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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: Numerous researchers have attempted to improve the mechanical properties of glass ionomer cement since 1972. In this study, ultrasonic curing treatment was introduced during the mixing of glass ionomer cement (GC Fuji IX) to facilitate intimate mixing, compaction and adaptation of residual glass particle which consequently improves densification of the material. OBJECTIVE: To assess the influence of ultrasonic treatment on the microhardness of glass ionomer cement (GC Fuji IX) and compare it with the conventionally cured method. METHODS: A total of 40 specimens (2 × 2 mm) were fabricated…and equally divided into two groups: Group I (conventional curing method) and Group II (ultrasonically cured). For Group II, an ultrasonic scaler was used which provides energy to ensure proper mixing of material without leaving any air bubbles or unmixed particles. Vicker’s hardness test was employed to generate the average microhardness values by making three indentations at different points on each specimen. Statistical Package for Social Sciences (SPSS) Version 17 was used, employing independent samples T test to compare the difference in microhardness values between two curing groups. RESULTS: The average surface hardness value for conventional cured GIC was 62.21 ± 13.61 while ultrasonically cured GIC exhibited a higher mean microhardness value of 66.37 ± 12.83. Additionally, the average microhardness values produced by the two groups showed statistically significant differences (p value < 0.035). CONCLUSION: Ultrasonic excitation treatment leads to intimate mixing and accelerated hardening of glass ionomer cement thereby enhancing its microhardness and reducing early weakness.
Abstract: BACKGROUND: Dynamic hip screw (DHS) is a common implant used to treat stable-type intertrochanteric hip fractures. There are many factors that can affect the success rate of the surgery, including the length of side plates. It is therefore important to investigate the biomechanical effect of different DHS side plates on bones. OBJECTIVE: In order to reduce the likelihood of an implant failure, the aim of this study was to use finite element analysis (FEA) to investigate and understand the effect of side plates with different lengths in DHS. METHODS: In this FEA study,…a 3D model with cortical bone, cancellous bone, side plate, lag screw, and cortical screws to simulate the implantation of DHS with different lengths of side plate (2-hole, 4-hole, and 6-hole) for intertrochanteric hip fractures was constructed. The loading condition was used to simulate the force (400 N) on the femoral head and the stress distribution on the lag screw, side plate, cortical screws, and femur was measured. RESULTS: The highest stress points occured around the region of contact between the screw and the cortical bones. The stress on the femur at the most distal cortical screw was the greatest. The shorter the length of the side plate, the greater the stress on the cortical screws, resulting in an increased stress on the femur surrounding the cortical screws. CONCLUSIONS: The use of DHS with 2-hole side plate may increase the risk of side plate pull-out. The results of this study provide a biomechanical analysis for selection of DHS implant lengths that can be useful for orthopaedic surgeons.
Keywords: Biomechanics, finite element analysis, dynamic hip screw, intertrochanteric hip fracture
Abstract: BACKGROUND: Zirconia has become a popular biomaterial in dental implant systems because of its biocompatible and aesthetic properties. However, this material is more fragile than titanium so its use is limited. OBJECTIVES: The aim of this study was to compare the stresses on morse taper implant systems under parafunctional loading in different abutment materials using three-dimensional finite element analysis (3D FEA). METHODS: Four different variations were modelled. The models were created according to abutment materials (zirconia or titanium) and loading (1000 MPa vertical or oblique on abutments). The placement of the implants (diameter, 5.0…× 15 mm) were mandibular right first molar. RESULTS: In zirconia abutment models, von Mises stress (VMS) values of implants and abutments were decreased. Maximum and minimum principal stresses and VMS values increased in oblique loading. VMS values were highest in the connection level of the conical abutments in all models. CONCLUSIONS: Using conical zirconia abutments decreases von Mises stress values in abutments and implants. However, these values may exceed the pathological limits in bruxism patients. Therefore, microfractures may be related to the level of the abutment.
Keywords: Abutment, bruxism, finite element analysis, titanium material, mandible, zirconia material
Abstract: BACKGROUND: Leg length discrepancy (LLD) can cause abnormal posture, muscle and/or joint pains, which leads to walking difficulties. The common treatment is to use a shoe lift on the shorter leg side, but this has unsatisfying results. OBJECTIVE: Through research and development, we created 3D printing orthotic insoles for LLD patients and aimed to improve their symptoms. METHODS: 1. Research and development of 3D printing orthotic insole: (1) foot scan and data acquisition; (2) insole software modeling; (3) 3D printing insole using TPU materials, and (4) post-processing. 2. Clinical observation: we customized insoles…for LLD patients and required them to wear them while walking. We conducted general inquiries and a functional evaluation before and after 12 weeks of wearing insoles. RESULTS: There are seven complete cases. The joint and lower back pains were alleviated. The stride frequency, stride and pace were improved in all seven cases. Patients’ overall health condition improved significantly. CONCLUSIONS: The 3D printing orthotic insoles are made with clear procedures and practical operability. By wearing insoles, patients’ muscle and/or joint pains were relieved and their gaits were improved.
