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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: Increased cognitive workload, sometimes known as mental strain or mental effort, has been associated with reduced performance. OBJECTIVE: The use of physiological monitoring was investigated to predict cognitive workload and performance. METHODS: Twenty-one participants completed a 10-minute seated rest, a visuospatial learning task modeled after crane operation, and the Stroop test, an assessment that measures cognitive interference. Heart rate, heart rate variability, electrodermal activity, skin temperature, and electromyographic activity were collected. RESULTS: It was found that participants’ ability to learn the simulated crane operation task was inversely correlated with…self-reported frustration. Significant changes were also found in physiological metrics in the simulation with respect to rest, including an increase in heart rate, electrodermal activity, and trapezius muscle activity; heart rate and muscle activity were also correlated with simulation performance. The relationship between physiological measures and self-reported workload was modeled and it was found that muscle activity and high frequency power, a measure of heart rate variability, were significantly associated with the workload reported. CONCLUSIONS: The findings support the use of physiological monitoring to inform real time decision making (e.g., identifying individuals at risk of injury) or training decisions (e.g., by identifying individuals that may benefit from additional training even when no errors are observed).
Keywords: Cognitive workload, visuospatial learning, wearable sensors, physiological monitoring, health and wellbeing
Abstract: BACKGROUND: Analysis of the heart activity is one of the important areas of research in biomedical science and engineering. For this purpose, scientists analyze the activity of the heart in various conditions. Since the brain controls the heart’s activity, a relationship should exist among their activities. OBJECTIVE: In this research, for the first time the coupling between heart and brain activities was analyzed by information-based analysis. METHODS: Considering Shannon entropy as the indicator of the information of a system, we recorded electroencephalogram (EEG) and electrocardiogram (ECG) signals of 13 participants (7 M, 6…F, 18–22 years old) in different external stimulations (using pineapple, banana, vanilla, and lemon flavors as olfactory stimuli) and evaluated how the information of EEG signals and R-R time series (as heart rate variability (HRV)) are linked. RESULTS: The results indicate that the changes in the information of the R-R time series and EEG signals are strongly correlated (ρ = - 0.9566). CONCLUSION: We conclude that heart and brain activities are related.
Abstract: BACKGROUND: Conventional ultrasound (US) is the most widely used imaging test for thyroid nodule surveillance. OBJECTIVE: We used the color-coded virtual touch tissue imaging (VTI) in the Acoustic Radiation Force Impulse (ARFI) technique to assess the hardness of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) TR3-5 nodules. The ability of color-coded VTI (CV) to discriminate between benign and malignant nodules was investigated. METHODS: In this retrospective study, US and CV were performed on 211 TR3-5 thyroid lesions in 181 consecutive patients. All nodules were operated on to…obtain pathological results. A multivariate logistic regression model was chosen to integrate the data obtained from the US and CV. RESULTS: The area under the receiver operating characteristic (ROC) curve for the model was 0.945 (95% CI, 0.914 to 0.976). The cutoff value of predictive probability for diagnosing malignant thyroid nodules was 10.64%, the sensitivity was 94.43%, and the specificity was 83.12%. Through comparing with US and CV, respectively, it had been observed that the regression model had the best performance (all P < 0.001). However, when the US was compared with CV, the difference was not significant (P = 0.3304). CONCLUSIONS: A combination of US and CV should be recommended for suspected malignant thyroid nodules in clinical practice.
Abstract: BACKGROUND: Thermoablation is an attractive treatment of thyroid nodules for its minimal-invasiveness. It remains unclear whether results and morbidity meet the patients’ expectations. OBJECTIVE: The aim of the presented study is to show data obtained after microwave thyroid ablation from a patients’ perspective. METHODS: Indications and preoperative diagnosis were chosen according to international guidelines. Thermoablation was achieved using a CE certified microwave system. The procedures heeded the published recommendations of the European Federation of Societies for Ultrasound in Medicine and Biology. Follow-up included ultrasound, laboratory parameters and a standardized questionnaire. RESULTS:…Thirty patients were enrolled into the study. All patients reported an improvement of complaints following the procedure. Scar formation occurred in 3 cases (10%) with 0.5 ± 1.3 mm length and 0.4 ± 1.0 mm width. No cosmetic, neurological, vocal or pharyngeal complication occurred. Energy required for non-functioning nodules (n = 15, 50%) was 2.56 ± 3.41 kJ/mL, for autonomous adenoma (n = 8, 27%) 0.96 kJ/mL (p < 0.05, t -test). CONCLUSION: The presented data summarize an initial experience in selected patients and resemble excellent patient reported outcome with minimal morbidity. These preliminary data indicate the majority of patients satisfied with the procedure. Further trials will be required to endorse these findings.
