Technology and Health Care - Volume 31, issue 6

Authors: Lee, Seung Cheol | Lee, Gang Hyun | Lee, Tae Young | Park, Sang Yoong

Article Type: Research Article

Abstract: BACKGROUND: Cardiac output (CO) decreases on reversing the patient’s position to the prone position. Estimated continuous cardiac output (esCCO) systems can noninvasively and continuously monitor CO calibrated by patient information or transesophageal echocardiogram (TEE). OBJECTIVE: To compare the accuracy, precision, and trending ability of two calibration methods of CO estimation in patients in prone position. METHODS: The CO estimates calibrated by TEE (esT) and patient information (esP) of 26 participants were included. CO was collected at four time points. The accuracy and precision of agreement were evaluated using the Bland-Altman method. A four-quadrant …plot was used for trending ability analysis. RESULTS: The bias between esP and TEE and between esT and TEE was 0.2594 L/min (95% limits of agreement (LoA): - 1.8374 L/min to 2.3562 L/min) and 0.0337 L/min (95% LoA: - 0.7381 L/min to 0.8055 L/min), respectively. A strong correlation was found between Δ esP and Δ TEE (p < 0.001, CCC = 0.700) and between Δ esT and Δ TEE (p < 0.001, CCC = 0.794). The concordance rates between Δ esP and Δ TEE and between Δ esT and Δ TEE were 91.9% and 97.1%, respectively. CONCLUSION: Despite limited accuracy and precision, esP showed acceptable trending ability. The trending ability of esCCO calibrated by the reference TEE value was comparable with that of TEE. Show more

Keywords: Calibration, cardiac output, prone position, pulse wave analysis, echocardiography, transesophageal

DOI: 10.3233/THC-220520

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2009-2019, 2023

Authors: Hu, Pan | Tao, Liming

Article Type: Research Article

Abstract: BACKGROUND: Various methods exist to intervene with and control myopia, including bifocal lenses, multifocal lenses, pirenzepine, atropine, soft gas-permeable contact lenses and aberration control frame lenses, each with its own advantages and disadvantages. OBJECTIVE: To compare the clinical effectiveness of digital keratoplasty lenses and traditional orthokeratology (OK) lenses in correcting juvenile myopia. METHODS: Sixty-one patients (122 eyes) with an average age of 10.43 ± 1.71 years and with myopia were enrolled from January 2021 to January 2022 in the treatment centre of our hospital. The patients were randomly divided into …two groups. Group I (the experimental group) consisted of 30 patients who were treated with digital corneal shaping (MCT) lenses, while group II (the control group) consisted of 31 patients who were treated with traditional OK lenses. Clinical indicators, such as visual acuity, ocular axis, intraocular pressure, degree of central positioning, naked visual acuity and first-order spotting, were statistically analysed before and after fitting. RESULTS: The naked eye vision of patients using MCT lenses was significantly improved compared with patients who used traditional OK lenses (0.95 ± 0.28 > 0.58 ± 0.25; p < 0.05). Moreover, the risk of primary spot staining was reduced (p < 0.05), intraocular pressure was lower (p < 0.05) and the centre position reached 100% in patients wearing MCT lenses, suggesting that wearing MCT lenses may be more beneficial than wearing traditional OK lenses. CONCLUSION: Compared with traditional OK lenses, MCT lenses reduce the degree of myopia, have significant effects and have the added advantages of safety and reliability. Show more

Keywords: Centre positioning, primary spot staining, orthokeratology contact lens, vision

DOI: 10.3233/THC-220893

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2021-2029, 2023

Authors: Shehri, Hamdan Al | Aedh, Abdullah

Article Type: Research Article

Abstract: BACKGROUND: Monitoring the vital signs of chronic patients with hypertension, asthma, and chronic obstructive pulmonary disease (COPD) aids in disease prevention. OBJECTIVE: This study enhances the patient quality of life while adding to the corpus of information about electronic medical devices. METHOD: The requirements for both the functional and non-functional system architecture were determined and designs were made. Diagrams were used to describe the system’s parts, behaviour, and connections before implementation. RESULTS: Although the project’s development produced a remote monitoring system prototype with outcomes comparable to those of patented and …regarded as reliable devices, CCFHAC is not yet prepared to be considered a fully finished good that can be used to define a person’s health status with absolute certainty. CONCLUSION: This endeavour marks a step in investigating how the Internet of Things might improve the quality of life for Jordanian patients. Show more

Keywords: Arterial hypertension, COPD, asthma, prototype, monitoring system, development, implementation, e-health system

DOI: 10.3233/THC-230534

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2031-2046, 2023

Authors: Zhang, Teng | Wang, Guodong | Li, Qiang | Yan, Pan | Sun, Jijun | Jin, Yun

Article Type: Research Article

Abstract: BACKGROUND: Chronic obstructive pulmonary disease (COPD) causes organic damage as well as anxiety, depression, fear, and other psychological disorders, which seriously affect the quality of life and prognosis of patients and cause a huge economic burden to the family and society. OBJECTIVE: The aim of this study was to investigate the correlation between an imbalance of serum Th1/Th2 indicators and psychiatric depression in elderly patients with COPD and analyze its implications for clinical management. METHODS: From January 2018 to May 2022, 120 elderly patients with COPD treated at our hospital were categorized into …two groups based on the self-rating depression scale (SDS): COPD with depression (SDS score ⩾ 50) and COPD alone (SDS score < 50). Blood gas analysis, pulmonary function, and serum Th1/Th2 index were determined. Receiver operating characteristic (ROC) curves were analyzed to explore the diagnostic value of serum Th1/Th2 ratios for COPD complicated by depression. RESULTS: Compared with the group without depression, the partial pressure of carbon dioxide and COPD assessment test scores were significantly higher, and the oxygenation index, forced expiratory volume in one second (FEV1), and percent predicted FEV1 were significantly lower in the COPD with depression group (P < 0.05). Interleukin (IL)-1β , IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α ) were significantly higher in the COPD with depression group than in the group without depression (P < 0.05). Logistic regression analysis indicated that the imbalance of serum IL-1β , IL-2, IL-6, IL-8, IL-10, and TNF-α was a risk factor for mental depression in elderly patients with COPD. When comparing prognostic indices, the interval before the first onset of clinically noticeable deterioration (CID-C) in the COPD with depression group was noticeably shorter than that in the COPD without depression group; the incidence of CID-C within 6 months was noticeably higher in the COPD with depression group than in the group without depression. CONCLUSION: Elderly patients with COPD and depression had reduced pulmonary function and higher serum Th1/Th2 levels, and an imbalance in serum Th1/Th2 indicators was a potential risk factor for depression. Moreover, elderly patients with COPD and depression were at a higher risk of disease progression and had a worse prognosis. Thus, an imbalance in serum Th1/Th2 indicators is a potential prognostic factor for evaluating depression in patients with COPD. Show more

Keywords: Th1/Th2, imbalance, COPD, depression, prognosis

DOI: 10.3233/THC-230665

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2047-2058, 2023

Authors: Qin, Qin | Han, Xu | Li, Hui | Zhou, Shui-Ying | Wang, Cai-Hong | Zhang, Gang-Ling

Article Type: Research Article

Abstract: BACKGROUND: At present, there is no consensus on the required duration of neoadjuvant endocrine therapy (NET), yet there is no consistent conclusion on the factors influencing the efficacy of treatment with breast cancer after prolonged treatment. OBJECTIVE: To explore the effect of prolonged NET on the efficacy of patients with breast cancer and analyze the factors influencing the efficacy of treatment with breast cancer after the treatment duration is prolonged. METHODS: The case histories of 51 patients who were diagnosed with breast cancer and received NET in our hospital from September 2017 to …December 2021 were retrospectively analyzed. All patients received NET for over 12 months. The clinical efficacy and tumor size changes after treatment for six months and 12 months were compared, and the factors influencing the efficacy of treatment with breast cancer after patients’ treatment duration was prolonged were analyzed. RESULTS: (1) Among the 51 patients, the objective remission rate (ORR) of NET, at T = 6 months was 21.6%, and the average tumor size was 15.52 ± 7.30 mm. The ORR of the NET at T = 12 months was 52.9%, and the average tumor size was 13.79 ± 7.43 mm. (2) After the treatment duration was prolonged, the clinical ORRs of patients with estrogen receptor (ER) (+) and progesterone receptor (PR) (+) were significantly higher than that of patients with ER (+) and PR (-) and patients with ER (-) and PR (+), which was (P < 0.05). (3) There was no significant difference between the patients’ axillary lymph node status and the Ki67 expression before treatment and the clinical ORR after prolonged treatment, which was (P > 0.05). CONCLUSIONS: (1) Prolonging the NET duration for patients with breast cancer can improve their clinical ORR and further reduce the tumor size, but patients’ conditions should be closely monitored during the treatment process to prevent the progression of disease due to drug resistance. (2) The expression state of ER or PR may be used as a factor influencing the efficacy of treatment with breast cancer after prolonged treatment. (3) There was no significant effect on the patients’ axillary lymph node status and the Ki67 expression before treatment on the clinical efficacy after prolonged treatment. Show more

