise at these degrees of BWS in a randomized order, separated by 4-min rest. The exercise was identically repeated on three occasions separated by a minimum of 3 days. Energy metabolism and heart rate (HR) were measured throughout the exercise by indirect calorimetry and a HR monitor, respectively. RESULTS: The observed BWS were significantly different from the expected BWS (p < 0.001), and there was a high inter- and intra-individual variability in BWS generated by the anti-gravity treadmill. Results showed an overall good reliability of VO2 (intraclass correlation coefficients (ICC) values ranging from 0.67 to 0.85) and HR (ICC > 0.8) in response to exercise. An effect of the degree of BWS was observed for VO2 (p < 0.001), illustrating reduced values at 15% and 18% of BWS compared to 0, 3, and 6%. CONCLUSIONS: Such device might not be adapted to simulate low degrees of WL in normal-weight males, particularly when it comes to the exploration of energy metabolism. Show more

Keywords: Lower-body positive pressure, accuracy, alleviation, exercise, energy metabolism

DOI: 10.3233/THC-240314

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4365-4380, 2024

Authors: H, Summia Parveen | S, Karthik | R, Sabitha

Article Type: Research Article

Abstract: BACKGROUND: Early pregnancy thyroid function assessment in mothers is covered. The benefits of using load-specific reference ranges are well-established. OBJECTIVE: We pondered whether the categorization of maternal thyroid function would change if multiple blood samples obtained early in pregnancy were used. Even though binary classification is a common goal of current disease diagnosis techniques, the data sets are small, and the outcomes are not validated. Most current approaches concentrate on model optimization, focusing less on feature engineering. METHODS: The suggested method can predict increased protein binding, non-thyroid syndrome (NTIS) (simultaneous non-thyroid disease), autoimmune …thyroiditis (compensated hypothyroidism), and Hashimoto’s thyroiditis (primary hypothyroidism). In this paper, we develop an automatic thyroid nodule classification system using a multi-scale vision transformer and image enhancement. Graph equalization is the chosen technique for image enhancement, and in our experiments, we used neural networks with four-layer network nodes. This work presents an enhanced linguistic coverage neuro-fuzzy classifier with chosen features for thyroid disease feature selection diagnosis. The training procedure is optimized, and a multi-scale vision transformer network is employed. Each hop connection in Dense Net now has trainable weight parameters, altering the architecture. Images of thyroid nodules from 508 patients make up the data set for this article. Sets of 80% training and 20% validation and 70% training and 30% validation are created from the data. Simultaneously, we take into account how the number of training iterations, network structure, activation function of network nodes, and other factors affect the classification outcomes. RESULTS: According to the experimental results, the best number of training iterations is 500, the logistic function is the best activation function, and the ideal network structure is 2500-40-2-1. CONCLUSION: K-fold validation and performance comparison with previous research validate the suggested methodology’s enhanced effectiveness. Show more

Keywords: Maternal thyroid disease, multi-scale vision transformer, improved linguistic hedges, neural-fuzzy classifier

DOI: 10.3233/THC-240362

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4381-4402, 2024

Authors: Xu, Leilei | Hua, Fu | Li, Changhua | Xu, Tong

Article Type: Research Article

Abstract: BACKGROUND: Laparoscopic and robotic-assisted techniques have gained popularity, and endometrial cancer (EC) remains a significant health problem among women. OBJECTIVE: Minimally invasive surgical (MIS) therapy options for early endometrial cancer will be evaluated for their effectiveness and safety is the aim of this paper. We also investigate the differences in oncologic outcomes between MIS and open surgery (OS) for individuals with early-stage EC. The patient was diagnosed with early-stage EC and treated with laparoscopic surgery and was the focus of a retrospective analysis. 162 patients with early EC were analyzed, with diagnoses occurring between 2002 and …2022. METHODS: The patients were fragmented into two groups, one for OS and another for laparoscopic procedures. The total tumor excision and recurrence rates were identical across the two methods, indicating similar oncologic results. Rates of complications were likewise comparable across the two groups. RESULTS: The quality of life ratings of patients with robotic-assisted surgery was higher than those with laparoscopic surgery. Sixty-two (62.2%) of the 162 patients in this research had OS, whereas Fifty-six (57.8%) had MIS. The probability of recurrence of EC from stages III to IV was significanitly higher in women who had OS. CONCLUSION: Minimally invasive procedures were shown to be effective in treating early-stage EC, and while these findings provide support for their usage, larger multicenter randomized controlled studies are required to verify these results and further examine possible long-term advantages. Patients with early-stage EC, regardless of histologic type, had superior survival rates with MIS compared to OS. Show more

