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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: Poor postural control constitutes a major impairment in children with cerebral palsy (CP), compromising everyday activities such as sitting- and standing-position. PURPOSE: In this study, we measured trunk sway during sitting- and standing-position. Additionally, we assessed trunk control ability using the trunk impairment scale (TIS), trunk control measurement scale (TCMS), and sitting assessment test for children with neuromotor dysfunction (SACND), in children with CP. METHODS: Fifteen children (10 boys and 5 girls) were recruited for this study. Trunk sway was measured using a triaxial accelerometer that recorded variation in movement acceleration during…quiet sitting- and standing-position. RESULTS: Anterior-posterior (AP) acceleration was significantly greater in the standing position than the sitting position (p = 0.001). Medio-lateral (ML) acceleration was significantly greater in the standing position than in the sitting position (p = 0.012). The TIS total score showed a moderate negative relationship with AP acceleration (r = - 0.635, p = 0.011). The TCMS total score moderately and negatively correlated with AP acceleration (r = - 0.582, p = 0.023). The SACND total score moderately and positively correlated with AP acceleration (r = 0.670, p = 0.006). CONCLUSION: Measurement of trunk sway using a triaxial accelerometer revealed a moderate correlation with trunk control test data and excellent reliability. Our findings suggest that measurement of trunk sway using a triaxial accelerometer is not time-consuming, and is simple and easy. Our approach can be applied in clinical settings to gain information on trunk control in children with CP.
Keywords: Accelerometer, cerebral palsy, trunk control
Abstract: BACKGROUND: Brain computer interface (BCI) technology is a communication and control approach. Up to now many studies have attempted to develop an EEG-based BCI system to improve the quality of life of people with severe disabilities, such as amyotrophic lateral sclerosis (ALS), paralysis, brain stroke and so on. The proposed BCIBSHS could help to provide a new way for supporting life of paralyzed people and elderly people. OBJECTIVE: The goal of this paper is to explore how to set up a cost-effective and safe-to-use online BCIBSHS to recognize multi-commands and control smart devices based on SSVEP.…METHODS: The portable EEG acquisition device (Emotiv EPOC) was used to collect EEG signals. The raw signals were denoised by discrete wavelet transform (DWT) method, and then the canonical correlation analysis (CCA) method was used for feature extraction and classification. Another part is the control of smart home devices. The classification results of SSVEP can be translated into commands to control several devices for the smart home. RESULTS: Here, the Power over Ethernet (PoE) technology was utilized to provide electrical energy and communication for those devices. During online experiments, four different control commands have been achieved to control four smart home devices (lamp, web camera, guardianship telephone and intelligent blinds). Experimental results showed that the online BCIBSHS obtained 86.88 ± 5.30% average classification accuracy rate. CONCLUSION: The BCI and PoE technology, combined with smart home system, overcoming the shortcomings of traditional systems and achieving home applications management rely on EEG signal. In this paper, we proposed an online steady-state visual evoked potential (SSVEP) based BCI system on controlling several smart home devices.
Keywords: Brain computer interface, smart home system, Power over Ethernet, steady-state visual evoked potential, discrete wavelet transform, canonical correlation analysis
Abstract: BACKGROUND: Assessment of asthma outside of the hospital using a patient independent device is highly in demand due to the limitation of existing devices, which are manual and unreliable if patients are not cooperative. OBJECTIVE: The study aims to verify the use of newly developed human respiration, carbon dioxide (CO 2 ) measurement device for the management of asthma outside of the hospital. METHOD: The data were collected from 60 subjects aged between 18–35 years via convenience sampling method reported in UTM Health Center using the device. Furthermore, the data were normalized…and analyzed using descriptive statistics, t-test, and area (A z ) under receiver operating characteristic curve (ROC). RESULT: Findings revealed that the normalized mean values of end-tidal carbon dioxide (EtCO 2 ), Hjorth Activity (HA), and respiratory rate (RR) were lower in asthmatic compared with healthy subjects with minimum deviation from the mean. In addition, each parameter was found to significantly differ statistically for asthma and non-asthma with p < 0.05. Furthermore, the A z shows the strong association for the screening of asthma and non-asthma with an average of 0.71 (95% CI: 0.57–0.83), 0.77 (95% CI: 0.64–0.90), and 0.83 (95% CI: 0.73–0.94) for RR, EtCO 2 , and HA, respectively. CONCLUSIONS: This study demonstrates that the newly developed handheld human respiration CO 2 measurement device may possibly be used as an effort-independent asthma management method outside of the hospital.
