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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.
Abstract: BACKGROUND: Autofluorescence imaging technology has been utilized for preserving or identifying parathyroid glands (PTGs) during thyroid surgery. We developed a wireless PTGs detection device linked with smart glasses that allows for real-time video recording and screen switching according to the light source. OBJECTIVE: This study aimed to confirm the feasibility of the device and whether it would help preserve the PTG during the surgery. METHODS: This prospective study was conducted in 30 patients with 66 PTGs. The device’s agreement with the physician’s judgment was evaluated, and we determined how many PTGs were preserved from thyroidectomy.…RESULTS: The positive agreement rate for PTGs detection between the surgeon and device was 70.9%. Inadvertent parathyroidectomy was identified in surgical specimens of 6 patients (20%). No PTG was removed when it was confirmed by the device (0/39). Of the 27 glands not detected by the device, there was inadvertent removal of 6 PTGs. CONCLUSIONS: PTGs can be preserved successfully when the detection of them by the device is consistent with the surgeon’s discretion. A large-scale controlled study is necessary to demonstrate the practical effect of this device on hypoparathyroidism after thyroidectomy.
Abstract: BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA), including balloon angioplasty, is a standard clinical invasive treatment for coronary artery disease. The coronary lesion with calcification is difficult to dilate and the prevention of balloon failure is especially important. OBJECTIVE: A novel superpressure balloon was fabricated with bilayered structure of polyethylene terephthalate (PET) and PA12 (polyamide). METHODS: The structures of bilayer balloon were adjusted to achieve overall excellent performance. Physicochemical, thermal and mechanical properties of bilayer balloons were characterized by X-ray diffraction, differential scanning calorimeter, hydraulic tester and theoretical simulation. RESULTS: Compared…with pure PA12 and PET balloons, PA12 outer layer: PET inner layer balloon with layer ratio of 3:7 shows the highest burst stress and relatively low compliance due to an increase in crystallinity and orientation. CONCLUSIONS: The produced bilayer balloon proved to possess a small folding dimension thanks to its ultrathin bilayer structure, which is good for crossing cramped vessels. We believe these optimally fabricated bilayer balloons are proved to provide attractive opportunities for preparation, performance enhancement, and practical applications of super-pressure balloon catheters and cryoablation balloons, that will significantly promote the development of percutaneous transluminal coronary angioplasty for clinical applications.
Abstract: BACKGROUND: The treatment of adolescent patients with distal femoral cancer has always been a concern. The limb-salvage, regarded as a mainstream treatment, had been developed in recent years, but its application in children still remains challenging. This is because it can lead to potential limb-length discrepancy from the continued normal growth of the contralateral lower body. The extendable prosthesis could solve this problem. The principle is that it can artificially control the length of the prosthesis, making it consistent with the length of the side of the lower limbs. However, this prosthesis has some complications. The extendable prosthesis is classified…into invasive and minimally invasive, which extends the prosthesis with each operation. OBJECTIVE: We designed a new non-invasive prosthesis that can be extended in the body. Based on the non-invasive and extendable characteristics, we need to verify the supporting performance of this prosthesis. METHODS: We carried out a mechanical testing method and finite element analysis simulation. CONCLUSION: The support performance and non-invasively extension of this prosthesis were verified.
Abstract: OBJECTIVE: This study aims to accurately measure the range of motion of the sternoclavicular (SC) joint using 3D reconstruction and image registration. The motion of the SC joint is analyzed by means of axial angle representation to identify the kinematical characteristics of this joint. METHODS: A total of 13 healthy volunteers were enrolled in the study. The limit postures of four SC joint movements were scanned by computerized tomography. The images were integrated with reconstruction and registration techniques. The range of motion of the SC joint was measured using 3D modelling. The axial angle was used…to indicate the range of motion of the SC joint. The difference between the dominant side and non-dominant side was compared and the differences in axial angle of the SC joint in different postures were compared. RESULTS: The active axial angle of the SC joint on the dominant side was approximately 1 ∘ higher than that of the non-dominant side when the upper limb moved from a rest position to a posteroinferior position. In the sagittal motion of the upper limbs, the axial angle of the SC joint was greatest when moving from a horizontal position to a posterosuperior position, with an average of 23.55 ∘ . Of the flexion and extension movements of the upper limbs from a rest position to a horizontal position, 13.66% (the smallest proportion) were completed by the SC joint. CONCLUSION: The combination of 3D reconstruction and image registration is a direct and accurate method of measuring the motion of the SC joint. Axial angle representation is an intuitive method of expressing rotation in a 3D space that allows for more convenient comparison; it is also more in line with the characteristics of human anatomy and kinesiology and therefore more accurately reflects the characteristics of joint motion. It is therefore useful for guiding clinical practice. In a physical examination, the extension of the upper limb from the horizontal position to the posterosuperior position and from the rest position to the posteroinferior position can best reflect the rotation function of the SC joint in the combined motion of shoulder joints.
