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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: Fetal heart rate (FHR) monitoring device is highly demanded to assess the fetus health condition in home environments. Conventional standard devices such as ultrasonography and cardiotocography are expensive, bulky and uncomfortable and consequently not suitable for long-term monitoring. Herein, we report a device that can be used to measure fetal heart rate in clinical and home environments. METHODS: The proposed device measures and displays the FHR on a screen liquid crystal display (LCD). The device consists of hardware that comprises condenser microphone sensor, signal conditioning, microcontroller and LCD, and software that involves the algorithm used…for processing the conditioned fetal heart signal prior to FHR display. The device’s performance is validated based on analysis of variance (ANOVA) test. RESULTS: FHR data was recorded from 22 pregnant women during the 17 th to 37 th week of gestation using the developed device and two standard devices; AngelSounds and Electronic Stethoscope. The results show that F -value (1.5) is less than F 𝑐𝑟𝑖𝑡 , (3.1) and p -value (p > 0.05). Accordingly, there is no significant difference between the mean readings of the developed and existing devices. Hence, the developed device can be used for monitoring FHR in clinical and home environments.
Abstract: BACKGROUND: The microprocessor-controlled prosthetic knees have been introduced to transfemoral amputees due to advances in biomedical engineering. A body of scientific literature has shown that the microprocessor-controlled prosthetic knees improve the gait and functional abilities of persons with transfemoral amputation. OBJECTIVE: The aim of this study was to propose a new microprocessor-controlled prosthetic knee (MPK) and compare it with non-microprocessor-controlled prosthetic knees (NMPKs) under different walking speeds. METHODS: The microprocessor-controlled prosthetic knee (i-KNEE) with hydraulic damper was developed. The comfortable self-selected walking speeds of 12 subjects with i-KNEE and NMPK were obtained. The…maximum swing flexion knee angle and gait symmetry were compared in i-KNEE and NMPK condition. RESULTS: The comfortable self-selected walking speeds of some subjects were higher with i-KNEE while some were not. There was no significant difference in comfortable self-selected walking speed between the i-KNEE and the NMPK condition (P = 0.138). The peak prosthetic knee flexion during swing in the i-KNEE condition was between sixty and seventy degree under any walking speed. In the NMPK condition, the maximum swing flexion knee angle changed significantly. And it increased with walking speed. There is no significant difference in knee kinematic symmetry when the subjects wear the i-KNEE or NMPK. CONCLUSIONS: The results of this study indicated that the new microprocessor-controlled prosthetic knee was suitable for transfemoral amputees. The maximum swing flexion knee angle under different walking speeds showed different properties in the NMPK and i-KNEE condition. The i-KNEE was more adaptive to speed changes. There was little difference of comfortable self-selected walking speed between i-KNEE and NMPK condition.
Abstract: BACKGROUND: Squat is the most important exercise for the strengthening of the lower limb muscles. The muscle contraction speed and type affect the muscle activation, strength, and power. OBJECTIVE: This study aimed to investigate the influence of two different speeds of squat exercise on the activation and balance of the lower limb muscles. METHODS: Thirty-eight healthy adults randomly performed squat exercises at different speeds and in different ground environments, 3 times per week for 4 weeks. The participants’ lower limb muscle activation and balance ability were evaluated before and after the training. RESULTS:…There was a significant difference in muscle activation between the squats in terms of speed (fast, moderate, and slow squat) (p < 0.05). After the training periods, there was a significant difference in the rectus femoris (RF) and biceps femoris (BF) of the groups that performed the fast squat (p < 0.05). There was significant difference between the pre- and post-static balance test in the group that performed fast squats on an unstable surface (p < 0.05). After the training periods, the stability index with eyes open values, which is static balance, showed a significant difference among the groups after 4 weeks (p < 0.05). The groups that performed fast squat showed a significant difference between the pre- and post-dynamic Y balance test (p < 0.05). CONCLUSIONS: For optimal performance and effect of selected squat exercises, the speed and ground environment should be taken into consideration.