Keywords: Early stage, endometrial cancer (EC), adjuvant treatment, minimally invasive surgery (MIS), open surgery (OS)Highlights•Certain patients with endometrial cancer at an early stage may be candidates for minimally invasive surgical. •There are several benefits to treating early endometrial cancer with minimally invasive surgical.•Selecting patients for minimally invasive treatments of early-stage endometrial cancer and performing thorough preoperative evaluations are essential for maximizing the probability of success.

DOI: 10.3233/THC-240439

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4403-4415, 2024

Authors: Cheng, Changfeng | Wang, Jiening | Yang, Kun | Wu, Xubo | Ren, Xue | Liu, Tiantian | Zhao, Zhongzhi | Zhang, Beibei | Ma, Bitao | Jiang, Liming

Article Type: Research Article

Abstract: BACKGROUND: Knee osteoarthritis is a common degenerative joint disease where a single treatment method often fails to fully alleviate symptoms. Hence, finding effective non-invasive combined treatment approaches is particularly crucial. OBJECTIVE: The efficacy of treating knee osteoarthritis with hip abductors exercise training combined with repetitive transcranial magnetic stimulation was assessed through functional scales and objective evaluation methods. METHODS: In this four-week randomized clinical trial, 160 patients meeting inclusion criteria were randomly assigned 1:1 to group A to receive oral celecoxib and group B to receive a combination of hip abductors exercise training and …repeated transcranial magnetic stimulation. The primary outcome was the western Ontario and McMaster universities osteoarthritis index. The secondary outcomes include Visual Analogue Scale, knee outcome survey activities of daily living scale, Active Range of Motion, and the Quadriceps Angle, the tibiofemoral angle, peak adductor moment, the integrated electromyography and root mean square of the surface electromyography of the lower extremity muscles. Paired sample t test was used for Within-Group comparison of outcome indicators, and independent sample t test was used for Between-Group comparison. RESULTS: Of the 160 randomly assigned patients, 150 completed the study. After 4 weeks, the WOMAC index decreased from 61 ± 10.83 to 40.55 ± 7.58 in the combined treatment group and from 60.97 ± 10.18 to 47.7 ± 10.13 in the celecoxib group. The effect of the combined treatment group was significantly higher than that in the celecoxib group (P < 0.001). In the combined treatment group, the score of knee joint daily living scale increased (P < 0.001), the active range of motion increased (P < 0.001), the quadriceps angle decreased (P < 0.001), the tibiofemoral angle increased (P < 0.001), and the peak adduction moment decreased (P < 0.001), integrated electromyography and root mean square increased (P < 0.001), and the effect was better than that of celecoxib group (P < 0.001). The visual analog scale score in celecoxib group was lower (P < 0.001) and knee outcome survey activities of daily living scale was higher (P < 0.001). The incidence of treatment-related adverse events was 10% in the celecoxib group and 2.5% in the combined treatment group, all of which were mild. CONCLUSIONS: Hip abductors exercise training combined with repetitive transcranial magnetic stimulation can enhance abduction muscle strength, improve mobility, reduce joint pain, and enhance quality of life. This combined approach shows superior clinical effectiveness compared to oral celecoxib. Show more

Keywords: Knee osteoarthritis, hip abductors exercise training, repetitive transcranial magnetic stimulation, surface electromyography, celecoxib

