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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: Hospital re-engineering initiatives aiming to meet the requirement for patient-centered care often face significant barriers. Opportunities from the optimization of patient flow logistics are often overlooked due to the perception that patient transport related services are ancillary. OBJECTIVES: To reorganize patient pathways by optimizing inpatient assignment and outpatient unit relocation. METHODS: Our analysis was conducted in a campus-based hospital hosting 1694 inpatient beds. Patient flow data was used for algorithm-based optimization to minimize the sum of the distances due to visits to outpatient units and visits by consulting physicians. Inpatients were reordered…and outpatient units were relocated to minimize transport need. Optimized schemes were analyzed using graph- and spectral graph theory. RESULTS: Both optimizations yielded an altered hospital layout in which the need for patient transfers decreased (over 30% and 23% in terms of total distance and transfer episodes, respectively). The optimized systems gave rise to buildings with greater specialization, higher importance in terms of contributing to the network architecture, greater synchronization and robustness. CONCLUSIONS: The top-down algorithm-based optimization scheme yielded a system in which the need for cross-building patient transfer decreased. We suggest that network analysis may be a useful tool for capacity planning.
Abstract: BACKGROUND: Trunk control ability has been identified as an important early predictor of functional recovery after stroke. OBJECTIVE: Our study aimed to investigate the effects of three-dimensional active trunk training exercise on trunk control ability, trunk muscle strength, and balance ability in sub-acute stroke patients. METHODS: Twenty-four sub-acute stroke patients were randomly assigned to an experimental (n = 12) or control (n = 12) group. The experimental group (EG) performed three-dimensional active trunk training exercises using the Space Balance 3D system, while the…control group (CG) performed only general trunk training exercises five times per week, for a total of three weeks. The Trunk Impairment Scale (TIS), trunk muscle strength, balance ability using the Space Balance 3D system, and Brunel Balance Assessment (BBA) scores were assessed before and after the intervention. RESULTS: Pre-to-post intervention improvement was noted in all outcome measures for both groups (p < 0.05). Post intervention, the TIS, trunk muscle strength, static balance, and BBA scores were significantly higher in the EG than those in the CG (p < 0.05). CONCLUSION: Our study suggests that the three-dimensional active trunk training exercise may be more effective compared to the general trunk training exercise in improving trunk control ability, trunk muscle strength, and balance ability in sub-acute stroke patients.
Keywords: Exercise therapy, Space Balance 3D system, sub-acute stroke, trunk control, trunk training exercise
Abstract: BACKGROUND: During uvulopalatopharyngoplasty (UPPP), cardiovascular adverse events may occur which can be harmful to patients. OBJECTIVE: To evaluate the effect of the protective ventilation strategy on the function of vascular endothelial cells. METHODS: Forty obstructive apnea syndrome (OSA) patients who underwent uvulopalatopharyngoplasty (UPPP) were enrolled. Patients were randomly divided into the control group (group C, PEEP = 0 cm H 2 O) and PEEP group (group P, PEEP = 5 cm H 2 O). Each group (n =…20) received intermittent volume controlled ventilation (VCV) with tidal volume 6 ml/kg of the predicted body weight, I:E 1:2, rate titrated for ETCO 2 35–45, FiO 2 0.7. Blood from the radial artery was sampled for blood gas analysis at four time points: the fifth minute of inhaling pure oxygen (T0), after tracheal intubation (T1), at the end of the operation (T2), and 20 minutes after extubation (T3). Three ml of arterial blood was retained, preserved at - 20 ∘ C after serum isolation, and plasma nitric oxide (NO), endothelin-1 (ET-1) and vascular celladhesion molecule-1 (VCAM-1) levels were determined by enzyme linked immunosorbent assay (ELISA). RESULTS: Compared with group C, plasma ET-1 at T3 decreased in group P, and plasma NO levels at T2 and T3 increased (P < 0.05). Compared with samples collected at T0, plasma VCAM-1 levels at T1, T2 and T3 increased in group C, while plasma VCAM-1 levels at T2 and T3 decreased in group P (P < 0.05). Compared with group C, plasma VCAM-1 levels T2 and T3 decreased in group P (P < 0.05). CONCLUSIONS: Positive end-expiratory pressure (PEEP) ventilation has a protective effect on vascular endothelial cell function in patients during UPPP.
