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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: Face symmetrization has extensive applications in both medical and academic fields, such as facial disorder diagnosis. Human face possesses an important characteristic, which is as known as symmetry. However, in many scenarios, the perfect symmetry doesn’t exist in human faces, which yields a large number of studies around this topic. For example, facial palsy evaluation, facial beauty evaluation based on facial symmetry analysis, and many among others. Currently, there are still very limited researches dedicated for automatic facial symmetrization. Most of the existing studies only utilized their own implantations for facial symmetrization to assist their interdisciplinary academic researches. Limitations thus…can be noticed in their methods, such as the requirements for manual interventions. Furthermore, most existing methods utilize facial landmark detection algorithms for automatic facial symmetrization. Though accuracies of the landmark detection algorithms are promising, the uncontrolled conditions in the facial images can still negatively impact the performance of the symmetrical face production. To this end, this paper presents a joint-loss enhanced deep generative network model for automatic facial symmetrization, which is achieved by a full facial image analysis. The joint-loss consists of a pair of adversarial losses and an identity loss. The adversarial losses try to make the generated symmetrical face as realistic as possible, while the identity loss helps to constrain the output to have the same identity of the person in the original input as much as possible. Rather than an end-to-end learning strategy, the proposed model is constructed by a multi-stage training process, which avoids the demand for a large size of the symmetrical face as training data. Experiments are conducted with comparisons with several existing methods based on some of the most popular facial landmark detection algorithms. Competitive results of the proposed method are demonstrated.
Abstract: BACKGROUND: Previous studies showed that compared with single-bundle (SB) precedures, double-bundle (DB) anterior cruciate ligament (ACL) reconstruction perform better. OBJECTIVE: To make assurance that distance of TT-TG may be altered along with ACL rupture and reconstruction. METHODS: Imaging study of 201 patients’s related cases by MRI and CT scans. RESULTS: Compared with the intact knee’s overall mean TT-TG value, the mean overall pre/postoperative TT-TG values showed a significant difference. For SB reconstruction, the mean pre/postoperative TT-TG values were 15.67± 2.46 mm and 14.72± 2.48…mm, respectively. Postoperative and intact knee TT-TG values were significantly different (p < 0.001). For DB reconstruction, the pre/postoperative mean TT-TG values were 15.11± 1.99 mm and 13.11± 1.71 mm. Postoperative and intact knee TT-TG values were not significantly different (p = 0.141). CONCLUSIONS: The increased TT-TG value from a ruptured ACL was significantly restored after ACL reconstruction. The TT-TG value after SB reconstruction was still obviously larger than that of the intact knee. It showed no significant difference between the postoperative TT-TG of the DB group and intact knees. The original TT-TG values of the knees were much closer to restoration after DB reconstruction.
Abstract: The incidence of cancers has increased year by year and the early diagnosis for cancer is important to prevent cancers. Due to abnormal metabolism of tumor cells, the acidification of extracellular environment is an important feature for cancer cells. To achieve efficient and accurate pH measurement, this paper proposes a new detection method based on the fluorescence characteristics of CdSe quantum dots detection, which uses CdSe QDs with unique optical properties as sensitive substances for pH detection. PBS buffer (0.2 mol/L) with different pH has been used to simulate cell metabolites at different pH values and use 365 nm laser source to…excite mixture liquid. The emitted light was detected by a fluorescence detection device. A mathematical model between fluorescence intensity and pH was finally obtained. The experimental results show the method show better effectiveness than other pH detection methods and has a high resolution of 0.037 within a pH range of 6.1–7.8 and a measurement resolution of 0.037 pH units. This method has high temperature stability and short testing time, which shows high potential for pH detection. This method has its superiority in all the testing methods. It exhibits a new way of generalizing to pH detection.