DOI: 10.3233/THC-240456

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4417-4430, 2024

Authors: Wang, Zhanchao | Wang, Wei | Zuo, Bin | Lu, Hua

Article Type: Research Article

Abstract: BACKGROUND: Osteoarthritis (OA) and osteoporosis (OS) are the most common orthopedic diseases. OBJECTIVE: To identify important genes as biomarkers for the pathogenesis of OA and OS. METHODS: Microarray data for OA and OS were downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) between the OA and healthy control groups and between the OS and healthy control groups were identified using the Limma software package. Overlapping hub DEGs were selected using MCC, MNC, DEGREE, and EPC. Weighted gene co-expression network analysis (WGCNA) was used to mine OA- and OS-related modules. Shared …hub DEGs were identified, human microRNA disease database was used to screen microRNAs associated with OA and OS, and an miRNA-target gene network was constructed. Finally, the expression of shared hub DEGs was evaluated. RESULTS: A total of 104 overlapping DEGs were identified in both the OA and OS groups, which were mainly related to inflammatory biological processes, such as the Akt and TNF signaling pathways Forty-six hub DEGs were identified using MCC, MNC, DEGREE, and EPC modules using different algorithms. Seven modules with 392 genes that highly correlated with disease were identified in the WGCNA. Furthermore, 10 shared hub DEGs were identified between the OA and OS groups, including OGN, FAP, COL6A3, THBS4, IGFBP2, LRRC15, DDR2, RND3, EFNB2, and CD48. A network consisting of 8 shared hub DEGs and 55 miRNAs was constructed. Furthermore, CD48 was significantly upregulated in the OA and OS groups, whereas EFNB2, DR2, COL6A3, and RND3 were significantly downregulated in OA and OS. Other hub DEGs were significantly upregulated in OA and downregulated in OS. CONCLUSIONS: The ten genes may be promising biomarkers for modulating the development of both OA and OS. Show more

Keywords: Osteoarthritis, osteoporosis, hub DEGs

DOI: 10.3233/THC-240574

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4431-4444, 2024

Authors: Yu, Qing | Hu, Jing

Article Type: Research Article

Abstract: BACKGROUND: The number of cesarean sections performed is increasing every year, and obstetric anesthesia is of great interest to physicians and research scholars because of its specificity, high risk, and high complication rate. OBJECTIVE: To investigate the effects of combined spinal epidural anesthesia (CSEA) with different intervertebral spaces during cesarean section on anesthesia effect, anesthesia onset time, anesthesia recovery time, maternal adverse reactions, and neonates. METHODS: Ninety-two women who underwent cesarean section in our hospital from September 2022 to February 2023 were selected as the study subjects and randomly divided them into two …groups (group A and group B), 46 women in each group. Group A underwent CSEA via an L2-3 gap and group B underwent CSEA via an L3-4 gap puncture. The anesthesia effect, anesthesia onset time, sensory recovery time, adverse effects, and neonatal Apgar score were compared between the two groups. RESULTS: When CSEA was performed from L2-3, the anesthesia efficiency was higher, but the difference was not statistically significant. When anesthesia was performed by puncture from L2-3, the onset of anesthesia and recovery time was shorter, and the incidence of intraoperative maternal nausea and vomiting, hypotension, respiratory depression, and other adverse reactions was low with a statistically significant difference. However, the Apgar scores of the neonates in the two groups have no difference. CONCLUSIONS: When CSEA is induced via L2-3 interspace, anesthesia has a rapid onset of action, shorter recovery time, and few maternal adverse effects, without affecting the final anesthetic outcome. Show more

Keywords: Combined spinal-epidural anesthesia, intervertebral spaces, cesarean section, difference

DOI: 10.3233/THC-240599

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4445-4452, 2024

Authors: K. P, Ajitha Gladis | D, Roja Ramani | N, Mohana Suganthi | P, Linu Babu

Article Type: Research Article

Abstract: BACKGROUND: Gastrointestinal tract (GIT) diseases impact the entire digestive system, spanning from the mouth to the anus. Wireless Capsule Endoscopy (WCE) stands out as an effective analytic instrument for Gastrointestinal tract diseases. Nevertheless, accurately identifying various lesion features, such as irregular sizes, shapes, colors, and textures, remains challenging in this field. OBJECTIVE: Several computer vision algorithms have been introduced to tackle these challenges, but many relied on handcrafted features, resulting in inaccuracies in various instances. METHODS: In this work, a novel Deep SS-Hexa model is proposed which is a combination two different deep …learning structures for extracting two different features from the WCE images to detect various GIT ailment. The gathered images are denoised by weighted median filter to remove the noisy distortions and augment the images for enhancing the training data. The structural and statistical (SS) feature extraction process is sectioned into two phases for the analysis of distinct regions of gastrointestinal. In the first stage, statistical features of the image are retrieved using MobileNet with the support of SiLU activation function to retrieve the relevant features. In the second phase, the segmented intestine images are transformed into structural features to learn the local information. These SS features are parallelly fused for selecting the best relevant features with walrus optimization algorithm. Finally, Deep belief network (DBN) is used classified the GIT diseases into hexa classes namely normal, ulcer, pylorus, cecum, esophagitis and polyps on the basis of the selected features. RESULTS: The proposed Deep SS-Hexa model attains an overall average accuracy of 99.16% in GIT disease detection based on KVASIR and KID datasets. The proposed Deep SS-Hexa model achieves high level of accuracy with minimal computational cost in the recognition of GIT illness. CONCLUSIONS: The proposed Deep SS-Hexa Model progresses the overall accuracy range of 0.04%, 0.80% better than GastroVision, Genetic algorithm based on KVASIR dataset and 0.60%, 1.21% better than Modified U-Net, WCENet based on KID dataset respectively. Show more