Abstract: BACKGROUND: Running-induced fatigue has received much attention in recent years. However, very few studies have investigated the effect of fatigue on lower limb biomechanics in three planes. OBJECTIVE: This study was designed to investigate biomechanical changes in the lower limb in three planes following running-induced fatigue. METHODS: Fifteen male novice runners were included in the study and performed three running trails pre- and post-fatigue. Wilcoxon signed-rank tests or paired-sample t tests were used to analyze the data. RESULTS: Lower limb biomechanics significantly changed, especially kinetic parameters, when…fatigue occurred. The peak ankle dorsiflexion angle and range of motion of the knee joint in the frontal plane increased. As for kinetic parameters, in the ankle joint, the peak external rotation moment, peak abduction power and peak internal rotation power increased. In the knee joint, the peak abduction and external rotation moment, peak flexion power, peak adduction and abduction power also increased. In the hip joint, the peak flexion moment was decreased, peak adduction and abduction moment, peak external rotation power, peak adduction and abduction power moment were increased. CONCLUSION: The findings of this study may contribute to our understanding of the impact of fatigue and provide some helpful information to prevent related injuries.
Abstract: BACKGROUND: Dental esthetic materials are constantly introduced to meet the increasing esthetic demand in contemporary dental practice. OBJECTIVE: To test the fracture resistance of endodontically treated teeth (ETT) restored with different esthetic post materials like fiber-reinforced composite post (FRC), polyether ether ketone (PEEK), and polymer infiltrated ceramic (PIC). METHODS: Thirty-six human root canal treated single-rooted premolar teeth were decoronated 3 mm above the cemento-enamel junction and prepared to receive the post. They were randomly divided into three groups (n = 12) to be restored with FRC, PEEK, and…PIC. After appropriate surface treatment, they were cemented with self-adhesive luting cement and restored with full veneer crowns. The samples were thermocycled, subjected to a compressive static load at 45 ∘ angulation until fracture. Obtained data were analyzed by one-way ANOVA and Tukey’s HSD post hoc comparison test. RESULTS: The results indicate that the ETT restored with PEEK post had the maximum fracture load (1929.94 N), followed by PIC endodontic post group (1810.65N), and FRC post (1715.68N). Meanwhile, ETT restored with FRC showed a predominantly favorable fracture, whereas PEEK restored teeth had a more unfavorable fracture. CONCLUSION: Of all the esthetic post materials, the group for which PEEK endodontic post was used displayed higher fracture resistance.
Keywords: Root canal treated teeth, PEEK, endodontic post, fiber-reinforced composite post, polymer infiltrated hybrid ceramic, fracture resistance
Abstract: BACKGROUND: The haemodynamics determined by different approaches for studying fluid dynamics – i.e. computational fluid dynamics (CFD), particle image velocimetry (PIV), and phase-contrast magnetic resonance imaging (PC-MRI) – have rarely been thoroughly compared; nor have the factors that affect accuracy and precision in each method. As each method has its own advantages and limitations, this knowledge is important for future studies to be able to achieve valid analyses of fluid flows. OBJECTIVE: To gauge the capacity of these methods for analysing aneurysmal flows, we compared the haemodynamic behaviours determined by each method within a patient-specific aneurysm…model. METHODS: An in vitro silicone aneurysm model was fabricated for PIV and PC-MRI, and an in silico aneurysm model with the same geometry was reconstructed for CFD. With the same fluid model prepared numerically and physically, CFD, PIV and PC-MRI were performed to study aneurysmal haemodynamics. RESULTS: 2D velocity vectors and magnitudes show good agreement between PIV and CFD, and 3D flow patterns show good similarity between PC-MRI and CFD. CONCLUSIONS: These findings give confidence to future haemodynamic studies using CFD technology. For the first time, the morphological inconsistency between the PCMRI model and others is found to affect the measurement of local flow patterns.