Keywords: Tumor cells, CdSe quantum dots, pH value of cell metabolites, fluorescence characteristics
Abstract: BACKGROUND: The main obstacle encountered in microarray technology is how to mine the valuable information under the profiles and study the genes function. OBJECTIVE: Maximal information coefficient (MIC) is a novel, non-parametric statistic that has been successfully applied to genome-wide association studies and differentially gene and miRNA expression analysis. However, the data used in these applications are not gold standard but real data. METHODS: Therefore, this study attempts to test the feasibility of MIC for differentially expressed gene identification with simulation data. RESULTS: Our experiments indicate that, MIC perfermance is…better than Limma always, which is almost the same level of SAM, ROTS or DESeq2. However, the count of AUC < 0.5 of MIC is significantly smaller than the three methods, and MIC does not exhibit an abnormal phenomenon in which the AUC increases as the noise increases. CONCLUSIONS: Compared to the existing methods, our experiments show that MIC is not only in the first tier in identifying differentially expressed genes and noise immunity, but also shows better robustness and stronger data/environment adaptability.
Keywords: Maximal information coefficient, differentially expressed gene, identification, feasibility
Abstract: BACKGROUND: Traditional cancer treatments such as surgery, radiation, and chemotherapy destroy both cancer and normal cells, which limit their clinical application. It is difficult to achieve the best results for any liver cancer patients using any single treatment method. Gene therapy for HCC demands non-invasive, efficient, targeted and safe gene transfection strategies. OBJECTIVE: In this study, a nonviral shRNA gene delivery system utilizing a combination of PEI, US, and NBs was developed for targeting survivin in liver Cancer. METHODS AND RESULTS: The PEI-shRNA-NBs cumulated in the tumor tissue because of the EPR effect. By…exposure to the US, micelles shRNA may be released from PEI-shRNA-NBs in tumor tissues and the shRNA then transmitted efficiently to cancer cells. Considerably enhanced therapeutic outcome was obtained with the gene silencing effect enhanced. CONCLUSIONS: PEI-shRNA-NBs possess the potential to become promising tools intended for shRNA delivery.
Abstract: BACKGROUND: Cerebral edema is a common secondary disease after stroke. It is very important to realize real-time continuous monitoring of cerebral edema for stroke patients. OBJECTIVE: A non-contact magnetic induction phase shift (MIPS) detection system is used to monitor the change of global brain electrical conductivity during cerebral edema. METHODS: In order to verify the feasibility of this system monitoring, we carry out salt solution simulation experiments and healthy people breath holding experiments. As a comparison of later clinical experiments, 13 young healthy volunteers aged 22–35 are selected for this study to carry out a 10…minute/time monitoring experiment. RESULTS: It is found that the MIPS values measured by the salt solution of edema and the salt solution of bleeding are significantly different. The results show that the MIPS value of healthy young people is in a stable state with an MIPS mean value of 1.106 (± 0.736) ∘ . Compare it with the monitoring results of a cerebral edema patient. The MIPS of patient fluctuates greatly, and the changes of MIPS and intracranial pressure show consistent trend at the peak of the edema period. CONCLUSIONS: We preliminarily verify that the system can be used for cerebral edema monitoring.
Abstract: OBJECTIVE: Atrial fibrillation (AF) is the most common type of persistent arrhythmia. Early diagnosis and intervention of AF is essential to avert the further fatality. The technique of noninvasive electrical mapping, especially the body surface potential mapping (BSPM), has a more practical application in the study of predicting AF, when compared with the invasive electrical mapping methods such as the epicardial mapping and interventional catheter mapping. However, the prediction of AF with noninvasive signals has been inadequately studied. Thus, the aim of this paper was to analyze the properties of atrial dynamic system based on the noninvasive BSPM signals…(BSPMs), using the recurrence complex network, and consequently to evaluate its role in predicting the recurrence of AF in clinical aspect. METHOD: Twelve patients with persistent AF were included in this study. Their preoperative and postoperative BSPMs were recorded. Initially, the preoperative BSPMs were transformed into the recurrence complex network to characterize the complexity property of the atria. Subsequently, the parameters of recurrence ratio (REC), determinism (DET), entropy of the diagonal structure distribution (ENTR), and laminarity (LAM) were calculated. Furthermore, the difference in the parameters in the four regions of the body and the difference obtained from the dominant frequency (DF) method were compared. Finally, the results obtained for the atrial dynamic system complexity from a 12-lead electrocardiogram (ECG) from the BSPMs were discussed. RESULTS: Our study revealed that the patients whose REC is greater than an average threshold, and with a lower LAM presented a much higher possibility of AF recurrence, after the AF surgery. CONCLUSIONS: The recurrence complex network is a useful and convenient way to evaluate the nonlinear properties of the BSPMs in patients with AF. It has good immunity to the lead position and has a potential role in the understanding of predicting the recurrence of AF.
