Technology and Health Care - Volume 30, issue 6

Authors: Tiwari, Alok | Tripathi, Sumit | Pandey, Dinesh Chandra | Sharma, Neeraj | Sharma, Shiru

Article Type: Research Article

Abstract: BACKGROUND: The infection caused by the SARS-CoV-2 (COVID-19) pandemic is a threat to human lives. An early and accurate diagnosis is necessary for treatment. OBJECTIVE: The study presents an efficient classification methodology for precise identification of infection caused by COVID-19 using CT and X-ray images. METHODS: The depthwise separable convolution-based model of MobileNet V2 was exploited for feature extraction. The features of infection were supplied to the SVM classifier for training which produced accurate classification results. RESULT: The accuracies for CT and X-ray images are 99.42% and 98.54% respectively. The …MCC score was used to avoid any mislead caused by accuracy and F1 score as it is more mathematically balanced metric. The MCC scores obtained for CT and X-ray were 0.9852 and 0.9657, respectively. The Youden’s index showed a significant improvement of more than 2% for both imaging techniques. CONCLUSION: The proposed transfer learning-based approach obtained the best results for all evaluation metrics and produced reliable results for the accurate identification of COVID-19 symptoms. This study can help in reducing the time in diagnosis of the infection. Show more

Keywords: Transfer learning, COVID-19, MobileNet V2, deep learning

DOI: 10.3233/THC-220114

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1273-1286, 2022

Authors: Song, Li-Gang | Bai, Su-Rong | Hui, Deng-Hua | Ding, Li-Ping | Sun, Lu

Article Type: Research Article

Abstract: BACKGROUND: The COVID-19 pandemic broke out in 2019 and rapidly spread across the globe. Most of the severe and dead cases are middle-aged and elderly patients with chronic systemic diseases. OBJECTIVE: This study aimed to assess the association between fasting blood glucose (FPG) and body mass index (BMI) levels in patients with coronavirus disease 2019 (COVID-19) under different conditions. METHODS: Experimental-related information (age, gender, BMI, and FPG on the second day of admission) from 86 COVID-19 cases (47 males and 39 females) with an average age of (39 ± 17) …years was collected in April and November 2020. These cases were divided into three groups according to the most severe classification of each case determined by the clinical early warning indicators of severe-critically illness, the degree of progression, and the treatment plan shown in the diagnosis and treatment plan of COVID-19 pneumonia. Statistical models were used to analyze the differences in the levels of FPG and BMI, age, and gender among the three groups. RESULTS: 1. Experimental group: 21 patients with asymptomatic or and mild symptoms (group A), 45 patients with common non-progression (group B), and 20 patients with common progression and severe symptoms (group C). 2. The age differences among the three groups were statistically significant and elderly patients had a higher risk of severe disease (t = 4.1404, 3.3933, 9.2123, P = 0.0001, 0.0012, 0.0000). There was a higher proportion of females than males in the normal progression and severe disease cases (χ 2 = 5.512, P = 0.019). 3. The level of FPG was significantly higher in group C than in group A (t = 3.1655, P = 0.0030) and B (t = 2.0212, P = 0.0475). The number of diabetes or IFG in group C was significantly higher than in group A (χ 2 = 5.979, P = 0.014) and group B (χ 2 = 6.088, P = 0.014). 4. BMI was significantly higher in group C than in groups A (t = 3.8839, P = 0.0004) and B (t = 3.8188, P = 0.0003). The number of overweight or obese patients in group C was significantly higher than in groups A (χ 2 = 8.838, P = 0.003) and B (χ 2 = 10.794, P = 0.001). 5. Patients’ age, gender, and FPG were independent risk factors for COVID-19 disease progression (β = 0.380, 0.191, 0.186; P = 0.000, 0.034, 0.045). CONCLUSION: The levels of FPG and BMI were significantly increased in the population with common progressive and severe COVID-19. FPG and age are independent risk factors for the progression of COVID-19. Show more

Keywords: COVID-19, fasting plasma glucose, body mass index, diabetes

DOI: 10.3233/THC-220248

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1287-1298, 2022

Authors: Zhu, Fubao | Zhu, Zelin | Zhang, Yijun | Zhu, Hanlei | Gao, Zhengyuan | Liu, Xiaoman | Zhou, Guanbin | Xu, Yan | Shan, Fei

Article Type: Research Article

Abstract: BACKGROUND: Coronavirus disease 2019 (COVID-19) is a deadly viral infection spreading rapidly around the world since its outbreak in 2019. In the worst case a patient’s organ may fail leading to death. Therefore, early diagnosis is crucial to provide patients with adequate and effective treatment. OBJECTIVE: This paper aims to build machine learning prediction models to automatically diagnose COVID-19 severity with clinical and computed tomography (CT) radiomics features. METHOD: P-V-Net was used to segment the lung parenchyma and then radiomics was used to extract CT radiomics features from the segmented lung parenchyma regions. …Over-sampling, under-sampling, and a combination of over- and under-sampling methods were used to solve the data imbalance problem. RandomForest was used to screen out the optimal number of features. Eight different machine learning classification algorithms were used to analyze the data. RESULTS: The experimental results showed that the COVID-19 mild-severe prediction model trained with clinical and CT radiomics features had the best prediction results. The accuracy of the GBDT classifier was 0.931, the ROUAUC 0.942, and the AUCPRC 0.694, which indicated it was better than other classifiers. CONCLUSION: This study can help clinicians identify patients at risk of severe COVID-19 deterioration early on and provide some treatment for these patients as soon as possible. It can also assist physicians in prognostic efficacy assessment and decision making. Show more