Keywords: Asthma, capnography, early screening, CO2 measurement
Abstract: BACKGROUND: The body area networks (BAN) are built by many wearable sensors to record, monitor or control the vital signals within the human body continuously. Human body communication (HBC) is a novel physical layer method to implement the BAN with low power consumption, low radiation, and strong anti-interference. However, the most existing HBC rarely consider the situation in which multiple sensors transmit data at the same time. OBJECTIVE: The aim of this paper is to investigate the feasibility of frequency division multiplexing for human body communication multiplex data transmission. METHODS: The signal was…injected into the human body, and the human channel gain was measured by the spectrum analyzer. Two frequency signals were selected with smaller gain to design the transceiver. The transmitter used OOK modulation technology to design each functional unit, and the receiver recovered the original signal with a non-coherent demodulation method. RESULTS: The experimental results show that after the dual signals were transmitted through the human body, the receiver could recover the original signal correctly. In both static and dynamic situations, even if the transmission rate was as high as 115.2 kb/s, the bit error rate was only 10 - 4 . CONCLUSIONS: The frequency division multiplexing scheme can be selected for multi-channel data transmission in human body communication.
Keywords: Human body communication, frequency division multiplexing, gain characteristics, bit error rate
Abstract: BACKGROUND: Periodontitis is a chronic inflammatory disease caused by Porphyromonas gingivalis that leads to a series of periodontal tissue injuries. Egg yolk immunoglobulins (IgY) is procuded in egg yolk and inhibits P. gingivalis . OBJECTIVE: The aim was to evaluate the effect of IgY on experimental periodontitis caused by P. gingivalis . METHODS: The second molars of rats were ligatured using medical 5-0 silk and smeared with P. gingivalis to induce experimental periodontitis. Then, the rats were smeared with 2 mL IgY solutions or 0.9% NaCl in the oral cavity for up…to 4 wk. The scores for gingival index, plaque index and probe on bleeding, the levels of IL-6 and TNF-α , X-ray radiography and histology were used to determine the efficacy of the IgY on experimental periodontitis. RESULTS: The clinical indices improved; the levels of IL-6 and TNF-α were significantly (p < 0.05) decreased; the X-rays and histomorphological observations suggested that the periodontal inflammation and periodontitis were alleviated compared to the control. CONCLUSIONS: IgY showed significant effects on anti-inflammatory, anti-coaggregation activity, and protected against alveolar bone loss. Therefore, it had a beneficial effect on preventing experimental periodontitis caused by P. gingivalis .
Abstract: Wearing high heels is thought to lead to various foot disorders and injuries such as metatarsal pain, Achilles tendon tension, plantar fasciitis and Haglund malformation. However, there is little available information explaining the specific mechanisms and reasons why wearing high heels causes foot deformity. Therefore, the purpose of this study was to investigate the foot kinematics of high heel wearers and compare any differences with barefoot individuals using the Oxford Foot Model (OFM). Fifteen healthy women aged 20–25 years were measured while walking barefoot and when wearing high heels. The peak value of angular motion for the hallux with respect to…the forefoot, the forefoot with respect to the hind foot, and the hind foot with respect to the tibia were all analyzed. Compared to the barefoot, participants wearing high heels demonstrated larger hallux dorsiflexion (22.55 ∘ ± 1.62 ∘ VS 26.6 ∘ ± 2.33 ∘ for the barefoot; P = 0.001), and less hallux plantarflexion during the initial stance phase (- 4.86 ∘ ± 2.32 ∘ VS - 8.68 ∘ ± 1.13 ∘ ; P < 0.001). There were also greater forefoot adduction (16.15 ∘ ± 1.37 ∘ VS 13.18 ∘ ± 0.79 ∘ ; P < 0.001), but no significant differences were found in forefoot abduction between the two conditions. The hind foot demonstrated a larger dorsiflexion in the horizontal plane (16.59 ∘ ± 1.69 ∘ VS 12.08 ∘ ± 0.9 ∘ ; P < 0.001), greater internal rotation (16.72 ∘ ± 0.48 ∘ VS 7.97 ∘ ± 0.55 ∘ ; P < 0.001), and decreased peak hind foot extension rotation (- 5.49 ∘ ± 0.69 ∘ VS - 10.73 ∘ ± 0.42 ∘ ; P = 0.001). These findings complement existing kinematic evidence that wearing high heels can lead to foot deformities and injuries.
