Technology and Health Care - Volume 32, issue 2

Authors: Liu, Bin | Sun, Chuan | Zhao, Xinyu | Liu, Lingyu | Liu, Shuang | Ma, Haichuan

Article Type: Research Article

Abstract: BACKGROUND: Surgery is the preferred treatment for rectal cancer, but surgical treatment alone sometimes does not achieve satisfactory results. OBJECTIVE: To explore the value of multimodal Magnetic Resonance (MR) images in evaluating T staging of rectal cancer after neoadjuvant therapy and to compare and analyze with pathological results. METHODS: This study retrospectively analyzed 232 patients with stage T3, T4 rectal cancer between January 1, 2017 and October 31, 2022. MR examination was performed within 3 days before surgery. Different MR sequences were used for mrT staging of rectal cancer after neoadjuvant therapy and …compared with pathological pT staging. The accuracy of different MR sequences in evaluating T staging of rectal cancer was calculated, and the consistency between the two was analyzed by kappa test. The sensitivity, specificity, negative predictive value and positive predictive value of different MR sequences in evaluating rectal cancer invading mesorectal fascia after neoadjuvant therapy were calculated. RESULTS: A total of 232 patients with rectal cancer were included in the study. The accuracy of high-resolution T2 WI in evaluating T staging of rectal cancer after neoadjuvant therapy was 49.57%, and the Kappa value was 0.261. The accuracy of high-resolution T2WI combined with diffusion weighted imaging (DWI) in evaluating T staging of rectal cancer after neoadjuvant therapy was 61.64%, and the Kappa value was 0.411. The accuracy of high-resolution combined with DCE-MR images in evaluating T staging of rectal cancer after neoadjuvant therapy was 80.60%, and the Kappa value was 0.706. The sensitivity and specificity of high-resolution t2-weighted imaging (HR-T2WI) combined with dynamic contrast-enhancement magnetic resonance (DCE-MR) in evaluating the invasion of mesorectal fascia were 83.46% and 95.33%, respectively. CONCLUSION: Compared with HR-T2WI combined with DWI images for mrT staging of rectal cancer after neoadjuvant chemoradiotherapy (N-CRT), HR-T2WI combined with DCE-M has the highest accuracy in evaluating mrT staging of rectal cancer after neoadjuvant therapy (80.60%), and has a high consistency with pathological pT staging. It is the best sequence for T staging of rectal cancer after neoadjuvant therapy. At the same time, the sequence has high sensitivity and specificity in evaluating mesorectal fascia invasion, which can provide accurate perioperative information for the formulation of surgical plan. Show more

Keywords: Rectal cancer, neoadjuvant therapy, efficacy, re-staging, magnetic resonance

DOI: 10.3233/THC-220798

Citation: Technology and Health Care, vol. 32, no. 2, pp. 615-627, 2024

Authors: Yu, Zhan-Biao | Cui, Na | Zhang, Nan | Su, Dan | Wu, Jia-Qian | Xi, Xiu-Ming