Keywords: Severity detection, COVID-19, CT radiomics features, clinical features, imbalance classification

DOI: 10.3233/THC-220321

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1299-1314, 2022

Authors: Badnjević, Almir | Pokvić, Lejla Gurbeta | Deumić, Amar | Bećirović, Lemana Spahić

Article Type: Review Article

Abstract: BACKGROUND: Medical devices (MDs) represent the backbone of the modern healthcare system. Considering their importance in daily medical practice, the process of manufacturing, marketing and usage has to be regulated at all levels. Harmonized evidence-based conformity assessment of MDs during PMS relying on traceability of medical device measurements can contribute to higher reliability of MD performance and consequently to higher reliability of diagnosis and treatments. OBJECTIVE: This paper discusses issues within MD post-market surveillance (PMS) mechanisms in order to set a path to harmonization of MD PMS. METHODS: Medline (1980–2021), EBSCO (1991–2021), and …PubMed (1980–2021) as well as national and international legislation and standard databases along with reference lists of eligible articles and guidelines of relevant regulatory authorities such as the European Commission and the Food and Drug Administration were searched for relevant information. Journal articles that contain information regarding PMS methodologies concerning stand-alone medical devices and relevant national and international legislation, standards and guidelines concerning the topic were included in the review. RESULTS: The search strategy resulted in 2282 papers. Out of those only 24 articles satisfied the eligibility criteria and were finally included in the review. Papers were grouped per categories: medical device registry, medical device adverse event reporting, and medical device performance evaluation. In addition to journal articles, national and international legislation, standards, and guidelines were reviewed to assess the state of PMS in different regions of the world. CONCLUSION: Although the regulatory framework prescribes PMS of medical devices, the process itself is not harmonized with international standards. Particularly, conformity assessment of MDs, as an important part of PMS, is not measured and managed in a traceable, evidence-based manner. The lack of harmonization within PMS results in an environment of increased adverse events involving MDs and overall mistrust in medical device diagnosis and treatment results. Show more

Keywords: Medical device, post-market surveillance, conformity assessment, performance inspection, standardization

DOI: 10.3233/THC-220284

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1315-1329, 2022

Authors: Chia, Alex Z.R. | Zhang, Melvyn W.B.

Article Type: Review Article

Abstract: BACKGROUND: Digital phenotyping has been defined as the moment-by-moment assessment of an illness state through digital means, promising objective, quantifiable data on psychiatric patients’ conditions, and could potentially improve diagnosis and management of mental illness. As it is a rapidly growing field, it is to be expected that new literature is being published frequently. OBJECTIVE: We conducted this scoping review to assess the current state of literature on digital phenotyping and offer some discussion on the current trends and future direction of this area of research. METHODS: We searched four databases, PubMed, Ovid …MEDLINE, PsycINFO and Web of Science, from inception to August 25 th , 2021. We included studies written in English that 1) investigated or applied their findings to diagnose psychiatric disorders and 2) utilized passive sensing for management or diagnosis. Protocols were excluded. A narrative synthesis approach was used, due to the heterogeneity and variability in outcomes and outcome types reported. RESULTS: Of 10506 unique records identified, we included a total of 107 articles. The number of published studies has increased over tenfold from 2 in 2014 to 28 in 2020, illustrating the field’s rapid growth. However, a significant proportion of these (49% of all studies and 87% of primary studies) were proof of concept, pilot or correlational studies examining digital phenotyping’s potential. Most (62%) of the primary studies published evaluated individuals with depression (21%), BD (18%) and SZ (23%) (Appendix 1). CONCLUSION: There is promise shown in certain domains of data and their clinical relevance, which have yet to be fully elucidated. A consensus has yet to be reached on the best methods of data collection and processing, and more multidisciplinary collaboration between physicians and other fields is needed to unlock the full potential of digital phenotyping and allow for statistically powerful clinical trials to prove clinical utility. Show more

Keywords: Digital phenotyping, digital sensing, psychiatry, scoping review, artificial intelligence, machine learning, mobile health

DOI: 10.3233/THC-213648

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1331-1342, 2022

Authors: Zhang, Wen-Qing | Li, Jia-Bin | Huang, Ye | Huang, Na-Qing | Huang, Fei-Bin | Huang, Qiao-Wen | Jiang, Li-Wei | Lu, Zhi-Wei

Article Type: Research Article

Abstract: BACKGROUND: Ultrasound-guided needle placement has revolutionized the thoracic paravertebral block technique and can be applied in thoracoscopic surgery. OBJECTIVE: This study investigated the median effective volume (EV 50 ) of an ultrasound-guided single shot of 0.3% ropivacaine used as a thoracic paravertebral nerve block for the radical thoracoscopic resection of lung cancer. METHODS: A total of 27 patients who received a single shot of ultrasound-guided thoracic paravertebral nerve block and underwent radical thoracoscopic resection of lung cancer were enrolled in this study between February 10 and August 13, 2018. All …patients were rated as ASA grades I or II. Using ultrasound as a guide, the block needle was gradually pushed through the lateral costotransverse ligaments to the thoracic paravertebral space by the in-plane technique. After confirming the absence of blood or cerebrospinal fluid, 1–2 ml of 0.3% ropivacaine hydrochloride was injected to confirm that the position of the needle was appropriate, and a pre-determined volume of 0.3% ropivacaine hydrochloride was then administered to the patients. Sensory testing by pinprick was performed every 5 minutes for 30 minutes following the thoracic paravertebral block injection to identify the time segments during which the loss of sensation to the pinprick and its blocking effect occurred. RESULTS: All patients completed the study and 14 (51.8%) had a successful block. CONCLUSION: The EV 50 of 0.3% ropivacaine was 18.46 ml (95% CI 17.09–19.95 ml) and the EV 95 was 20.89 ml. Show more