Keywords: Breast cancer, hormone receptor-positive, neoadjuvant endocrine therapy (NET), anastrozole

DOI: 10.3233/THC-220443

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2059-2071, 2023

Authors: Akilan, S.S. | Sekar, J. Raja

Article Type: Research Article

Abstract: BACKGROUND: Protection of wireless technology-enabled e-healthcare data transfer over constrained devices of body sensor networks using lightweight security mechanisms is the demand of health sector nowadays. OBJECTIVE: A new secure wireless body sensor network architecture (S-WBSN) with reduced CPU cycles and computational cost is proposed. S-WBSN uses OTP-Q (One-Time Pad-Quasi) and Diffie-Hellman key exchange algorithms for encryption and mutual authentication, respectively. METHODS: To ensure mutual authentication among < WBSN, Local Processing Center (LPC)> and < WBSN, Data Server> components, the Diffie-Hellman key exchange …algorithm is used. Using the S-WBSN architecture, security requirements such as mutual authentication, and privacy preservation thwarting security attacks are perfectly met comparing other security-based research works on healthcare data monitoring. RESULTS: The one-time pad-based quasi-group algorithm is a stream block cipher that operates on the data observed from the sensors of the WBSN. Before transmitting encrypted data, authentication is to be established. CONCLUSION: The proposed system methodology proves to be efficient and consumes fewer CPU cycles. The encryption and decryption processing times are comparatively less than the state-of-the-art approaches. Show more

Keywords: Body area network, secure wireless body sensor networks, one-time pad, quasi-group encryption, Diffie-Hellman key exchange algorithm, Local Processing Centre (LPC)

DOI: 10.3233/THC-220588

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2073-2090, 2023

Authors: Zhou, Deshui | Zhan, Qianqian | Wen, Xin

Article Type: Research Article

Abstract: BACKGROUND: The Healthy China strategy is an important development objective of the 14th Five-Year Plan and Vision 2035 in China, while health service use in rural China has been a weak link in this strategy. OBJECTIVE: Nowadays, people’s health service use will be influenced by digital technology due to the arrival of the Digital Age, and that is the reason why our interest is to discuss the effect of digital life on health service use among rural residents. METHODS: We use the data from the China Family Panel Studies (CFPS) 2020 to examine …the effect of digital life on health service use among rural residents, and we use Instrumental Variables method to control the endogenous problem and use KHB model to discuss the mechanism of this effect. RESULTS: It was found that digital life has increased the health service use among rural residents significantly, and this result has been verified by robust test and Instrumental Variables method. Besides, digital life can increase health service use through the information channel effect and the health literacy effect indirectly. Moreover, digital life has a more significant impact on the residents with low social capital, low physical capital and low social trust, which represents the inclusivity of digital life. CONCLUSION: The results of our paper will be helpful to examine the effect of the digital policy on promoting the health service use in rural China, and our findings will provide evidence of how to use digital life to enhance health service use among rural residents. Based on this, the government should take measures to eliminate the digital divide between urban and rural areas by promoting the level of digital life among rural residents, paying more attention to the digital literacy development among them, and forging ahead toward the great goal of the Healthy China under the Digital Age. Show more

Keywords: Digital life, health service use, health literacy, inclusivity

DOI: 10.3233/THC-220631

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2091-2106, 2023

Authors: Bhatia, Vibha | Vaishya, Rahul O. | Jain, Ashish | Grover, Vishakha | Arora, Suraj | Das, Gotam | Algarni, Youssef A. | Baba, Suheel Manzoor | Khateeb, Shafait Ullah | Saluja, Priyanka | Bavabeedu, Shashit Shetty

Article Type: Research Article

Abstract: BACKGROUND: Evaluation of the working postures and development of new techniques are paramount in reducing the awkward postures and occurrence of musculoskeletal disorders (MSDs). The Kinect sensor, a portable and cost-effective device, appears to be a promising alternative to study work postures. OBJECTIVE: The current study aimed to evaluate the validity of Kinect against the gold-standard instrument (electro-goniometers) for body joint angle measurements. METHODS: A unique software application was developed to measure the critical body joint angles for postural evaluation by using the Kinect’s skeletal tracking feature. The body joint angle data of …ten volunteers were measured simultaneously by both Kinect and electro-goniometers. The validation analysis was conducted in both static and dynamic domains of application. RESULTS: Minimal variation was observed between the two techniques, and the Kinect correlated well for upper-arm joint angles of 45 ∘ , 60 ∘ and 90 ∘ ; lower-arm joint angles of 30 ∘ , 45 ∘ , 60 ∘ , and 90 ∘ ; straight neck position, neck joint angle at maximum possible flexion; straight trunk position, trunk bend angle at full flexion. In dynamic analysis, four out of five ICC values were > 0.75 except for the upper arm. Discrepancies in the results indicated the disapproval of Kinect for only wrist measurements. CONCLUSION: The results of the static and dynamic studies gave a sufficient basis to consider the Kinect tool as an alternative to contemporary posture-based ergonomic evaluation methods. Show more

Keywords: Postures, kinect, motion analysis, joint angles, musculoskeletal disorders, ergonomics, electro-goniometers

DOI: 10.3233/THC-220727

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2107-2123, 2023

Authors: Li, Feng | Fan, Bao-Han | Shen, Tong-Tong | Cheng, Zi-Ping | An, Cheng-Ling | Li, Zhao-Wei | Fan, Zhen | Fang, Chun-Mei | Liu, Ya-Yuan | Zhang, Jun

Article Type: Research Article

Abstract: BACKGROUND: Pacing is the most effective and dependable method for treating complete atrioventricular block (AVB). OBJECTIVE: The purpose of this study is to investigate the use of His bundle pacing (HBP) in patients with atrioventricular block. METHODS: Patients who underwent HBP or right ventricular pacing (RVP) were enrolled and divided into two groups: the HBP group and the RVP group, respectively. We compared baseline clinical data, fluoroscopy duration, operation duration, pacing electrode parameters during the operation or follow-up, baseline QRS duration, and pacing QRS duration. RESULTS: HBP was attempted in …48 patients and was successful in 34 patients who were included in the HBP group. In addition, 30 RVP patients were included in the RVP group. Fluoroscopy duration and operation duration were significantly longer in the HBP group compared to the RVP group. Compared to the RVP group, the HBP group had a higher pacing threshold, a lower R wave amplitude, and a shorter pacing QRS duration. At 6 months of follow-up, the pacing threshold remained higher, the R wave amplitude was significantly lower, and the end-diastolic diameter of the left ventricle was smaller in the HBP group. CONCLUSION: HBP was safe and effective for atrioventricular block despite the longer fluoroscopy and operation duration in the HBP group when compared to the RVP group. Show more

Keywords: Atrioventricular block, his bundle pacing, left ventricular remodeling, right ventricular pacing

DOI: 10.3233/THC-220746

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2125-2134, 2023

Authors: Yuan, Wen-Xiu | Li, Zheng-Fang | Li, Ya | Dong, Ting | Yang, Man-Rong | Yang, Ren-Mei

Article Type: Research Article

Abstract: BACKGROUND: Early postoperative activity, an important part of enhanced recovery after surgery (ERAS) in clinical practice, is considered to be a significant component of postoperative quality care. OBJECTIVE: To evaluate the effect of a standardized early activity program on ERAS in patients after surgery for pulmonary nodules. METHODS: A total of 100 patients with pulmonary nodules who underwent a single-port thoracoscopic segmental resection or a wedge resection of the lung were selected for the present study. These patients were divided into a control group (n = 50) and …an intervention group (n = 50) by a digital random method. The patients in the control group received routine perioperative nursing intervention for thoracic surgery due to lung cancer, and those in the intervention group received an intervention using a standardized early activity program along with routine nursing care. The evaluation indexes in both groups included postoperative indwelling time of the closed chest drainage tube, the time to the first off-bed activity after surgery, the incidence of postoperative pulmonary complications, the length of postoperative hospital stay, and patient satisfaction. RESULTS: The postoperative indwelling time of the closed chest drainage tube and the time to the first off-bed activity in the intervention group were less than in the control group. The length of the postoperative hospital stay in the intervention group was shorter than in the control group, and the patient satisfaction in the intervention group was higher than in the control group. The difference for these evaluation indexes were statistically significant (P < 0.05). The number of cases of postoperative complications was four and eight in the intervention group and the control group, respectively, and the difference was not statistically significant (P > 0.05). CONCLUSION: A standardized early activity program is a safe and effective nursing measure for ERAS for patients after surgery for pulmonary nodules, which can promote earlier off-bed activity, shorten the postoperative indwelling time of the closed chest drainage tube, shorten the postoperative hospital stay, improve patient satisfaction, and promote rapid recovery. Show more

Keywords: Early activity program, pulmonary nodules, postoperative, enhanced recovery after surgery, single-port thoracoscopy

DOI: 10.3233/THC-220843

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2135-2143, 2023

Authors: Ademović, Enisa | Čakarić, Mirza | Durak-Nalbantić, Azra | Džubur, Alen | Hodzić, Enisa | Mahmutović, Sabina | Aganović, Izeta | Dilić, Mirza | Begić, Alden | Jahić, Elmedina | Begić, Edin | Hamzić-Mehmedbašić, Aida | Rebić, Damir | Gojak, Refet | Badnjevic, Almir | Čavaljuga, Semra

