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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: This study aimed to investigate the clinical characteristics and outcomes of coronavirus disease-19 (COVID-19) long-term nucleic acid positive patients (hereinafter referred to as CLTAPs). METHODS: Patients were recruited from the Xiaogan Central Hospital between 16 January 2020 and 28 March 2020. Among the 562 cases of patients with laboratory-identified COVID-19 infection by real-time polymerase chain reaction (qtPCR), 19 cases of COVID-19 patients with more than 41 days from the first to the last time of nucleic acid test were selected as the study group, and 76 cases of age- and gender-matched COVID-19 patients were selected…as the control group (hereinafter referred to as C-CLTAPs). Demographic characteristics, clinical symptoms, laboratory examination and computed tomography (CT) imaging characteristics were retrospectively analyzed. RESULTS: On admission, among the 562 cases of patients with COVID-19, there were 398 cases of ordinary COVID-19 patients, 99 cases of severe COVID-19 patients and 99 cases of critical COVID-19 patients. CLTAPs had milder clinical symptoms and longer viral shedding time in comparison to C-CLTAPs. Compared to C-CLTAPs, CLTAPs had a lower infection index at admission. CLTAPs used less oxygen therapy and a higher proportion of hydroxychloroquine treatment in comparison to C-CLTAPs. In comparison to C-CLTAPs, CLTAPs showed slower pulmonary CT progression and faster pulmonary CT absorption. CONCLUSION: In this study, out of the 562 cases, we found 19 CLTAPs. The clinical differences between CLTAPs and C-CLTAPs were compared and analyzed. We hope that these finding can provide a theoretical basis for the treatment of CLTAPs.
Abstract: BACKGROUND: The pulse transit time is an important factor that can be used to estimate the blood pressure indirectly. In many studies, pressures in the artery near and far from the heart are measured or the electrocardiogram and photoplethysmography are used to calculate the pulse transit time. In other words, the so-called contact measurements have been mainly used in these studies. OBJECTIVE: In this paper, a new method based on radar technology to measure the pulse transit time in a non-contact manner is proposed. METHODS: Radar pulses were simultaneously emitted to the chest…and the wrist, and the reflected pulses were accumulated. Heartbeats were extracted by performing principal component analysis on each time series belonging to the accumulated pulses. Then, the matched heartbeat pairs were found among the heartbeats obtained from the chest and wrist and the time delay between them, i.e. the pulse transit time, was obtained. RESULTS: By comparing the pulse transit times obtained by the proposed method with those obtained by conventional methods, it is confirmed that the proposed method using the radar can be used to obtain the pulse transit time in a non-contact manner.
Keywords: Ultra-wide band, impulse radar, pulse transit time, principal component analysis, heartbeat
Abstract: BACKGROUND: Offspring with a genetic predisposition to hypertension may have higher blood pressure (BP) at rest compared with those without a genetic predisposition to hypertension. They are also expected to have a higher sympathetic component in the heart rate variability (HRV) which could be computed with signal processing algorithms. OBJECTIVE: The purpose of this study is to design a wavelet-based system to estimate the heart rate variability that can be used to detect early cardiovascular changes in offspring with a genetic predisposition to hypertension. Early detection will help in the treatment of those young people. In…this work, the relation between the hypertension and the changes in HRV is investigated. METHODS: The frequency domain and time domain analysis of heart rate variability (HRV) are studied to understand their relationship to the autonomic nervous system in offspring with and without a genetic predisposition to hypertension in Oman at resting state. The wavelet-based soft-decision algorithm is used as the spectral analysis tool to obtain different features from the HRV signal and to select the best performing features for detection of hypertension. The main task is to classify between three categories of subjects: 36 subjects with both normotensive parents (ONT), 22 subjects with single hypertensive parent (OHT1), and 11 subjects with both hypertensive parents (OHT2). RESULTS: The summation of the power of bands B4 and B5 of the 32 bands HRV wavelet-based spectrum, which is equivalent to the frequency range (0.046875 Hz-0.078125 Hz), is used as a classification factor among OHT2, OHT1, and ONT groups. The efficiency of classification between ONT and OHT2 is 85.10%, and between OHT1 and OHT2 is 81.81%. The result of classifying between (ONT and OHT1 as one group) and OHT2 is 85.50%. CONCLUSIONS: The work proves that the wavelet-based spectral analysis technique is a successful tool for classifying the three groups of subjects (ONT, OHT1, and OHT2) with different susceptibility for development of hypertension.