Keywords: Median effective volume, sequential trial, thoracic paravertebral nerve block, ultrasound-guided, thoracoscopic radical surgery

DOI: 10.3233/THC-213608

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1343-1350, 2022

Authors: Wang, Guoyu | Wang, Haoyu | Wang, Yiwei | Ba, Chunhe

Article Type: Research Article

Abstract: BACKGROUND: Lower respiratory tract infection (LRTI) is a clinical multi-infectious disease caused by viral, bacterial, and other microbial infections. OBJECTIVE: The present study aims to explore the therapeutic effects of high-flow nasal cannula (HFNC) oxygen therapy and its influence on the serum levels of inflammatory factors in senior patients with LRTI. METHODS: In this randomized controlled trial, 84 senior patients with LRTI were enrolled between March 2017 and December 2019 and divided into the observation group and the control group according to the random number table method, with 42 cases in each group. …Conventional nasal cannula (CNC) oxygen therapy was conducted in the control group and HFNC was conducted in the observation group. After 3 days of treatment, sputum properties, sputum volume, sputum viscosity, and sputum crust formation were recorded to determine the clinical efficacy. ELISA was performed to detect the serum levels of tumor necrosis factor alpha (TNF-α ) and interlukein (IL)-8 before and after treatment. RESULTS: The total efficacy in the observation group was 92.86%, which was higher than in the control group (73.81%) (P < 0.05). Three days after treatment, the percentage of grade I sputum in the observation group (73.81%) was higher than in the control group (40.48%). Moreover, the percentage of grade II sputum (23.81%), the percentage of grade III sputum (2.38%), together with the sputum crust formation rate in the observation group (4.76%) were all lower than in the control group (45.24, 14.28, and 26.19%, respectively) (P < 0.05). Three days after treatment, the levels of IL-8 (0.21 ± 0.03 pg/L) and TNF-α (1.27 ± 0.14 ng/L) in the observation group were lower than in the control group (0.30 ± 0.04 pg/L, and 1.49 ± 0.18 ng/L) (t = 6.525, 11.665, 6.252, respectively; P < 0.05). CONCLUSION: The application of HFNC in senior patients with LRTI could improve respiratory humidification, reduce the number of sputum aspirations, and improve anti-inflammatory effects. It is worthy of application in elderly patients with LRTI. Show more

Keywords: Lower respiratory tract infection, high-flow nasal cannula oxygen therapy, therapeutic effect, inflammatory factor, IL-8, TNF-, clinical

DOI: 10.3233/THC-213609

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1351-1357, 2022

Authors: Ta, Na | Wei, Hai-Cheng | Li, Miao-Miao

Article Type: Research Article

Abstract: BACKGROUND: Arteriosclerosis is one of the diseases that endanger human health. There is a large amount of information in pulse wave signals to reflect the degree of arteriosclerosis. OBJECTIVE: The degree of arteriosclerosis is assessed by analyzing pulse wave signal and calculating multi-scale entropy values. METHODS: A method based on the multiscale cross-approximate entropy of the pulse wave of the human finger is proposed to assess the degree of arteriosclerosis. A total of 86 subjects were divided into three groups. The data of 1000 pulse cycles were selected in the experiment, and the …multiscale cross-approximate entropy was calculated for the climb time and pulse wave peak interval. Independent sample t -test analysis gives the small-scale cross-approximate entropy of the two time series of climb time and pulse wave peak interval as p < 0.001 in Groups 1 and 2. The large-scale cross-approximate entropy of the two time series of climb time and pulse wave peak interval is p < 0.017 in Groups 2 and 3. RESULTS: Using the proposed algorithm, the results showed that the small-scale cross-approximate entropy of climb time and pulse wave peak interval could reflect the degree of arteriosclerosis in the human body from the perspective of autonomic nerve function. The large-scale cross-approximate entropy of climb time and pulse wave peak interval confirmed the effect of diabetes on the degree of arteriosclerosis. CONCLUSIONS: The results demonstrate the multiscale cross-approximate entropy is a comprehensive index to evaluate the degree of human arteriosclerosis. Show more

Keywords: Arteriosclerosis, diabetes, multiscale cross-approximate entropy, pulse wave

DOI: 10.3233/THC-220040

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1359-1369, 2022

Authors: Luschi, Alessio | Villa, Eleonora Annamaria Borsani | Gherardelli, Monica | Iadanza, Ernesto

Article Type: Research Article

Abstract: BACKGROUND: Navigation portable applications have largely grown during the last years. However, the majority of them works just for outdoor positioning and routing, due to their architecture based upon Global Positioning System signals. Real-Time Positioning System intended to provide position estimation inside buildings is known as Indoor Positioning System (IPS). OBJECTIVE: This paper presents an IPS implemented as a mobile application that can guide patients and visitors throughout a healthcare premise. METHODS: The proposed system exploits the geolocation capabilities offered by existing navigation frameworks for determining and displaying the user’s position. A hybrid …mobile application architecture has been adopted because it allows to deploy the code to multiple platforms, simplifying maintenance and upgrading. RESULTS: The developed application features two different working modes for on-site and off-site navigation, which offer both the possibility of actual navigation within the hospital, or planning a route from a list of available starting points to the desired target, without being within the navigable area. Tests have been conducted to evaluate the performance and the accuracy of the system. CONCLUSION: The proposed application aims to overcome the limitations of Global Navigation Satellite System by using magnetic fingerprinting in combination with sensor fusion simultaneously. This prevents to rely on a single technology, reducing possible system failures and increasing the scalability. Show more

