Technology and Health Care - Volume 32, issue 5

Authors: Vater, Adrian Matthias | Lamby, Philipp | Moncher, Johanna | Schmidt, Karsten | Jordan, Martin | Jakubietz, Michael | Meffert, Rainer | Jakubietz, Rafael

Article Type: Research Article

Abstract: BACKGROUND: Coverage of soft tissue defects following surgery at the trochanteric area is challenging. Revision surgery in case of compromised wound healing may lead to soft tissue defects requiring reconstruction with pedicled or free flaps. Previous access to the hip joint may jeopardize neurovascular structures relevant to the flap. OBJECTIVE: In this study, we evaluated if the use of a pedicled anterior lateral thigh (ALT) flap is a valuable option for soft tissue reconstruction. METHODS: In this retrospective study, seven patients were included. Defect etiology was tumor resection in one case, screw osteosynthesis …in another case and total hip arthroplasty in three cases. All patients underwent reconstruction by proximal pedicled anterior lateral thigh (ALT) flap. RESULTS: Pedicled ALT flap was a safe procedure in all cases. One patient showed delayed wound healing with need for additional surgery. No further complications were observed. CONCLUSIONS: Pedicled ALT flap transfer represents a reliable option for soft tissue coverage in the trochanteric area after primary surgery such as hip arthroplasty, osteosynthesis or tumor resection. Show more

Keywords: ALT flap, trochanteric defect, reconstructive surgery, revision surgery, hip arthroplasty, plastic surgery

DOI: 10.3233/THC-240381

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3505-3512, 2024

Authors: Wu, Jing | Yang, Xiaoyan | Liu, Yun | Xi, Fang | Lei, Ping

Article Type: Research Article

Abstract: BACKGROUND: Deep vein thrombosis (DVT) of the lower limbs is a venous reflux disorder caused by abnormal coagulation of blood components, primarily characterised by swelling and pain in the lower limbs. Key risk factors include prolonged immobility due to bed rest, pregnancy, postpartum or postoperative states, traumas, malignant tumours and long-term contraceptive use. OBJECTIVE: To investigate the application of real-time shear wave elastography (SWE) in diagnosing lower-limb deep vein thrombosis (DVT). METHODS: A total of 91 patients with DVT were selected and divided into three groups: acute phase (n = …29), subacute phase (n = 30) and chronic phase (n = 32). The Young’s modulus of the patients was measured using real-time SWE. The diagnostic efficacy of Young’s modulus was evaluated by ROC curves. The hardness differences in Young’s modulus across different parts of the same thrombus (head, body and tail) were measured using SWE. RESULTS: Before treatment, significant differences were observed in Young’s modulus among patients with DVT (P < 0.001). Following anticoagulant therapy, catheter-directed thrombolysis and systemic thrombolysis, significant differences were noted in Young’s modulus among patients at the same stage but receiving different treatments (acute phase: P = 0.003; subacute phase: P = 0.014; chronic phase: P = 0.004). Catheter-directed thrombolysis had greater efficacy than anticoagulant therapy. The area under the curve for SWE in staging patients was 0.917, with a sensitivity of 92.36% and specificity of 93.81%. Significant differences in Young’s modulus were found between the thrombus head and thrombus body and tail but not between the thrombus body and thrombus tail. CONCLUSION: Measurement of Young’s modulus using SWE can serve as an auxiliary means of evaluating staging, predicting pulmonary embolism and selecting treatment in patients with DVT. Show more

Keywords: Real-time shear wave elastography, lower-limb deep vein thrombosis, diagnosis, treatment plan

DOI: 10.3233/THC-240386

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3513-3523, 2024

Authors: Begic, Zijo | Djukic, Milan | Begic, Edin | Aziri, Buena | Gojak, Refet | Mladenovic, Zorica | Begic, Nedim | Badnjevic, Almir