Keywords: Gastrointestinal tract, wireless capsule endoscopy, mobile network, structural and statistical features, deep belief network

DOI: 10.3233/THC-240603

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4453-4473, 2024

Authors: Teng, Xiaohuan | Sun, Yanrong | Zhao, Landi | Kang, Yingxian

Article Type: Research Article

Abstract: BACKGROUND: In 2019, approximately 330 million individuals in China were affected by cardiovascular diseases, with 11.4 million cases specifically attributed to coronary artery disease (CAD). A national public health report indicated that the mortality rate for CAD ranged from 121.59 to 130.14 per 100,000 individuals in 2019. The treatments for CAD include lifestyle changes, medications, percutaneous coronary intervention (PCI) and coronary artery bypass grafting. OBJECTIVE: To investigate the management effect of a digital health program in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). METHODS: This retrospective study compares …blood pressure, blood glucose, low-density lipoprotein cholesterol (LDL-C), medication adherence, lifestyle modification, and readmission rate between digital health users and traditional follow-up in post-PCI CAD patients. RESULTS: In this study of 698 CAD patients, the 6-month readmission rate of all patients was 27.4%, with digital health users showing lower rates than those in traditional follow-up (22.6% vs. 32.1%, p = 0.005). Digital health users had significantly higher target achievements rates in blood pressure (79.7% vs. 54.7%, p < 0.001), blood glucose (98.9% vs. 82.5%, p < 0.001) and LDL-C level (71.3% vs. 52.7%, p < 0.001) at 6-month post-PCI. The digital health group had more patients adopting lifestyle changes, including quitting smoking, maintaining a healthy diet, and exercising regularly. In risk factor analysis, digital health utilization (OR = 0.60, 95%CI: 0.40–0.90, p = 0.014) and multivessel disease (double: OR = 1.72, 95%CI: 1.09—2.72, p = 0.02; triple: OR = 2.59, 95%CI: 1.61–4.17, p < 0.001) were independent predictors of CAD-related cardiovascular readmissions. CONCLUSIONS: Post-PCI patients using digital health platforms exhibited improved blood pressure, glucose, and LDL-C control, greater treatment adherence, enhanced lifestyle changes, and reduced six-month readmission rates versus those with traditional follow-up. Show more

Keywords: Coronary artery disease, PCI, disease management, digital health

DOI: 10.3233/THC-240621

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4475-4484, 2024

Authors: Radhakrishnan, Menaka | Ramamurthy, Karthik | Shanmugam, Saranya | Prasanna, Gaurav | S, Vignesh | Y, Surya | Won, Daehan