Keywords: Indoor Positioning System, RTLS, wayfinding, sensor fusion, health care

DOI: 10.3233/THC-220146

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1371-1395, 2022

Authors: Müller, Konstantin | Lerch, Solveig | Sauer, Bernd | Lerch, Matthias

Article Type: Research Article

Abstract: BACKGROUND: Patient-individualised anatomic alignment in total knee arthroplasty (TKA) requires exact positioning of the tibial and femoral components. Patient-specific instrumentation (PSI) may be advantageous for implantation. However, the role of PSI in the instrumentation of such knee designs has not been investigated. OBJECTIVE: The aim of this study was to investigate the accuracy of a PSI system designed for patient-individualised anatomic alignment. METHODS: Fifty-four patients from a single centre were consecutively enrolled in this study. Patient-specific femoral and tibial cutting guides were manufactured using 3D models from computed tomography (CT) scans. All patients …received an anatomic TKA implant design through an extension gap first technique. Postoperative radiography was taken, and implant component alignment and leg alignment were compared to the preoperative planning. RESULTS: Thirty-four patients were evaluable. Mean differences between planned angles values obtained from CT scans and the measured radiographic values were small and not significantly different from zero. CONCLUSIONS: Implantation of an anatomic knee design that allows individual component alignment using PSI is feasible. The percentage of component misalignment in the coronal plane was remarkably low. Whether this leads to clinical benefits requires further verification. Show more

Keywords: Total knee arthroplasty, patient-specific instrumentation, anatomic alignment, surgical technique

DOI: 10.3233/THC-213507

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1397-1406, 2022

Authors: Li, Jian | Yu, Xiao-Kun | Dong, Xiao-Man | Guo, Lin | Li, Xiao-Feng | Tian, Wei

Article Type: Research Article

Abstract: BACKGROUND: The treatment of sacral fractures accompanied by nerve injury is complex and often leads to an unsatisfactory prognosis and poor quality of life in patients. OBJECTIVE: The present study aimed to investigate the clinical value of using 3.0T magnetic resonance contrast-enhanced three-dimensional (MR CE-3D) nerve view magnetic resonance neurography (MRN) in the diagnosis and management of a sacral fracture accompanied by a sacral plexus injury. METHODS: Thirty-two patients with a sacral fracture accompanied by a sacral plexus injury, including 24 cases of Denis spinal trauma type II and 8 cases of type …III, were enrolled in the study. All patients had symptoms or signs of lumbosacral nerve injury, and an MRN examination was performed to clarify the location and severity of the sacral nerve injury. Segmental localization of the sacral plexus was done to indicate the site of the injury as being intra-spinal (IS), intra-foraminal (IF), or extra-foraminal (EF), and the severity of the nerve injury was determined as being mild, moderate, or severe. Surgical nerve exploration was then conducted in six patients with severe nerve injury. The location and severity of the nerve injury were recorded using intra-operative direct vision, and the results were statistically compared with the MRN examination results. RESULTS: MRN showed that 81 segments had mild sacral plexus injuries (8 segments of IS, 20 segments of IF, 53 segments of EF), 78 segments had moderate sacral plexus injuries (8 segments of IS, 37 segments of IF, and 33 segments of EF), and 19 segments had severe sacral plexus injuries (7 segments of IS, 9 segments of IF, and 3 segments of EF). The six patients who underwent surgery had the following intra-operative direct vision results: 3 segments of moderate injury (IF) and 20 segments of severe injury (7 segments of IS, 10 segments of IF, 3 segments of EF). There was no statistically significant difference in the results between the intra-operative direct vision and those of the MRN examination (p > 0.05). CONCLUSION: MR CE-3D nerve view can clearly and accurately demonstrate the location and severity of sacral nerve injury accompanied by a sacral fracture, and has the potential for being the first choice of examination method for this kind of injury, which would be of important clinical value. Show more

Keywords: Sacral fracture, sacral nerve injury, magnetic resonance, neurography

DOI: 10.3233/THC-213543

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1407-1415, 2022

Authors: Linhart, Christoph | Neuwieser, Dominik | Kussmaul, Adrian C. | Degen, Nikolaus | Greiner, Axel | Kammerlander, Christian | Suero, Eduardo M.