Keywords: Leg length discrepancy (LLD), pain, gait deviations, 3D printing, orthotic insole
Abstract: BACKGROUND: Fresnel prism shifts the field of view and converts object position in space, but its effect on stroke patients without unilateral neglect has not been examined. OBJECTIVE: We aimed to investigate the effect of Fresnel prism glasses on balance and gait in stroke patients with hemiplegia. METHODS: This study included 17 stroke patients with hemiplegia without unilateral neglect. Balance and gait training were applied in the control group (n = 9), and Fresnel prism glasses were applied with balance and gait training in the experimental group (n…= 8). In all groups, interventions were done for 30 min/day for 5 times/week for 4 weeks. Motor-free visual perception test for visual perception (MVPT), Berg Balance Scale (BBS), and functional reach test (FRT) for dynamic balance ability, and gait were performed. Measurements were done before and after interventions. RESULTS: MVPT showed no significant difference between the groups (p > 0.05). A significant increase in BBS and FRT results was found before and after interventions in the experimental group (p < 0.05). Gait variables showed significant difference in the experimental group (p < 0.05). CONCLUSION: Fresnel prism glasses may effectively improve dynamic balance and gait functions by shifting body weight to the affected side of stroke patients with hemiplegia without vision loss.
Abstract: BACKGROUND: Clinicians routinely provide provisional crowns following teeth preparation. Three-dimensional (3D) printing technology could be used over conventional methods for better fit as lack of adequate fit would result in plaque accumulation, micro-leakage, teeth sensitivity, caries and periodontal diseases. OBJECTIVE: The aim of the study was to evaluate the marginal and internal fit of provisional crowns fabricated using 3D printing technology and to compare it with that of compression molding and milling methods. METHODS: Ninety study models were fabricated by duplicating metal master models of the maxillary first premolar molar with three different…finish line chamfer, rounded shoulder and rounded shoulder with bevel. On each study model, provisional crowns were fabricated using compression molding (Mo. group, n = 30 – by over impression technique), milling (Mi. group, n = 30 – by 5-axis dental milling machine), and 3D printing method (3D-P. group, n = 30 – by 3D printer). Marginal and internal fit of the samples were evaluated by measuring gap using a scanning electron microscope with a magnification of 27 × , at 7 zones A–G on different finish line models. The data were statistically analysed using one-way analysis of variance (ANOVA) at the 0.05 significance level. The p -values were calculated using Dunnett’s test. RESULTS: The marginal gap was minimal for the 3D-P. group for each finish line with lowest for rounded shoulder with bevel at zone A 30.6 ± 5.3 and at zone G 32.8 ± 5.4. In axial area, i.e. zones B and F, the minimum gap was noticed for the Mo. group and in Occlusal area (cusp and fossa), for zones C–E maximum gap was determined in Mi. group followed by Mo. and 3D-P. groups. CONCLUSIONS: 3D printed provisional crowns have better marginal and internal fit compared to milled and molded provisional crowns.
Keywords: Temporary crown, additive manufacturing, internal discrepancy, 3D printing, CAD-CAM
Abstract: BACKGROUD: Hydrocephalus is the most common anomaly of the fetal head characterized by an excessive accumulation of fluid in the brain processing. The diagnostic process of fetal heads using traditional evaluation techniques are generally time consuming and error prone. Usually, fetal head size is computed using an ultrasound (US) image around 20–22 weeks, which is the gestational age (GA). Biometrical measurements are extracted and compared with ground truth charts to identify normal or abnormal growth. METHODS: In this paper, an attempt has been made to enhance the Hydrocephalus characterization process by extracting other geometrical and textural…features to design an efficient recognition system. The superiority of this work consists of the reduced time processing and the complexity of standard automatic approaches for routine examination. This proposed method requires practical insidiousness of the precocious discovery of fetuses’ malformation to alert the experts about the existence of abnormal outcome. The first task is devoted to a proposed pre-processing model using a standard filtering and a segmentation scheme using a modified Hough transform (MHT) to detect the region of interest. Indeed, the obtained clinical parameters are presented to the principal component analysis (PCA) model in order to obtain a reduced number of measures which are employed in the classification stage. RESULTS: Thanks to the combination of geometrical and statistical features, the classification process provided an important ability and an interesting performance achieving more than 96% of accuracy to detect pathological subjects in premature ages. CONCLUSIONS: The experimental results illustrate the success and the accuracy of the proposed classification method for a factual diagnostic of fetal head malformation.