Article Type: Research Article

Abstract: BACKGROUND: Atherosclerotic cardiovascular diseases (ASCVD) are still the leading cause of morbidity and mortality in Bosnia and Herzegovina. Elevated LDL-cholesterol is established as a strong marker of cardiovascular risk. Some researchers believe that measuring triglyceride levels gives a good assessment of the residual risk for ASCVD besides the measurement of LDL-cholesterol. OBJECTIVE: The aim of this study was to evaluate the overall prevalence of major risk factors for ASCVD, lipid profile and 10-year fatal cardiovascular risk using the HeartSCORE scoring system. Further, we want to evaluate the prevalence and relationship between elevated triglyceride levels and high …10-year fatal cardiovascular risk calculated as a HeartSCORE. METHODS: This is a cross-sectional study conducted on 832 volunteers aged between 40 and 65 years without a diagnosis of diabetes and without known preexisting cardiovascular disease, as a part of the preventive program conducted at the Family Medicine office. Data were collected for ASCVD risk factors and lipid panel (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides). 10-year fatal cardiovascular risk was calculated using the HeartSCORE scoring system for countries with high CV risk. RESULTS: Among 832 participants included, 565 (67.9%) were female, and 267 (32.1%) were male. We found high prevalence of hypertension (27.7%), obesity (32.2%), and smoking (36.2%). All lipid parameters, except HDL-C, were not optimal. Only 17.4% of participants had normal estimated HeartSCORE risk, while more than one-third (33.9%) had high or very high estimated HeartSCORE risk. Although we found a higher percentage of participants with elevated triglycerides in groups with higher HeartSCORE, there was a very weak positive correlation between values of triglycerides and the 10-year risk of a fatal cardiovascular event (r = 0.249, p = 0.000). CONCLUSION: The high prevalence of major known risk factors and high estimated HeartSCORE risk indicate a high overall risk for ASCVD in the sample. The proportion of participants with elevated triglycerides was increased in patients with high HeartSCORE risk what implicates importance of triglyceride measurement. Show more

Keywords: Risk factor, triglycerides, cardiology, HeartScore

DOI: 10.3233/THC-220874

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2145-2153, 2023

Authors: Al-Jazaeri, Ayman | Alhammad, Abdulaziz | Almuhaideb, Mana | Alyahya, Ahmed | Al-Jazaeri, Sarah | Alyami, Fahad

Article Type: Research Article

Abstract: BACKGROUND: A multi-pod catheter (MPC) is a large drainage catheter that can house multiple smaller retractable (MPC-R) and deployable catheters (MPC-D) within the body. OBJECTIVE: The drainage capabilities and resistance to clogging of a novel MPC have been assessed. METHODS: The drainage capabilities are evaluated by placing the MPC in a bag of either a non-clogging (H 2 O) or clogging medium. The results are then compared to matched-size single-lumen catheters with either a close (CTC) or open tip (OTC). The means of five test runs were used to measure …drainage rate, maximum drained volume (MaxDV), and time to drain the first 200 mL (TTD200). RESULTS: In the non-clogging medium, MPC-D had a slightly higher MaxDV than MPC-R, and higher flow rate than CTC and MPC-R. Moreover, MPC-D needed less TTD200 than MPC-R. In the clogging medium, MPC-D had a higher MaxDV than CTC and OTC, higher flow rate, and faster TTD200 than CTC. However, comparison with MPC-R showed no significant difference. CONCLUSION: The novel catheter may offer superior drainage compared to the single-lumen catheter in a clogging medium, implying various clinical applications, particularly when clogging is a potential risk. Further testing may be required to simulate various clinical scenarios. Show more

Keywords: Catheter, drainage, peritoneal dialysis, foley, ventriculoperitoneal shunt

DOI: 10.3233/THC-230015

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2155-2164, 2023

Authors: Li, Yang | Han, Qinglin | Chen, Simeng | Cui, Gaozhi | Bai, Ke | Cui, Linqi

Article Type: Research Article

Abstract: BACKGROUND: The emergency rescue ability of firefighters is particularly important in the event of major disasters or accidents. Therefore, an assessment of the firefighter-training effectiveness is necessary. OBJECTIVE: This paper aims to achieve a scientific and effective assessment of the firefighter-training effectiveness in China. An assessment method based on human factor parameters and machine learning was proposed. METHOD: The model is constructed by collecting the corresponding human factor parameters such as electrocardiographic signals, electroencephalographic signals, surface electromyographic signals, and photoplethysmographic signals through wireless sensors and using them as constraint indicators. For the problems …of weak human factor parameters and high noise proportion, an improved flexible analytic wavelet transform algorithm is used to denoise and extract the corresponding feature values. To overcome the limitations of traditional assessment methods, improved machine learning algorithms are used to comprehensively assess the training effectiveness of firefighters and provide targeted training suggestions. RESULTS: The effectiveness of this study’s evaluation method is verified by comparing it with the expert scoring method and considering firefighters from a special fire station in Xhongmen, Daxing District, Beijing, as an example. CONCLUSION: This study can effectively guide the scientific training of firefighters and the method is more objective and accurate than the traditional method. Show more

Keywords: Firefighters, training-effectiveness assessment, human factor parameters, flexible analytic wavelet transform (FAWT), machine learning

DOI: 10.3233/THC-230071

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2165-2192, 2023

Authors: Ge, Yi | Xia, Jiaqi | He, Chao | Liu, Shuang

Article Type: Research Article

Abstract: BACKGROUND: Head and neck squamous cell carcinoma (HNSCC) is one of the most prevalent neoplasms of malignancy. The pathogenesis of HNSCC is involved in the change of gene expression and the abnormal interaction between genes. OBJECTIVE: The purpose of our research is to find genes that affect the survival time of patients and construct circRNA-lncRNA-miRNA-mRNA network. This paper aims to reveal the development mechanism of HNSCC and provide new ideas for clinical prognosis prediction. METHODS: Transcriptome data were obtained from TCGA and GEO databases. A total of 556 samples were included. We screened the …differentially expressed lncRNAs, circRNAs and mRNAs to predict interactions between lncRNA-miRNA, circRNA-miRNA and miRNA-mRNA. Then, we selected the hub mRNAs to predict the prognosis of patients. RESULTS: We identified 8 hub prognostic mRNAs (FAM111A, IFIT2, CAV1, KLF9, OCIAD2, SLCO3A1, S100A16 and APOL3) by a series of bioinformatics analyses and established the prognostic ceRNA network of 8 mRNAs, 3 miRNAs, 2 circRNAs and 1 lncRNAs according to the targeting relationship by using databases. CONCLUSION: We established the circRNA-lncRNA-miRNA-mRNA gene interaction network in HNSCC. We illuminated the molecular mechanism underlying the gene regulation associated with the pathogenesis of HNSCC and predicted the biomarkers related to prognosis. Show more

Keywords: Head and neck squamous cell carcinoma, ceRNA, bioinformatics, interaction network

DOI: 10.3233/THC-230083

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2193-2212, 2023

Authors: Wang, Mei | Liu, Yali

Article Type: Research Article

Abstract: BACKGROUND: The etiology of early neurological deterioration (END) occurring after intravenous thrombolysis is unclear. OBJECTIVE: To investigate the factors associated with END following intravenous thrombolysis in patients with acute ischemic stroke, and to construct a prediction model. METHODS: We selected a total of 321 patients with acute ischemic stroke, who were divided into two groups: the END group (n = 91) and the non-END group (n = 230). They were compared for their demographics, onset-to-needle time (ONT), door-to-needle time (DNT), related score results, …and other data. The risk factors of the END group were identified using logistic regression analysis, and we constructed a nomogram model using the R software. A calibration curve was used to evaluate the calibration of the nomogram, and we assessed its clinical applicability using decision curve analysis (DCA). RESULTS: In our multivariate logistic regression analysis, we found that four indexes, namely, complication with atrial fibrillation, post-thrombolysis National Institutes of Health Stroke Scale (NIHSS) score, pre-thrombolysis systolic blood pressure (SBP), and serum albumin level, were independent risk factors for END following intravenous thrombolysis in the patients (P < 0.05). We constructed an individualized nomogram prediction model using the above four predictors. The AUC value of the nomogram model was 0.785 (95% CI: 0.727–0.845) after internal validation, and the mean absolute error (MAE) in the calibration curve was 0.011, which indicated that the nomogram model had good prediction value. The decision curve analysis indicated that the nomogram model was clinically relevant. CONCLUSION: The model was found to have excellent value in clinical application and prediction of END. This will be beneficial for healthcare providers to develop individualized prevention measures for END in advance, and thus reduce the incidence of END following intravenous thrombolysis. Show more

Keywords: Early neurological deterioration (END), intravenous thrombolysis, nomogram, prediction model, risk factor