Article Type: Research Article

Abstract: BACKGROUND: Left atrial stiffness index (LASI), defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e’) to peak atrial strain, reflects reduced left atrial (LA) compliance and represents an emerging marker that can be used for noninvasive measurement of fibrosis of LA in patients with mitral regurgitation (MR). OBJECTIVE: To investigate the impact of chronic MR in children and adolescents on the remodeling and function of the LA, quantified through strain parameters and diastolic function. METHODS: The study included fifty patients (n = …50) diagnosed with primary and secondary chronic MR lasting at least 5 years. The echocardiographic recordings were performed by a third party, two cardiologists actively engaged in echocardiography on a daily basis. RESULTS: Older participants had higher values of the LASI (r = 0.467, p = 0.001). Participants with higher LASI values had a smaller LA reservoir (r = 0.784, p = 0.0001) and smaller LA conduit values (r = - 0.374, p = 0.00). Participants with higher LASI values had a larger LA diameter (r = 0.444, p -value= 0.001) and higher average E/e’ ratio (r = 0.718, p = 0.0001). There was a significant difference (p = 0.04) in the LASI among participants based on the MR jet area (< 20.85% ⩾ 20.85%), LASI was higher in participants with an area greater than 20.85%. Differences in other parameters such as LA reservoir, LA conduit, LA contractile were not statistically significant. CONCLUSION: Increased LA stiffness is associated with diminished atrial compliance and reservoir capacity, and LASI has a potential to as an early marker for assessing disease severity and progression in pediatric MR. Show more

Keywords: Left atrium, mitral regurgitation, echocardiography, fibrosis

DOI: 10.3233/THC-240402

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3525-3533, 2024

Authors: Thomas, Anvin | Jose, Rejath | Syed, Faiz | Wei, Ong Chi | Toma, Milan

Article Type: Research Article

Abstract: BACKGROUND: Cardiovascular diseases remain a leading cause of global morbidity and mortality, with heart attacks and strokes representing significant health challenges. The accurate, early diagnosis and management of these conditions are paramount in improving patient outcomes. The specific disease, cardiovascular occlusions, has been chosen for the study due to the significant impact it has on public health. Cardiovascular diseases are a leading cause of mortality globally, and occlusions, which are blockages in the blood vessels, are a critical factor contributing to these conditions. OBJECTIVE: By focusing on cardiovascular occlusions, the study aims to leverage machine learning …to improve the prediction and management of these events, potentially helping to reduce the incidence of heart attacks, strokes, and other related health issues. The use of machine learning in this context offers the promise of developing more accurate and timely interventions, thus improving patient outcomes. METHODS: We analyze diverse datasets to assess the efficacy of various machine learning algorithms in predicting heart attacks and strokes, comparing their performance to pinpoint the most accurate and reliable models. Additionally, we classify individuals by their predicted risk levels and examine key features that correlate with the incidence of cardiovascular events. The PyCaret machine learning library’s Classification Module was key in developing predictive models which were evaluated with stratified cross-validation for reliable performance estimates. RESULTS: Our findings suggest that machine learning can significantly improve the prediction accuracy for heart attacks and strokes, facilitating earlier and more precise interventions. We also discuss the integration of machine learning models into clinical practice, addressing potential challenges and the need for healthcare professionals to interpret and apply these predictions effectively. CONCLUSIONS: The use of machine learning for risk stratification and the identification of modifiable factors may empower preemptive approaches to cardiovascular care, ultimately aiming to reduce the occurrence of life-threatening events and improve long-term patient health trajectories. Show more

Keywords: Machine learning, cardiovascular diseases, heart attack, stroke, predictive modeling, risk factors, clinical decision-making

DOI: 10.3233/THC-240582

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3535-3556, 2024

Authors: Zheng, Yanhua | Ren, Ruilin | Zuo, Teng | Chen, Xuan | Li, Hanxuan | Xie, Cheng | Weng, Meiling | He, Chunxiao | Xu, Min | Wang, Lili | Li, Nainong | Li, Xiaofan