Keywords: Heart rate variability, hypertension, classification, wavelet analysis, offspring, hypertensive parents, normotensive parents, oman family study
Abstract: BACKGROUND: Doctors with various specializations and experience order brain computed tomography (CT) to rule out intracranial hemorrhage (ICH). Advanced artificial intelligence (AI) can discriminate subtypes of ICH with high accuracy. OBJECTIVE: The purpose of this study was to investigate the clinical usefulness of AI in ICH detection for doctors across a variety of specialties and backgrounds. METHODS: A total of 5702 patients’ brain CTs were used to develop a cascaded deep-learning-based automated segmentation algorithm (CDLA). A total of 38 doctors were recruited for testing and categorized into nine groups. Diagnostic time and accuracy were…evaluated for doctors with and without assistance from the CDLA. RESULTS: The CDLA in the validation set for differential diagnoses among a negative finding and five subtypes of ICH revealed an AUC of 0.966 (95% CI, 0.955–0.977). Specific doctor groups, such as interns, internal medicine, pediatrics, and emergency junior residents, showed significant improvement with assistance from the CDLA (p = 0.029). However, the CDLA did not show a reduction in the mean diagnostic time. CONCLUSIONS: Even though the CDLA may not reduce diagnostic time for ICH detection, unlike our expectation, it can play a role in improving diagnostic accuracy in specific doctor groups.
Keywords: Intracranial hemorrhages, diagnosis, artificial intelligence, deep learning, ROC curve
Abstract: OBJECTIVES: Autism Spectrum Disorder (ASD) is a complex range of neurodegenerative conditions that impact individuals’ social behaviour and communication skills. However, ASD data often contains far more controls than cases. This poses a serious challenge when creating classification models due to deriving models that favour controls during the classification of individuals. This problem is known as class imbalance, and it may reduce the performance in classification models derived by machine learning (ML) techniques due to individuals may remain undetected. METHODS: ML appears to help in the distressing disorder by improving outcome quality besides speeding up the…access to early diagnosis and consequential treatment. A screening dataset that consists of over 1100 instances was used to perform extensive quantitative analysis using different data resampling techniques and according to specific evaluation metrics. We measure the effect of class imbalance on autism screening performance using different data resampling techniques with a ML classifier and with respect to sensitivity, specificity, and F1-measure. We would like to know which resampling methods work well in balancing autism screening data. RESULTS: The results reveal that data resampling, and especially oversampling, improve results derived by the considered ML classifier. More importantly, there was superiority in terms of sensitivity and specificity for models derived by Naive Bayes classifier when oversampling methods have been used for data pre-processing on the autism data considered. CONCLUSION: The results reported encourages further improvement of the design and implementation of ASD screening systems using intelligent technology.
Keywords: Artificial intelligence, autism screening, classification, class imbalance, data resampling, machine learning
Abstract: BACKGROUND: The mucous membrane of the maxillary sinus is sensitivis susceptible to infection or inflammation adjacent to it, which may contribute to mucous membrane thickening (MMT). Residual alveolar bone quality (RABQ) is considered a quality of the remaining bone apical to periodontal defect adjoining to the floor of the maxillary sinus. OBJECTIVE: The current study aimed to analyze the minimum RABQ to prevent the extension of periodontal pathology from reaching maxillary sinus using cone-beam computed tomography (CBCT). METHODS: In this retrospective observational study, 240 sinus exposure CBCT records of 146 patients were evaluated.…Patients with at least one sinus exposure were included. RABQ and MMT were calculated using CBCT inbuilt tools. RABQ was divided into four groups based on gray scale values (GSV). Statistical analysis was performed using one way ANOVA and independent sample t -tests. Correlation was completed applying Pearson’s correlation coefficient. RESULTS: A significant difference (p < 0.05) was observed between the MMT values of the four RABQ groups. Inverse correlation was observed between mean MMT and GSV values. Mean MMT was higher than pathological MMT range (> 2 mm), with significant differences in groups A and B, where mean GSV values are less than 500. Mean GSV greater than 500 in groups C and D show non-pathological MMT. Prevalence of MMT is 91.4% if GSV is < 500 and 7.5% if GSV is > 500. CONCLUSIONS: Our study suggests that MMT is present if RABQ has GSV values < 500. Maxillary sinusitis and its etiology from periodontal pathology can be excluded based on RABQ adjoining periodontal lesion. Early detection and prompt treatment along with appropriate regenerative protocols can be performed to increase the RABQ. Further microbiological investigation is required to support the present results.
