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Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured.
The following types of contributions and areas are considered:
1. Original articles:
Technology development in medicine: New concepts, procedures and devices associated with the use of technology in medical research and clinical practice are presented to a readership with a widespread background in engineering and/or medicine.
Significance of medical technology and informatics for healthcare: The appropriateness, efficacy and usefulness deriving from the application of engineering methods, devices and informatics in medicine and with respect to public health are discussed.
2. Technical notes:
Short communications on novel technical developments with relevance for clinical medicine.
3. Reviews and tutorials (upon invitation only):
Tutorial and educational articles for persons with a primarily medical background on principles of engineering with particular significance for biomedical applications and vice versa are presented.
4. Minisymposia (upon invitation only):
Under the leadership of a Special Editor, controversial issues relating to healthcare are highlighted and discussed by various authors.
Abstract: Climate chambers have been widely used in in vitro and in vivo studies which require controlled environmental temperature and humidity conditions. This article describes a new desktop climate chamber that was developed for application of respiratory airflows on cultured nasal epithelial cells (NEC) under controlled temperature and humidity conditions. Flow experiments were performed by connecting the climate chamber to an airflow generator via a flow chamber with cultured NEC. Experiments at two controlled…climate conditions, 25°C and 40% relative humidity (RH) and 37°C and 80%RH, were conducted to study mucin secretion from the cultures inresponse to the flow. The new climate chamber is a relatively simple and inexpensive apparatus which can easily be connected to any flow system for climate controlled flow experiments. This chamber can be easily adjusted to various in vitro experiments, as well as to clinical studies with animals or human subjects which require controlled climate conditions.
Abstract: Introduction: Accurate intraoperative assessment of lower limb alignment is crucial for the treatment of long bone fractures, implantation of knee arthroplasties and correction of deformities. Purpose: The aim of this study is to present a new technique for the intraoperative analysis of the mechanical axis. Methods: The axis board is placed under the patient's lower limb. With the centre of the ankle and hip lying on the reference line we can assess…the mechanical axis of the lower limb. This technique was used in 38 cases (19 high tibial osteotomies, 13 femoral fractures and 6 tibial fractures). Results: Comparing the intraoperative tibiofemoral angles and Mechanical Axis Deviations (MAD) with the results of the postoperative long standing radiographs we showed an accuracy of 1 ± 0.9° and 2.9 ± 2.6 mm respectively. Conclusion: The method is a simple and convenient option for intraoperative evaluation of the mechanical axis. However, for complex corrections we still recommend the use of navigation systems.
Abstract: Introduction: The insertion site for an antegrade femoral intramedullary nail in the treatment of a femoral shaft fracture has traditionally been performed using a free-hand technique. An inappropriate starting point can result in suboptimal nail insertion leading to malreduction, or iatrogenic fracture. Furthermore, repeated attempts to establishthe optimal starting point cancause additional soft tissue trauma and radiation exposure. In the following study we compared a robot-guided technique with the standard free-hand technique…for establishing the entry point of an antegrade femoral nail. We hypothesized that the robot-guided technique is more reliable and efficient. Methods: A custom-made drill-guide was mounted onto the arm of an industrial robot. Two orthogonal fluoroscopic images were acquired from the proximal femur of five cadaveric human specimens. Images were processed with a specialsoftwarein order to create an enhanced contour-recognition map from which the bone axes were automatically calculated. The drilling trajectory was computed along the extension of the bone-axis. The robot then moved the drill-guide on this trajectory toward the entry point. The drilling was then performed by the surgeon. In the control group, five cadaveric human femora were utilized to manually establish the starting pointusing the free-hand technique. Results: 100% of the intramedullary cavities were successfully accessed with both the robot-guided and the manual techniques. In the manual technique repositioning of the drill was necessary in three out of five cases. The mean number of acquired fluoroscopic images was significantly reduced from 11.6 (manual) to 4 (robot-guided). Conclusion: Robot-assisted drilling ofthe entry-point in antegrade femoral nailingis more reliable and requires fewer radiographic images than the free hand technique. Yet, based on economical and logistical considerations, its application will probably only be accepted when a concomitant application for fracture reduction is available.