Article Type: Research Article

Abstract: BACKGROUND: Diagnostic challenges exist for CMV pneumonia in post-hematopoietic stem cell transplantation (post-HSCT) patients, despite early-phase radiographic changes. OBJECTIVE: The study aims to employ a deep learning model distinguishing CMV pneumonia from COVID-19 pneumonia, community-acquired pneumonia, and normal lungs post-HSCT. METHODS: Initially, 6 neural network models were pre-trained with COVID-19 pneumonia, community-acquired pneumonia, and normal lung CT images from Kaggle’s COVID multiclass dataset (Dataset A), then Dataset A was combined with the CMV pneumonia images from our center, forming Dataset B. We use a few-shot transfer learning strategy to fine-tune the pre-trained models and evaluate …model performance in Dataset B. RESULTS: 34 cases of CMV pneumonia were found between January 2018 and December 2022 post-HSCT. Dataset A contained 1681 images of each subgroup from Kaggle. Combined with Dataset A, Dataset B was initially formed by 98 images of CMV pneumonia and normal lung. The optimal model (Xception) achieved an accuracy of 0.9034. Precision, recall, and F1-score all reached 0.9091, with an AUC of 0.9668 in the test set of Dataset B. CONCLUSIONS: This framework demonstrates the deep learning model’s ability to distinguish rare pneumonia types utilizing a small volume of CT images, facilitating early detection of CMV pneumonia post-HSCT. Show more

Keywords: Cytomegalovirus pneumonia, hematopoietic stem cell transplantation, imaging diagnosis, deep learning, transfer learning

DOI: 10.3233/THC-240597

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3557-3568, 2024

Authors: Sawan, Nozha | Ben Gassem, Afnan

Article Type: Research Article

Abstract: BACKGROUND: Esthetic orthodontic wires are preferred for their ease to fit in with natural tooth color, but their susceptibility to staining in the oral environment poses a concern. Various Coatings such as Teflon and Epoxy aim to enhance appearance and biocompatibility but may still result in discoloration. Understanding the color stability of these wires under different staining conditions is crucial for a better and enhanced treatment plan. OBJECTIVE: This study intended to assess the color stability of esthetic orthodontic wires under various staining solutions that are often used in daily life. METHOD: …Color changes of Teflon and Epoxy-coated esthetic orthodontic wires were meticulously measured at baseline, 7, 14, and 21-day intervals utilizing the precise CIE Lab* color measurement system. A total of thirty-two samples of wires from each brand were prepared (n = 8/group) and immersed in staining solutions (coffee, tea, cola, and saffron). The color change within and between the groups was statistically evaluated (p < 0.05). RESULTS: Significant variations in color stability were observed across different staining solutions. Saffron emerged as the most potent agent, inducing the most pronounced color changes, whereas cola demonstrated the least impact. Furthermore, Epoxy-coated wires consistently exhibited superior color stability compared to their Teflon-coated counterparts across all staining solutions and time intervals. CONCLUSION: This study underlines the significance for orthodontists to consider staining agents’ possible effects on orthodontic wires into account when selecting the orthodontic wires. The findings suggest that Epoxy-coated wires hold promise in mitigating discoloration issues during orthodontic therapy. Show more

Keywords: Esthetic orthodontic wire, color change, tea, coffee, cola, saffron

DOI: 10.3233/THC-240638

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3569-3578, 2024

Authors: Chen, Han | Yang, Qiaorui | Yu, Fangjie | Shen, Yunxiang | Xia, Hong | Yang, Mengfan | Yin, Riping | Shen, Yiwei | Fan, Junfen | Fan, Zhenliang