DOI: 10.3233/THC-230140

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2213-2223, 2023

Authors: Wang, Mei | Liu, Yali

Article Type: Research Article

Abstract: BACKGROUND: Patients’ self-efficacy levels are significantly associated with the process of recovery and creating social support in the inpatient recovery setting can help prevent post-stroke depression and anxiety. OBJECTIVE: To explore the current status of factors influencing chronic disease self-efficacy in patients with ischemic stroke, to provide theoretical basis and clinical data for implementing corresponding nursing interventions. METHODS: The study included 277 patients with ischemic stroke who were hospitalized in the neurology department of a tertiary hospital in Fuyang, Anhui Province, China from January to May 2021. Participants for the study were selected …by convenience sampling method. A questionnaire for general information developed by the researcher and the Chronic Disease Self-Efficacy Scale were used for collecting data. RESULTS: The patients’ total self-efficacy score was (36.79 ± 10.89), which was in the middle to the upper level. Results of our multifactorial analysis showed that history of falls in the previous 12 months, presence of physical dysfunction, and cognitive impairment were all independent risk factors for chronic disease self-efficacy in patients with ischemic stroke (P < 0.05). CONCLUSION: Chronic disease self-efficacy in patients with ischemic stroke was at an intermediate to high level. History of falls in the previous year, physical dysfunction, and cognitive impairment were factors influencing patients’ chronic disease self-efficacy. Show more

Keywords: Chronic disease self-efficacy, current situation, influencing factors, stroke

DOI: 10.3233/THC-230145

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2225-2233, 2023

Authors: Li, Jie | Zhang, Yunyun | Gu, Wei | Wang, Tianying | Zhou, Yang

Article Type: Research Article

Abstract: BACKGROUND: The anesthesia machine serves as a vital piece of lifesaving equipment. OBJECTIVE: To analyze incidents of failures in the Primus anesthesia machine and address these malfunctions to reduce recurrence of failure, save maintenance costs, enhance safety, and improve overall efficiency. METHODS: We conducted an analysis on the records pertaining to the maintenance and parts replacement of the Primus anesthesia machines used in the Department of Anaesthesiology at Shanghai Chest Hospital over the past two years to identify the most common causes of failure. This included an assessment of the damaged parts and …degree of damage, as well as a review of factors that caused the fault. RESULTS: The main cause of the faults in the anesthesia machine was found to be air leakage and excessive humidity in the central air supply of the medical crane. The logistics department was instructed to increase inspections to check and ensure the quality of the central gas supply and ensure gas safety. CONCLUSION: Summarizing the methods for dealing with anesthesia machine faults can save hospitals a lot of money, ensure normal hospital and department maintenance, and provide a reference to repair such faults. The use of Internet of Things platform technology can continuously develop the direction of digitalization, automation, and intelligent management in each stage of the “whole life cycle” of anesthesia machine equipment. Show more

Keywords: Internet of things platform, preventive maintenance, Primus anesthesia machine, whole life cycle

DOI: 10.3233/THC-230191

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2235-2242, 2023

Authors: Wang, Fei-Fei | Zhang, Xiao-Nan | Wang, Xiao-Juan

Article Type: Research Article

Abstract: BACKGROUND: Rhabdomyosarcoma (RMS) is a highly malignant tumor that originates from myogenic progenitor cells. OBJECTIVE: To investigate the magnetic resonance imaging (MRI) characteristics of prostate embryonal rhabdomyosarcoma (ERMS). METHODS: We retrospectively analyzed the clinical and MRI imaging data of 9 cases of prostate ERMS that were confirmed pathologically. The patients were aged between 14∼ 49 years with a median age of 27 years, and they all underwent MRI, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI). RESULTS: The MRI scan of the lesions showed an irregular shape, mixed …signals, uneven equal/long T1 signal and an equal/long T2 signal, cystic necrosis in 9 cases and hemorrhage in 6 cases; DWI and ADC images showed a mixed high/low signal, and the tumor parenchyma showed ADC low signal, with an average ADC value of 0.666 × 10 - 3 mm 2 /s. There were 5 cases of DCE-MRI TIC type II and 4 cases of DCE-MRI TIC type I. The average value of Tpeak was 120 s and the average value of MCER was 172.3%. After the enhancement, the signal of tumor enhancement was uneven, and showed patchy and reticular enhancement, however, the cyst degeneration, necrosis area, and hemorrhage focus were not enhanced. There were 3 cases with multiple pelvic lymph nodes and 1 case with multiple bone metastases. CONCLUSION: The MRI manifestations of prostate ERMS have certain characteristics, and the combination of DWI and DCE-MRI are helpful in the diagnosis. Show more

Keywords: Apparent diffusion coefficient, diffusion weighted imaging, dynamic contrast-enhanced MRI, rhabdomyosarcoma

DOI: 10.3233/THC-230192

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2243-2250, 2023

Authors: Pan, Ling | Liu, Wenya | Zhao, Hao | Chen, Bin | Yue, Xuandi

Article Type: Research Article

Abstract: BACKGROUND: MicroRNAs (miRNAs) exert certain functions in the development of several cancers and can be a potential hallmark for cancer diagnosis and prognosis. MiR-191-5p has been proven to have high expression in breast cancer (BC), while its biological role and potential regulatory mechanisms in BC remain an open issue. OBJECTIVE: Bioinformatics was utilized to assay miR-191-5p level in BC tissues and predict its downstream target gene as well as the enriched signaling pathways of the target gene. METHODS: qRT-PCR was carried out to assay miR-191-5p and KLF6 levels in BC cells as well …as miR-191-5p level in blood-derived exosomes from BC patients. Western blot was to examine the expression of proteins linked with cell adhesion, epithelial-mesenchymal transition (EMT), and exosome markers. A dual luciferase reporter assay was utilized to verify the interaction between miR-191-5p and KLF6. Abilities of cell phenotypes of BC cells were detected by CCK8, Transwell, and cell adhesion assay, separately. RESULTS: Upregulated miR-191-5p expression and downregulated KLF6 expression were observed in BC cells. There was a targeting relationship between miR-191-5p and KLF6. MiR-191-5p negatively regulated KLF6 to promote EMT and malignant progression of BC cells. Additionally, we described a dramatically high level of miR-191-5p in the blood exosomes of BC patients. CONCLUSION: MiR-191-5p advances the EMT of BC by targeting KLF6, indicating that miR-191-5p and KLF6 may be new biomarkers for BC. Show more

Keywords: microRNAs, KLF6 protein, breast neoplasms, cell adhesion, epithelial-mesenchymal transition

DOI: 10.3233/THC-230217

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2251-2265, 2023

Authors: Alkhalaf, Mohammad | Zhang, Zhenyu | Chang, Hui-Chen (Rita) | Wei, Wenxi | Yin, Mengyang | Deng, Chao | Yu, Ping

Article Type: Research Article

Abstract: BACKGROUND: Malnutrition is a serious health risk facing older people living in residential aged care facilities. Aged care staff record observations and concerns about older people in electronic health records (EHR), including free-text progress notes. These insights are yet to be unleashed. OBJECTIVE: This study explored the risk factors for malnutrition in structured and unstructured electronic health data. METHODS: Data of weight loss and malnutrition were extracted from the de-identified EHR records of a large aged care organization in Australia. A literature review was conducted to identify causative factors for malnutrition. Natural language …processing (NLP) techniques were applied to progress notes to extract these causative factors. The NLP performance was evaluated by the parameters of sensitivity, specificity and F1-Score. RESULTS: The NLP methods were highly accurate in extracting the key data, values for 46 causative variables, from the free-text client progress notes. Thirty three percent (1,469 out of 4,405) of the clients were malnourished. The structured, tabulated data only recorded 48% of these malnourished clients, far less than that (82%) identified from the progress notes, suggesting the importance of using NLP technology to uncover the information from nursing notes to fully understand the health status of the vulnerable older people in residential aged care. CONCLUSION: This study identified 33% of older people suffered from malnutrition, lower than those reported in the similar setting in previous studies. Our study demonstrates that NLP technology is important for uncovering the key information about health risks for older people in residential aged care. Future research can apply NLP to predict other health risks for older people in this setting. Show more

Keywords: Natural language processing, malnutrition, electronic health records, residential aged care, nursing home

DOI: 10.3233/THC-230229

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2267-2278, 2023

Authors: Ertuğrul, Duygu Çelik | Akcan, Neşe | Bitirim, Yiltan | Koru, Begum | Sevince, Mahmut