Abstract: BACKGROUND: Hip disarticulation prostheses (HDPs) are not routinely seen in clinical practice, and traditional hip prostheses rotate around an axis at the front side of the pelvic socket. OBJECTIVE: This study proposes a mechanism to restore the rotation center to the acetabulum of the amputated side and uses comparative experiments with traditional HDP to verify the validity of the novel design. METHODS: A double parallelogram design of HDP based on a remote center of motion (RCM) mechanism was presented in this paper. Optimization was achieved by a genetic algorithm with the maximal integral…size and minimal driving force of the mechanism. RESULTS: The prototype was developed by final optimal results and tested by a hip disarticulated amputee. Testing results revealed that the RCM-HDP improved the range of motion of the hip prosthesis by 78%. The maximal flexion of the assorted prosthetic knee was closer to the sound side than a traditional HDP by 15%. CONCLUSION: The proposed RCM-HDP promoted the kinematic performance and symmetry of the hip prosthesis compared to the traditional design.
Keywords: Hip disarticulation, prosthesis, remote center of motion, double parallelogram, genetic algorithm
Abstract: BACKGROUND: The interaction between people is one of the usual daily activities. For this purpose, people mainly connect with others, using their voice. Voices act as the auditory stimuli on the brain during a conversation. OBJECTIVE: In this research, we analyze the relationship between the brains’ activities of subjects during a conversation. METHODS: Since human voice transfers information from one subject to another, we used information theory for our analysis. We investigated the alterations of Shannon entropy of electroencephalography (EEG) signals for subjects during a conversation. RESULTS: The results demonstrated…that the alterations in the information contents of the EEG signals for the listeners and speakers are correlated. Therefore, we concluded that the brains’ activities of both subjects are linked. CONCLUSION: Our results can be expanded to analyze the coupling among other physiological signals of subjects (such as heart rate) during the conversation.
Keywords: Brain, conversation, information theory, shannon entropy, EEG signals
Abstract: BACKGROUND: Robot-assisted therapy (RT) has become a promising stroke rehabilitation intervention. OBJECTIVE: To examine the effects of short-term upper limb RT on the rehabilitation of sub-acute stroke patients. METHODS: Subjects were randomly assigned to the RT group (n = 23) or conventional rehabilitation (CR) group (n = 22). All subjects received conventional rehabilitation therapy for 30 minutes twice a day, for 2 weeks. In addition, the RT group received RT for 30 minutes twice a day, for 2 weeks. The outcomes before treatment…(T0) and at 2 weeks (T1) and 1 month follow-up (T2) were evaluated in the patients using the upper limb motor function test of the Fugl-Meyer assessment (FMA) the Motricity Index (MI), the Modified Ashworth Scale (MAS), the Functional Independence Measure (FIM), and the Barthel Index (BI). RESULTS: There were significant improvements in motor function scales (P < 0.001 for FMA and MI) and activities of daily living (P < 0.001 for FIM and BI) but without muscle tone (MAS, P > 0.05) in the RT and CR groups. Compared to the CR group, the RT group showed improvements in motor function and activities of daily living (P < 0.05 for FMA, MI, FIM, BI) at T1 and T2. There was no significant difference between the two groups in muscle tone (MAS, P > 0.05). CONCLUSIONS: RT may be a useful tool for sub-acute stroke patients’ rehabilitation.
Abstract: BACKGROUND: Traditional least mean square algorithm (LMS) tends to converge faster and thus the larger the steady-state error of the algorithm. OBJECTIVE: In order to solve this issue, an improved adaptive normalized least mean square (NLMS) ECG signal denoising algorithm is proposed through utilizing the NLMS and the least mean square algorithm with added momentum term (MLMS). METHODS: The algorithm firstly performs LMS adaptive filtering on the original ECG signal. Then, the algorithm uses the relative error of the prior error signal and the posterior error signal before and after filtering to adaptively…determine the iteration step factor. Finally, the expected error is set to determine whether the denoising meets the expected requirements. This method is applied to the MIT-BIH ECG database established by the Massachusetts Institute of Technology. RESULTS: Experimental results have shown that the proposed algorithm can achieve good denoising for the target signal, and the average signal to noise ratio (SNR) of the proposed method is 17.6016, the RMSE is only 0.0334, and the average smoothness index R is only 0.0325. CONCLUSION: The proposed algorithm effectively removes the original ECG signal noise, and improves the smoothness of the signal the denoising efficiency.
Keywords: ECG signal, adaptive filter, normalized minimum mean square, signal to noise ratio