Article Type: Research Article

Abstract: BACKGROUND: Posterior instrumentation using pedicle screws and rods is the most commonly used technique for the treatment of thoracolumbar fractures of the spine. The procedure aims to restore the neurologic and biomechanical functions of the spine and allows for early mobilization and rapid reintegration into society. It is unclear whether the magnitude of correction has an effect on postoperative outcomes. OBJECTIVE: We aimed to determine whether the magnitude of sagittal angular correction during posterior instrumentation of the spine had an effect on postoperative quality of life, pain and function outcomes as measured using the EQ5D-3L and …the Core Outcome Measures Index (COMI) instruments. We also aimed to quantify the correlation between EQ5D-3L and COMI scores. METHODS: We analyzed the pre- and postoperative radiographs of 52 patients who underwent percutaneous pedicle screw placement for thoracolumbar fractures, as well as their self-reported EQ5D-3L and COMI quality of life, pain and functional outcome scores. Regression models were constructed to estimate the effect that the magnitude of Cobb angle correction had on postoperative outcomes. We also estimated the correlation between EQ5D-3L and COMI scores. RESULTS: The median EQ5D-3L TTO score was 0.9 (range, - 0.1 to 1). The median COMI score was 3.1 (range, 0 to 10). There was no significant effect of the magnitude of correction on EQ5d-3L TTO scores (p = 0.3379; R = 0.36) or on COMI scores (p = 0.3379; R = 0.15). Age and bone mineral density were not found to be significant predictors of outcome (p = 0.05). There was a strong correlation between the EQ5D-3L TTO and COMI scores (r = - 0.62). CONCLUSION: The magnitude of Cobb angle correction during pedicle screw instrumentation of thoracolumbar fractures did not influence quality of life, pain or function outcomes. There was good correlation between EQ5D-3L TTO scores and COMI scores. Show more

Keywords: Thoracolumbar fracture, closed reduction, comi-score, EuroQol EQ-5D, quality of life

DOI: 10.3233/THC-213616

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1417-1422, 2022

Authors: Melcher, Carolin | Paulus, Alexander C. | Roßbach, Bjömrn P. | Gülecyüz, Mehmet F. | Birkenmaier, Christof | Schulze-Pellengahr, Christoph von | Teske, Wolfram | Wegener, Bernd

Article Type: Research Article

Abstract: BACKGROUND: Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when non-operative treatment has failed. Apart from acute complications such as hematoma and infections, same-level recurrent lumbar stenosis and adjacent-segment disease (ASD) are factors that can occur after index lumbar spine surgery. OBJECTIVE: The aim of this retrospective case series was to evaluate the outcome of surgery and the odds of necessary revisions. METHODS: Patients who had undergone either decompressive lumbar laminotomy or laminotomy and spinal fusion due to lumbar spinal stenosis (LSS) between 2000 and 2011 were included in …this analysis. Demographic, perioperative and radiographic data were collected. Clinical outcome was evaluated using numeric rating scale (NRS), the symptom subscale of the adapted version of the german Spinal Stenosis Measure (SSM) and patient-sreported ability to walk. RESULTS: Within the LSS- cohort of 438 patients, 338 patients underwent decompression surgery only, while instrumentation in addition to decompression was performed in 100 cases (22.3%). 38 patients had prior spinal operations (decompression, disc herniation, fusion) either at our hospital or elsewhere. Thirty-five intraoperative complications were documented with dural tear with CSF leak being the most common (33/35; 94.3%). Postoperative complications were defined as complications that needed surgery and differentiated between immediate postoperative complications (⩽ 3 weeks post operation) and complications that needed revisions surgery at a later date. Within all patients 51 revisions were classified as immediate complications of the index operation with infections, neurological deficits and hematoma being the most common. Within this group only 22 patients had fusion surgery in the first place, while 29 were treated by decompression. Revision surgery was indicated by 53 patients at a later date. While 4 patients decided against surgery, 49 revision surgeries were planned. 28 were performed at the same level, 10 at the same level plus an adjacent level, and 10 were executed at index level with indications of adjacent level spinal stenosis, adjacent level spinal stenosis plus instability and stand-alone instability. Pre- operative VAS score and ability to walk improved significantly in all patients. CONCLUSIONS: While looking for predictors of revision surgery due to re-stenosis, instability or same/adjacent segment disease none of these were found. Within our cohort no significant differences concerning demographic, peri-operative and radiographic data of patients with or without revision wer noted. Patients, who needed revision surgery were older but slightly healthier while more likely to be male and smoking. Surprisingly, significant differences were noted regarding the distribution of intraoperative and early postoperative complications among the 6 main surgeons while these weren’t obious within the intial index group of late revisions. Show more

Keywords: Lumbar spinal stenosis, claudication, treatment options, lamiotomy, fusion, revision

DOI: 10.3233/THC-223389

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1423-1434, 2022

Authors: Alqahtani, Nasser M. | Alqahtani, Ali Fahed | Zarbah, Mohammad A. | Alqahtani, Saeed M. | Shukla, Anuj Kishor | Kulkarni, Manisha Mangesh

Article Type: Research Article

Abstract: BACKGROUND: The prime concern of an implant-supported prosthesis (ISP) is to maintain an optimal proximal contact tightness, which further maintains arch integrity, improves masticatory effectiveness, and minimizes peri-implantitis. OBJECTIVE: To investigate the loss of proximal contact tightness between single tooth implant-supported prosthesis and the adjacent natural teeth. METHODS: Forty patients treated by a single mandibular first molar ISP, aged between 18–50 years were selected. All were randomly allocated in Group I and Group II. Group I, 20 subjects who have received ISP without an insertion of Essix retainer, and Group II patients received …an insertion with Essix retainer. The groups were subdivided into Subgroup A, B, and Subgroup C, D, in which A and C are control groups. To measure the tightness at proximal contact points, a digital force analyzer was used. Proximal contact tightness (PCT) was measured immediately after the placement of the prosthesis, 3 months, 6 months, and 1-year follow-up respectively, and the PCT values at end of 1 year were statistically evaluated. Statistical analysis was done, mean and standard deviation was calculated by independent sample t -test wit p < 0.05 as a statistically significant value. RESULTS: In Group I, towards the end of 1 year, 2.09 N (65.5%) and 1.50 N (53.1%) loss of PCT were found on mesial and distal contact areas respectively. In Group II, loss of PCT at mesial contact area was 0.87 N (28.9%) and at distal contact area was 1.77 N (53.3%), which is significantly less compared with the non-usage of Essix retainer (p < 0.05). CONCLUSION: The usage of Essix retainer, PCT increases especially on the mesial contact area. The frequency of contact loss was decreased. Thus, to minimize the loss of proximal contact the usage of Essix retainer is recommended. Show more