Article Type: Research Article

Abstract: BACKGROUND: Diabetes Mellitus (DM) is a significant risk, mostly causing blindness, kidney failure, heart attack, stroke, and lower limb amputation. A Clinical Decision Support System (CDSS) can assist healthcare practitioners in their daily effort and can improve the quality of healthcare provided to DM patients and save time. OBJECTIVE: In this study, a CDSS that can predict DM risk at an early stage has been developed for use by health professionals, general practitioners, hospital clinicians, health educators, and other primary care clinicians. The CDSS infers a set of personalized and suitable supportive treatment suggestions for patients. …METHODS: Demographic data (e.g., age, gender, habits), body measurements (e.g., weight, height, waist circumference), comorbid conditions (e.g., autoimmune disease, heart failure), and laboratory data (e.g., IFG, IGT, OGTT, HbA1c) were collected from patients during clinical examinations and used to deduce a DM risk score and a set of personalized and suitable suggestions for the patients with the ontology reasoning ability of the tool. In this study, OWL ontology language, SWRL rule language, Java programming, Protégé ontology editor, SWRL API and OWL API tools, which are well known Semantic Web and ontology engineering tools, are used to develop the ontology reasoning module that provides to deduce a set of appropriate suggestions for a patient evaluated. RESULTS: After our first-round of tests, the consistency of the tool was obtained as 96.5%. At the end of our second-round of tests, the performance was obtained as 100.0% after some necessary rule changes and ontology revisions were done. While the developed semantic medical rules can predict only Type 1 and Type 2 DM in adults, the rules do not yet make DM risk assessments and deduce suggestions for pediatric patients. CONCLUSION: The results obtained are promising in demonstrating the applicability, effectiveness, and efficiency of the tool. It can ensure that necessary precautions are taken in advance by raising awareness of society against the DM risk. Show more

Keywords: Health informatics, diabetes mellitus, knowledge bases, clinical decision support systems, smart healthcare

DOI: 10.3233/THC-230237

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2279-2302, 2023

Authors: Meng, Yinghui | Du, Zhenglong | Zhao, Chen | Dong, Minghao | Pienta, Drew | Tang, Jinshan | Zhou, Weihua

Article Type: Research Article

Abstract: BACKGROUND: Accurate extraction of coronary arteries from invasive coronary angiography (ICA) images is essential for the diagnosis and risk stratification of coronary artery disease (CAD). OBJECTIVE: In this study, a novel deep learning (DL) method is proposed for automatically extracting coronary arteries from ICA images. METHODS: A convolutional neural network (CNN) was developed with full-scale skip connections and full-scale deep supervisions. The encoder architecture was based on the residual and inception modules to obtain multi-scale features from multiple convolutional layers with different window shapes. Transfer learning was utilized to improve both the initial …performance and learning efficiency. A hybrid loss function was employed to further optimize the segmentation model. RESULTS: The model was tested on a data set of 616 ICAs obtained from 210 patients, composed of 437 images for training, 49 images for validation, and 130 images for testing. The segmentation model achieved a Dice score of 0.8942, a sensitivity of 0.8735, a specificity of 0.9954, and a Hausdorff distance of 6.0794 mm; it could predict arteries for a single ICA frame in 0.2114 seconds. CONCLUSIONS: The results showed that our model outperformed the state-of-the-art deep-learning models. Our new method has great potential for clinical use. Show more

Keywords: Coronary artery disease, invasive coronary angiography, image segmentation, deep learning, convolutional neural network

DOI: 10.3233/THC-230278

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2303-2317, 2023

Authors: Tang, Hui-Wen | Wang, Zha-Gen | Huang, Jia-Hu | Zhang, Guo-Qin | Xu, Yun-Feng | Zheng, Lu-Lu | Li, Ting-Jun

Article Type: Research Article

Abstract: BACKGROUND: Acute appendicitis in children refers to the acute inflammation of the appendix, which accounts for 20% ∼ 30% of cases of acute abdomen in pediatric surgery. OBJECTIVE: This study aimed to establish a decision tree model of complicated appendicitis in children using appendiceal ultrasound combined with an inflammatory index and evaluated its clinical efficacy in pediatric patients. METHODS: A total of 395 children admitted to the Emergency Department of the Shanghai Children’s Hospital from January 2018 to December 2021 and diagnosed with appendicitis by postoperative pathology were retrospectively analyzed. …According to the postoperative pathology, the children were divided into a complicated and non-complicated appendicitis group, respectively. Routine laboratory inflammatory indicators, including white blood cell count, N(%), neutrophil (Neu) count, Neu/lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin were collected from the two groups. Collecting data on ultrasound examination of the appendix includes whether the appendix diameter is thickened, whether the echogenicity of the mesenteric rim surrounding the appendix is enhanced, whether there is rich blood supply in the appendix, and whether there are fecaliths in the appendix lumen. The risk factors for complicated appendicitis were screened out by univariate and multivariate logistic regression analyses, the binary logistic regression prediction and decision tree models were established, respectively, and the receiver operating characteristic (ROC) curve was used to verify the accuracy of the two prediction models. RESULTS: Binary logistic regression analysis showed that CRP, NLR, the presence of an appendicolith, and peripheral retina echo enhancement were independent risk factors for complicated appendicitis in children (P < 0.05). The decision tree model had an overall accuracy of 79%, an area under the ROC curve (AUC) of 0.809 (95% confidence interval [CI] 0.780–0.865), and sensitivity and specificity of 71.3% and 77.7%, respectively. The logistic regression model had an overall accuracy of 74.9%, an AUC value of 0.823 (95% CI, 0.765–0.853), a sensitivity value of 80.3%, and a specificity of 71.8%. CONCLUSION: This predictive model, based on ultrasound of the appendix combined with inflammatory markers, provides a useful method to assist pediatric emergency physicians in diagnosing childhood appendicitis. The decision tree model reflected the interaction of various indexes, and the model was simple, intuitive, and effective. Show more

Keywords: Complicated appendicitis, appendiceal ultrasound, inflammatory index, decision tree model, children

DOI: 10.3233/THC-230285

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2319-2329, 2023

Authors: Tan, Pei-Ze | Li, Shang-Lun | Zhang, Qing | Liu, Xiang | Tang, Feng | Liu, Chang-Le

Article Type: Research Article

Abstract: BACKGROUND: Myocardial infarction (MI) is a series of clinical syndromes caused by ischemic necrosis of myocardial cells that results from severe and persistent acute ischemia of the myocardium due to a dramatic reduction or interruption of coronary blood supply. OBJECTIVE: In this study, we analyzed the role of pre-hospital emergency services in the rescue of patients suffering from ST-elevation myocardial infarction (STEMI). METHODS: We enrolled 229 patients with STEMI who were transported to the Second Hospital of Tianjin Medical University by Tianjin Emergency Center from January 2017 to June 2021. With the development …of the pre-hospital emergency medical system in Tianjin (2019) as the time node, the patients were divided into three groups: A (87 cases), B (68 cases), and C (74 cases). The onset-to-call time, emergency response time, door-to-balloon (D-B) time, first medical contact to balloon dilation (FMC-B) time, symptom onset-to-balloon dilation (S-B) time, proportion of patients receiving prehospital administration of bispecific antibodies, number of days hospitalized, total hospitalization expenses, and in-hospital incidence and mortality of heart failure were compared between the three groups. RESULTS: Group C differed significantly from group A and group B in terms of emergency response time, D-B time, FMC-B time, S-B time, the proportion of patients who received prehospital administration of bispecific antibodies, and the number of days of hospitalization (P < 0.05), but there was no significant difference in the onset-to-call time (P > 0.05) and the decreasing trends in the in-hospital incidence and mortality of heart failure were not statistically significant (incidence: 9.50% vs. 13.23%, 12.64%; mortality: 4.10% vs. 5.90%, 4.60%). CONCLUSION: A reasonable pre-hospital emergency medical network layout and resource investment, as well as the strengthening of the interface between pre-hospital and in-hospital medical emergencies and pre-hospital standardized rescue, can shorten the emergency response time and the total ischemic time in patients with chest pain, which can improve patient prognosis to a certain extent. Show more

Keywords: Chest pain center, door-to-balloon time, emergency response time, pre-hospital medical emergency, ST-elevation myocardial infarction

DOI: 10.3233/THC-230353

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2331-2338, 2023

Authors: Peng, Jigui | He, Changjin | Yan, Haiqiang | Zhou, Wang

Article Type: Research Article

Abstract: BACKGROUND: Although it has been established that cancer-associated fibroblasts (CAFs) facilitate tumor development, the relationship between CAFs and the prognosis of patients with lung adenocarcinoma (LUAD) has not been extensively explored. OBJECTIVE: This study was formulated to investigate the prognostic value of CAF-related genes in LUAD. METHODS: Differential analysis was carried out with TCGA-LUAD dataset as the training set. By overlapping differentially expressed genes (DEGs) with genes associated with CAF, CAF-related DEGs specific to LUAD were obtained. A prognostic risk model was constructed by Lasso and Cox regression analysis, and samples were grouped …according to median risk score. The efficacy of the model was accessed through survival curve and receiver operating characteristic curve (ROC) analyses, with the validation set for verification. Risk score combined with clinical factors was utilized for Cox analysis to verify the independence of the model, and a nomogram was drawn. GSEA was performed on different risk groups. Immunologic infiltration and tumor mutational burden were assessed in different risk groups. RESULTS: Eleven feature genes including DLGAP5, KCNE2, UPK2, NPAS2, ARHGAP11A, ANGPTL4, ANLN, DKK1, SMUG1, C16orf74, and ACAD8 were identified, based on which a prognostic model was constructed. Risk score could predict the prognosis of LUAD patients and could be an independent prognostic factor for LUAD patients. GSEA outcomes displayed significant enrichment of genes in the high-risk group in the P53 SIGNALING PATHWAY. In comparison to the low-risk group, the high-risk group exhibited a decreased degree of immune infiltration and an elevated level of tumor mutational burden. CONCLUSION: An 11-gene model was constructed based on CAF-related genes to predict LUAD prognosis. This model represented an independent prognostic factor for LUAD. Show more