Abstract: BACKGROUND: The human hematopoietic stem/progenitor cell 117 (HSPC117) protein is involved in many important biological processes. OBJECTIVE: This study was designed to identify the level of HSPC117 mRNA expression in 10 min pig tissue samples and HSPC117 subcellular localization in the PK15 cell line. METHODS: In this study, 10 tissue samples of min pigs were collected, and EGFP-HSPC117 vectors were constructed to express EGFP-HSPC117 fusion proteins in PK15 cells. RESULTS: HSPC117 mRNA was expressed in all of the tissue samples, although the levels of expression in fat and lung tissues were…significantly lower than in other tissues (P < 0.01). After generating and detecting the EGFP-HSPC117 fusion protein, fluorescence was found to be distributed throughout the cytoplasm and nucleus during interphase; however, the fluorescence was concentrated in the nuclear area in mitotic cells. CONCLUSIONS: These results indicate that the HSPC117 gene is expressed in many min pig tissues. The HSPC117 protein was distributed throughout the cells during interphase, but was concentrated in the nuclear area in mitotic cells.
Abstract: OBJECTIVE To investigate the roles and underlying mechanism of exogenous H 2 S (hydrogen sulfide) in attenuating the myocardial fibrosis in diabetic rats. METHODS: A total of 40 SD rats were randomly divided into 4 groups: control group, STZ group, STZ + H 2 S group and H 2 S group. To build the DM rat model , the rats in the STZ group and STZ + H 2 S group were injected streptozotocin (STZ) intraperitoneally, While the rats…in the STZ + H 2 S group and the H 2 S group received sodium hydrosulfide (NaHS), which provides exogenous H 2 S. Eight weeks later, the myocardial tissues of rats were used to detecting the collagen deposition through Masson staining, as well as some protein expressions related to myocardial fibrosis and signaling pathway by western blotting. RESULTS: Comparing to control group, the collagen deposition of myocardial matrix remarkably increased in the STZ group, and almost all the proteins that are relative to myocardial fibrosis, inflammatory and signaling pathway show an overexpression, except for PPARG and NF-κ Bp65. When Compared with the STZ group, the collagen deposition was obviously attenuated in STZ + H 2 S group, as well as the protein expressions above-mentioned, While PPARG was up-regulated. CONCLUSION: The myocardial fibrosis in DM rats can be attenuated effectively by exogenous H 2 S, and the underlying mechanism is likely to regulating PKC-ERK1/2MAPK signaling pathway, improving the MMPs/TIMPs expression dysregulation and inhibiting inflammatory reaction.
Keywords: Exogenous hydrogen sulfide, DM rats, myocardial fibrosis, inflammatory reaction, protein kinase C, ERK1/ 2mitogen-activated protein kinase, MMPs/TIMPs expression dysregulation
Abstract: BACKGROUND: Stroke is a leading cause of mortality and disability, which can be affected by people’s daily living habits. OBJECTIVE: To investigate the effects of main daily living habits (smoking, drinking, diet, vegetable and fruits consumption, and exercise) on stroke risk in patients and provide the scientific basis for the assessment of the risk factors, a novel risk analysis model of the stroke is proposed. METHODS: A data mining method using decision trees which adopted the optimized C4.5 algorithm is presented. It is able to deal with the unbalanced data problem of the classification. Meanwhile,…the proposed method has been verified on a clinical dataset of 23,682 patients with 21 risk factors. RESULTS: The overall accuracy and kappa coefficient for stroke risk classification has reached 84.88% and 0.7763, respectively. Through the generated knowledge rules, it demonstrates that the behavioral habits in daily life have an indirect effect on the risk of stroke. While, it has an obvious effect on stroke when hypertension, diabetes mellitus, hypercholesterolemia, and BMI risk factors exist. In addition, it was observed that the aforementioned five daily living habits have a decreased impact on the stroke. CONCLUSIONS: It is anticipated that the proposed system could help in reducing the risk, mortality, and disability of stroke, and provide clinical decision support for the treatment of stroke.