Abstract: BACKGROUND: Motor imagery electroencephalogram (MI-EEG) play an important role in the field of neurorehabilitation, and a fuzzy support vector machine (FSVM) is one of the most used classifiers. Specifically, a fuzzy c-means (FCM) algorithm was used to membership calculation to deal with the classification problems with outliers or noises. However, FCM is sensitive to its initial value and easily falls into local optima. OBJECTIVE: The joint optimization of genetic algorithm (GA) and FCM is proposed to enhance robustness of fuzzy memberships to initial cluster centers, yielding an improved FSVM (GF-FSVM). METHOD: The features…of each channel of MI-EEG are extracted by the improved refined composite multivariate multiscale fuzzy entropy and fused to form a feature vector for a trial. Then, GA is employed to optimize the initial cluster center of FCM, and the fuzzy membership degrees are calculated through an iterative process and further applied to classify two-class MI-EEGs. RESULTS: Extensive experiments are conducted on two publicly available datasets, the average recognition accuracies achieve 99.89% and 98.81% and the corresponding kappa values are 0.9978 and 0.9762, respectively. CONCLUSION: The optimized cluster centers of FCM via GA are almost overlapping, showing great stability, and GF-FSVM obtains higher classification accuracies and higher consistency as well.
Keywords: Motor imagery electroencephalogram, fuzzy c-means, genetic algorithm, fuzzy support vector machine, joint optimization
Abstract: BACKGROUND: Telemedicine is playing an increasingly more important role in disease diagnosis and treatment. The market of telemedicine application is continuously promoted, thus bringing some issues on telemedicine operations management. OBJECTIVE: We aimed to compare the teleconsultation scheduling performance of newly designed proactive strategy and existing static strategy and explore the decision-making under different conditions. METHODS: We developed a discrete-event simulation model based on practical investigation to describe the existing static scheduling strategy of teleconsultation. The static strategy model was verified by comparing it with the historical data. Then a new proactive strategy…was proposed, whose average waiting time, variance of waiting time and completed numbers were compared with the static strategy. RESULTS: The analysis indicated that the proactive strategy performed better than static under the current resource allocation. Furthermore, we explored the impact on the system of both strategies varying arrival rate and experts’ shift time. CONCLUSIONS: Under different shift times and arrival rates, the managers of telemedicine center should select different strategy. The experts’ shift time had a significant impact on all system performance indicators. Therefore, if managers wanted to improve the system performance to a greater extent, they needed to reduce the shift time as much as possible.
Abstract: BACGROUND: Cervical stenoses are one of the main long-term consequences after conization of the uterine cervix. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of a uterine cervix supporting device (Con-Cap TM ) in reducing uterine cervical stenosis after Loop Electrosurgical Excisional Procedure (LEEP). METHODS: We enrolled 112 patients who underwent LEEP between March 2017 to May 2019. Con-Cap TM was inserted into the uterine endocervical canal for 4 weeks after LEEP. Laboratory values and clinical symptoms were evaluated. The presence…of uterine cervical narrowing was determined at 2 weeks after removal of the Con-Cap TM . Data were analyzed using the two-sample t test and χ 2 test. RESULTS: A total of 78 women completed the 6-week study period. Thirty-four patients did not complete the study period. The diameter of the uterine cervical canal was significantly greater at postoperative 6 weeks than preoperatively (Hegar dilator No, 2.10 ± 0.56 vs. 3.21 ± 0.71, P < 0.01). The complications were acceptable. CONCLUSIONS: Con-Cap TM can be used to reduce uterine cervical stenosis safely and effectively after conization of uterine cervix.
Abstract: BACKGROUND: As a common secondary pathophysiological process in postischemic stroke (IS), cytotoxic brain edema (CBE) is an independent factor leading to poor prognosis of patients. Near-field coupling (NFC) technology has some advantages such as non-invasive, non-contact, and unimpeded penetration of the skull. In theory, it can reflect the difference between normal and edema tissues through the near-field coupling phase shift (NFCPS) in the electromagnetic wave transmission trait. METHODS: Combining NFC detection principle and computer programming, we established a high-performance real-time monitoring system with functions such as automatic setting of measurement parameters, data acquisition, real-time filtering and…dynamic waveform display. To investigate the feasibility of this system to detect CBE, a saline simulation experiment and a 24-hour real-time monitoring experiment after middle cerebral artery occlusion (MCAO) in rats were carried out. RESULTS: The results of the saline simulation experiment showed that the change of NFCPS was proportional to the increase of the simulated edema solution, and the variation range of NFCPS was more than 9 ∘ after 5 ml injection. In the 24-hour monitoring after MCAO, the NFCPS of the experimental group showed an overall downward trend over time an average change of - 17.7868 ± 1.6325 ∘ and the change rate gradually decreased. The 24-hour NFCPS in the control group fluctuates slightly around the initial value, which has no obvious upward or downward trend. CONCLUSION: The intragroup and intergroup difference statistical analysis shows that NFCPS can effectively distinguish different intracranial pathophysiological states after IS. This work provides sufficient evidence and a technical basis for using NFCPS to monitor CBE in the future.