Keywords: Hydrocephalus, fetal US imaging, fetal head biometry, modified Hough transform (MHT), feature extraction
Abstract: BACKGROUND: The human voice is the main feature of human communication. It is known that the brain controls the human voice. Therefore, there should be a relation between the characteristics of voice and brain activity. OBJECTIVE: In this research, electroencephalography (EEG) as the feature of brain activity and voice signals were simultaneously analyzed. METHOD: For this purpose, we changed the activity of the human brain by applying different odours and simultaneously recorded their voices and EEG signals while they read a text. For the analysis, we used the fractal theory that deals with…the complexity of objects. The fractal dimension of EEG signal versus voice signal in different levels of brain activity were computed and analyzed. RESULTS: The results indicate that the activity of human voice is related to brain activity, where the variations of the complexity of EEG signal are linked to the variations of the complexity of voice signal. In addition, the EEG and voice signal complexities are related to the molecular complexity of applied odours. CONCLUSION: The employed method of analysis in this research can be widely applied to other physiological signals in order to relate the activities of different organs of human such as the heart to the activity of his brain.
Abstract: BACKGROUND: Walking is one of the important actions of the human body. For this purpose, the human brain communicates with leg muscles through the nervous system. Based on the walking path, leg muscles act differently. Therefore, there should be a relation between the activity of leg muscles and the path of movement. OBJECTIVE: In order to address this issue, we analyzed how leg muscle activity is related to the variations of the path of movement. METHOD: Since the electromyography (EMG) signal is a feature of muscle activity and the movement path has complex…structures, we used entropy analysis in order to link their structures. The Shannon entropy of EMG signal and walking path are computed to relate their information content. RESULTS: Based on the obtained results, walking on a path with greater information content causes greater information content in the EMG signal which is supported by statistical analysis results. This allowed us to analyze the relation between muscle activity and walking path. CONCLUSION: The method of analysis employed in this research can be applied to investigate the relation between brain or heart reactions and walking path.
Keywords: Leg muscle, walking path, electromyography (EMG) signal, Shannon entropy, information
Abstract: BACKGROUND: Biological hydrogels provide a conducive three-dimensional extracellular matrix environment for encapsulating and cultivating living cells. Microenvironmental modulus of hydrogels dictates several characteristics of cell functions such as proliferation, adhesion, self-renewal, differentiation, migration, cell morphology and fate. Precise measurement of the mechanical properties of gels is necessary for investigating cellular mechanobiology in a variety of applications in tissue engineering. Elastic properties of gels are strongly influenced by the amount of crosslinking density. OBJECTIVE: The main purpose of the present study was to determine the elastic modulus of two types of well-known biological hydrogels: Agarose and Gelatin…Methacryloyl. METHODS: Mechanical properties such as Young’s modulus, fracture stress and failure strain of the prescribed gels with a wide range of concentrations were determined using tension and compression tests. RESULTS: The elastic modulus, failure stress and strain were found to be strongly influenced when the amount of concentration in the hydrogels was changed. The elastic modulus for a lower level of concentration, not considered in this study, was also predicted using statistical analysis. CONCLUSIONS: Closed matching of the mechanical properties of the gels revealed that the bulk tension and compression tests could be confidently used for assessing mechanical properties of delicate biological hydrogels.
Abstract: BACKGROUND: The design of Patient Management and Information Systems during outbreaks of highly infectious diseases in low resource environments poses special challenges. Such systems necessitate special functional and design requirements to support patient care under austere conditions. A primary concern is to minimize spread of the disease to caregivers and non-infected individuals. Patient management in these conditions requires the design and development of systems customized for complex patient and caregiver workflows. OBJECTIVE: Design and develop a Patient Management and Information System for healthcare facilities on the frontlines of outbreaks of highly infectious diseases in low resource…environments. METHODS: A team composed of clinicians with experience in Ebola care in affected areas of Africa and informaticians developed detailed hardware, software and functionality requirements. These were translated into hardware designs, software architectures, screen and interface designs and implemented using Common Off-The-Shelf hardware. An experimental app development system was used to develop mHealth software modules. RESULTS: The system was developed and implemented as a proof of concept. Acceptance testing showed that the system met functionality requirements. CONCLUSION: Useful Patient Management and Information systems can be developed and implemented for frontline use in low-resource environments during outbreaks of highly infectious diseases.