Keywords: High heels, Oxford foot model, gait, hallux valgus
Abstract: BACKGROUND: Knee and hip replacement surgery are still the mainstay therapy for osteoarthritis. In spite of the improvement of techniques and implants, anemia is a relatively common complication, with transfusion rates of up to 23% in some centers. OBJECTIVE: The purpose of the study was to determine a correlation of transfusions to complications including infection since this topic is still being debated or even disputed in the literature. METHODS: This is a level III, single center retrospective observational cohort study of 2760 unilateral primary knee and hip replacements. Preoperative assessment, the number of transfusions…and the occurrence of complications were collected and the correlations were analyzed using analysis of variance and logistic regression. RESULTS: Fifteen percent of all patients developed at least one complication. Transfusion rate was 9%. Risk factors for receiving a transfusion were female gender, hip replacement, American Society of Anesthesiologists’ Score (ASA) > III, history of myocardial infarction, chronic cardiac disease, diabetes mellitus, chronic kidney disease, and length of surgery. The risk factors for developing a complication were: ASA score, presence of chronic renal insufficiency, and transfusion during hospital stay. Transfusion increases the risk of complications and infection rate. Complication rate with transfusion was 34.7% and without transfusion 13.2%. Infection rate without transfusion was 0.4% and with transfusion 2.82%. CONCLUSIONS: The complication rate is higher in transfused patients. The number of complications rises linearly with the number of transfusions. Infection rate is also higher after a transfusion. Efforts should be made to reduce the transfusion rate.
Abstract: Although many studies have focused on stretching techniques for athletes, no comprehensive studies have investigated the use of the instrument-assisted soft tissue mobilization (IASTM) technique in young basketball players. The active properties of muscle and subjective reporting of functional ability were used to identify the effects of IASTM on the calf muscle. Active range of motion (AROM), functional fitness, and isokinetic lower strength in the knees and ankles were measured in 40 healthy young basketball players. They were divided into the IASTM group (n = 20) and a control group (CG, n =…20). Twenty asymptomatic young basketball players were treated with IASTM six times per week for 8 weeks. The remaining 20 participants did not receive a treatment intervention between tests and served as the control. Ankle AROM (two knee positions of 0 ∘ and 45 ∘ flexion), functional fitness at the knee and ankle (side-step and vertical jump), and isokinetic peak torque were determined during ankle dorsiflexion (DF) and plantar flexion (PF) and knee extension (EX) and flexion (FX). The data were analyzed using repeated-measures analysis of variance. Significant differences were observed between the two groups in IASTM and control AROM 0 ∘ knee flexion (right: DF; p < 0.001 and PF; p < 0.001; left: DF; p < 0.001 and PF; p = 0.011), AROM 45 ∘ knee flexion (right: DF; p < 0.001 and PF; p = 0.009; left: DF; p < 0.001 and PF; p = 0.001), functional fitness (side step; p = 0.001, sit and reach; p = 0.025, vertical jump; p = 0.001), ankle isokinetic strength 30 ∘ /sec (right: DF; p = 0.001 and PF; p = 0.001; left: DF; p < 0.001 and PF; p = 0.002), ankle isokinetic strength 120 ∘ /sec (right: DF; p = 0.049 and PF; p = 0.001; left: DF; p = 0.023 and PF; p < 0.001), knee isokinetic strength 60 ∘ /sec (right: EX; p = 0.001, FX; p = 0.001 and hamstring and quadriceps ratio [H/Q]; p = 0.001, left: EX; p = 0.001, FX; p = 0.001 and H/Q; p = 0.001), and knee isokinetic strength 180 ∘ /sec (right: EX; p = 0.001, FX; p = 0.001 and H/Q; p = 0.001; left: EX; p = 0.001, FX; p = 0.010 and H/Q; p = 0.001). These results suggest that IASTM improves functional fitness and lower body muscle strength in young basketball players.
Keywords: Instrument-assisted soft tissue mobilization, active range of motion, isokinetic strength
Abstract: BACKGROUND: Thermal damage induced by bone drilling is a common problem during surgical procedures. A recent and promising method utilizes high-frequency low-amplitude vibration in the feed direction during drilling and has the potential to reduce drilling temperature, minimizing the risk of thermal damage. OBJECTIVE: The purpose of this study was to investigate the effects of ultrasonically-assisted drilling (UAD) on cortical bone temperature. METHODS: A series of experiments was conducted to compare the cortical bone temperature during UAD with that during conventional drilling (CD). A thermo-mechanical 3D finite element model (FEM) of UAD was…developed, using ABAQUS, to help understand temperature changes during drilling of cortical bone. The numerical simulation results of FEM showed good agreement with the experimental data. Subsequently, a predictive model was developed for bone temperature during drilling, using multiple regression analysis based on the results from numerical simulation. RESULTS: The results showed drill diameter had the greatest influence on drilling temperature, followed by the rotational speed of the drill. Additionally, the variation of vibration frequency had more influence on the drilling temperature than did the amplitude. CONCLUSIONS: Ultrasonically-assisted drilling is helpful to lower drilling temperature to reduce the thermal damage of bone tissue.