Keywords: Lung adenocarcinoma, fibroblasts, prognostic risk model, immune infiltration, tumor mutational burden

DOI: 10.3233/THC-230453

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2339-2354, 2023

Authors: Zhang, Xiao-Hua | Zhang, Xin | Feng, Hong-Ye | Cao, Chang-Chun | Lv, Hui-Lan | Wang, Yu-Long | Ren, Li-Jie

Article Type: Research Article

Abstract: BACKGROUND: At present, the pathogenesis of post-stroke insomnia (PSI) is still inconclusive. OBJECTIVE: To explore the changes and significance of serum cholecystokinin-8 (CCK-8), substance P (SP), and 5-hydroxytryptamine (5-HT) in patients with PSI. METHODS: Ninety-one patients with stroke were selected as the research subjects, and according to the score of the Athens Insomnia Scale (AIS), they were divided into the insomnia group and the non-insomnia group. The serum levels of CCK-8, SP, and 5-HT in the two groups were compared to explore their relationships with PSI. RESULTS: Among the 91 …patients, 56 were in the insomnia group and 35 were in the non-insomnia group, and the incidence of insomnia was 61.5%. There was no significant difference in the serum levels of CCK-8, SP, and 5-HT between the two groups (P = 0.696, 0.980, and 0.809, respectively). One-way analysis of variance showed that there was no significant correlation between the serum levels of CCK-8, SP, 5-HT, and the AIS score (P = 0.7393, 0.9581, and 0.5952, respectively). CONCLUSION: The incidence of PSI was relatively high, but it could not be proved that CCK-8, SP, and 5-HT were involved in the pathogenesis of PSI. There might exist other neurotransmitters involved in the pathophysiological process of PSI, which should be further explored. Show more

Keywords: Stroke, insomnia, cholecystokinin-8, serum substance P, 5-hydroxytryptamine

DOI: 10.3233/THC-230506

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2355-2361, 2023

Authors: Xia, Yunqing | Tang, Liang | Hu, Yu

Article Type: Review Article

Abstract: BACKGROUND: Currently, the frequency of coagulation dysfunction associated with chimeric antigen receptor-T cell (Car-T) therapy cannot yet be determined. OBJECTIVE: We performed a systematic review and meta-analysis to examine the prevalence of abnormal laboratory tests related to coagulation disorders in patients receiving Car-T therapy and provide a reference for future risk assessment mechanisms. METHODS: We searched PubMed, Embase, and Web of Science for relevant studies and evaluated their quality using the methodology index of non-random research (MINORS). 2672 quotations were retrieved via systematic searches. After screening of titles, abstracts and full-text, 45 trials …involving 2541 patients were ultimately included. 41 studies reported the incidence of thrombocytopenia, 8 studies reported the rate of low fibrin, 4 trials reported the rate of APTT or PT abnormalities and only 3 trials reported the incidence of venous thromboembolism (VTE). We performed a quantitative meta-analysis to explore the incidence of thrombocytopenia following Car-T treatment. The incidence of hypofibrinogenemia, VTE, and abnormal APTT or PT was only qualitatively assessed, as fewer reports were included in this study. RESULTS: The overall incidence of thrombocytopenia associated with Car-T therapy was 45.8% (95%[CI], 0.384–0.533). The highest rates of thrombocytopenia occurred in patients with multiple myeloma (60.1%, 95%[CI], 0.507–0.688) and aged between 18 to 60 (50%, 95%[CI], 0.367–0.633). There was greater prevalence of thrombocytopenia in BCMA-Car-T therapy of 58.7% (95%[CI], 0.482–0.685). Thrombocytopenia occurred most frequently in Car-T patients treated with a dosage of 1 × 10 5 –1 × 10 6  cell/kg, at a rate of 66.2% (95%[CI], 0.561–0.749). CONCLUSION: Overall, 45.8 percent of patients receiving Car-T treatment suffered from thrombocytopenia. Multiple myeloma patients, ages between 18–60, a dose of 1 × 10 5 –1 × 10 6  cell/kg and BCMA-Car-T therapy are all considered high-risk factors. Show more

Keywords: Car-T, thrombocytopenia, hematological tumors, meta-analysis

DOI: 10.3233/THC-220537

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2363-2380, 2023

Authors: Wu, Jiaqi | Heng, Modi | Bai, Yunyang

Article Type: Other

Abstract: BACKGROUND: The minimally invasive endodontics could retain more peri-cervical dentin (PCD) and other important dental structures, thus realizing the minimal loss of teeth structures and preserving the strength and function of the endodontically treated tooth (ETT). The search for abnormal root canals or calcified root canals could be quite time-consuming and increase the risk of perforation. OBJECTIVE: This study introduced a novel multifunctional 3D printing guided splint inspired by the dice, which can achieve the minimally invasive access cavity preparation and canal orifice identification. METHOD: Data were collected from an outpatient with dens …invaginatus. Cone-beam Computed Tomography (CBCT) revealed a type III invagination. The CBCT data of the patient were imported into a computer-aided design (CAD) software (Exocad 3.0; Exocad GmbH) for the 3D reconstruction of jaw bones and teeth. The dice-inspired 3D printing guided splint consists of the sleeve and guided splint. The sleeve with minimal invasive opening channel and orifice locating channel were designed with a reverse-engineering software (Geomagic Wrap 2021). The reconstructed models in the Standard Template Library (STL) format were imported into a CAD software. The design of the template was aided by the dental CAD software in Splint Design Mode. The sleeve and splint were exported into the STL files separately. A 3D printer (ProJet ® 3600 3D Systems) was used to separately generate the sleeve and guided splint, and was made by stereolithography and processed in a medical resin (VisiJet M3 StonePlast). RESULTS: The novel multifunctional 3D printing guided splint could be set in position. The opening side in the sleeve was selected and the sleeve was inserted in place. The minimal invasive opening was made in the crown of the tooth to access the pulp. The sleeve was draw out and turned to the orifice location side, and then inserted in place. The target orifice was located rapidly. CONCLUSION: This novel dice-inspired multifunctional 3D printing guided splint allow dental practitioners to gain accurate, conservative, and safe cavity access from teeth with anatomical malformations. Complex operations might be carried out with less reliance on the operator’s experience than with conventional access preparations. This novel dice-inspired multifunctional 3D printing guided splint would have a broad application in the dental field. Show more

Keywords: Guided endodontics, minimally invasive endodontics, CAD, 3D printing

DOI: 10.3233/THC-230002

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2381-2387, 2023

Authors: Wu, Bao-Qiang | Zhang, Xu-Dong | Zhu, Chun-Fu | Qin, Xi-Hu

Article Type: Research Article

Abstract: BACKGROUND: Ectopic replantation and regeneration of splenic tissue fragments following splenic trauma or splenectomy is known as replantation of splenic tissue. It typically takes place in the abdominal cavity, however, splenic tissue replantation in the liver is extremely rare and difficult to diagnose. It is often misdiagnosed as a liver tumor and removed. CASE PRESENTATION: We present the case of a patient with a history of traumatic splenectomy 15 years prior to the replantation of splenic tissue in the liver. A 4 cm mass in the liver was found during the most recent physical examination, and …a computed tomography scan indicated the possibility of a malignant tumor. The tumor was then removed using fluorescence laparoscopy. CONCLUSION: There is a possibility of intrahepatic replantation of splenic tissue in patients who have had a splenectomy in the past, have recently discovered an intrahepatic space-occupying lesion, and do not have any high-risk factors for liver cancer. Unnecessary surgery can be avoided if 99m Tc-labeled red blood cells imaging using mass puncture or radionuclide examination provides a clear preoperative diagnosis. Globally, there are no reports of the use of fluorescence laparoscopy in resecting replanted splenic tissue in the liver. Specifically, in the current case, there was no indocyanine green uptake in the mass, and only a small amount was found in the normally functioning liver tissue surrounding the tumor. Show more

Keywords: Fluorescence laparoscopy, hepatectomy, liver tumor, replantation of splenic tissue

DOI: 10.3233/THC-220475

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2389-2394, 2023

Article Type: Correction

DOI: 10.3233/THC-235017

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2395-2395, 2023

Authors: Daunoravičienė, Kristina | Pauk, Jolanta

Article Type: Other

DOI: 10.3233/THC-235005

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2397-2399, 2023

Authors: Osa-Sanchez, Ainhoa | Jossa-Bastidas, Oscar | Mendez-Zorrilla, Amaia | Oleagordia-Ruiz, Ibon | Garcia-Zapirain, Begonya

