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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: BACKGROUND: Over the past few years, because of high attenuation and lightweight, non-toxic, lead-free aprons (LFAs) have been replaced by lead aprons (LAs). Lots of studies declared that this fact was based on the interactions of diagnostic X-ray with material such as the photoelectric effect (PE) and Compton scattering. These studies have demonstrated that in these types of aprons, due to the presence of different K-edge absorption, PE has a wide absorption in various metals with divers K-edges. The measurement geometry in most of these studies was narrow beam geometry, i.e. a collimated source and a collimated detector with…a large source-detector distance. OBJECTIVE: The present study intended to evaluate the attenuation of radiology scattered radiations in LAs and LFAs in both narrow and broad beam geometries, which is a more realistic situation, in order to check whether or not the higher attenuation is valid. METHODS: In this study, a lead apron contains (Pb + EPV) and two non-lead compounds of (W + Sn + EPVC) with different weight percent (Wt%) were evaluated in the energy range of diagnostic radiology (100 kVp). The MCNPX code was applied to simulate broad - and narrow-beam measurement geometries. The evaluations have been performed in three situations: 1st ) the same density thickness of LA and LFAs 2nd ) same line thickness of LA and LFAs 3rd ) considering the thickness of LFAs which has the same attenuation with LAs i.e. lead equivalent thickness for LFAs in the narrow beam. Finally, the x-ray transmission ratio (I/I_0) of LAs and LFAs was compared in 100 kVp for three mentioned conditions. RESULTS: Our results indicated that LFAs had more radiation attenuation rather than LA in the 1st and 2nd conditions with both geometries. However, LFAs had lower attenuation in comparison to LAs in the 3rd condition with broad beam geometry. More importantly, the transmission ratio (I/I_0) of LFAs in the broad beam condition was more significant than LA. CONCLUSION: The scattered radiations produced by LFAs are more than LAs because of the production of characteristic radiations resulted from K-edge absorption in composited aprons. Consequently, the LFAs should be evaluated in both narrow and broad beam situation using the lead equivalent thickness of LFAs to make sure that the non-lead aprons do not increase the radiation dose of the user.
Keywords: Lead-free aprons, lead aprons, diagnostic radiology, MCNPX, narrow and broad beam
Abstract: OBJECTIVE: To investigate the effects of strengthening exercise integrated repetitive transcranial magnetic stimulation (rTMS) on motor function recovery in subacute stroke patients. SUBJECTS AND METHODS: Thirty subacute stroke patients were randomly assigned to three groups: an ankle strengthening exercise group (group I), ankle strengthening exercise integrated rTMS group (group II), or an rTMS group (control group (CG)). Study subjects received therapy five days per week for eight weeks. Motor-evoked potential testing, peak torque at the ankle joint, and 10 m walk test were performed before and after the eight-week treatment period. RESULTS: Subjects…in group II showed significantly higher amplitude of MEP, plantarflexor and dorsiflexor of peak torque, 10 m walk test than groups I and CG (p < 0.05). Subjects in groups I and II differed significantly in the pre- and post-test for all variables, (p < 0.05). In the CG group, the pre- and post-test scores for the amplitude of MEP, dorsiflexor, and 10-walk test differed significantly (p < 0.05). CONCLUSIONS: Strengthening exercise integrated rTMS has positive effects on motor function recovery in subacute stroke patients.
Keywords: Motor recovery, repetitive transcranial magnetic stimulation, stroke
Abstract: BACKGROUND: Unprofessional conduct is detrimental to the Orthopaedic Surgery profession. Currently, no formal guidelines exist to define online professionalism other than the protection of patient confidentiality. OBJECTIVE: This study will extract a random but statistically significant number of practicing Orthopaedic Surgeons and review their online postings. METHODS: We observed the Internet content posted by 1,021 Orthopaedic Surgeons that were randomly selected from the American Academy of Orthopaedic Surgeons 2013 member directory. Each surgeon's name was entered into the Google.com search engine and on Social Media sites including Facebook.com, Twitter.com, LinkedIn.com, and…YouTube.com. The content was evaluated and recorded where it was encountered. Unprofessional content was recorded and reviewed by a panel for appropriateness. RESULTS: Of the 1,021 Orthopaedic Surgeons sampled, 82% have professional websites, 4% have professional blogs, 21% have professional Facebook accounts, 14% have professional Twitter accounts, 26% have professional LinkedIn accounts, and 14% have professional YouTube accounts. Unprofessional content was identified in 3.5% of all surgeons sampled who have some form of content on the Internet. CONCLUSION: Every Orthopaedic Surgeon should be aware of the content posted on the Internet. Our recommendation is for surgeons to routinely evaluate content posted on publically available venues for professionalism.