Keywords: Bone drilling, temperature, ultrasonically-assisted drilling, thermal damage, predictive model
Abstract: BACKGROUND: Total hip arthroplasty (THA) is one of the most common orthopedic procedures in developed countries, and the high volume of surgery and the socioeconomic burden of failures demand continuous optimization. Operative time has been identified as a significant independent factor influencing the clinical outcome of THA. OBJECTIVE: The aim of this study was to analyze factors influencing the operative time for THA in a large, single-center cohort. METHODS: A consecutive series of 7,674 cases undergoing primary THA was identified, and after multiple imputation of missing values, univariable and multivariable linear regression analyses were…performed. RESULTS: In the univariable analysis, all factors showed significant influences on operative time, while multivariable regression analysis revealed that sex, a diagnosis of hip dysplasia and small femoral component size did not reach significance. Younger age, an underlying diagnosis other than osteoarthritis or hip dysplasia, a large stem size, usage of a conventional stem rather than a short stem, a larger cup size and a cemented fixation technique, however, remained significantly influential in terms of a longer operative time. CONCLUSIONS: This study identified risk factors for longer operative time that in turn is associated with a higher rate of periprosthetic joint infection and impaired clinical outcome. Our findings could help to refine scheduling of total hip arthroplasty procedures in times of increasing cost and efficiency pressure.
Keywords: Operative time, total hip arthroplasty, total hip replacement, scheduling
Abstract: BACKGROUND: Although AIDS-related mortality has declined since the introduction of antiretroviral therapy (ART), HIV/ AIDS patients are predominantly present in developing countries that lack high-cost diagnostic devices and human expertise. OBJECTIVE: New methods for counting CD4+ cells cost-effectively are needed to replace conventional flow cytometry-based diagnosis. METHODS: We developed a CD4+ cell analyzer, ADAMII, which is a benchtop fluorescence image-based CD3+/4+ cell counting analyzer. It bears a three-channel light source and performs CD3+/4+ counting assays. The automatic 3D stage captures a maximum of 136 images that are subsequently processed and analyzed using a software…integrated into the system. RESULTS: Results obtained using ADAMII were compared with data obtained by conventional methods using a FACSCalibur flow cytometer and the point-of-care PIMA CD4 analyzer. Both comparisons between ADAMII vs. FACS and ADAMII vs. PIMA data yielded a strong correlation with an R 2 value of 0.98, which ensures the feasibility of CD4 test by ADAMII. CONCLUSIONS: The proposed method using ADAMII can be easily employed in resource-limited areas to replace conventional flow cytometers, which are expensive and require highly trained staff.
Abstract: BACKGROUND: The orientation of the pelvis is of particular importance to the sagittal curve of the spine and has geometric relationships with the top of the spine and lumbar lordosis. Changes in spinal shape or disruptions of sagittal balance in the spine, such as a flattened lumbar spine, have significant negative effects. OBJECTIVE: The aim of this study was to investigate the effects of the posterior superior iliac spine support device (PSD) on upper trunk acceleration during gait in individuals with flat lumbar back posture. METHODS: In total, 10 young male subjects with reduced…lumbar lordosis (global lumbar lordosis angle (T10–S2): < - 20 ∘ ) were recruited for this study. Participants walked 7 m with and without wearing a PSD at a self-selected speed while fitted with an accelerometer attached over the T7 spinous process. RESULTS: The normalized AP acceleration of T7 with PSD (40.57 ± 11.22%) was significantly higher than those without PSD (37.10 ± 10.46%, p = 0.035). CONCLUSIONS: We found that wearing the PSD immediately improved pelvic physiological movement during walking in individuals with lumbar flat back posture. Our findings may help healthcare professionals manage flat back posture in asymptomatic younger individuals.
Keywords: Flat lumbar back posture, posterior superior iliac spine support device, pelvic movement, upper trunk acceleration