Article Type: Research Article

Abstract: BACKGROUND: It is still unknown whether unsaturated fatty acids (UFA) have the same effect on preventing cognitive impairment in chronic kidney disease (CKD) patients as in healthy people. OBJECTIVE: To investigate the protective effect of dietary UFA intake and proportion on cognitive impairment in patients with CKD. METHODS: We extracted data from the National Health and Nutrition Examination Survey (NHANES, 2011–2014) on participants with a previous diagnosis of CKD and at least one complete cognitive assessment (Consortium to Establish a Registry for Alzheimer’s Disease test, Animal Fluency Test and Digit Symbol Substitution Test). …We used the lower quartile of the total scores of these three tests as the cut-off point, and divided the participants into two groups of normal cognitive performance and low cognitive performance to extract participants’ intake of various UFA from the NHANES dietary module. The data were weighted using weighting parameters included in NHANES, and logistics regression and restricted cubic spline were used to analyze the protective effect of UFA intake on cognitive impairment in CKD participants. RESULTS: We found that participants with low cognitive performance all had significantly lower intakes of total monounsaturated fatty acids, total polyunsaturated fatty acids, ω -3 UFA, ω -6 UFA and ω -9 UFA than participants with normal cognitive performance (p < 0.05), and the ω -6 UFA and ω -9 UFA had the most significant protective effects on cognitive impairment of participants. We also discovered that oleic and linoleic acids play important roles in protecting against cognitive impairment in CKD participants. The protective effect of oleic acid, but not linoleic acid, on cognitive impairment showed a nonlinear relationship. The changes in the proportion of monounsaturated fatty acids to polyunsaturated fatty acids, ω -6 UFA to ω -3 UFA, and oleic acid to linoleic acid did not affect the risk of cognitive impairment in CKD participants. CONCLUSIONS: UFA can reduce the risk of cognitive impairment in CKD patients, especially oleic acid and linoleic acid have a more obvious protective effect on cognitive impairment in patients with CKD. Among them, the protective effect of linoleic acid on cognitive impairment was continuously enhanced with the increase of intake, indicating that linoleic acid may be the most important UFA to reduce cognitive impairment in CKD patients. Show more

Keywords: Unsaturated fatty acids, cognitive impairment, chronic kidney disease, oleic acid, linoleic acid

DOI: 10.3233/THC-240671

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3579-3593, 2024

Authors: Dou, Fengjiao | Tian, Qingxiu | Zhang, Ran

Article Type: Research Article

Abstract: BACKGROUND: Gestational diabetes, a frequent pregnancy complication marked by elevated maternal blood glucose, can cause serious adverse effects for both mother and fetus, including increased amniotic fluid and risks of fetal asphyxia, hypoxia, and premature birth. OBJECTIVE: To construct a predictive model to analyze the risk factors for macrosomia in deliveries with gestational diabetes. METHODS: From January 2021 to February 2023, 362 pregnant women with gestational diabetes were selected for the study. They were followed up until delivery. Based on newborn birth weight, the participants were divided into the macrosomia group (birth weight ⩾ …4000 g) and the non-macrosomia group (birth weight < 4000 g). The data of the two groups of pregnant women were compared. ROC curves were plotted to analyze the predictive value of multiple factors for the delivery of macrosomic infants among pregnant women with gestational diabetes. A logistic regression model was constructed to identify the risk factors for delivering macrosomic infants and the model was tested. RESULTS: A total of 362 pregnant women with gestational diabetes were included, of which 58 (16.02%) had babies with macrosomia. The macrosomia group exhibited higher metrics in several areas compared to those without: pre-pregnancy BMI, fasting glucose, 1 h and 2 h OGTT sugar levels, weight gain during pregnancy, and levels of triglycerides, LDL-C, and HDL-C, all with significant differences (P < 0.05). ROC analysis revealed predictive value for macrosomia with AUCs of 0.761 (pre-pregnancy BMI), 0.710 (fasting glucose), 0.671 (1 h OGTT), 0.634 (2 h OGTT), 0.850 (weight gain), 0.837 (triglycerides), 0.742 (LDL-C), and 0.776 (HDL-C), indicating statistical significance (P < 0.05). Logistic regression identified high pre-pregnancy BMI, fasting glucose, weight gain, triglycerides, and LDL-C levels as independent risk factors for macrosomia, with odds ratios of 2.448, 2.730, 1.884, 16.919, and 5.667, respectively, and all were statistically significant (P < 0.05). The model’s AUC of 0.980 (P < 0.05) attests to its reliability and stability. CONCLUSION: The delivery of macrosomic infants in gestational diabetes may be related to factors such as body mass index before pregnancy, blood-glucose levels, gain weight during pregnancy, and lipid levels. Clinical interventions targeting these factors should be implemented to reduce the incidence of macrosomia. Show more

Keywords: Gestational diabetes, delivery, macrosomia, risk factors, predictive model

DOI: 10.3233/THC-240679

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3595-3604, 2024

Authors: Begic, Zijo | Djukic, Milan | Begic, Edin | Aziri, Buena | Begic, Nedim | Badnjevic, Almir

