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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: Bioengineering products can help bone tissue regeneration. OBJECTIVE: There is an ongoing research for more effective biomaterials in bone regeneration. Chitosan (Ch) grafted stearic acid (Ch-g-Sa) polymer was synthesized and its usability as a putty was evaluated in this study. METHODS: The chemical structure of Ch-g-Sa polymer was investigated using Proton nuclear magnetic resonance (H-NMR) and Fourier-transformed infrared spectroscopy-attenuated total reflectance (FTIR-ATR). Thermal properties of Ch-g-Sa polymer were determined by thermal gravimetric analysis (TGA). Putties containing nano-hydroxyapatite were prepared and in-vitro degradation properties and viscosity of the putties were determined.…RESULTS: The cytotoxicity, oxidation effect and osteogenic potential of the putties were investigated on MC3T3 cells while the inflammatory effect of the putties was studied on THP-1 cells. For the determination of the osteogenic effect of the putties, ALP and RUNX2 gene expression of MC3T3 cells were studied. CONCLUSION: Ch-g-Sa/HA putties are promising biomaterials for bone tissue regeneration.
Abstract: BACKGROUND: Gray matter (GM) imaging is important in the investigation of many neurological diseases, including schizophrenia, multiple sclerosis, stroke, Alzheimer’s disease, tuberous sclerosis, and epilepsy, which are all associated with changes in cortical GM. OBJECTIVE: The aim of this study was to develop a quantitative statistical analysis system for double inversion recovery (DIR) MRI and to evaluate the new system using preliminary clinical data. METHODS: The study population comprised of 10 healthy volunteers and six patients with or without brain degeneration. A quantitative statistical analysis system for DIR images was developed using the…following steps: 1) brain spatial normalization, 2) mean and standard deviation (SD) map creation, and 3) Z-score map creation. To evaluate the new voxel-based morphometry system, Z-scores of lesions in patients with brain degeneration were measured and then compared with Z-scores of normal regions. RESULTS: All DIR images were adequately spatially normalized to Montreal Neurological Institute MNI coordinate. Lesions in each patient were indicated by high Z-score values on a Z-score map, which were significantly higher than Z-scores of normal regions (p < 0.05). CONCLUSIONS: In this study, we developed a quantitative statistical analysis system for DIR MRI. Using our system, clinicians might accurately diagnose early brain degeneration.
Abstract: BACKGROUND: There are several challenges in terms of mandibular reconstruction. The defect size, graft materials, and plate combinations should be taken into consideration in surgical planning. OBJECTIVE: The aim of this study was to evaluate the effect of different reconstruction variations on the stress distribution of segmental resected mandibles with two different defect sizes using finite element analysis (FEA). METHODS: Computerized tomography images of a human mandible, fibula, and iliac crest were used as references to build three-dimensional (3D) models on a PC. The virtual plates and screws were used to simulate reconstruction…of the mandibular defects. The models were divided into two groups based on the longitudinal defect size. Different osteosynthesis variations and autogenous graft material combinations were used to reconstruct the mandibles. RESULTS: In all models, higher von Mises stress values occurred on the mandibles reconstructed with the fibula than those with the iliac crest. Fixation of the bone grafts with a reconstruction plate for the 10-mm defects and using a mini-plate in addition to the reconstruction plate for the 30-mm defects decreased stresses on the grafted bones. CONCLUSIONS: Mandibular reconstruction with the iliac grafts is biomechanically superior to that with the fibular grafts. In addition, osteosynthesis methods and the defect size affect the stress distribution.
Keywords: Autogenous bone graft, finite element analysis, mandibular reconstruction, osteosynthesis, stress distribution
Abstract: BACKGROUND: Brain neural activity is measured using electroencephalography (EEG) recording from the scalp. The EEG motor/imagery tasks help disabled people to communicate with the external environment. OBJECTIVE: In this paper, robust multiscale sample entropy (MSE) and wavelet entropy measures are employed using topographic maps’ analysis and tabulated form to quantify the dynamics of EEG motor movements tasks with actual and imagery opening and closing of fist or feet movements. METHODS: To distinguish these conditions, we used the topographic maps which visually show the significance level of the brain regions and probes for dominant…activities. The paired t-test and Posthoc Tukey test are used to find the significance levels. RESULTS: The topographic maps results obtained using MSE reveal that maximum electrodes show the significance in frontpolar, frontal, and few frontal and parietal brain regions at temporal scales 3, 4, 6 and 7. Moreover, it was also observed that the distribution of significance is from frontoparietal brain regions. Using wavelet entropy, the significant results are obtained at frontpolar, frontal, and few electrodes in right hemisphere. The highest significance is obtained at frontpolar electrodes followed by frontal and few central and parietal electrodes.