Abstract: Pulmonary valve diseases include the different degrees of aortic stenosis or congenital defects in children or adults. Valve repair or replacement surgery is commonly performed to relieve valvular dysfunction and improve the significant flow regurgitation in the aortic valve and the pulmonary valve. However, commercial valve stents and valved conduits are sometimes not available for children or patients with special conditions. The handmade trileaflet valve design has been used with different range of diameters for patch-valved conduit reconstruction. Thus, we propose a multiple regression model, as a generalized regression neural network (GRNN), to determine the optimal trileaflet parameters, including the…width, length, and upper lower curved structure. Through computed tomography pulmonary angiography, while the diameter of the main pulmonary artery is determined, a leaflet template can be rapidly sketched and made. Using an experimental pulmonary circulation loop system, the efficacy of the valved conduit can be validated using the regurgitation fraction method. In contrast to commercial valve stents, experimental results indicate that the handmade trileaflet valve can also improve severe pulmonary regurgitations.
Abstract: BACKGROUND: Bone drilling is a mandatory process in orthopedic surgery to fix the fractured bones. Excessive heat is generated due to the shear deformation of bone and friction energy during the drilling process. OBJECTIVE: This paper is carried out to optimize the bone drilling parameters to prevent thermal bone necrosis. The main contribution of this work is instead of only consider the influence of rotational speed and feed rate, the effect of tool diameter and drilling hole depth are also incorporated for optimization study. METHODS: Response surface methodology (RSM) was used to develop…a temperature prediction model. Drilling experiments were performed using finite element software DEFORM-3D. Analysis of variance (ANOVA) was conducted to investigate the drilling parameters’ effect. Desirability function in RSM was used to determine the optimum combination of drilling parameters. RESULTS: Results indicated that one applicable combination of drilling parameters could increase the bone temperature by less than 0.03%. To avoid thermal bone necrosis, eight reasonable combinations of drilling parameters were proposed. 3.3 ∘ C residuals between in-vitro experiments and predicted values were demonstrated. CONCLUSIONS: It is envisaged that finite element simulation with RSM can simplify tedious experimental works and useful in the clinical application to avoid bone necrosis.
Abstract: Gestational diabetes mellitus (GDM) is defined as glucose intolerance that is diagnosed in pregnancy period, leading to possible complications for both mother and fetus during pregnancy. The aim of this study was to build an objective method to evaluate diabetes mellitus (DM) risk from past GDM data recorded 15 years ago and find a short list of most informative indicators. The dataset consists of demographic, lifestyle, clinical, genetic and pregnancy related information recorded 15 years ago. Due to the large time gap data are limited and have missing values (MVs). Follow-up tests were performed to see if DM…or impaired metabolism has developed after pregnancy with previously diagnosed GDM. The research steps involve pre-processing data to evaluate MVs, finding most informative attributes and testing standard classification algorithms to combine in to most effective voting meta-algorithm. Initially the attributes and records with large number of MVs were rejected. A small percentage (2.04%) was imputed using regression based methods. The data set was prepared for two scenarios: classification in two classes (1-healthy; 2-impaired metabolism including DM) and three classes (1-healthy; 2-impaired metabolism; 3-DM). Voting meta-algorithm combining best algorithms of 21 from five different groups including Bayesian, regression, lazy, rule, and decision trees makes classification more objective and not depending on preferences. Relative frequency of occurrence (RFO) analysis of attributes combined with voting meta-algorithm helped finding optimal amount of attributes giving best possible classification result. The algorithm applied to two class data set with 12 selected attributes produced accuracy of 75.85 and AUC = 0.82 with standard error of 0.11. Similarly for three class dataset the 9 attributes were selected allowing to reach classification accuracy 63.77 and AUC = 0.76 with standard error of 0.1. Meta-algorithm based classification of limited anamnestic GDM related data for DM prediction is proving to be effective. Testing multiple algorithms and performing RFO analysis appears to be natural and objective way of selecting most informative attributes and evaluating their importance.