Article Type: Research Article

Abstract: BACKGROUND: Left atrial strain (LAS) analysis represents a newer non-invasive, sensitive and specific technique for assessing left atrial (LA) function and early detection of its deformation and dysfunction. However, its applicability in mitral regurgitation (MR) in pediatric population remains unexplored, raising pertinent questions regarding its potential role in evaluating the severity and progression of the disease. OBJECTIVE: To investigate the impact of chronic MR in children and adolescents on LA remodeling and function. METHODS: The study included 100 participants. Patients with primary and secondary chronic MR lasting at least 5 years fit our …inclusion criteria. The exclusion criteria from the study were: patients with functional mitral regurgitation due to primary cardiomyopathies, patients with artificial mitral valve, patients with MR who had previously undergone surgery due to obstructive lesions of the left heart (aortic stenosis, coarctation of the aorta), patients with significant atrial rhythm disorders (atrial fibrillation, atrial flutter). The echocardiographic recordings were conducted by two different cardiologists. Outcome data was reported as mean and standard deviation (SD) or median and interquartile range (Q1–Q3). RESULTS: The study included 100 participants, of whom 50 had MR and the remaining 50 were without MR. The average age of all participants was 15.8 ± 1.2 years, with a gender distribution of 37 males and 63 females. There was a significant difference in the values of LA volume index (LAVI), which were higher in patients with MR (p = 0.0001), S/D ratio (and parameters S and D; p = 0.001, p = 0.0001, p = 0.013), mitral annulus radius (p = 0.0001), E/A ratio (p = 0.0001), as well as septal e’ (m/s), lateral e’ (m/s), and average E/e’ ratio, along with the values of TV peak gradient and LV global longitudinal strain (%). There was no significant difference in LA strain parameters, nor in LA stiffness index (LASI). CONCLUSION: Our findings revealed significant differences in several echocardiographic parameters in pediatric patients with MR relative to those without MR, providing insight into the multifaceted cardiac structural and functional effects of MR in this vulnerable population. Show more

Keywords: Left atrium, mitral regurgitation, echocardiography, fibrosis

DOI: 10.3233/THC-240768

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3605-3612, 2024

Authors: Schuh, Alexander | Feyrer, Matthias | Benditz, Achim | Sesselmann, Stefan | Koehl, Philipp

Article Type: Case Report

Abstract: BACKGROUND: Uncemented acetabular components are widely used in modern total hip arthroplasty (THA). Modularity has numerous advantages including the ability to use supplementary screw fixation for the shell, and allow to switch from ceramic to polyethylene (PE) bearings and vice versa, and the use of lipped and face-changing liners. OBJECTIVE: Despite these advantages, a problem with modular PE liners is dissociation. This is a rare complication in modern implants. The rate of liner dissociation is reported to be very low between 0.17% and 0.8%. Typical symptoms are sudden onset of groin pain in a previously well-functioning …hip joint, followed by grinding or clicking sensations during hip joint motions indicating, that the femoral head is articulating with the metal acetabular shell rather than with the PE liner. Any newly observed noise or squeaking from a THA should undergo radiographic investigation to exclude liner dissociation. CASE PRESENTATION: We present the case of an 88-yearold male patient who developed PE liner dissociation in a cementless THA with a Pinnacle acetabular component six years after the index operation. We recommended revision of the left hip, which was performed two days later. In the interim, the patient was advised to use a pair of crutches. During revision surgery, it was observed that the metal head made contact with the cementless cup shell without damaging it from a macroscopic standpoint. Consequently, a simple exchange of the PE liner was conducted, and a 36 mm metal head was implanted due to scratches on the original head. CONCLUSION: Early diagnosis facilitates a straightforward exchange of the liner along with the head, potentially preserving the osseous integrated cup shell and stem integrity. Routine radiologic follow-up allows to distinguish between PE liner dissociation and severe PE wear. Show more

Keywords: Polyethylene, PE, liner, dissociation, THR, THA, pinnacle cup

DOI: 10.3233/THC-240016

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3613-3619, 2024