Abstract: OBJECTIVE: To investigate the differences of tumor necrosis factor-α (TNF-α ), interleukin-6 (IL-6) and galectin-3 concentrations in lobar pneumonia and bronchopneumonia induced by mycoplasma pneumoniae (MP) in children and to explore these related factors predicting the severity of MP. METHODS: A total of 148 children with mycoplasma pneumoniae pneumonia (MPP) and 32 healthy controls were analyzed from March 2017 to August 2018 in our province. Clinical information was collected from the hospitalized MP patients. The 148 patients with MPP were divided into two groups: lobar pneumonia group and bronchial pneumonia group.…The 32 healthy children were considered the control group. The concentrations of TNF-α , IL-6 and Gal-3 were examined in the serum of 148 children patients with MPP and 32 healthy children by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS: The TNF-α , IL-6 and Gal-3 levels were obviously higher in both the lobar pneumonia and bronchial pneumonia groups, compared to those in the control group. Furthermore, these levels were significantly higher in the lobar pneumonia group, compared to the bronchial pneumonia group. After treatment, the levels of TNF-α , IL-6 and Gal-3 totally descended during the recovery period. CONCLUSION: There are differences in serum TNF-α , IL-6 and Gal-3 concentrations in lobar pneumonia and bronchial pneumonia caused by MP in children. In general, the TNF-α , IL-6 and Gal-3 levels were significantly higher in the lobar pneumonia group, when compared to the bronchial pneumonia group. This was because most lobar pneumonia cases are much more serious than bronchial pneumonia. Moreover, it has been proven that TNF-α , IL-6 and Gal-3 may play an important role in the pathogenesis development of MPP. At the same time, these are important issues in diagnosing MPP.
Abstract: BACKGROUND: To date only scanty data exist regarding the effect of failed debridement, antibiotics, irrigation and retention of the prostheses (DAIR) and negative pressure wound therapy (NPWT) on the outcome of a subsequent exchange arthroplasty. OBJECTIVE: The objective of this study was to determine the success rate of a two- or multi-stage procedure after initial failed DAIR/NPWT in patients with an acute periprosthetic joint infection (PJI) and to evaluate the influence of possible risk factors for treatment failure. METHODS: Nineteen consecutive patients with a persisting PJI and ongoing NPWT after treatment of an…acute PJI with DAIR of the hip or knee joint from October 2010 to June 2017 were included. All patients were treated according to a structured treatment algorithm after referral to our hospital. The endpoint was a successful reimplantation with absence of signs of infection two years after replantation (“replantation group”) or treatment failure (“treatment failure group”) in terms of a permanent girdlestone arthroplasty, fistula, amputation or death. A risk factor analysis was performed between the two groups. RESULTS: Explantation was performed in 15 cases, amputation in one case, and DAIR/establishment of a fistula in three cases. The treatment success rate after reimplantation in terms of “definitively free of infection” two years after surgery according to Laffer was 36.85% (seven out of 19 patients). Statistical analysis revealed the number of surgeries until wound consolidation (p = 0.007), number of detected bacterial strains (p = 0.041), a polymicrobial PJI (p = 0.041) and detection of a difficult-to-treat organism (p = 0.005) as factors associated with treatment failure. After failed DAIR/NPWT we could detect a significant higher number of different bacterial strains (p = 0.001). CONCLUSIONS: The treatment success rate after failed DAIR and NPWT with 36% is low and associated with a high treatment failure rate (permanent girdlestone arthroplasty, fistula or amputation, death). Thus, the definition of risk factors is crucial. We found that the number of revisions until wound consolidation, a polymicrobial PJI and detection of a difficult-to-treat organisms were risk factors for treatment failure. Furthermore, after failed DAIR/NPWT we could detect a significant higher number of different bacterial strains, with a possible adverse effect on a consecutive exchange.
Abstract: BACKGROUND: Symmetry of gait is an important component of rehabilitation in stroke patients. Insufficient weight-bearing causes gait asymmetry. OBJECTIVE: This study aimed to identify the immediate effects of sufficient weight-bearing on the forefoot during the stance phase using visual feedback. METHODS: Twenty-seven individuals with stroke enrolled in this study. All patients were evaluated for gait parameters with and without visual feedback. Visual feedback was provided through a smart application and a beam projector screen that showed a weight shift as a change in color. Spatiotemporal gait parameters were evaluated, resulting in values for…a calculated symmetry index, in addition to heel % and toe % temporal values. RESULTS: Velocity and cadence were significantly decreased when visual feedback was provided (p < 0.05). Spatiotemporal parameters, except for bilateral step length, swing time of affected side, and single-limb support of less affected side, showed significant improvement (p < 0.05). The gait pattern of subjects was more symmetrical with visual feedback compared to non-visual feedback (p < 0.05). The toe-on time significantly improved on the affected side with visual feedback (p < 0.05). CONCLUSION: This study suggests that visual feedback aids in the improvement of gait symmetry, forefoot weight-bearing on the affected side, and spatiotemporal parameters.