Article Type: Research Article

Abstract: BACKGROUND: Autism Spectrum Disorder (ASD) is a condition with social interaction, communication, and behavioral difficulties. Diagnostic methods mostly rely on subjective evaluations and can lack objectivity. In this research Machine learning (ML) and deep learning (DL) techniques are used to enhance ASD classification. OBJECTIVE: This study focuses on improving ASD and TD classification accuracy with a minimal number of EEG channels. ML and DL models are used with EEG data, including Mu Rhythm from the Sensory Motor Cortex (SMC) for classification. METHODS: Non-linear features in time and frequency domains are extracted and ML …models are applied for classification. The EEG 1D data is transformed into images using Independent Component Analysis-Second Order Blind Identification (ICA-SOBI), Spectrogram, and Continuous Wavelet Transform (CWT). RESULTS: Stacking Classifier employed with non-linear features yields precision, recall, F1-score, and accuracy rates of 78%, 79%, 78%, and 78% respectively. Including entropy and fuzzy entropy features further improves accuracy to 81.4%. In addition, DL models, employing SOBI, CWT, and spectrogram plots, achieve precision, recall, F1-score, and accuracy of 75%, 75%, 74%, and 75% respectively. The hybrid model, which combined deep learning features from spectrogram and CWT with machine learning, exhibits prominent improvement, attained precision, recall, F1-score, and accuracy of 94%, 94%, 94%, and 94% respectively. Incorporating entropy and fuzzy entropy features further improved the accuracy to 96.9%. CONCLUSIONS: This study underscores the potential of ML and DL techniques in improving the classification of ASD and TD individuals, particularly when utilizing a minimal set of EEG channels. Show more

Keywords: Independent component analysis – Second Order Blind Identification (ICA – SOBI), Continuous Wavelet transform (CWT), stacking classifier, hybrid model, spectrogram, electroencephalogram

DOI: 10.3233/THC-240644

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4485-4503, 2024

Authors: Cui, Lin | Zhang, Xueyan | Wen, Yingying | Li, Cuihua | Zhang, Jianyun | Cui, XiWei | Sun, Hao | Chang, Liu

Article Type: Research Article

Abstract: BACKGROUND: Endoscopic submucosal dissection (ESD) is a well-established treatment for gastrointestinal tumors and enables en bloc resection. Adequate counter traction with good visualization is important for safe and effective dissection. OBJECTIVE: Based on magnetic anchor-guided endoscopic submucosal dissection (MAG-ESD), we would like to explore the feasibility of magnetic hydrogel as an internal magnetic anchor that can be injected into the submucosa through an endoscopic needle to assist colonic endoscopic submucosal dissection. METHODS: This prospective trial was conducted on 20 porcine colons ex vivo. We injected magnetic hydrogel into submucosa of the porcine colons …ex vivo for MAG-ESD to evaluate the traction effect and operation satisfaction. RESULTS: Magnetic hydrogel assisted ESD was successfully performed on 20 porcine colons ex vivo. Adequate counter traction with good visualization was successfully obtained during the procedure of dissection. CONCLUSION: Magnetic hydrogel assisted MAG-ESD is feasible and effective. Show more

Keywords: Magnetic surgery, magnetic hydrogel, magnetic anchor-guided endoscopic submucosal dissection, colonic tumorsMain points:•Magnetic hydrogel can play the role of target magnet during ESD, which can provide adequate counter traction with good visualization and effective dissection;•Magnetic hydrogel can make ESD more simple and efficient, shorten the procedure time, improve the endoscopists’ satisfaction, especially for ESD beginners more friendly.

DOI: 10.3233/THC-240653

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4505-4514, 2024

Authors: Zhao, Zhifeng | Yua, Yadong

Article Type: Research Article

Abstract: BACKGROUND: Lung cancer (LC) is one of the leading causes of death worldwide. Treatment methodologies such as chemotherapy and radiotherapy have improved patient survival rates. Nevertheless, these treatments can also lead to adverse reactions and impact patients’ nutritional status and quality of life (QOL). Antibiotics are commonly used for treating infections, but there is still controversy regarding their potential adverse effects on LC patients. OBJECTIVE: This work aimed to investigate the impact of antibiotic adoption on the nutritional status and QOL of LC patients undergoing radiotherapy or chemotherapy, providing valuable insights for the clinical management of …LC. METHODS: A meta-analysis approach was employed to comprehensively evaluate the relationship by synthesizing relevant literature. Published studies were identified through searches in databases such as PubMed, EMBASE, Cochrane Library, Web of Science, and CNKI. The inclusion criteria encompassed randomized controlled trials, cohort studies, and cross-sectional studies. Assessment indicators included patient weight, BMI, hemoglobin levels, and QOL. Meta-analysis was conducted using software such as the Cochrane Collaboration and RevMan5.3. Heterogeneity was evaluated using the Higgins I 2 index, where values between 25% and 50% indicate moderate heterogeneity, and values greater than 50% indicate substantial heterogeneity. RESULTS: 12 eligible studies involving 1,917 patients were finally included. LC patients who received antibiotics during radiotherapy or chemotherapy were found to have a higher risk of malnutrition. The antibiotic group exhibited a more significant decrease in body mass index (BMI) (P < 0.05) and lower serum albumin levels (P < 0.05) versus the control (C) group. Additionally, the overall QOL scores in the antibiotic group were dramatically lower than those in the C group, showing a significant difference with P < 0.05. Sensitivity analysis indicated that the overall conclusions of this work were robust and unbiased. CONCLUSION: Antibiotics in LC patients undergoing radiotherapy or chemotherapy may increase the risk of malnutrition and decrease their QOL. Hence, physicians should carefully consider antibiotics and take necessary preventive measures and supportive treatments to improve LC patients’ nutritional status and QOL. Show more