Abstract: BACKGROUND: Recently, health care and disease prevention are more and more important in people’s daily life. Human body communication (HBC) is an emerging short distance wireless communication mode, which is quite suitable for the communication between the wearable human health care equipment. However, most research on HBC mainly focuses on the electromagnetic model and the circuit model of equivalent human and the in vivo experiment is based on the commercial equipment. OBJECTIVE: The aim of this paper is to design a circuit device for measuring the attenuation of the human body channel based on a floating-ground-electrode…method. METHODS: This paper proposed a new floating-ground-electrode method so as to solve problems of power and high frequencies interference and impedance matching. A circuit module, including signal generator, analog frontend circuit and MCU, was designed to initially replace the spectrum analyzer to measure the attenuation of the human body channel. The floating-ground-electrode added to the receiving end of the human body channel was connected to the ground of the analog frontend circuit, forming an equal potential circuit. The three-electrodes of the receiving terminal can act as a differential probe, since one electrode is connected to the ground and the other two electrodes achieved signal input and output respectively. RESULTS: The results showed that the experimental data of channel attenuation were similar to the measured value of the spectrum analyzer. The maximum absolute error was 1.148 dB and the relative error was 3.55%. In addition, different sizes of the floating-ground-electrode cannot affect the attenuation path of human body channels. Moreover, the common mode rejection ratio (CMRR) was approximated to the value of the commercial differential probe. CONCLUSION: This paper proposed a new floating-ground-electrode method for measuring the attenuation of the human body channel. It could provide the possibility for the dynamic measurement of attenuation and take the place of the spectrum analyzer and make the process of experiments simple and efficient.
Keywords: Human body communication, galvanic coupling, channel attenuation, floating-ground-electrode
Abstract: BACKGROUND: Deep brain stimulation is a method of nerve regulation that uses human body conductance characteristics; signals are diffused and transmitted through human tissues to regulate diseases. OBJECTIVE: We analyzed the distribution and the transmission mechanism of implantable electrical signals from a point source field in the human body using the point source field implanting channel model. METHODS: The model was established using a mathematical modeling method, with reasonable boundary conditions and assumptions. Further, we established an equivalent numerical solution model to verify its accuracy and compared the model to published experimental results…to evaluate its consistency. RESULTS: The analysis results of the two models revealed that both had errors of < 1%. A comparison of the experimental results to published experimental data revealed that the error between the two was < 4 dB, and the model displayed excellent consistency. CONCLUSIONS: Our proposed model is accurate and exhibits good consistency with published experimental results. We therefore conclude that the proposed model is reliable.
Keywords: Deep brain stimulation, body conduction communication, implantable, point source field
Abstract: BACKGROUND: Children with cerebral palsy (CP) have abnormal postures and gait patterns. Many physiotherapists use the Vojta approach as intervention for children with CP. However, its effects remain unclear. OBJECTIVE: This study aimed to investigate the effect of the Vojta approach on abdominal muscles and gait in children with spastic CP. METHODS: Thirteen children with spastic CP were randomly assigned to a general exercise and a Vojta approach group. The interventions were administered in 30 min sessions, 3 times a week for a total of 6 weeks. We used ultrasonography to measure the thicknesses…of the abdominal muscles. The gait and foot pressure were measured by GAITRite. RESULTS: The Vojta approach group showed significant difference in the thicknesses of the rectus abdominis, and external oblique abdominal muscles, which are involved in trunk stability (p < 0.05). There were significant differences in the step width, functional ambulation profile, swing time, stance time, and single support % of cycle as well as foot pressure distribution (p < 0.05). CONCLUSION: The Vojta approach may be considered as an effective treatment method for improving trunk stability and gait functions of children with spastic CP.
Abstract: BACKGROUND: Spinal metastases are being diagnosed more frequently because of increasing life expectancies and advances in the diagnosis and therapy of primary tumours. OBJECTIVE: This aim of this study was to assess the quality of life (QoL) and functional outcomes after surgical intervention for spinal metastases in a large cohort. METHODS: A single-centre, prospective, observational study was conducted from June 2016 to February 2018. Patients treated surgically for spinal metastasis were included. Primary endpoints were the Core Outcome Measure Index (COMI), Oswestry Disability Index (ODI), and QoL questionnaire (EuroQoL-5D) scores recorded preoperatively, 6…weeks postoperatively, and 3, 6, and 12 months postoperatively. RESULTS: Ninety-two patients (mean age, 62.7 ± 12.8 years) were included. The most frequent neoplasms were multiple myeloma (n = 18; 19.6%), lung cancer (n = 16; 17.4%), prostate cancer (n = 14; 15.2%), and breast cancer (n = 11; 12.0%). During the observation period, 44.6% of patients died. The COMI score improved significantly from preoperatively (mean, 7.1; 95% CI, 6.6–7.6) to 3 months (mean, 5.5; 95% CI, 4.8–6.2; p = 0.01) and 12 months (mean, 4.6; 95% CI, 3.7–5.5; p = 0.001) postoperatively. The ODI showed a significant improvement from preoperatively (mean, 52.9; 95% CI, 48.5–57.4) to 6 weeks (mean, 43.4; 95% CI, 37.1–49.6; p = 0.03), 3 months (mean, 37.0; 95% CI, 31.0–42.9) 6 months mean, 40.5; 95% CI, 34.2–46.8; p = 0.01), and 12 months (mean, 31.9; 95% CI, 24.8–39.1; p = 0.005) postoperatively. Improvements in the COMI at 6 weeks (p = 0.05), and 6 months (p = 0.05) postoperatively were not statistically significant. QoL improved from preoperatively to 6 weeks (mean, 0.48; 95% CI, 0.38–0.59; p = 0.002), 3 months (mean, 0.50; 95% CI, 0.38–0.61; p = 0.009), and 12 months (mean, 0.61; 95% CI, 0.51–0.71; p = 0.001) postoperatively. After 6 months, the difference was not significant (p = 0.08). CONCLUSION: Short-term and long-term improvements in functional outcomes and QoL were observed after surgical treatment of spinal metastases. Surgery is a good option for patients with an estimated life expectancy of more than 3 months.