Article Type: Research Article

Abstract: BACKGROUND: Finding a simple and reliable method to predict and assess fluid responsiveness has long been of clinical interest. OBJECTIVE: To investigate the predictive value of a ventilator disconnection (DV) test combined with the pulse contour-derived cardiac output (PiCCO) index on fluid responsiveness for patients in shock. METHODS: Thirty-two patients were chosen for the study. Patients who were in shock, received mechanical ventilation, and met the inclusion criteria were selected. Patients were divided into a fluid-responsive group (14 patients) and fluid-unresponsive group (18 patients) based on whether the increase in cardiac index (Δ …CI) was > 10% or not, respectively, following the fluid challenge test. Changes in heart rate, pulse oximeter-measured oxygen saturation, mean arterial pressure (MAP), and CI before and after passive leg raising (PLR), DV, and fluid challenge tests were observed. We used Pearson’s correlation coefficient to analyze an increase in the MAP (Δ MAP) and Δ CI before and after the PLR, DV, and fluid challenge tests; the sensitivity and specificity of the Δ MAP and Δ CI in the PLR and DV tests for predicting fluid response were also analyzed by plotting the receiver operating characteristic (ROC) curves. RESULTS: CI results in the PLR and DV tests, as well as the fluid challenge test, were significantly higher in the fluid-responsive group compared with before the test (P < 0.05). The Δ CI before and after the PLR, DV, and fluid challenge tests were positively correlated among patients in the fluid-responsive group. The area under the ROC curve for the post-PLR test CI and the post-DV CI for predicting fluid responsiveness was 0.869 (95% confidence interval (CI) [0.735–1.000, P = 0.000]) and 0.937 (95% CI [0.829–1.000, P = 0.000]), respectively, in patients in the fluid-responsive group. The sensitivity and specificity of the post-DV CI for predicting fluid responsiveness in all patients was 100.0% and 88.9%, respectively, using a 5% increase as the cut-off value. CONCLUSION: Application of DV, combined with PiCCO, has a high predictive value for fluid responsiveness among patients in shock. Show more

Keywords: Shock, ventilator, mechanical, fluid responsiveness, ventilator disconnection test, pulse contour-derived cardiac index

DOI: 10.3233/THC-220799

Citation: Technology and Health Care, vol. 32, no. 2, pp. 629-638, 2024

Authors: Liu, Wen-Juan

Article Type: Research Article

Abstract: BACKGROUND: Strokes are the most common cause of death and the leading cause of acquired disability in adults worldwide. OBJECTIVE: The present study aimed to investigate the value of transcranial Doppler ultrasound (TCD) in the diagnosis of intracranial vascular stenosis in patients with a history of stroke. METHODS: This is a meta-analysis study of diagnostic tests. PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP databases were systematically searched. Diagnostic tests using TCD or transcranial colour Doppler ultrasound (TCCD) for detecting intracranial arterial stenosis in patients with a history of stroke …were included, with reference standards of intracranial angiography, computed tomography angiography (CTA), or magnetic resonance angiography. The risk bias map was drawn by Revman v5.3, the sensitivity and specificity forest plot was drawn by Stata v16.0, the receiver operating characteristic curve was drawn, and the area under the curve (AUC) was calculated. RESULTS: A total of 812 patients with stroke in 12 studies were included in the meta-analysis. The estimated sensitivity of TCD or TCCD for the detection of intracranial vascular stenosis was 0.77–1.00, and the combined sensitivity was 0.96 (95% confidence interval [CI]: 0.88–0.99); the estimated specificity was 0.32–1.00, and the combined specificity was 0.94 (95% CI: 0.82–0.98); the positive likelihood ratio was 15.8 (95% CI: 5.1–48.6); and the negative likelihood ratio was 0.04 (95% CI: 0.01–0.14). The AUC was 0.99 (95% CI: 0.97–0.99). CONCLUSION: Doppler ultrasound has good consistency with conventional methods for the diagnosis of intracranial artery stenosis in patients with a history of stroke. Different reference standards may affect sensitivity and specificity; when CTA was used as the reference standard, the consistency of the TCD in the diagnosis of intracranial artery stenosis in stroke patients was relatively good. Show more

Keywords: Transcranial Doppler, stroke, intracranial artery stenosis, diagnostic value