Keywords: Antibiotics, lung cancer patients, radiotherapy, chemotherapy, nutritional status, quality of life

DOI: 10.3233/THC-240660

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4515-4536, 2024

Authors: Takahashi, Hakuo | Yamashita, Shingo | Yakura, Nobuki

Article Type: Research Article

Abstract: BACKGROUND: Blood pressure (BP) naturally undergoes fluctuations and variations, particularly during anesthesia administration during surgery, hemodialysis, upper and lower gastrointestinal endoscopy, exercise testing, arterial and venous catheterization, and rehabilitation. These changes in BP may lead to life-threatening events. OBJECTIVES: The performance of the Omron HBP-M4500 device in monitoring blood pressure (BP) in the upper arm was validated according to the International Organization for Standardization (ISO) 81060-2:2018+ amendment (Amd) 1:2020 protocol. METHODS: The device was used to assess 113 participants in the inflation mode, and 107 participants in the deflation mode. All …the patients fulfilled the inclusion criteria, including the arm circumference range and systolic and diastolic BP levels, outlined in the protocol. Data validation and analysis were performed according to the manufacturer’s instructions. RESULTS: In criterion 1, the mean ± standard deviation (SD) values of the differences between the test device and reference BP were - 0.6 ± 5.80/2.8 ± 6.78 mmHg (systolic/diastolic) and - 1.0 ± 5.35/3.2 ± 6.52 mmHg for the inflation and deflation modes, respectively. These data fulfilled the ISO81060-2:2018+ Amd1:2020 requirements of ⩽ 5 ± ⁣ ⩽ 8 mmHg. In criterion 2, the differences were - 0.6 ± 4.44/2.8 ± 6.26 and - 1.0 ± 3.84/3.2 ± 6.09 mmHg for the inflation and deflation modes, respectively, fulfilling criterion 2 with SD values of ⩽ 6.91 and ⩽ 6.87 for systolic BP and ⩽ 6.34 and ⩽ 6.14 for diastolic BP in the inflation and deflation modes, respectively. These two criteria were fulfilled in both studies. CONCLUSION: The Omron HBP-M4500 device, either in inflation or deflation mode, fulfilled the criteria outlined in the ISO protocol. Therefore, this device is valuable for BP measurement in clinical and hospital settings. Show more

Keywords: Blood pressure monitoring device, validation study, international protocol

DOI: 10.3233/THC-240676

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4537-4544, 2024

Authors: Mansoor, C.M.M. | Chettri, Sarat Kumar | Naleer, H.M.M.