Keywords: Thyroid ablation, thermoablation of thyroid nodules, microwave thyroid ablation
Abstract: BACKGROUND: Essential tremor (ET) and the tremor in Parkinson’s disease (PD) are the two most common pathological tremors with a certain overlap in the clinical presentation. OBJECTIVE: The main purpose of this work is to use an artificial neural network to select the best features and to discriminate between the two types of tremors. The features used are of hybrid type obtained from two different algorithms: the statistical signal characterization (SSC) of the signal describing its morphology, and the soft-decision wavelet-decomposition (SDWD) features extracted from the accelerometer and surface EMG signals. METHODS: The…SSC method is used to obtain morphology-based features of the spectrum of the accelerometer and two surface EMG signals. The SDWD technique is used in this work to obtain the approximate spectral representation of both accelerometer and the two surface EMG signals. Two sets of data (training and test) are used in this paper. The training set consists of 21 ET subjects and 19 PD subjects, while the test set consists of 20 ET and 20 PD subjects. A neural network of the type feed forward back propagation has been used to combine best SSC features and best SDWD features of the accelerometer and EMG signals. RESULTS: Efficiency result of 92.5% was obtained using best hybrid features. CONCLUSIONS: The artificial neural network has been used successfully to combine two types of features in an automatic discrimination system between PD and ET.
Keywords: Artificial neural networks, statistical signal characterization, wavelet-decomposition, hybrid features, discrimination, PD, ET, accelerometer, EMG
Abstract: BACKGROUND: Severe acetabular bone loss in revision total hip arthroplasty (RTHA), both with or without pelvic discontinuity, remains a great challenge in orthopaedic surgery. OBJECTIVE: The aim of this study was to evaluate risk factors for failure of custom-made acetabular implants in RTHA. METHODS: Seventy patients with severe acetabular bone loss (Paprosky Type III) and pelvic discontinuity, who required RTHA, were included in our study. All prostheses were constructed based on a thin-layer computed-tomography (CT) scan of the pelvis. The treatment was considered unsuccessful in the event of periprosthetic joint infection (PJI) or…aseptic loosening (AL) with need for explantation of the custom-made acetabular implant. RESULTS: The average follow-up was 41.9 ± 34.8 months (range 1.5–120). Implant survival at last follow-up was 75.7% (53 of 70). Explantation was necessary in 17 cases (15 PJI; 2 AL). Previous PJI as reason for RTHA (p = 0.025; OR 3.56 (95% CI: 1.14; 11.21)), additional revision of femoral components (p = 0.003; OR 8.4 (95% CI: 1.75; 40.42)), rheumatoid disease (p = 0.039; OR 3.43 (95% CI: 1.01; 11.40)), elevated preoperative CRP > 15.2 mg/l (p = 0.015; AUC: 0.7) and preoperative haemoglobin < 10.05 (p = 0.022; AUC: 0.69) were statistically significant risk factors associated with treatment failure. Age and BMI were not statistically significant contributing to implant failure. CONCLUSION: Risk factors for treatment failure were a previous PJI, additional revision of femoral component, rheumatoid disease, elevated preoperative CRP and low preoperative haemoglobin. Awareness of these risk factors will help to improve future treatment standards.
Keywords: Revision total hip arthroplasty, pelvic discontinuity, acetabular bone loss, custom-made implant, risk factor, treatment failure, periprosthetic joint infection, aseptic loosening
Abstract: BACKGROUND: Electromyographic systems are widely used in scientific and clinical practice. The reproducibility and reliability of these measures are crucial when conducting scientific research and collecting experimental data. OBJECTIVE: To test the reliability of surface electromyography signals from both the Flexor Digitorum Superficialis (FDS) and Extensor Carpi Radialis Brevis (ECRB) muscles of both the left and right arms during an individual, static multi-planar maximum voluntary contraction handgrip task using the Myon 320 system (Myon AG, Switzerland). METHODS: Eight right-handed male participants performed two maximal handgrip tests in five separate wrist positions using both…hands. Muscle activity was recorded from both forearms. Reliability was measured using the Standard Error of Measurement (SEM), Coefficient of Variation (CV) and Intra-class correlation coefficients. Wrist joint position correlations within and between the FDS and ECRB muscle activities were also analysed. RESULTS: Absolute reliability was shown across all positions for both hands with CV and SEM recorded at below 10%. The output measures indicate that the Myon 320 system (Myon AG, Switzerland) produces good to fair reliability when assessing forearm muscle activity. Correlations in the left FDS muscles were negative. Correlations between the left ECRB and left FDS muscles were variable but positive between the right ECRB and right FDS muscles. CONCLUSIONS: The data sets retrieved from all participants were reliably evaluated. Wrist position correlations within and between the FDS and ECRB muscles may have been influenced by hand dominance. The findings demonstrate that the methods and systems outlined in this study can be used reliably in future research.