Abstract: Automatic control systems of brain temperature for water surface-cooling were first-ever applied to the brain hypothermic treatment of patients. A patient in ICU was regarded as a unity controlled system with an input (temperature of water into blanket) and an output (tympanic membrane temperature). The proposed algorithm of optimal-adaptive and fuzzy control laws inclusive of our developed cooling and warming machine were well confirmed during the hypothermic course to keep brain temperature of patients within its…allowable range. It was well controlled without much influence due to room temperature, metabolic and circulatory change caused by various medical treatments including the effect of nonlinear and time-varying characteristics of individual patients. The clinical control of brain temperature was almost continuously performed in around 10 days, under the brain temperature between 35°C and 37°C scheduled by physicians according to the state of patients. Their state had been monitored during the therapeutic course of pharmacological treatment with almost everyday examinations by CT imaging, referring various vital signs inclusive of the temperature of urinary bladder with continuous measurement of intracranial pressure by a catheter placement in cerebral sinus. The patients had good recovery to their rehabilitation after mild hypothermia by the proposed automatic control systems.
Keywords: Brain hypothermia, brain temperature, clinical practice, optimal-adaptive control system, fuzzy control system
Abstract: Up-to-date no indicator for hemodialysis in severe ethanol intoxication is available. In these cases, the benefits have to outweigh the risks and costs of hemodialysis. In this case report, a suicidal patient had ingested 250 ml of 95% ethanol and was found in deep coma. In literature, some cases, especially of adolescents, are described with severe ethanol poisoning and blood ethanol levels above 740 mg/dL. Hemodialysis, if initiated, decreased ethanol levels significantly as compared to peritoneal…dialysis, charcoal or gastric lavage and reduced also clinical costs. While recommendations exist for starting dialysis in ethylene glycol or methanol intoxications, no algorithm is available to determine the situations when hemodialysis is required in ethanol intoxication. The osmole gap may serve as an indicator to differentiate, which patients need haemodialysis – right now, the decision depends upon the physicians experience or preference.
Keywords: Ethanol intoxication, hemodialysis, suicide, cerebral edema, osmole gap
Abstract: Robot assisted fracture reduction of femoral shaft fractures provides precise alignment while reducing the amount of intraoperative imaging. The connection between the robot and the fracture fragment should allow conventional intramedullary nailing, be minimally invasive and provide interim fracture stability. In our study we tested three different reduction tools: a conventional External Fixator, a Reposition-Plate and a Three-Point-Device with two variations (a 40° and a 90° version). We measured relative movements between…the tools and the bone fragments in all translation and rotation planes. The Three-Point-Device 90° showed the smallest average relative displacement and was the only device able to withstand the maximum applied load of 70 Nm without failure of any bone fragment. The Three-Point-Device 90° complies with all the stipulated requirements and is a suitable interface for robot assisted fracture reduction of femoral shaft fractures.
Abstract: Osseointegration of long-term implants is still a problem in orthopaedic surgery. In recent years, several techniques to modify the implant surface to increase bone formation around implants have been described by many authors. Most endoprostheses used in orthopaedic surgery are manufactured from titanium. To understand the process of osseointegration, one has to take into account, that the adhesion of plasma proteins on the surface of titanium implants plays an essential role in the process of implant…integration. In the last years, several modifications of implant surfaces (structure, chemistry, surface charge, wettability) have been investigated to improve osseointegration of titanium implants. Furthermore, several cytokines and growth factors have also been suggested to stimulate an implant ingrowth. In this respect, functionalized titanium implant surfaces with bone morphogenetic proteins-2 (BMP-2) as one particular member of the superfamily of transforming growth factor β (TGF-β), have proven a potential to stimulate bone formation around implants in different species. In this review the authors provide an overview of surface coatings with BMP-2 and their use in laboratory and experimental settings.
Abstract: High frequency ultrasound (2–8 MHz typically) has established itself as a major medical imaging method associated with a wide range of clinical applications. Advantages include real-time applicability, lower cost compared with other medical imaging technologies, possibility of measuring blood flow velocities and desk-top instrumentation. Disadvantage is associated with lower image quality than is obtained with x-ray or magnetic resonance methods.
Keywords: Ultrasound, medical imaging, Doppler flow measurement, color Doppler