Keywords: Orthopaedic, professionalism, Internet, website, social media
Abstract: BACKGROUND: Long-term, sustained progress is necessary in drop foot rehabilitation. The necessary inconvenient body training movements, the return trips to the hospital and repetitive boring training using functional electrical stimulation (FES) often results in the patient suspending their training. The patient's drop foot rehabilitation will not progress if training is suspended. OBJECTIVE: A fast spread, highly portable drop foot rehabilitation training device based on the smart phone is presented. This device is combined with a self-made football APP and feedback controlled FES. The drop foot patient can easily engage in long term rehabilitation training that…is more convenient and interesting. METHODS: An interactive game is established on the smart phone with the Android system using the originally built-in wireless communications. The ankle angle information is detected by an external portable device as the game input signal. The electrical stimulation command to the external device is supplemented with FES stimulation for inadequate ankle efforts. RESULTS: After six-weeks training using six cases, the results indicated that this training device showed significant performance improvement (p< 0.05) in the patient's ankle dorsiflexion strength, ankle dorsiflexion angle, control timing and Timed Up and Go. CONCLUSIONS: Preliminary results show that this training device provides significant positive help to drop foot patients. Moreover, this device is based on existing and universally popular mobile processing, which can be rapidly promoted. The responses of clinical cases also show this system is easy to operate, convenient and entertaining. All of these features can improve the patient's willingness to engage in long term rehabilitation.
Keywords: Stroke, smartphone, drop foot, portable, rehabilitation, FES
Abstract: BACKGROUND: Pelvic tilt influences acetabular orientation (AO). Anatomical AO can be measured in relation to the anterior pelvic plane (APP), functional AO can be calculated relative to table's plane. OBJECTIVE: To assess to what extent functional AO is determined by pelvic tilt and if APP and table plane give equal information for correct AO. METHODS: AO was evaluated by computed tomography (CT) scans of 138 patients. Pelvic tilt, anatomical and functional AO were measured, differences between the two reference planes were calculated. RESULTS: Anatomical and functional acetabular anteversion (AA) were…found to be different in 21% of individuals with an enhanced extent of pelvic tilt. Functional AA was increased compared to anatomical AA at high posterior pelvic tilt (p < 0.001). Enlarged anterior tilting of the pelvis reduced APP-related AA (p < 0.002). Anatomical AA positively correlated with pelvic tilt, particularly in females (p < 0.01, correlation coefficient = 0.698, R2 = 0.523). CONCLUSIONS: APP and table plane do not provide equal information about AO at enhanced pelvic tilt. Functional orientation of the acetabulum is dependent on pelvic tilt, which itself is influenced by anatomical AA and should therefore be analyzed for precise AO.
Abstract: BACKGROUND: 30% of myeloma patients suffer from vertebral compression fractures (VCF). Consequently, augmentation often becomes inevitable to prevent further problems. This study evaluated the interaction of radiation therapy (RT) and radiofrequency kyphoplasty (RFK) in the treatment of myeloma associated VCF. METHODS: Eighty-six myeloma patients with VCF were treated with RFK followed by radiation therapy (RFK group) or vice versa (RT group). Visual analgoue scale (VAS), Oswestry-Disability-Index (ODI), vertebral height and kyphosis angle were assessed preoperatively, 3-4 days, 3 and 6 months postoperatively. Adverse events like cement leakage or additional fractures were documented.…RESULTS: Both groups achieved comparable outcomes, but the course of VAS and kyphosis angle differed. Early postoperative kyphosis angles improved significantly in the RFK group, but significantly worsened afterwards. The RT group showed a trend towards significantly improvement postoperatively and minor worsening afterwards. VAS remained constant in the RT group and worsened in the RFK group after 6 months. More cement leakages and additional fractures were noted in the RT group. CONCLUSIONS: RFK is an effective method for treating VCF in myeloma patients independent of treatment order with regard to radiation therapy. However, RT should be conducted after RFK to minimize risks of cement extrusion and additional fractures.