Abstract: BACKGROUND: Lesions of articular cartilage represent a crucial risk factor for the early development of osteoarthritis. Autologous chondrocyte implantation (ACI) is a well-established procedure in therapy of those lesions in the knee. The aim of the presented study is to detect differences in short-term radiological outcome depending on defect localization (femoral condyle vs. retropatellar) after spheroid-based ACI. OBJECTIVE: This study aimed to demonstrate that radiological outcome after spheroid-based ACI in the knee is independent of defect localization. METHODS: MRI-scans after retropatellar ACI and ACI of the medial/lateral femoral condyle, with a preoperative Outerbridge…grade of III or IV were evaluated regarding MOCART 2.0. RESULTS: The mean defect-size was 5.0 ± 1.8 cm 2 , with a minimum size of 2 cm 2 and a maximum size of 9 cm 2 . Scans were performed 7.7 months (± 3.1 months) postoperatively. The mean MOCART 2.0 score was 78.5 ± 15.6. No statistically significant influence neither of the localization (p = 0.159), the gender (p = 0.124) nor defect size (< 5 cm 2 vs. ⩾ 5 cm 2 ; p = 0.201) could be observed. CONCLUSIONS: The presented data demonstrate good to excellent radiological short-term results after spheroid-based ACI. Data indicates, that at least radiological results are independent of gender, defect-size and defect-localization.
Abstract: BACKGROUND: Pulmonary metastasis is the most frequent cause of death in osteosarcoma (OS) patients. Recently, several bioinformatics studies specific to pulmonary metastatic osteosarcoma (PMOS) have been applied to identify genetic alterations. However, the interpretation and reliability of the results obtained were limited for the independent database analysis. OBJECTIVE: The expression profiles and key pathways specific to PMOS remain to be comprehensively explored. Therefore, in our study, three original datasets of GEO database were selected. METHODS: Initially, three microarray datasets (GSE14359, GSE14827, and GSE85537) were downloaded from the GEO database. Differentially expressed genes (DEGs)…between PMOS and nonmetastatic osteosarcoma (NMOS) were identified and mined using DAVID. Subsequently, GO and KEGG pathway analyses were carried out for DEGs. Corresponding PPI network of DEGs was constructed based on the data collected from STRING datasets. The network was visualized with Cytoscape software, and ten hub genes were selected from the network. Finally, survival analysis of these hub genes also used the TARGET database. RESULTS: In total, 569 upregulated and 1238 downregulated genes were filtered as DEGs between PMOS and NMOS. Based on the GO analysis result, these DEGs were significantly enriched in the anatomical structure development, extracellular matrix, biological adhesion, and cell adhesion terms. Based on the KEGG pathway analysis result, these DEGs were mainly enriched in the pathways in cancer, PI3K-Akt signaling, MAPK signaling, focal adhesion, cytokine-cytokine receptor interaction, and IL-17 signaling. Hub genes (ANXA1 and CXCL12) were significantly associated with overall survival time in OS patient. CONCLUSION: Our results may provide new insight into pulmonary metastasis of OS. However, experimental studies remain necessary to elucidate the biological function and mechanism underlying PMOS.
Abstract: BACKGROUND: Wearable lower extremity exoskeletons can provide walking assistance for the physical rehabilitation of paralyzed individuals. However, most of the existing exoskeletons require crutches to maintain balance, thus a self-balancing type is needed to improve applicability. OBJECTIVE: The purpose of this work is to study the kinematic characteristics of a novel lower extremity exoskeleton for crutch-less walking rehabilitation, and evaluate the movement performance through practical experiments. METHODS: Based on the human lower limb structure and movement characteristics, a fully actuated 10 degrees-of-freedom (DoF) lower extremity exoskeleton was proposed. The kinematic characteristics of the…exoskeleton were analyzed by the D-H method and geometric method, and the model validity was verified through simulations and experiments. RESULTS: The closed-form solutions for both forward and inverse kinematics models were obtained. The consistent results of theoretical calculation and numerical simulation have shown the accuracy of the established models. The practical experiments regarding six trials have demonstrated the movement performance of the proposed exoskeleton, including sit, stance, leg extension/flexion, and left/right swing. CONCLUSIONS: The kinematic characteristics of the proposed 10-DoF lower extremity exoskeleton are similar to the human lower limb, and it could meet the motion demands of crutch-less walking rehabilitation.