Abstract: OBJECTIVE: To explore the effect of gefitinib-coated balloon suppressive action on the excessive hyperplasia of intima after balloon injury of common carotid artery in rats and on the PI3K/AKT signal pathway. METHODS: MTT method and the expression of Bcl-2 and Caspase-3 proteins were detected in vitro ; Adult SD rats were randomly split into 5 groups, namely sham group, model group, low-dosage gefitinib-coated balloon group, high-dosage gefitinib-coated balloon group, and paclitaxel-coated balloon group. The intimal proliferation of arteries, PCNA, P-AKT and PI3K protein expression, the cell apoptosis, expression of MMP9, TGFβ and IL6…mRNA were measured by hematoxylin and eosin (H&E) staining, immunohistochemistry, TUNEL staining, and RT-qPCR. RESULTS: At the same time and concentration, Gefitinib suppressed the proliferation of smooth muscle cell more significantly than paclitaxel. Bcl-2 and Caspase-3 in vascular smooth muscle and endothelial cells (VSMC, EC) were significantly down-regulated and up-regulated after the cells were treated with gefitinib and paclitaxel. In gefitinib- and paclitaxel-coated balloon groups, significant up-regulations were found in the area of lumen. Furthermore, the expression of PCNA suggested that all coated balloons could suppress the excessive proliferation of smooth muscle cells in the hyperplastic intima compared with the control group. In gefitinib- and paclitaxel-coated balloon group, the expression of PI3K/AKT was significantly down-regulated. The use of drug-coated balloons mitigated the cell apoptosis in TUNEL. The expressions of MMP9, TGFβ and IL6 mRNA in the model group were obviously up-regulated; and they were obviously down-regulated in the high-dose gefitinib-coated balloon group compared with the model group. CONCLUSIONS: Gefitinib-coated balloons were able to suppress the excessive proliferation in the common carotid arterial intima of rats more effectively than the paclitaxel-coated ones. The underlying mechanism may cover the PI3K/AKT signal pathway.
Abstract: BACKGROUND: Most fall intervention studies attempted to improve the mobility, range of motion of upper and lower extremities, or all major muscle strengths. Yet, there has been little effort to identify movements or actions that may be mainly responsible for recovering from a slipping. It was imperative to link lower extremity kinematics in conjunction with the functional anatomy of lower extremity muscles during forward heel-slipping to identify what muscles should have been activated substantially if a person would have recovered from forward heel-slipping. OBJECTIVE: The present study investigated lower extremity movements, such as the ankle, knee,…and hip rotations, which could contribute to falls from forward heel-slipping. Determining changes in positions of foot, shank, and thigh during slipping would provide information to develop the optimal training regimen or interventions that may be effective for improving a chance to recover from the postural disturbance. METHODS: Twenty healthy adults (24–68 years old) participated in this experiment. Among twenty participants, only eight participants’ data were analyzed in this study. The 3D position data were used to compute the sagittal foot, shank, and thigh angles and frontal thigh angle. RESULTS: The study results indicated that, during the period of slipping, the angles of the segments of the slipping leg were different from that of the foot, shank, and thigh when walking ordinarily over the dry surface in the present study. CONCLUSIONS: The characteristics or differences in the angular kinematics of lower extremity during unexpected slips in the present study demonstrate possible causes for slip-induced falls.