DOI: 10.3233/THC-220844

Citation: Technology and Health Care, vol. 32, no. 2, pp. 639-649, 2024

Authors: Ochiai, Ryoichi | Terada, Takashi | Sakamoto, Noriaki

Article Type: Research Article

Abstract: BACKGROUND: Several monitors have been developed that measure stroke volume (SV) in a beat-to-beat manner. Accordingly, Stroke volume variation (SVV) induced by positive pressure ventilation is widely used to predict fluid responsiveness. OBJECTIVE: The purpose of this study was to compare the ability of two different methods to predict fluid responsiveness using SVV, stroke volume variation by esCCO (esSVV) and stroke volume variation by FloTrac/VigileoTM (flSVV). METHODS: esSVV, flSVV, and stroke volume index (SVI) by both monitoring devices of 37 adult patients who underwent laparotomy surgery, were measured. Receiver operating characteristic (ROC) …analysis was performed. RESULTS: The area under the ROC curve (AUC) of esSVV was significantly higher than that of flSVV (p = 0.030). esSVV and flSVV showed cutoff values of 6.1% and 10% respectively, to predict an increase of more than 10% in SVI after fluid challenge. The Youden index for esSVV was higher than flSVV, even with a cutoff value between 6% and 8%. CONCLUSION: Since esSVV and flSVV showed significant differences in AUC and cutoff values, the two systems were not comparable in predicting fluid responsiveness. Furthermore, it seems that SVV needs to be personalized to accurately predict fluid responsiveness for each patient. Show more

Keywords: Estimated continuous cardiac output, stroke volume variation, stroke volume index, pulse wave transit time, pressure wave analysis

DOI: 10.3233/THC-220849

Citation: Technology and Health Care, vol. 32, no. 2, pp. 651-662, 2024

Authors: Gao, Jingfang | Zhu, Yuxin | Zhang, Congcong | Yin, Xinxin

Article Type: Research Article

Abstract: BACKGROUND: Peripherally inserted central catheter (PICC) is widely used in chemotherapy of children with malignant tumors because of its safe operation and long indwelling time. OBJECTIVE: To investigate the effect of intracavitary electroencephalogram (CEEG) localization technique on the success rate and complications of PICC in infants. METHODS: A total of 180 children with PICC catheterization and maintenance at Shijiazhuang People’s Hospital First Hospital from January 2017 to January 2020 were selected and divided into control group (n = 90 cases) and observation group (n = …90 cases). The control group observed the tip position of the fixed catheter through X-ray film and adjusted the catheter until its tip was located in the superior vena cava. The observation group used intracavitary electrocardiogram positioning technology. Comparison of the effects of two groups on the success rate and complications of PICC puncture in infants and young children. RESULTS: The success rate of one puncture in the observation group was significantly higher than that in the control group (P < 0.05). Within one month of catheterization, 13 cases had complications, with an incidence rate of 16.00% lower than the control group’s 34.00% (27/80) (P < 0.05). The screening test results showed that the specificity, sensitivity, Youden index, accuracy, kappa coefficient, positive and negative predictive value were 88.89%, 97.56%, 0.86, 96.00%, 0.86, 0.86, respectively. The measured values were 97.56% and 88.89% respectively, and the cost and time of localization were lower than those of X-ray. CONCLUSION: The technique of intracavitary electrogram can be more accurate for infants to place the tip of central venous catheter through peripheral vein, which can effectively improve the success rate of one puncture with low cost, and has high reliability, accuracy and practicability, which is safe and effective. Show more

Keywords: Intracavitary electrocardiogram, infants, peripherally inserted central venous catheter, puncture, complications