Keywords: Spinal metastases, spine, metastatic spine surgery, quality of life, functional outcome, Core Outcome Measures Index
Abstract: BACKGROUND: Incorrect cup positioning in primary total hip arthroplasty is known as a risk factor for early implant failure. The use of navigation systems leads to more accurate cup positioning. OBJECTIVE: The aim of this study was to compare the registration accuracy of the anterior pelvic plane and the measurement accuracy of the definite cup position for a pointer computer-assisted orthopaedic navigation system (P-CAOS) and an ultrasound-based navigation tool (US-CAOS) in an intra-individual study design. METHODS: Anterior pelvic plane registration was performed in 44 patients receiving a primary total hip arthroplasty with P-CAOS…and US-CAOS. The cup implantation was performed using US-CAOS. Intraoperatively, the cup position was assessed using P-CAOS and US-CAOS. The postoperative cup position was determined via CT scan. Inclination and anteversion errors were calculated using intraoperative values and CT data. All operations were performed by a single, high-volume surgeon using a minimally invasive anterolateral approach. RESULTS: The mean inclination error was 0.9 ∘ in the US-CAOS group and - 1.1 ∘ in the P-CAOS group. This was not statistically significant. The mean anteversion error was significantly reduced (p < 0.001) in the US-CAOS group (1.4 ∘ ) compared to the P-CAOS group (- 8.0 ∘ ). Significantly more cups (23 of 44; 52%) in the P-CAOS group were outliers regarding to the defined anteversion error range of 15 ∘ ± 10 ∘ . Outliers in the US-CAOS group amounted to two (of 44; 5%) (p < 0.001). The number of outliers regarding the inclination error range of 40 ∘ ± 10 ∘ , did not differ significantly between the P-CAOS (2; 5%) and US-CAOS (1; 2%) group. CONCLUSION: We were able to show a systematic anterior pelvic plane registration error in this intraindividual study design. US-CAOS based APP landmark registration showed to be significantly more precise compared to P-CAOS registration. The anteversion error of the cup using US-CAOS showed to be significantly reduced compared to the P-CAOS method.
Keywords: Primary total hip arthroplasty, ultrasound-based navigation, pointer-based navigation, anterior pelvic plane, registration error, anteversion error, inclination error, orthopaedic navigation system, cup positioning
Abstract: In the last decade, the attention of the scientific community has been focused on bile acids and their salts as systems for the transportation of drugs; specifically their role as carriers and integration into nanomedicine. Bile acids can play a critical role as drug carriers in the form of chemical conjugates, complexation, mixed micelles formation as well as stabilized bile acid liposomes (bilosomes). The unique molecular structure and interaction of these amphiphilic-steroidal compounds make them an interesting subject of research. This review is based on literature research in order to emphasize the importance of bile acids and their salts as…absorption modulators in order to improve therapeutic potentials of low bioavailability drugs.
Keywords: Bile acids, bilosomes, nano-structures, absorption enhancers, drug delivery
Abstract: OBJECTIVES: This paper analyzes ICT diffusion in the biopharmaceutical industry. Since new paradigms emerge in the industry towards precision medicine and fasten the digitalization of health care, it is necessary to measure the changing value system, especially between life science and the IT industry. METHODS: The global value chain (GVC) concept is used and data are extracted from the Trade in Value Added (TiVa) dataset (June 2015) from the GVC-OECD project on interconnectivity of economics and industry. A number of indicators were selected: Foreign value added share of gross exports, % of ICT imported in chemicals…as a final product, either exported or in use in domestic demand. Trade data are analyzed for two industries: chemical industry, including pharmaceuticals, and the ICT industry for a group of countries: USA, Switzerland, France, Germany, UK and Japan. RESULTS: Only 0.5 to 1% of value added embodied in final chemicals and chemical products can be attributed to the ICT industry. An additional analysis shows higher prices of connectivity for services in the USA versus Japan and Germany, on a price index for a basket of broadband services (fixed and wireless, OECD 2013); this may also reflect the open model of US innovation with more transactions. CONCLUSIONS: Fast digitalization of life science requires new measures. TiVa dataset is useful for some IT equipment, but not sufficient for all forms of digital economy. The value chain concept is useful for pricing mobile computing in pharmaceuticals, but needs specific data on connectivity. Complementary datasets (e.g. EU KLEMS) can also track ICT investment in chemicals.
Keywords: Global value chains, pharmaceuticals and chemicals, digitalization, Trade in Added Value (TiVa) database