Keywords: Forward heel slip, leg kinematics, segment angles, fall
Abstract: Dexamethasone (DEX) is associated with many inflammation and metabolic diseases. We analyzed the effects of DEX on the expression of estrogen metabolism enzyme 17β -HSD1 at the optic nerve. Rats were treated with different concentrations of intraperitoneal DEX. Western Blot analysis showed that 17β -HSD protein was expressed in the optic nerve tissue. The enzyme was detected by immunohistochemistry on the terminal foot of Muller cells from the ganglion cell layer of rat retina. ELISA analysis showed that the 17β -HSD1 protein expression of DEX-treated group is 2.4 fold comparing to the control group.…The results indicated that DMXS sodium phosphate might modulate the expression of 17β -HSD1 protein in optic tissue. This study sheds light on understanding of the relationship among DEX, 17β -HSD presence and distribution of visual neural systems. At the same time, DEX treatment affects the athletic ability and memory of the animals. Compared with the control group, the experimental group showed slow response to stimulation, inertia, depression, cowardice and lack of appetite. The results of ethology experiments showed that all the parameters decreased by 15–30%.
Keywords: Dexamethasone, 17β-HSDs, rat optic nerve
Abstract: Traditional Chinese Medicine (TCM) multiple-acupoints stimulation is widely used to improve dysphagia among post-stroke patients. However, prior research in evidence-based acupuncture mostly focused on the treatment effects of single acupoint’s on dysphagia, while the evidence of optimal sequence of multiple-acupoints stimulation remains limited. In this paper, we developed an evaluation method of hybrid knowledge (deterministic knowledge and the experiential group decision knowledge) sequences based on segmentation mechanism of sub-sequence fragments, and then, we proposed a Monte Carlo Tree Search (MCTS) sequential decision-making method under the hybrid knowledge. Thereafter, we applied this proposed sequential decision-making approach to optimizing sequential decision-making schema…of multiple-acupoints stimulation, to treat dysphagia among post-stroke patients. Finally, we verified the validity and the feasibility of this method by comparing it to other sequential decision-making search methods.
Keywords: Hybrid knowledge, Monte Carlo Tree Search (MCTS) algorithm, sequential decision-making, multiple acupoints
Abstract: BACKGROUND: An important part of the rehabilitation process using exoskeleton robots has been the creation of a friendly Human Robot Interaction (HRI) system. OBJECTIVE: In order to combine SEMG signal into the HRI system, a SEMG-angle model based on Hidden Markov Model (HMM) was put forward in this paper. METHODS: Feature extraction as a critical issue of signal preprocessing was handled by Principal Component Analysis (PCA) which realized signal data dimension reduction and solved the common problem of redundant features. A comparison study was given to show the different performance of various EMG-angle…model separately based on HMM, Back Propagation (BP) neural network and Radial Basis Function (RBF) neural network. RESULTS: The HMM modeling method which with lower calculation complexity can achieve a better modeling performance (average accuracy 93.063%) compared with BP neural network (average accuracy 88.180%) and RBF neural network (average accuracy 88.752%). CONCLUSIONS: SEMG signals have some characteristic properties which is similar to a quasi-stationary filtered white noise stochastic process, the structure of HMMs makes it ideally suited for classification and modeling SEMG signals, and the results of this study show that it can achieve a better performance than the commonly used methods (BP and RBF).
Abstract: BACKGROUND: Current multispectral photoacoustic instruments must use large and separate combinational structures to obtain various biological tissue information for multispectral ranges. OBJECTIVE: The optical aberration generated from the multispectral photoacoustic systems may reduce the image quality of biological tissue because the improper structures for combining light of different wavelength cannot produce good optical ray convergence points. To prevent this, complex combined structures need to be considered at the design level for multispectral photoacoustic systems. METHODS: In place of an optical refracted lens system, reflective mirrors could be designed for optical systems. To verify…our proposed idea, we assessed optical distortion performance using red, green, and blue light, and combined optical light sources to compare their chromatic aberration characteristics. RESULTS: The high optical performance is realized regardless of the wavelength for a light source combined with multiple wavelengths, because our optical system was designed with only a reflective surface. CONCLUSIONS: The designed optical system using a reflective mirror can provide multispectral optical sources (such as infrared, visible, and ultraviolet optical lights) with only one light ray path, without any chromatic aberrations.