DOI: 10.3233/THC-230014

Citation: Technology and Health Care, vol. 32, no. 2, pp. 663-673, 2024

Authors: Liu, Xinyi | Liu, Hao | Liu, Yuanji

Article Type: Research Article

Abstract: BACKGROUND: During an outbreak such as COVID-19, hospital staff needs to be in close contact with all types of patients visiting the hospital and the risk of cross-infection is extremely high. Payment and medication pickup is a mandatory part of a patient’s hospital visit, with direct contact between healthcare workers and patients, and long waiting times in the hospital area, which can easily lead to the spread of disease infection. OBJECTIVE: This paper designed the prototype of a contactless smart medicine cabinet based on RFID technology and optimized the patient consultation and medication pickup process to …address these problems. METHODS: We conducted a 50-day field observation of patients for consultation and medication pickup at the First Hospital in H city, Jiangsu Province, China, and randomly timed 1600 sets of data from Surgery (ophthalmology) and Internal patients, then we designed the prototype of a contactless smart medicine cabinet based on RFID technology, optimized the patient consultation and medication pickup process, comparing the traditional and intelligent models using AnyLogic. RESULTS: The results show that this contactless medicine cabinet was able to reduce the time taken by patients in consultation and medicine pickup by 18.74 minutes, increasing the overall efficiency of the consultation by 32.20%. The simulation revealed that this contactless intelligent medication pickup model was able to reduce the time taken by patients in consultation and medicine pickup, increasing the overall efficiency of the consultation, effectively reducing the frequency of contact between healthcare workers and patients, and reducing the risk of disease infection. CONCLUSION: The proposed technical model provides a new idea to solve the problems of long queues, low efficiency and high risk of infection for patients to consult and get medicine during epidemics. Especially within hospitals it has important theoretical and practical implications for epidemic prevention and control as well as future hospital management. Show more

Keywords: COVID-19, RFID, contactless, hospital, intelligent medication pickup

DOI: 10.3233/THC-230027

Citation: Technology and Health Care, vol. 32, no. 2, pp. 675-693, 2024

Authors: Ma, Jun | Jin, Nana | Wang, Jingyi | Cao, Xiaoli | Zhang, Mingxia

Article Type: Research Article

Abstract: BACKGROUND: Bone defects and deep periodontal pockets often exist distal to the second molar after mandibular third molar extraction, seriously threatening the periodontal health of the second molar. OBJECTIVE: To evaluate the effect of socket preservation with bone substitute materials on alveolar bone resorption and prevention of the distal periodontal defect of the adjacent tooth after mandibular impacted third molar extraction compared with natural healing. METHODS: Ninety-nine patients with mandibular impacted teeth, treated in our hospital from January 2018 to December 2020, were randomly divided into the control and experimental groups. The experimental …group underwent minimally invasive tooth extraction and socket preservation using the deproteinised bovine bone mineral, Bio-Oss and the bioabsorbable collagen membrane, Bio-Gide. The control group healed naturally after minimally invasive tooth extraction. The alveolar ridge dimension of the extraction sites, the probing depth, tooth mobility and gingival index on the distal aspect of the mandibular second molars were examined and recorded before and six months after the operations. RESULTS: There was a significant difference between the experimental group and the control group in the alveolar bone width (P < 0.05) and height (P < 0.05) before and after surgery. The probing depth of the extraction sites in both groups was reduced. CONCLUSION: Using Bio-Oss and Bio-Gide to preserve extraction sites of impacted teeth can promote recovery more effectively than natural healing on the height of the distal alveolar bone and the width of the alveolar crest of the second molar and thus improve the periodontal status of the adjacent second molar. Show more

Keywords: Impacted mandibular third molar, second molar, alveolar bone, socket preservation

DOI: 10.3233/THC-230043

Citation: Technology and Health Care, vol. 32, no. 2, pp. 695-704, 2024

Authors: Lin, Bi-Hua | Zhong, Gui-Qin | Meng, Xiao-Hong | Han, Hai-E | Hu, Xue-Qin | Lin, Jing-Jing | Zhong, Shi-Chai | Lin, Yan-Juan

Article Type: Research Article

Abstract: BACKGROUND: With improving living standards, the incidence of cervical spondylotic myelopathy (CSM) has become increasingly high. OBJECTIVE: The study aims to explore the effect of diversified health-promoting models on rehabilitation exercises in patients with CSM after an operation. METHOD: This was a randomized controlled trial, wherein 107 patients with CSM treated by neurosurgery were selected as the subjects. Of those, 52 patients in the control group adopted the conventional health-promoting model, while the remaining 55 patients in the intervention group adopted diversified health-promoting models. The effect of rehabilitation exercises in the two groups …was evaluated according to the self-efficacy rehabilitation outcome scale, grip strength measurement of the affected limb, and Barthel index. RESULTS: At Day 3 post-operation and before discharge, the self-efficacy management of rehabilitation exercises in the intervention group was better than that of the control group (P < 0.05). The grip strength measurement of the affected limb, Japanese Orthopedic Association score of the cervical vertebra, and Barthel index of the two groups at Day 3 post-operation were lower than before the intervention and were not statistically significant (P > 0.05). However, these three items before discharge were improved when compared with those of before intervention and were statistically significant (P < 0.05). CONCLUSION: Postoperative rehabilitation exercises guided by the diversified health-promoting models for patients with CSM can improve the patients’ self-efficacy management ability in rehabilitation exercises, help improve grip strength, and promote the recovery of cervical vertebra function, thereby improving the patients’ quality of life. Show more