Article Type: Research Article

Abstract: BACKGROUND: Heart disease is a severe health issue that results in high fatality rates worldwide. Identifying cardiovascular diseases such as coronary artery disease (CAD) and heart attacks through repetitive clinical data analysis is a significant task. Detecting heart disease in its early stages can save lives. The most lethal cardiovascular condition is CAD, which develops over time due to plaque buildup in coronary arteries, causing incomplete blood flow obstruction. Machine Learning (ML) is progressively used in the medical sector to detect CAD disease. OBJECTIVE: The primary aim of this work is to deliver a state-of-the-art approach …to enhancing CAD prediction accuracy by using a DL algorithm in a classification context. METHODS: A unique ML technique is proposed in this study to predict CAD disease accurately using a deep learning algorithm in a classification context. An ensemble voting classifier classification model is developed based on various methods such as Naïve Bayes (NB), Logistic Regression (LR), Decision Tree (DT), XGBoost, Random Forest (RF), Convolutional Neural Network (CNN), Support Vector Machine (SVM), K Nearest Neighbor (KNN), Bidirectional LSTM and Long Short-Term Memory (LSTM). The performance of the ensemble models and a novel model are compared in this study. The Alizadeh Sani dataset, which consists of a random sample of 216 cases with CAD, is used in this study. Synthetic Minority Over Sampling Technique (SMOTE) is used to address the issue of imbalanced datasets, and the Chi-square test is used for feature selection optimization. Performance is assessed using various assessment methodologies, such as confusion matrix, accuracy, recall, precision, f1-score, and auc-roc. RESULTS: When a novel algorithm achieves the highest accuracy relative to other algorithms, it demonstrates its effectiveness in several ways, including superior performance, robustness, generalization capability, efficiency, innovative approaches, and benchmarking against baselines. These characteristics collectively contribute to establishing the novel algorithm as a promising solution for addressing the target problem in machine learning and related fields. CONCLUSION: Implementing the novel model in this study significantly improved performance, achieving a prediction accuracy rate of 92% in the detection of CAD. These findings are competitive and on par with the top outcomes among other methods. Show more

Keywords: Machine learning, coronary artery disease, heart disease, feature selection, classification

DOI: 10.3233/THC-240740

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4545-4569, 2024

Authors: Liu, Fengjie | Wang, Buquan | Mao, Chenggang

Article Type: Research Article

Abstract: BACKGROUND: Allergic Rhinitis (AR), a prevalent condition in otorhinolaryngology, is mediated by Type 1 hypersensitivity through IgE, characterized by Type 2 inflammatory response and eosinophil infiltration in the nasal mucosa. Since AR disease exhibits significant heterogeneity in symptom severity, an objective assessment of AR severity may facilitate better individualized treatment. OBJECTIVE: To explore the changes in peripheral blood IL-9, Th9, and BAFF levels of allergic rhinitis (AR) in patients and the clinical significance associated with it. METHODS: A retrospective study selected 80 AR patients admitted from January 2022 to October 2022 as the …case group, dividing them into mild and moderate-to-severe groups based on symptom scores. Concurrently, 50 patients without AR, who were treated for nasal bone fractures or underwent septoplasty, were selected as the group for comparison. Alterations in the expression levels of peripheral blood IL-9, Th9, and BAFF were analyzed and compared among the different groups. The diagnostic value of serum BAFF for the severity of AR was analyzed using the receiver operating characteristic (ROC) curve. RESULTS: Noticeable variations were observed in clinical variables among the three groups such as, total IgE levels, peripheral blood eosinophil count and proportion, TNSS, and VAS (P < 0.05), while no statistically significant differences were observed in other variables (P > 0.05). The comparison of IL-9, Th9, and BAFF among the three groups revealed statistically significant differences (P < 0.05). Analysis using multivariate logistic regression revealed that IL-9 (OR = 2.365), Th9 (OR = 2.186), BAFF (OR = 2.307) were influencing factors of moderate-to-severe AR (P < 0.05). The ROC curve indicated that the AUC for the diagnosis of moderate-to-severe AR by IL-9, Th9, BAFF were 0.770, 0.734, 0.761, respectively, and the combined detection AUC was 0.888, an area under the curve higher than individual testing. CONCLUSION: Changes in peripheral blood IL-9, Th9, and BAFF levels in AR patients may function as indicators to assess the level of severity in diagnostic procedures. Show more

Keywords: Allergic rhinitis, peripheral blood, IL-9, Th9, BAFF, clinical significance

DOI: 10.3233/THC-240756

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4571-4580, 2024

Authors: Cai, Zhuhua | Guo, Xueke | Zheng, Ge | Xiang, Junmiao | Liu, Lingyun | Lin, Dongmei | Deng, Xiaohui