Keywords: Proximal contact loss, implant supported prosthesis (ISP), contact area, digital force analyzer

DOI: 10.3233/THC-220028

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1435-1442, 2022

Authors: Cerón-Zamora, Eduardo | Scougall-Vilchis, Rogelio José | Lara-Carrillo, Edith | Contreras-Bulnes, Rosalía | Robles-Bermeo, Norma Leticia | Mendoza-Rodríguez, Martha | Medina-Solís, Carlo Eduardo | Maupomé, Gerardo

Article Type: Research Article

Abstract: BACKGROUND: Adverse effects can occur during orthodontic treatment. OBJECTIVE: To evaluate the relationship between prevalence and severity of enamel demineralization using a laser-fluorescence device, with length of orthodontic treatment time. METHOD: A cross-sectional study was conducted in 60 patients in a university orthodontic clinic. A clinical examination to establish demineralization at four sites on each tooth (premolar to premolar) was performed using the DIAGNOdent pen. The dependent variable was enamel demineralization, from which the prevalence (at least one affected site), extension (percentage of affected teeth) and adjusted average (average of the mean DIAGNOdent …values per tooth) were calculated. The length of time for orthodontic treatment was determined in months. Various sociodemographic and clinical covariates were included. RESULTS: Average number of months under orthodontic treatment was 26.37 ± 24.81 months. Prevalence of enamel demineralization was 80.0%, its extension was 21.9% ± 17.2 and adjusted average of DIAGNOdent values was 6.09 ± 1.75. By quadrant, the teeth most affected were 14 (34.4%), 24 (25.0%), 31 (30.2%) and 44 (33.3%). No significant relationship (p > 0.05) was observed between enamel demineralization and length of time under orthodontic treatment. CONCLUSIONS: A high prevalence of dental demineralization was observed. In this sample, no relationship was observed between months under treatment and dental demineralization, or with other variables included in the study. Show more

Keywords: Oral health, dental demineralization, orthodontic treatment, DIAGNOdent

DOI: 10.3233/THC-220039

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1443-1452, 2022

Authors: Dragan, Irina F. | Wright, Tanya | Holtzman, Lucrezia Paterno | Ausenda, Federico | Malik, Umer | Al-hamoudi, Nawwaf | Karimbux, Nadeem | Alasqah, Mohammed

Article Type: Research Article

Abstract: BACKGROUND: The natural Omega-3 lipids in the OADM serve to reduce inflammation. Preliminary results in a human model reported no adverse events and favorable healing and esthetic outcomes. OBJECTIVE: The primary objective of this animal model study was to histologically evaluate the use of Omega-3 piscine acellular dermal matrix (OADM) as a soft tissue alternative in surgically created mucogingival defects. METHODS: Bilateral maxillary canines in 6 adult beagle dogs were randomly assigned to the test (OADM) and control sub-epithelial connective tissue graft (SCTG) groups. Dehiscence defects 4 × 6 mm …were created surgically on the buccal surfaces. The OADM/SCTG were placed to completely cover the root surface to the level of the cemento-enamel junction and sutured with resorbable sling sutures. The gingival flap was repositioned to cover the grafts. At two months follow-up, the dogs were sacrificed, and block samples were retrieved, including the whole canine and periodontium. The histological outcomes were evaluated using qualitative analysis. RESULTS: The qualitative histological analysis revealed the oral, sulcular and junctional epithelium had healed with normal appearance on both test and control sites. None of the test (OADM) samples presented with any foreign body reaction. CONCLUSION: The use of this new piscine xenograft resulted in minimal complications and the attachment apparatus healed normally. Show more

Keywords: Acellular dermal matrix, mucogingival defects, connective tissue graft, xenograft, dentistry

DOI: 10.3233/THC-220068

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1453-1461, 2022

Authors: Wu, Keqing | Wang, Hongmei | Wang, Yujue | Duan, Shengbao | Gao, Xin

Article Type: Research Article

Abstract: BACKGROUND: Precise classification of incomplete antibody reactants (IAR) in the Coombs test is the primary means to prevent incompatible blood transfusions. Currently, an automatic and contactless method is required for accurate IAR classification to avoid human error. OBJECTIVE: We present an ensemble learning algorithm that integrates five convolutional neural networks and the least absolute shrinkage and selection operator (LASSO) regression algorithm into an IAR intensity classification model. METHODS: A dataset including 1628 IAR and corresponding labels of IAR intensity categories ((-), (1+), (2+), (3+), and (4+)) was used. We trained the ensemble model …using 1302 IAR and validated its performance using 326 IAR. The optimal ensemble model was used to assist immunologists in classifying IAR. The chord diagrams based on the human-machine interaction were established. RESULTS: The ensemble model achieved 98.8%, 98.4%, 99.7%, 99.5%, and 99.4% accuracies in the (-), (1+), (2+), (3+), and (4+) categories, respectively. The results were compared with those of manual classification by immunologists (average accuracy: 99.2% vs. 75.6%). Using the model, all three immunologists achieved increased accuracy (average accuracy: + 8.4%). CONCLUSIONS: The proposed algorithm can thus effectively improve the accuracy and efficiency of IAR intensity classification and facilitate the automation of haemolytic disease screening equipment. Show more