Keywords: Diversified, health-promoting, publicity and education, cervical spondylotic myelopathy, rehabilitation exercise

DOI: 10.3233/THC-230056

Citation: Technology and Health Care, vol. 32, no. 2, pp. 705-718, 2024

Authors: Wang, Wei-Zhong | Ying, Li-Jun | Liu, Wei-Dong | Zhang, Pan | Li, Shun-Fa

Article Type: Research Article

Abstract: BACKGROUND: Providers should adjust the depth of sedation to promote lung-protective ventilation in patients with severe ARDS. This recommendation was based on the assumption that the depth of sedation could be used to assess respiratory drive. OBJECTIVE: To assess the association between respiratory drive and sedation in patients with severe ARDS by using ventilator-measured P0.1 and RASS score. METHODS: Loss of spontaneous breathing was observed within 48 h of mechanical ventilation in patients with severe ARDS, and spontaneous breathing returned after 48 hours. P0.1 was measured by ventilator every 12 ± …2 hours, and the RASS score was measured synchronously. RESULTS: The RASS score was moderately correlated with P0.1 (R 𝑆𝑝𝑒𝑎𝑟𝑚𝑎𝑛 , 0.570; 95% CI, 0.475 to 0.637; p = 0.00). However, only patients with a RASS score of - 5 were considered to have no excessive respiratory drive, but there was a risk for loss of spontaneous breathing. A P0.1 exceeding 3.5 cm H2 O in patients with other RASS scores indicated an increase in respiratory drive. CONCLUSION: RASS score has little clinical significance in evaluating respiratory drive in severe ARDS. P0.1 should be evaluated by ventilator when adjusting the depth of sedation to promote lung-protective ventilation. Show more

Keywords: Acute respiratory distress syndrome, P0.1, respiratory drive, mechanical ventilation, sedation

DOI: 10.3233/THC-230096

Citation: Technology and Health Care, vol. 32, no. 2, pp. 719-726, 2024

Authors: Qi, Hai-Feng | Sun, Xiao-Qin | Du, Hai-Kun | Li, Jun-Hua | Zhang, Li-Yan | Xi, Yong-Guo

Article Type: Research Article

Abstract: BACKGROUND: With more pregnant women undergoing cesarean section, the number of women with scarring in the uterus undergoing uterine magnetic resonance (MR) examination in the second and third trimesters following a subsequent pregnancy, has increased. OBJECTIVE: To investigate features of MR signals in retroplacental basal decidual space. METHODS: The MR imaging data of patients with clinically and pathologically confirmed placenta implantation and complete placental abruption were retrospectively analyzed. RESULTS: Patients with high-intensity signals in T2-weighted images (T2WI) of the retroplacental basal decidual space did not suffer placenta implantation after delivery, …while high-intensity signals in T2WI of the retroplacental basal decidual space was not observed in patients with different degrees of placenta implantation. CONCLUSION: As the retroplacental basal decidual space is the barrier between the placenta and myometrium, high-intensity signals in T2WI can improve the confidence of MR exclusion diagnostics of placenta implantation, and can be used as exclusion criteria for MR diagnosis of placenta implantation. Show more

Keywords: Decidua basalis, magnetic resonance imaging, placenta implantation

DOI: 10.3233/THC-230098

Citation: Technology and Health Care, vol. 32, no. 2, pp. 727-734, 2024