Abstract: BACKGROUND: Anterior-posterior displacement of center of pressure (AP_CoP) reflects stance limb function. However, AP_CoP’s clinical applicability in post-stroke hemiplegia is unclear. OBJECTIVE: To investigate the clinical usefulness of parameters from AP_CoP in subacute stage post-stroke hemiplegia, their relationships with usage of gait aid, functional ambulatory category, and spatial-temporal parameters were tested. METHODS: Nineteen participants with post-stroke hemiplegia were included in gait with aid group. Twenty one participants were included in gait with independence group. Twenty one participants were included in control group. Insole foot pressure measurement system was used to measure AP_CoP and…spatial-temporal parameters. Effects of gait aid usage and functional ambulatory category on AP_CoP were tested with ANOVA. Relationships between AP_CoP and temporo-spatial parameters were investigated with correlation and linear regression analysis. RESULTS: AP_CoP parameters were shorter in gait with aid group than gait with independence group. With better functional ambulatory category, AP_CoP were longer. AP_CoP showed positive relationship with walking speed. AP_CoP in more affected side showed positive relationship with symmetry of single support phase proportion. AP_CoP showed positive relationship with stride length. CONCLUSIONS: AP_CoP reflects overall gait function, impairments in more affected side and adaptation in less affected side in subacute recovery stage of post-stroke hemiplegia. It can be used as a clinically significant parameter for gait rehabilitation.
Abstract: BACKGROUND: Many robots can induce passive movements and passive resistance movements to facilitate recovery of upper-extremity function, but it is rare to find robots that can also enable active resistance movements. OBJECTIVE: The purpose of this study was to investigate the effects of robot-assisted therapy on upper-extremity function and the ability to perform activities of daily living (ADL) in patients with stroke-induced hemiplegia. METHODS: Thirty patients with stroke-induced hemiplegia were randomly assigned to the experimental and control groups, with 15 patients in each group. All subjects underwent general occupational therapy consisting of five 30-min…sessions per week for 8 weeks, in addition to 30 min of robot-assisted therapy for the experimental group and 30 additional min of general occupational therapy for the control group for each session. RESULTS: Both the experimental and control groups showed a statistically significant increase in post-treatment Fugl-Meyer assessment and modified Barthel index scores compared to the pre-treatment scores. Intergroup comparisons revealed that the experimental group showed a statistically significant greater increase in scores for all assessments than the control group did (p < 0.05). CONCLUSION: The findings from this study showed that combining robot-assisted therapy with general occupational therapy may enhance upper-extremity function and the ability to perform ADL in patients with stroke-induced hemiplegia compared to those obtained with general occupational therapy alone.
Abstract: BACKGROUND: Foot deformities are serious problems in the elderly as they increase the risk of falling. OBJECTIVE: This study aimed to examine the relationship between foot plantar pressure during gait and hallux valgus (HV). METHODS: Foot-pressure data were recorded using an F-scan II system. We analyzed the entire waveform of plantar pressure during gait from 37 healthy adults using principle component analysis (PCA), conducted using a 370 × 357 matrix of time-normalized plantar data of 7 areas during gait (5 gait trials × 2 (both feet) of 37 participants ×…51 data points × 7 plantar areas). Two-way (plantar pressure × presence or absence of HV) analyses of variance were conducted on the principal component scores (PCSs) of principal component vectors (PCVs) 1 through 5, each of which exhibited more than 5% variance. RESULTS: The PCA clarified that the 2nd, 3rd, and 5th PCVs (PCV 2, 3, and 5) were related to HV (p < 0.01). These PCVs exhibit a significant interaction between plantar pressure area and HV presence. CONCLUSIONS: The larger plantar pressure of the HV group around the hallux area during walking compared with the non-HV group is a dominant difference in plantar pressure features due to HV.
Abstract: BACKGROUND: Despite recent advances in surgical techniques and perioperative management, the surgical mortality of acute type A aortic dissection remains high. OBJECTIVE: In a hospital with few acute type A aortic dissection operations, we retrospectively investigated whether simplified surgical approach could obtain proper surgical outcomes. METHODS: Between October 2007 and December 2016, we performed emergency surgery in 99 patients who had acute type A aortic dissection, including replacement of the hemi-arch in 62 patients (63%) and total arch in 32 patients (32%) and aortic root surgery in 7 patients (7%). Surgical strategy has been simplified over time.…RESULTS: We performed right axillary artery perfusion in 61 patients (62%) and antegrade cerebral perfusion in 78 patients (79%). During the last 3 years, in-hospital mortality was decreased to 4% (2/47). Preoperative unresolved shock was an independent predictor of hospital death. Although the patients with total arch replacement or aortic root surgery had a mean significantly long cardiopulmonary bypass or circulatory arrest time, in-hospital mortality or neurologic complications was not increased. CONCLUSIONS: Simplified surgical approach could provide a reasonable surgical outcome in acute type A aortic dissection surgery in a center with a small volume of acute aortic dissection surgery.