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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: OBJECTIVE: To compare the spectral computed tomography (CT) imaging parameters between squamous cell carcinoma (SCC) and adenocarcinoma (AC) at the gastroesophageal junction (GEJ). METHODS: A total of 80 patients were enrolled in this retrospective study. Among them, 35 were diagnosed with SCC (SCC group) and 45 were diagnosed with AC (AC group). All patients underwent an enhanced scan with spectral CT. The following CT imaging parameters were evaluated: iodine concentration (IC), water content (WC), effective atomic number (Eff-Z) and slope of the spectral HU curve (λ HU ) of lesions. Receiver operating characteristic…(ROC) curve was used to analyze the predictive value of spectral CT imaging parameters for diagnosis of SCC and AC. RESULTS: Patients with SCC had lower IC, Eff-Z, and λ HU in arterial phase and venous phase compared with AC (p < 0.05). There were no significant differences in WC between the two groups. ROC curve analyses revealed that IC, Eff-Z, and λ HU in arterial phase and venous phase were predictors for diagnosis of SCC and AC (AUC > 0.5). Moreover, the IC, Eff-Z and λ HU in venous phase had better differential diagnostic performances than that in arterial phase. CONCLUSIONS: Spectral CT could be useful in the differential diagnosis of SCC and AC at the GEJ. Therefore, a routine spectral CT scan is recommended for patients with carcinoma of the GEJ.
Abstract: BACKGROUND: Finger plethysmography derived stroke volumes are frequently measured during tilt table testing. There are two algorithms to determine stroke volumes: Modelflow and Nexfin CO Trek. Most tilt studies used Modelflow, while there are differences between the two algorithms. OBJECTIVE: To compare stroke volume indices by Nexfin CO Trek (SVI NexfinCOTrek ) with suprasternal Doppler derived SVI (SVI Doppler ) in healthy controls (HC) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients during tilt testing. These patients may have a large SVI decrease during the tilt enabling a large range of…SVI to be studied. METHODS: One hundred and fifty-four patients and 39 HC with a normal tilt test were included. Supine and end-tilt SVI Doppler and SVI NexfinCOTrek were compared using the Bland-Altman analysis. Also, the effect of calibrating supine SVI NexfinCOTrek to SVI Doppler was studied. RESULTS: Supine and end-tilt SVI NexfinCOTrek were significantly higher than SVI Doppler : both P < 0.005. Bias, limits of agreement, and percent error (PE) were high with PE’s between 37 and 43%. The calibration procedure resulted in an acceptable variance with a PE of 29%. CONCLUSIONS: SVI NexfinCOTrek overestimates stroke volumes compared to SVI Doppler , leading to high PE’s. Calibration reduced variance to an acceptable level, allowing SVI NexfinCOTrek to be used for assessment of SVI changes during tilt testing.
Abstract: BACKGROUND: Gait impairment is an essential symptom of Parkinson’s disease (PD). OBJECTIVE: This paper introduces a novel computer-vision framework for automatic classification of the severity of gait impairment using front-view motion analysis. METHODS: Four hundred and fifty-six videos were recorded from 19 PD patients using an RGB camera during clinical gait assessment. Gait performance in each video was rated by a neurologist using the unified Parkinson’s disease rating scale for gait examination (UPDRS-gait). The proposed algorithm detects and tracks the silhouette of the test subject in the video to generate a height signal.…Gait features were extracted from the height signal. Feature analysis was performed using the Kruskal-Wallis rank test. A support vector machine was trained using the features to classify the severity levels according to UPDRS-gait in 10-fold cross-validation. RESULTS: Features significantly (p < 0.05) differentiated between median-ranks of UPDRS-gait levels. The SVM classified the levels with a promising area under the ROC of 80.88%. CONCLUSION: Findings support the feasibility of this model for Parkinson’s gait assessment in the home environment.