Abstract: BACKGROUND: Dental caries is one of the most common diseases around the world. The newly erupted permanent posterior teeth are at great risk due to the complex occlusal morphology of pits and fissures, infraocclusion and incomplete maturation of enamel. Pit and fissure sealants are the treatment of choice in such conditions. OBJECTIVES: To compare the successful outcome of pit and fissure sealants bonded with etch-and-rinse adhesive system and self-etch adhesive systems in newly erupted permanent first molars. METHODS: This randomized clinical trial was conducted at the Fatimah Jinnah Dental Hospital from June 2017…to May 2019. Children aged between 6 to 9 years who fulfilled the inclusion criteria were recruited for this study after parents’ consent. Patients were randomly divided into two groups by the lottery method. Thirty patients with 60 first molar teeth in Group A were treated with etch-and-rinse adhesive system, while the other thirty patients with 60 first molar teeth in Group B were treated with self-etch adhesive system. After adhesive placement, all children received the same fissure sealants in newly erupted maxillary and mandibular permanent first molar. Each group was clinically evaluated at 6 and 12 months follow-up visit. Modified United States Public Health Service (USPHS) criteria were used for direct clinical evaluation of successful outcomes such as sealant retention and marginal discoloration. RESULTS: Successful outcome was statistically significant in Group B compared to Group A (60% vs. 30% p = 0.020) at 12 months follow-up. Stratification analysis was performed with respect to age in which a successful outcome was not significant (p = 0.43) between groups for 6 to 7 years of age, while it was significant (p = 0.012) between groups in 8 to 9 years of age children. CONCLUSION: Self-etch adhesive system is better than etch-and-rinse adhesive system in terms of long-term sealant retention. In addition, the bonding procedure is simple with relatively short clinical application time therefore it would offer great benefit to clinicians in treating pediatric patients.
Keywords: Self-etch adhesive, etch-and-rinse adhesive, pits and fissure sealant
Abstract: BACKGROUND: The definition of rehabilitation training trajectory is of great significance during rehabilitation training, and the dexterity of human-robot interaction motion provides a basis for selecting the trajectory of interaction motion. OBJECTIVE: Aimed at the kinematic dexterity of human-robot interaction, a velocity manipulability ellipsoid intersection volume (VMEIV) index is proposed for analysis, and the dexterity distribution cloud map is obtained with the human-robot cooperation space. METHOD: Firstly, the motion constraint equation of human-robot interaction is established, and the Jacobian matrix is obtained based on the speed of connecting rod. Then, the Monte Carlo…method and the cell body segmentation method are used to obtain the collaborative space of human-robot interaction, and the VMEIV of human-robot interaction is solved in the cooperation space. Finally, taking the upper limb rehabilitation robot as the research object, the dexterity analysis of human-robot interaction is carried out by using the index of the approximate volume of the VMEIV. RESULTS: The results of the simulation and experiment have a certain consistency, which indicates that the VMEIV index is effective as an index of human-robot interaction kinematic dexterity. CONCLUSIONS: The VMEIV index can measure the kinematic dexterity of human-robot interaction, and provide a reference for the training trajectory selection of rehabilitation robot.
Abstract: BACKGROUND: The transport of the inpatients to and from locations inside the hospital can vary in complexity depending on the patient location, status, and logistical needs. Most transport systems have not developed at the same speed as other medically related technologies. We conducted a pilot study of a new automated transport system for patients within the hospital. METHODS: Our innovative system was introduced in January 2020. We present a retrospective case review of all in-patient transport request during April 15, 2020 through May 30, 2020 at the Shaare Zedek Medical Center, Jerusalem, Israel. The system is fully…automated and works via smartphone and electronic medical record integration. Transfer requests are processed on the basis of priority, proximity, and availably. RESULTS: During the study period there were 15, 581 transfer requests. Mean times to hospital destinations ranged from 9:25 to 28:02 minutes. Overall, mean times were quicker for emergency and surgical services. Trip times by priority code were likely influence by unmeasured confounders. There were no reported patient identification adverse events. Peak requests occurred during 0900-1500, and at the beginning of the week. CONCLUSION: Our automated in-patient transfer system appears to be efficient, safe, well received, and capable of servicing our large tertiary care medical center. Future controlled studies are needed to assess efficacy, adverse events, and clinical outcomes.