Keywords: Antibodies, Coombs test, neural network, least absolute shrinkage and selection operator (LASSO), blood transfusion

DOI: 10.3233/THC-213621

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1463-1474, 2022

Authors: Peng, Quchen | Yan, Yunqi | Qian, Lijun | Suo, Shiteng | Guo, Yi | Xu, Jianrong | Wang, Yuanyuan

Article Type: Research Article

Abstract: BACKGROUND: The incidence of liver tumors is among the top three in China. The treatments of benign and malignant tumors are different. Accurate diagnosis plays an important role in guiding the treatment of tumors. OBJECTIVE: The aim of this study is to solve the following: (1) blurred boundary between the liver tumor and other organs causes incorrect segmentation of liver tumor boundaries; (2) large difference in tumor size and the diversity in texture and grayscale are major challenges in liver tumor classification tasks. METHODS: Firstly, the liver tumor is segmented from the original …CT images by a tumor segmentation network, UNet++ with fusion loss and atrous spatial pyramid pooling (FLAS-UNet++). The proposed segmentation method can solve the problem of tumor edge segmentation error by learning the tumor edge information. Secondly they are adaptively cropped according to the tumor volume to reduce the over-fitting and over-sensitivity of the deep network. Thirdly an improved Dense Block is designed to pay more attention to the changes in grayscale and texture between benign and malignant tumors. Finally, the features extracted from the network combined with tumor volume, patient’s sex and age, are sent to a classifier for diagnosis. RESULT: Liver tumor segmentation results show that the dice, HD95 reached 71.9%, 12.1 mm, respectively. The classification results show that the accuracy, specificity, sensitivity and area under curve reached 82.4%, 79.8%, 84.4%, 87.5%, respectively. The segmentation and classification results are both better than other’s methods and mainstream networks. CONCLUSIONS: In order to solve existing problems of liver tumor CT image classification methods, our method realizes the accurate segmentation and classification of liver tumors in CT images and has important clinical application value. Show more

Keywords: Liver CT image, liver tumor segmentation, FLAS-UNet++, liver tumors classification, IDenseNet

DOI: 10.3233/THC-213655

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1475-1487, 2022

Authors: Zou, Tengyue | Huang, Haojun | Huang, Xuanyu | Chen, Jialun | Pan, Xiaodong | Xin, Jiawei

Article Type: Research Article

Abstract: BACKGROUND: The injury of the knee joint is found to be directly related to the fatigue caused by excessive exercise. Many previous studies used wearable devices to measure the angle of knee joint during activities, but did not pay enough attention to the load of knee joint related to the fatigue degree of it. OBJECTIVE: A wearable embedded system was designed to sense the motion state and load of knee joint and uses the sensoring data to estimate and predict the fatigue degree of knee joint during exercise in real time, so as to prevent it …from being injured. METHODS: An economical wearable system is designed to measure the parameters of the knee joint during exercises. Then the warning message and recommended healthy lasting time are able to be sent to users to avoid excessive exercise. 24 healthy volunteers aged 20–25 years were involved in the experiments. Two famous evaluation scales for knee joint from Department of Orthopedics (Lysholm score and IKDC score) were adopted to evaluate the protective effect. RESULTS: After 14 days of the first stage testing, all the participants with wearable devices reported healthy knee joint state to verify the effectiveness of the system. For the second stage, the testing group equipped with wearable warning devices did not receive obvious change in the two scales. However, Lysholm score of control group dropped by at least 7.4 and IKDC score dropped by at least 11.1 which were significantly reduced. CONCLUSION: Only using human perception to prevent knee joint fatigue had a risk of failure while the designed wearable system could protect the knee successfully from injuries during exercises, such as running, badminton, table tennis and basketball. Moreover, female gender and a high BMI value may be two factors that increase the risk of knee injuries during sports. Show more

Keywords: Knee joint, fatigue, injury, wearable device, exercise

DOI: 10.3233/THC-213579

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1489-1502, 2022

Authors: Lingampally, Pavan Kalyan | Doss, Arockia Selvakumar Arockia | Kadiyam, Vikram Reddy

Article Type: Research Article

Abstract: BACKGROUND: This article examines a dynamic wearable assistive device for individuals suffering from pain in the neck. As a part of the clinical treatment, static braces/cervical collars are suggested, however, these collars aid the person in maintaining the upright position of the head but restrict the head motion to a single configuration. To address this problem, a dynamic wearable assistive cervical collar is fabricated based on human anatomical head/neck data. OBJECTIVE: The objective of this study is to observe the strain acting on the neck surface muscles for bending and compression neck movements with and without …the neck brace using a strain sensor. METHODS: To evaluate the performance of this device, experimental trials were conducted on test subjects to find out the angular tilt of the head with the device worn using the cervical range of motion (CROM) device. In addition, a neck surface muscle strain study is also conducted using strain sensors to investigate the strain produced while using the wearable assistive device. The strain on the neck surface muscle is measured using NI-9236 strain DAQ (data acquisition system). In this experimental study, a group of aged individuals with minor neck pain were recruited to study the head/neck movements. RESULTS: It was found that by using the proposed assistive device, test subjects were able to mimic 65% of human head/neck movements like flexion, extension, lateral bending, and rotation, and the strain generated from the neck surface muscle was minimal. CONCLUSION: The results show that using the designed assistive device reduced the strain on neck surface muscle, and strain obtained is within the range of 40 × 10 - 6 to 80 × 10 - 6 , and may aid in recovery of the individuals suffering with neck pain. Show more