Abstract: This paper deals with the investigation of external joint movement with respect to leg kinematics. The overall leg kinematics were investigated by means of a rigid, three-segment, 3D leg model. A 3D kinematics and ground reaction forces was being restructured. The images were then authenticated with the help of a cadaveric investigation and analysis. This was eventually used for prediction of the overall leg kinematics. Thereafter FEM based simulations were undertaken, and muscle forces were investigated based on the data available. With the help of FEM predictions it was found and understood that the overall leg kinematics were having higher…loading factor with respect to the lateral.
Keywords: Strain gauge, medical instrumentation, pressure sensor, resonance
Abstract: BACKGROUND: Subjects with Spinal Cord Injury (SCI) should use various assistive devices to stand and walk. Unfortunately they suffer from slow walking speed, high energy consumption, and too much force applied on upper limb while walking. The aim of this study was to determine the gap between the gait performance of SCI and normal subjects to conclude how the performance of SCI can be improved. METHOD : Three groups of SCI walked with orthosis, SCI walked without orthosis, and normal subjects were recruited in this study. The normal subjects also walked with the same orthoses as SCI…subjects. Some parameters such as ranges of motion of hip, knee and spatiotemporal gait parameters were evaluated by use of Qualysis motion analysis system. The difference between the gait parameters of three groups were evaluated by use of two sample t test. RESULTS : The mean values of hip joint range of motion of normal subjects while walking with and without orthosis were 48.3 ± 2.5 and 18.5 ± 8.8 degrees, respectively (p-value = 0.00). There was a significant difference between walking speed of normal subjects with and without orthosis. The walking speed of SCI subject with and without orthosis differed significantly. CONCLUSION : Although use of orthosis enable SCI subjects to stand and walk, but has some restrictions. As use of orthosis decreased the abilities of normal subjects it can be concluded that more attention should be done on design of orthosis and style of walking.
Keywords: Spinal cord injury, kinematic, gait, style of walking, orthosis
Abstract: BACKGROUND: An active ankle dorsiflexion is essential for a proper gait pattern. If there is a failure of the foot lifting, considerable impairments occur. The therapeutic effect of an implantable peroneus nerve stimulator (iPNS) for the ankle dorsiflexion is already approved by recent studies. However, possible affection for knee and hip motion after implantation of an iPNS is not well described. OBJECTIVE: The objective of this retrospective study was to examine with a patient cohort whether the use of iPNS induces a lower-extremity flexion withdrawal response in the form of an increased knee and hip flexion…during swing phase. METHODS: Eighteen subjects (12 m/6 w) treated with an iPNS (ActiGait® , Otto Bock, Duderstadt, Germany) were examined in knee and hip motion by gait analysis with motion capture system (Vicon Motion System Ltd® , Oxford, UK) and Plug-in-Gait model after a mean follow up from 12.5 months. The data were evaluated and compared in activated and deactivated iPNS. RESULTS: Only little changes could be documented, as a slight average improvement in peak knee flexion during stand phase from 1.0° to 2.5° and peak hip flexion in stance from 3.1° to 2.1° In contrast, peak knee flexion during swing appeared similar (25.3° to 25.7°) same as peak hip flexion during swing. In comparison with the healthy extremity, a more symmetric course of the knee flexion during stand phase could be shown. CONCLUSIONS: No statistical significant improvements or changes in hip and knee joint could be shown in this study. Only a more symmetric knee flexion during stand phase and a less hip flexion during stand phase might be hints for a positive affection of iPNS for knee and hip joint. It seems that the positive effect of iPNS is only based on the improvement in ankle dorsiflexion according to the recent literature.
Keywords: Stroke, implantable peroneus nerve stimulator, gait pattern, knee and hip motion
Abstract: The use of medical imaging in diagnosing brain disease is growing. The challenges are related to the big size of data and complexity of the image processing. High standard of hardware and software are demanded, which can only be provided in big hospitals. Our purpose was to provide a smart cloud system to help diagnosing brain diseases for hospital with limited infrastructure. The expertise of neurologists was first implanted in cloud server to conduct an automatic diagnosis in real time using image processing technique developed based on ITK library and web service. Users upload images through website and the result,…in this case the size of tumor was sent back immediately. A specific image compression technique was developed for this purpose. The smart cloud system was able to measure the area and location of tumors, with average size of 19.91 ± 2.38 cm2 and an average response time 7.0 ± 0.3 s. The capability of the server decreased when multiple clients accessed the system simultaneously: 14 ± 0 s (5 parallel clients) and 27 ± 0.2 s (10 parallel clients). The cloud system was successfully developed to process and analyze medical images for diagnosing brain diseases in this case for tumor.
Keywords: Cloud system, ITK, web services, medical image, brain diseases