Abstract: BACKGROUND: Tubular structure segmentation in chest CT images can reduce false positives (FPs) dramatically and improve the performance of nodules malignancy levels classification. OBJECTIVE: In this study, we present a framework that can segment the pulmonary tubular structure regions robustly and efficiently. METHODS: Firstly, we formulate a global tubular structure identification model based on Frangi filter. The model can recognize irregular vascular structures including bifurcation, small vessel, and junction, robustly and sensitively in 2D images. In addition, to segment the vessels from JVN, we design a local tubular structure identification model with a sliding window.…Finally, we propose a multi-view voxel discriminating scheme on the basis of the previous two models. This scheme reduces the computational complexity of obtaining high entropy spatial tubular structure information. RESULTS: Experimental results have shown that the proposed framework achieves TPR of 85.79%, FPR of 24.83%, and ACC of 84.47% with the average elapsed time of 162.9 seconds. CONCLUSIONS: The framework provides an automated approach for effectively segmenting tubular structure from the chest CT images.
Abstract: OBJECTIVE: This study aims to compare and analyze the difference of impact force attenuation according to size and impact location on a Taekwondo body protector. METHODS: Body protectors sized 1 to 5, were impact tested by equipment based on the specifications in the European standard manual (EN 13277-1, 3). The impactor release heights were set to match impact energies of 3 and 15 J. The impactor was made from a 2.5 kg cylindrically cut piece of aluminum. Each body protector was impacted 10 times at the two impact energies and two locations. The differences in performance…for each body protector size were compared using a two-way analysis of variance with a significance level of p < 005. The effect sizes were investigated using a partial eta squared value (η 2 ). RESULTS: The significant mean differences between the body protector size and impact area (p < 005) and the average impact time of impact strengths 3 and 15 J were 0.0017 and 0.0012 s, respectively In addition, when an impact strength of 15 J was applied, the maximum resulting impact force exceeded 2000 N for both locations on all sizes. Furthermore, at an impact strength of 3 J size 3 significantly reduced the impact force more than the other sizes; however, size 1 showed the greatest shock absorption at an impact of 15 J. CONCLUSION: The results of this study show that the shock absorption of body protectors does not increase according to size; i.e., a larger body protector does not reduce the impact load more effectively. To improve safety performance, we recommend a maximum impact force of 2000 N or less for all body protectors.
Abstract: BACKGROUND: The study of the neural mechanism of human gait control can provide a theoretical basis for the treatment of walking disorders or the improvement of rehabilitation strategies, and further promote the functional rehabilitation of patients with movement disorders. However, the performance and changes of cerebral cortex activity corresponding to gait adjustment intentions are still not clear. OBJECTIVE: The purpose of this study was to detect the blood oxygen activation characterization of the cerebral cortex motor function area when people have the intention to adjust gait during walking. METHODS: Thirty young volunteers (21…± 1 years old) performed normal walking, speed increase, speed reduction, step increase, and step reduction, during which oxygenated hemoglobin (HbO), deoxygenated hemoglobin (HbR), and total oxyhemoglobin (HbT) information in the prefrontal cortex (PFC), premotor cortex (PMC), supplementary motor area (SMA) was continuous monitored using near-infrared brain functional imaging. RESULTS: (1) With the intention to adjust gait, the HbO concentration in the SMA increased significantly, while the HbT concentration in the medial-PFC decreased significantly. (2) In the HbO concentration, step reduction is more activated than the step increase in the left-PMC (p = 0.0130); step adjustment is more activated than speed adjustment in the right-PMC (p = 0.0067). In the HbR concentration, the speed reduction is more activated than the speed increase in the left-PFC (p = 0.0103). CONCLUSIONS: When the intention of gait adjustment occurs, the increase of HbO concentration in the SMA indicates the initial stage of gait adjustment will increase the cognitive-locomotor demand of the brain. The left brain area meets the additional nerve needs of speed adjustment. The preliminary findings of this study can lay an important theoretical foundation for the realization of gait control based on fNIRS-BCI technology.
Abstract: OBJECTIVE: In this study we explore the method to prepare tanshinone self-microemulsifying sustained-release microcapsules using tanshinone self-microemulsion as the core material, and chitosan and alginate as capsule materials. METHODS: The optimal preparation technology of chitosan-alginate tanshinone self-microemulsifying sustained-release microcapsules was determined by using the orthogonal design experiment and single-factor analysis. The drug loading and entrapment rate were used as evaluation indexes to assess the quality of the drug, and the in vitro release rate was used to evaluate the drug release performance. RESULTS: The best technology of chitosan-alginate tanshinone self-microemulsifying sustained-release microcapsules…is as follows: the concentration of alginate is 1.5%, the ratio of tanshinone self-microemulsion volume to alginate volume to chitosan mass is 1:1:0.5 (ml: ml: g), and the best concentration of calcium chloride is 2.0%. To prepare the microcapsules using this technology, the drug loading will be 0.046%, the entrapment rate will be 80.23%, and the 24-hour in vitro cumulative release rate will be 97.4%. CONCLUSION: The release of the microcapsules conforms to the Higuchi equation and the first-order drug release model and has a good sustained-release performance.