Article Type: Research Article

Abstract: BACKGROUND: Loneliness and social isolation are recognized as critical public health issues. Older people are at greater risk of loneliness and social isolation as they deal with things like living alone, loss of family or friends, chronic illness, and hearing loss. Loneliness increases a person’s risk of premature death from all causes, including dementia, heart disease, and stroke. To address these issues, the inclusion of technological platforms and the use of commercial monitoring devices are vastly increasing in healthcare and elderly care. OBJECTIVE: The objective of this study is to design and develop a loneliness monitor …serverless architecture to obtain real-time data from commercial activity wristbands through an Application Programming Interface. METHODS: For the design and development of the architecture, the Amazon Web Services platform has been used. To monitor loneliness, the Fitbit Charge 5 bracelet was selected. Through the web Application Programming Interface offered by the AWS Lambda service, the data is obtained and stored in AWS services with an automated frequency thanks to the event bridge. RESULTS: In the pilot stage in which the system is, it is showing great possibilities in the ease of collecting data and programming the sampling frequency. Once the request is made, the data is automatically analyzed to monitor loneliness. CONCLUSION: The proposed architecture shows great potential for easy data collection, analysis, security, personalization, real-time inference, and scalability of sensors and actuators in the future. It has powerful benefits to apply in the health sector and reduces cases of depression and loneliness. Show more

Keywords: Loneliness, serverless, AWS, wearables, monitoring

DOI: 10.3233/THC-235006

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2401-2409, 2023

Authors: Petuchova, Aleksandra | Maknickas, Algirdas | Kostenko, Ernest | Stonkus, Rimantas

Article Type: Research Article

Abstract: BACKGROUND: Understanding the mechanical properties of aortic tissue is essential for developing numerical computation tools and assessing the risk of aortic aneurysm fractures. Tensile tests using aortic wall specimens allow for the determination of stress and strain depending on the location and direction of the sample. OBJECTIVE: The aim of this study was to perform a mechanical tensile test using canine aorta samples and create a numerical model of aortic tissue tension from the processed data. METHODS: Dogbone-shaped samples were dissected from canine aortic segments. The initial measurements were made at zero tension …and the tensile tests were conducted at 10 mm/min until rupture. Force and stretch data were used to obtain engineering and true stress-strain curves. The true stress-strain curves were taken until the maximum strength was obtained, after which they were smoothed and fitted using a logistic function with three coefficients. These curves were then used as material mechanical properties for a numerical model of the aortic tissue tension. A simplified rectangle form was used to mimic the middle of the dogbone-shaped portion of the tissue specimen. Experimental displacement data were collected for the boundary conditions of the finite element 3D model. RESULTS: The experimental data processing revealed that the logistic function described the nonlinear behaviour of the aorta soft tissue with an accuracy of 95% from the start of the tension to the media layer rupture. By applying numerical simulations, we obtained a correspondence of the load curve with an RMSE = 0.069 for the theoretical and experimental external tension data. CONCLUSION: The numerical investigation confirmed that the non-linear soft tissue was validated by applying a logistic function approach to the mechanical properties of the aortic wall. Show more

Keywords: Aortic wall, mechanical properties, stress-strain curve, tensile test

DOI: 10.3233/THC-235007

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2411-2421, 2023

Authors: Daugulis, Pauls | Kataševs, Aleksejs | Okss, Aleksandrs

Article Type: Research Article

Abstract: BACKGROUND: Unsupervised sports activities could cause traumas, about 70% of them are those of the low extremities. To avoid traumas, the athlete should be aware of dangerous forces acting within low extremity joints. Research in gait analysis indicated that plantar pressure alteration rate correlates with the gait pace. Thus, the changes in plantar pressure should correlate with the accelerations of extremities, and with the forces, acting in the joints. Smart socks provide a budget solution for the measurement of plantar pressure. OBJECTIVE: To estimate the correlation between the plantar pressure, measured using smart socks, and forces, …acting in the joints of the lower extremities. METHODS: The research is case study based. The volunteer performed a set of squats. The arbitrary plantar pressure-related data were obtained using originally developed smart socks with embedded knitted pressure sensors. Simultaneously, the lower extremity motion data were recorded using two inertial measurement units, attached to the tight and the ankle, from which the forces acted in the knee joint were estimated. The simplest possible model of knee joint mechanics was used to estimate force. RESULTS: The estimates of the plantar pressure and knee joint forces demonstrate a strong correlation (r = 0.75, P < 0.001). The established linear regression equation enables the calculation of the knee joint force with an uncertainty of 22% using the plantar pressure estimate. The accuracy of the classification of the joint force as excessive, i.e., being more than 90% of the maximal force, was 82%. CONCLUSION: The results demonstrate the feasibility of the smart socks for the estimation of the forces in the knee joints. Smart socks therefore could be used to develop excessive joint force alert devices, that could replace less convenient inertial sensors. Show more

Keywords: Knee joint force, plantar pressure, smart textile, smart socks

DOI: 10.3233/THC-235008

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2423-2434, 2023

Authors: Žukauskienė, Milda | Markauskienė, Asta | Juraitis, Tomas | Kuzborska, Zyta

Article Type: Research Article

Abstract: BACKGROUND: The prototype of mobility trainer-verticalizer (hereinafter – PMTV) is designed to develop existing movements caused by individual physical conditions and disease damage, as close as possible to the natural biomechanics of a healthy person. The aim is to make the equipment comfortable, simple, suitable for everyday use in a variety of environments, from medical institutions to the patient’s home, and customizable according to the anthropometric data of the growing child. OBJECTIVE: To investigate and evaluate the technical characteristics and feasibility of a PMTV for children (2 to 7 years) weighing up to 20 kg. …METHODS: Empirical research method (anthropometric measurements); quantitative research method (survey); qualitative research method (interviews). RESULTS: The PMTV is suitable for use with children aged 2 to 7 years, although children with various disabilities may have heights, weights and other anthropometric data that fall far below or exceed the healthy standard. The exercise with the use of a PMTV had a positive effect on muscle tone, with a decrease in muscle tone in both the upper and lower limbs. An increased range of motion (hereinafter – ROM) of shoulder flexion and abduction was observed. In the lower limb, there was an improvement in the ROM of hip internal and external rotation and the flexion and extension of knee. CONCLUSION: Physiotherapy using PMTV had a positive effect on the subject’s limb volume and muscle tone, a positive effect on the subject’s passive ROM, and a positive effect on the subject’s gross motor function. Show more

Keywords: Mobility trainer-verticalizer, physiotherapy, children

DOI: 10.3233/THC-235009

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2435-2445, 2023

Authors: Gourrame, Khadija | Griškevičius, Julius | Haritopoulos, Michel | Lukšys, Donatas | Jatužis, Dalius | Kaladytė-Lokominienė, Rūta | Bunevičiūtė, Ramunė | Mickutė, Gabrielė

Article Type: Research Article

Abstract: BACKGROUND: Parkinson’s disease (PD) is a chronic neurodegenerative disorder characterized by motor impairments and various other symptoms. Early and accurate classification of PD patients is crucial for timely intervention and personalized treatment. Inertial measurement units (IMUs) have emerged as a promising tool for gathering movement data and aiding in PD classification. OBJECTIVE: This paper proposes a Convolutional Wavelet Neural Network (CWNN) approach for PD classification using IMU data. CWNNs have emerged as effective models for sensor data classification. The objective is to determine the optimal combination of wavelet transform and IMU data type that yields the …highest classification accuracy for PD. METHODS: The proposed CWNN architecture integrates convolutional neural networks and wavelet neural networks to capture spatial and temporal dependencies in IMU data. Different wavelet functions, such as Morlet, Mexican Hat, and Gaussian, are employed in the continuous wavelet transform (CWT) step. The CWNN is trained and evaluated using various combinations of accelerometer data, gyroscope data, and fusion data. RESULTS: Extensive experiments are conducted using a comprehensive dataset of IMU data collected from individuals with and without PD. The performance of the proposed CWNN is evaluated in terms of classification accuracy, precision, recall, and F1-score. The results demonstrate the impact of different wavelet functions and IMU data types on PD classification performance, revealing that the combination of Morlet wavelet function and IMU data fusion achieves the highest accuracy. CONCLUSION: The findings highlight the significance of combining CWT with IMU data fusion for PD classification using CWNNs. The integration of CWT-based feature extraction and the fusion of IMU data from multiple sensors enhance the representation of PD-related patterns, leading to improved classification accuracy. This research provides valuable insights into the potential of CWT and IMU data fusion for advancing PD classification models, enabling more accurate and reliable diagnosis. Show more

Keywords: Parkinson’s disease, classification, Convolutional Wavelet Neural Networks (CWNN), wavelet transformations, IMU data

DOI: 10.3233/THC-235010

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2447-2455, 2023

Authors: Daunoraviciene, Kristina | Pauk, Jolanta | Ziziene, Jurgita | Belickiene, Vaida | Raistenskis, Juozas