Abstract: BACKGROUND: The current method to evaluate major depressive disorder (MDD) relies on subjective clinical interviews and self-questionnaires. OBJECTIVE: Autonomic imbalance in MDD patients is characterized using entropy measures of heart rate variability (HRV). A machine learning approach for screening depression based on the entropy is demonstrated. METHODS: The participants experience five experimental phases: baseline (BASE), stress task (MAT), stress task recovery (REC1), relaxation task (RLX), and relaxation task recovery (REC2). The four entropy indices, approximate entropy, sample entropy, fuzzy entropy, and Shannon entropy, are extracted for each phase, and a total of 20…features are used. A support vector machine classifier and recursive feature elimination are employed for classification. RESULTS: The entropy features are lower in the MDD group; however, the disease does not have a significant effect. Experimental tasks significantly affect the features. The entropy did not recover during REC1. The differences in the entropy features between the two groups increased after MAT and showed the largest gap in REC2. We achieved 70% accuracy, 64% sensitivity, and 76% specificity with three optimal features during RLX and REC2. CONCLUSION: Monitoring of HRV complexity changes when a subject experiences autonomic arousal and recovery can potentially facilitate objective depression recognition.
Keywords: Heart rate variability (HRV), major depressive disorder (MDD), entropy, machine learning, depression, feature selection, support vector machine (SVM), recursive feature elimination (RFE), mental task, autonomic nervous system (ANS)
Abstract: BACKGROUND AND OBJECTIVE: Post-traumatic stress disorder (PTSD) is a chronic mental disorder caused by mental or psychological trauma after sudden events of a catastrophic or threatening nature. Synaptic plasticity is the core mechanism of PTSD and the main point of treatment of this disease. METHODS: Male Sprague Dawley rats were randomly divided into blank control (Ctrl), SPS (single-prolonged stress) model, SPS&S model (SPS and foot electric shock), SPS+EA (SPS plus electroacupuncture), and SPS&S+EA groups. Tranquilize Mind and Regulate Kidney (TMRK) electroacupuncture method was performed in each rat in the SPS+EA and SPS&S+EA groups, the treatment lasted…for 20 minutes per day, simultaneously for 3 consecutive weeks. Behavioral evaluations, molecular tests, electron microscopy, electrophysiological testing were conducted following the treatment. RESULTS: First, electro-acupuncture can significantly improve the PTSD-like symptoms. Second, electro-acupuncture can up-regulate the long-term potentiation (LTP) in hippocampus, repair the synaptic morphology and improve BDNF levels in amygdala and hippocampus. Third, electroacupuncture can significantly up-regulate SYN, GAP43, and PSD95 protein levels and mRNA expression in amygdala and hippocampus. CONCLUSIONS: The effect of TMRK electro-acupuncture method on the regression of fear memory of PTSD rats may be through its repair of synaptic plasticity in amygdala and hippocampus.
Keywords: PTSD, fear memory, TMRK, electroacupuncture, synaptic plasticity
Abstract: BACKGROUND: This paper describes the design and implementation of a dual-coil type electromagnetic actuator for implantable bone conduction hearing devices. OBJECTIVE: The structure of the proposed actuator was designed to generate maximum Lorentz force via the dual-coil method with a closed magnetic circuit. To satisfy the indications required by implantable bone conduction hearing devices, high output was generated within a specific frequency range using a vibrational membrane with a cantilever. METHODS: The structure of the membrane consists of a fixed ring, a circular plate, and two cantilevers connected symmetrically. Variable elements of the…vibrational membrane affecting the actuator frequency characteristics were analyzed through mathematical modeling and finite element analysis, based on the analysis used to derive the optimum structure of the vibrational membrane. The components of the actuator were fabricated through chemical etching and computer numerical control process, and the bone conduction actuator was fabricated through the precision assembly process. RESULTS: The output characteristics of the implemented actuator were measured using a laser Doppler vibrometer. As a result of measurement, the proposed actuator generated mechanical resonance at 1.2 kHz. CONCLUSIONS: By comparing the measured results with the finite element analysis results, we confirmed the validity of the proposed actuator design.
Keywords: Actuator, implantable bone conduction hearing device, electromagnetic, finite element method