Keywords: Tanshinone, chitosan-alginate, self-microemulsifying sustained-release microcapsules, preparation, in vitro release
Abstract: BACKGROUND: Due to its fast service and high utilization, day surgery is becoming more and more important in the medical system. As a result, an effective day surgery scheduling can reasonably release the supply and demand pressure. OBJECTIVE: This paper aims to investigate the day surgery scheduling problem with patient preferences and limited operation room for the sake of increasing operation efficiency and further decreasing surgery costs. METHODS: A multiple objective stochastic programming model is constructed to seek a satisfactory surgical scheduling for both patients and hospitals under different scenarios. Multi-objective genetic algorithm…is designed to solve the model and different scales of scenarios are utilized to test the effectiveness of the algorithm and modeling process. RESULTS: Results show that the proposed model and algorithm can provide a feasible solution for maximizing individual preference of surgeons with surgery date and operation room utilization as well. CONCLUSIONS: Patient preference is proposed to be incorporated into day surgery scheduling, and the variability of surgery duration considered to seek a satisfactory surgery scheduling scheme for both patients and hospitals is more in line with the actual hospital situation.
Abstract: BACKGROUND: Upper limb rehabilitation robots have become an important piece of equipment in stroke rehabilitation. Human-robot coupling (HRC) dynamics play a key role in the control of rehabilitation robots to improve human-robot interaction. OBJECTIVE: This study aims to study the methods of modeling and analysis of HRC dynamics to realize more accurate dynamic control of upper limb rehabilitation robots. METHODS: By the analysis of force interaction between the human arm and the upper limb rehabilitation robot, the HRC torque is achieved by summing up the robot torque and the human arm torque. The…HRC torque and robot torque of a 2-DOF upper limb rehabilitation robot (FLEXO-Arm) are solved by Lagrangian equation and step-by-step dynamic parameters identification method. RESULTS: The root mean square (RMS) is used to evaluate the accuracy of the HRC torque and the robot torque calculated by the parameter identification, and the error of both is about 10%. Moreover, the HRC torque and the robot torque are compared with the actual torque measured by torque sensors. The error of the robot torque is more than twice the HRC. Therefore, the HRC torque is more accurate than the actual torque. CONCLUSIONS: The proposed HRC dynamics effectively achieves more accurate dynamic control of upper limb rehabilitation robots.
Abstract: BACKGROUND: Assessment of buccal alveolar bone thickness (ABT) and crown-to-root dimensions are essential in implant density; therefore, three-dimensional evaluation of these parameters provides a superior visualization than conventional radiographs. OBJECTIVE: The present cross-sectional cohort study aims to investigate the relationship between buccal ABT and crown-to-root dimensions around the mandibular first and second molars using cone-beam-computed tomography (CBCT). METHODS: Initially, CBCT-based scans from 271 individuals were assessed. Based on the inclusion and exclusion criteria, 171 CBCT-based scans were excluded. In total, 100 CBCT-scans were included in the present investigation and processed for data extraction.…On the mandibular first and second molars, the mesial and distal root lengths and mesiodistal diameter of the crowns were measured. The pulpal floor served as a reference point for assessment of root length. The buccal ABT was measured at the coronal, middle and apical one-third of the root. Statistical analysis was performed and the level of significance was set at P < 0.01. One-hundred CBCT-scans from 294 mandibular teeth (137 first molars and 157 second molars) were included. One hundred and eighty-nine and 105 teeth were from males and females, respectively. RESULTS: The normality plot showed a normal data distribution. The mesiodistal crown width showed a weak yet significant correlation with mesial root length (r = 0.137), bone thickness at mesial apical third (r = 0.180), distal apical (r = 0.157) and distal coronal third (r = 0.161). Bone thickness at mesial, middle and apical third correlated significantly with one other (r = 0.786). CONCLUSION: There is a direct correlation between the buccal ABT and tooth dimensions around the mandibular first and second molars.
Keywords: Alveolar bone thickness, tooth dimensions, crown width, root length, and CBCT