Article Type: Research Article

Abstract: BACKGROUND: Healthy children’s gait support patterns play a critical role in their development and overall well-being. Therefore, in order to develop a correct gait, it is necessary to constantly update knowledge. OBJECTIVE: To identify differences in gait support among children in neighbouring countries. METHODS: 44 healthy children from Poland and Lithuania (4–11 years old) participated in the study. The spatiotemporal and plantar pressure parameters of 88 neutrally aligned feet were analysed and compared. RESULTS: Statistically significant differences between stance, single-limb support, double support, swing duration, cadence, and velocity, max. force …and pressure in the forefoot, as well as in the times of occurrence of max. forces in all three zones. Defined that age is related (p < 0.05) to cadence (R = 0.32), swing phase (R = 0.53), max. force under the midfoot (R = 0.35) and the heel (R = 0.47), max. pressure under the forefoot (R = - 0.52), midfoot (R = - 0.63) and heel (R = - 0.47). CONCLUSION: The results can help caregivers, as well as clinicians and researchers, understand how gait mechanics change with development and the growth course of the children of that country. Also, the results are important for the analysis and comparison of children’s gait, as control reference data from the same country. Show more

Keywords: Support patterns, gait, healthy children, physical growth, motor skills

DOI: 10.3233/THC-235011

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2457-2466, 2023

Authors: Derlatka, Marcin

Article Type: Research Article

Abstract: BACKGROUND: Automatic recognition of a person’s gender as well as his or her unilateral load state are issues that are often analyzed and utilized by a wide range of applications. For years, scientists have recognized human gait patterns for purposes connected to medical diagnoses, rehabilitation, sport, or biometrics. OBJECTIVE: The present paper makes use of ground reaction forces (GRF) generated during human gait to recognize gender or the unilateral load state of a walking person as well as the combination of both of those characteristics. METHODS: To solve the above-stated problem parameters calculated …on the basis of all GRF components such as mean, variance, standard deviation of data, peak-to-peak amplitude, skewness, kurtosis, and Hurst exponent as well as leading classification algorithms including kNN, artificial neural networks, decision trees, and random forests, were utilized. Data were collected by means of Kistler’s force plates during a study carried out at the Bialystok University of Technology on a sample of 214 people with a total of 7,316 recorded gait cycles. RESULTS: The best results were obtained with the use of the kNN classifier which recognized the gender of the participant with an accuracy of 99.37%, the unilateral load state with an accuracy reaching 95.74%, and the combination of those two states with an accuracy of 95.31% which, when compared to results achieved by other authors are some of the most accurate. CONCLUSION: The study has shown that the given set of parameters in combination with the kNN classifying algorithm allows for an effective automatic recognition of a person’s gender as well as the presence of an asymmetrical load in the form of a hand-carried briefcase. The presented method can be used as a first stage in biometrics systems. Show more

Keywords: Ground reaction force, gender recognition, gait with unilateral load, biometrics

DOI: 10.3233/THC-235012

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2467-2475, 2023

Authors: Grycuk, Slawomir | Mrozek, Piotr

Article Type: Research Article

Abstract: BACKGROUND: Orthotic braces play a key role in the correction of spinal deformities. The effectiveness of these devices depends on the design and distribution of corrective forces transmitted through the corset shell. OBJECTIVE: The present study aimed to reduce the weight of the orthosis and improve its functionality while maintaining its corrective function. METHODS: The distribution of corrective forces transmitted by the orthosis was evaluated using the finite element method (FEM). Areas of the orthosis, which had minimal impact on the overall stiffness, were identified and material from these areas was removed. The …modified orthosis shell was subjected to minor adjustments to maintain its corrective stiffness. RESULTS: With the modifications made, a 39% reduction in the weight of the orthosis was achieved, while maintaining its corrective stiffness. This indicates that the corrective function was largely preserved. CONCLUSION: The study provides a novel approach to orthosis design demonstrating that optimizing the structure using the distribution of maximum principal stress trajectories can significantly improve the functionality of the brace. The proposed method offers potential advances in the design of various types of orthoses, contributing to developments in the field. Show more

Keywords: Scoliosis, orthosis, brace, torso

DOI: 10.3233/THC-235013

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2477-2486, 2023

Authors: Zadoń, Hanna | Michnik, Robert | Nowakowska-Lipiec, Katarzyna

Article Type: Research Article

Abstract: BACKGROUND: Correct body weight is one of the factors that allows you to maintain a properly functioning body. Abnormal body weight can cause muscle tissue remodelling, affecting activity and muscle fatigue. Changes in the muscular system can cause occurrence of functional limitations. OBJECTIVE: To determine the effect of weight change on fatigue and activity of the muscular system during daily activities. METHODS: The evaluation of musculoskeletal functioning was based on the results of computer simulations conducted in the AnyBody Modeling System. The following activities were analysed: standing, sitting down and getting up from …a chair, holding and lifting an object, and walking. The simulations of the activities were carried out using averaged kinematic data, and by changing body mass in the range of 50 kg to 100 kg by increments of 2 kg, to map different nutritional status from excessive thinness to extreme obesity. Identification of loads in the musculoskeletal system was based on solving an inverse dynamics problem and then the estimation of muscle force values using static optimization. The simulation results allowed to determine the value of muscle fatigue and the level of muscle activity. RESULTS: For activities (i.e., standing, walking, sitting down and getting up from a chair) it was observed that the value of muscle fatigue increases with increasing body mass. However, for activities that cause more load on the musculoskeletal system, i.e. lifting and holding an object, the highest value of muscle fatigue was observed in underweight individuals. CONCLUSION: The change in body weight alters the functioning of the muscular system and thus the ability to perform activities. It was shown that in case of underweight, overweight or obese people, abnormal body weight can be the reason for occurrence of difficulties in performing the activities of lifting and holding a 20 kg object, as well as walking. Show more

Keywords: Mass changes, underweight, overweight, muscular system, mathematical modelling, AnyBody Modeling System

DOI: 10.3233/THC-235014

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2487-2498, 2023

Authors: Abromavičius, Vytautas | Serackis, Artūras | Katkevičius, Andrius | Kazlauskas, Mantas | Sledevič, Tomyslav

Article Type: Research Article

Abstract: BACKGROUND: Physiological signals, such as skin conductance, heart rate, and temperature, provide valuable insight into the physiological responses of students to stress during examination sessions. OBJECTIVE: The primary objective of this research is to explore the effectiveness of physiological signals in predicting grades and to assess the impact of different models and feature selection techniques on predictive performance. METHODS: We extracted a comprehensive feature vector comprising 301 distinct features from seven signals and implemented a uniform preprocessing technique for all signals. In addition, we analyzed different algorithmic selection features to design relevant features …for robust and accurate predictions. RESULTS: The study reveals promising results, with the highest scores achieved using 100 and 150 features. The corresponding values for accuracy, AUROC, and F1-Score are 0.9, 0.89, and 0.87, respectively, indicating the potential of physiological signals for accurate grade prediction. CONCLUSION: The findings of this study suggest practical applications in the field of education, where the use of physiological signals can help students cope with exam stress and improve their academic performance. The importance of feature selection and the use of appropriate models highlight the importance of engineering relevant features for precise and reliable predictions. Show more

Keywords: Grades prediction, physiological signals, feature selection, exam stress

DOI: 10.3233/THC-235015

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2499-2511, 2023

Authors: Lycholip, Valentinas | Puronaitė, Roma | Skorniakov, Viktor | Navickas, Petras | Tarutytė, Gabrielė | Trinkūnas, Justas | Burneikaitė, Greta | Kazėnaitė, Edita | Jankauskienė, Augustina

Article Type: Research Article

Abstract: BACKGROUND: The coronavirus disease 2019 (COVID-19) was a cause of concern in the healthcare system and increased the need for disease severity indicators. However, they still vary in use to evaluate in-hospital outcomes and severity. The National Early Warning Score (NEWS) is routinely used to evaluate patient health status at the hospital. Further research is needed to ensure if NEWS can be a good instrument for an overall health status assessment with or without additional information like laboratory tests, intensive care needs, and history of chronic diseases. OBJECTIVE: To evaluate if NEWS can be an indicator …to measure COVID-19 patient status in-hospital. METHODS: We used the fully anonymized Electronic Health Records (EHR) characterizing patients admitted to the hospital with COVID-19. Data was obtained from Vilnius University Hospital Santaros Klinikos EHR system (SANTA-HIS) from 01-03-2020 to 31-12-2022. The study sample included 3875 patients. We created several statistical and machine learning models for discrimination between in-hospital death/discharge for evaluation NEWS as a disease severity measure for COVID-19 patients. In these models, two variable sets were considered: median NEWS and its combination with clinical parameters and medians of laboratory test results. Assessment of models’ performance was based on the scoring metrics: accuracy, sensitivity, specificity, area under the ROC curve (AUC), and F1-score. RESULTS: Our analysis revealed that NEWS predictive ability for describing patient health status during the stay in the hospital can be increased by adding the patient’s age at hospitalization, gender, clinical and laboratory variables (0.853 sensitivity, 0.992 specificity and F1-score – 0.859) in comparison with single NEWS (0.603, 0.995, 0.719, respectively). A comparison of different models showed that stepwise logistic regression was the best method for in-hospital mortality classification. Our findings suggest employing models like ours for advisory routine usage. CONCLUSION: Our model demonstrated incremental value for COVID-19 patient’s status evaluation. Show more

Keywords: COVID-19, early warning score, in-hospital mortality, health status, statistical models, machine learning, electronic health records

DOI: 10.3233/THC-235016

Citation: Technology and Health Care, vol. 31, no. 6, pp. 2513-2524, 2023