Article Type: Research Article

Abstract: BACKGROUND: Elevated levels of tumor necrosis factor-alpha (TNF-α ) have been associated with adverse pregnancy outcomes, specifically recurrent pregnancy loss (RPL). These elevated levels may be associated with the presence of autoantibodies. Although TNF-α inhibitors have shown promise in improving pregnancy rates, further research is needed to comprehend their impact and mechanisms in RPL patients. OBJECTIVE: This study aims to investigate the association between elevated TNF-α levels and autoantibodies in RPL patients, as well as evaluate the effect of TNF-α inhibition on pregnancy outcomes. …METHODS: A total of 249 RPL patients were included in this study. Serum levels of TNF-α , autoantibodies, and complement were measured and monitored. Among these patients, 138 tested positive for TNF-α , while 111 tested negative. The medical records of these patients were retrospectively evaluated. Additionally, 102 patients with elevated TNF-α levels were treated with TNF-α inhibitors, and their pregnancy outcomes were assessed. RESULTS: TNF-α -positive RPL patients had higher levels of complement C1q, anti-cardiolipin (ACL)-IgA, ACL-IgM ,ACL-IgG, thyroglobulin antibody, and Anti-phosphatidylserine/prothrombin IgM antibody, as well as a higher positive rate of antinuclear antibodies compared to TNF-α -negative patients (23.19% vs. 12.6%, P < 0.05). Conversely, complement C3 were lower in TNF-α -positive patients (t test, P < 0.05). The use of TNF-α inhibitors led to a reduction in the early abortion rate (13.7% vs. 44.4%, P < 0.001) and an improvement in term delivery rate (52.0% vs. 27.8%, P = 0.012). Furthermore, patients who used TNF-α inhibitors before 5 weeks of pregnancy had a lower early abortion rate (7.7% vs. 24.3%, P = 0.033) and a higher term delivery rate (69.2% vs. 48.6%, P = 0.033). CONCLUSION: TNF-α plays a role in the occurrence and development of RPL, and its expression is closely associated with autoantibodies and complements. TNF-α inhibitors increase the term delivery rate in TNF-α -positive RPL patients, and their use before 5 weeks of pregnancy may more beneficial. Show more

Keywords: Antinuclear antibodies, anti-phospholipid antibodies, estrogen, human chorionic gonadotropin, pregnancy, pregnancy outcome, tumor necrosis factor

DOI: 10.3233/THC-240757

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4581-4591, 2024

Authors: Hu, Xia | Jiang, Huiqing | Liu, Peizhen | Li, Zhiquan | Zhang, Ruiying

Article Type: Research Article

Abstract: BACKGROUND: The Stepped Care Model (SCM) is an evidence-based treatment approach that tailors treatment intensity based on patients’ health status, aiming to achieve the most positive treatment outcomes with the least intensive and cost-effective interventions. Currently, the effectiveness of the Stepped Care Model in postoperative rehabilitation for TKA (Total Knee Arthroplasty) patients has not been reported. OBJECTIVE: The present study aimed to investigate whether the stepped care model could improve early-stage self-report quality of life and knee function after total knee arthroplasty via a prospective randomized controlled design. METHODS: It was a mono-center, …parallel-group, open-label, prospective randomized controlled study. Patients who aging from 60–75 years old as well as underwent unilateral primary total knee arthroplasty due to end-stage knee osteoarthritis between 2020.06 to 2022.02 were enrolled. Participants were randomized and arranged into two groups in a 1:1 allocation. The control group was given traditional rehabilitation guidance, while the stepped care model group was given continued stepped care. Hospital for special surgery knee score, daily living ability (ADL), knee flexion range, and adverse events at 1, 3, and 6 months after total knee arthroplasty were recorded. RESULTS: 88 patients proceeded to the final analysis. There was no significant difference of age, gender, length of stay, BMI, and educational level between the two groups at the baseline. After specific stepped care model interventions, patients showed significant improvements in HHS in 1 month (85.00 (82.25, 86.00) vs. 80.00 (75.00, 83.00), p < 0.001), 3 months (88.00 (86.00, 92.00) vs. 83.00 (76.75, 85.00), p < 0.001), and 6 months (93.00 (90.25, 98.00) vs. 88.00 (84.25, 91.75), p < 0.001) when compared with the control group. Similar results were also found in both daily living ability and knee flexion angle measurements. No adverse event was observed during the follow-up. CONCLUSION: The present study found that the stepped care model intervention significantly improved early-stage knee function and self-reported life quality after total knee arthroplasty due to knee osteoarthritis. Female patients and those less than 70 years old benefit more from the stepped care model intervention after total knee arthroplasty. Show more

Keywords: Stepped care model, total knee arthroplasty, randomized controlled trail, knee function, life quality

DOI: 10.3233/THC-240780

Citation: Technology and Health Care, vol. 32, no. 6, pp. 4593-4601, 2024