Keywords: Neck surface muscle strain, cervical collar, parallel manipulator, dropped head syndrome, active range of motion

DOI: 10.3233/THC-220101

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1503-1513, 2022

Authors: He, Dong-Cheng | Zhu, Zhi-Jian | Zhang, Xiao-Ye | Zhang, Yan | Hong, Jun | Shi, Ting-Ting | Han, Ji-Hua

Article Type: Research Article

Abstract: BACKGROUND: Cervical cancer is a common gynecological cancer among women worldwide. OBJECTIVE: To determine the effects of 6 MV and 10 MV volumetric-modulated arc therapy (VMAT) photon beams on the target volume (TV) planning and critical organs in cases of cervical cancer. METHODS: Fifty patients with carcinoma of the cervix who underwent radiotherapy were selected. The transverse diameter (T) of the cross section of the upper edge of the sacroiliac joint on computerized tomography (CT) images of the patients was measured, and the mean value was calculated as 34 cm. All patients were divided into two …groups: Group A (T < 34 cm) and Group B (T > 34 cm). The VMAT plans were generated using 6 MV and 10 MV plans separately. The prescription dose was 47.5 Gy, and the daily dose was 1.9 Gy. RESULTS: In Group A, the planning target volume (PTV) dose assessment parameters of 6 MV and 10 MV plans and their homogeneity and conformity indices were not statistically significantly different. A significant difference was observed between the 6 MV and 10 MV plans for the PTV dose assessment parameters and the homogeneity index of the plans for Group B. The monitor units (MUs) of the 10 MV plans were lower than in the 6 MV plans in both Groups A and B, and the difference was statistically significant. The assessment parameter V 40 Gy of both the rectum and bladder in the 6 MV plans was smaller than the corresponding parameter in the 10 MV plans in Group A; in Group B, the assessment parameter V 50 Gy of the rectum in the 10 MV plans was smaller than in the 6 MV plans. CONCLUSION: When T < 34 cm, 6 MV energy is more suitable for the external irradiation of cervical cancer. When T > 34 cm, 10 MV energy is more suitable for cervical cancer radiotherapy. Therefore, 10 MV should be considered for patients with a large abdominal size. Show more

Keywords: Volumetric-modulated arc therapy, cervical cancer, transverse diameter, 6 MV, 10 MV

DOI: 10.3233/THC-213617

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1515-1523, 2022

Authors: Fu, Wen-Sheng | Song, Yi-Cun | Wu, Bao-Ai | Qu, Chen-Huan | Zhao, Jin-Feng

Article Type: Research Article

Abstract: BACKGROUND: Children with cerebral palsy (CP) have disorders of posture and movement and which can limit physical activities such as walking OBJECTIVE: This study aims to investigate the effectiveness of virtual reality (VR) combined with robot-assisted gait training (RAGT) on walking ability in children with CP and clarify the most effective degree of weight reduction. METHODS: Sixty CP children were recruited and randomly allocated into four different groups. The control group received conventional physical therapy (n = 15), and task groups performed VR combined with RAGT with 15% (Group A, …n = 15) /30% (Group B, n = 15) /45% (Group C, n = 15) weight loss. All participants were given 50 min of therapy per session four times a week for 12 weeks and were assessed pre-and post-test with the surface electromyography (EMG), the Modified Ashworth Scale, the Gross Motor Function Measure (GMFM) dimension E and D, and Six-Minute Walking Test (6-MWT). RESULTS: All indicators had improved significantly in each group after the intervention (P < 0.05). The result of our study demonstrated that the more effective impacts of VR combined with RAGT on walking ability compared to the control group (P < 0.05), and 30% of weight loss had the best improvement in CP children (P < 0.01). CONCLUSIONS: VR combined RAGT can effectively improve walking ability in children with CP, especially when the weight loss is 30%. Show more

Keywords: Virtual reality, robot-assisted gait, cerebral palsy, walking ability

DOI: 10.3233/THC-212821

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1525-1533, 2022

Authors: Owida, Hamza Abu | Al-Nabulsi, Jamal | Ma’touq, Jumana | Al-Naami, Bassam | Alnaimat, Feras

Article Type: Short Communication

Abstract: BACKGROUND: Drawing blood from the fingertips for glucose testing is painful and likely to cause tissue damage over time. Earlobes are an alternative site for glucose measurement. OBJECTIVE: This work aims to validate the earlobe as an alternate test site for blood glucose testing by demonstrating valid and reliable statistically significant differences between the earlobes and standard reference sites. METHODS: Blood glucose concentrations from 50 volunteers were measured and statistically analysed from the reference sites (forearm and fingertip) and earlobe. The analysis included: 1) one-way analysis of variance (ANOVA), 2) regression analysis, 3) …Bland Altman analysis, and 4) Clarke Error Grid analysis. RESULTS: The results indicated that there is no statistically significant difference between the three blood glucose-testing methods. For the forearm-earlobe and fingertip-earlobe, all measurements were grouped around the mean of 3.7 ± 1.96 SD and 2.96± 1.96 SD, respectively. Error grid analysis showed > 97% of all earlobe and references measurements fell in Zones A and B and were in the clinically acceptable level. CONCLUSIONS: The results have shown that the earlobe is a valid substitute for blood glucose measurements. Show more

Keywords: Blood glucose testing, earlobe, fingertip, forearm, descriptive statistical analyses

DOI: 10.3233/THC-220033

Citation: Technology and Health Care, vol. 30, no. 6, pp. 1535-1541, 2022