Technology and Health Care - Volume 32, issue 5

Authors: Wu, Jianlei | Guo, Jing | Luo, Yong | Sun, Jianfeng | Xu, Liangwei | Zhang, Jianxing | Liu, Yunfeng

Article Type: Research Article

Abstract: BACKGROUND: As a new intelligent polymer material, shape memory polymer (SMP) was a potential orthodontic appliance material. OBJECTIVE: This study aimed to investigate the thermodynamic responses of SMP under different loads via finite element analysis (FEA). METHODS: FEA specimens with a specification of 0.1 × 0.1 × 1 mm were designed. One end of the specimen was fixed, and the other was subjected to displacement load. Different loading, cooling, and heating rates were separately exerted on the specimen in its shape recovery process and used to observe …the responses of the SMP constitutive model. Furthermore, specimens with various tensile elongation and sectional areas were simulated and used to elucidate their effect on shape recovering force. RESULTS: The specimens obtained a similar stress of 0.5, 0.44, and 1.07 Mpa for different loading, cooling, and heating rates after a long time. The shape recovering force of specimen increased from 0.0102 to 0.0315 N when the elongation improved from 10% to 40% and to 0.0408 N when the sectional areas were expanded to 0.2 × 0.2 mm. CONCLUSION: The stiffness of SMP was small at a high temperature but large at a low temperature. The effects of the loading, cooling, and heating rates on SMP can be eliminated after a long time. Furthermore, it was possible to increase the recovering force by increasing the elongation or expanding the sectional area of the specimen. The force was quadratically dependent on the elongation ratio. Show more

Keywords: Shape memory polymer, constitutive model, thermodynamic response, finite element analysis

DOI: 10.3233/THC-240078

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3383-3391, 2024

Authors: Zhao, Mei | Zhou, Hengyu | Wang, Jing | Liu, Yongyue | Zhang, Xiaoqing

Article Type: Research Article

Abstract: BACKGROUND: The theory of Chinese medicine (TCM) constitution contributes to the optimisation of individualised healthcare programmes. However, at present, TCM constitution identification mainly relies on inefficient questionnaires with subjective bias. Efficient and accurate TCM constitution identification can play an important role in individualised medicine and healthcare. OBJECTIVE: Building an efficient model for identifying traditional Chinese medicine constitutions using objective tongue features and machine learning techniques. METHODS: The DS01-A device was applied to collect tongue images and extract features. We trained and evaluated five machine learning models: Support Vector Machine (SVM), Decision Tree (DT), …Random Forest (RF), LightGBM (LGBM), and CatBoost (CB). Among these, we selected the model with the best performance as the base classifier for constructing our heterogeneous ensemble learning model. Using various performance metrics, including classification accuracy, precision, recall, F1 score, and area under curve (AUC), to comprehensively evaluate model performance. RESULTS: A total of 1149 tongue images were obtained and 45 features were extracted, forming dataset 1. RF, LGBM, and CB were selected as the base learners for the RLC-Stacking. On dataset 1, RLC-Stacking1 achieved an accuracy of 0.8122, outperforming individual classifiers. After feature selection, the classification accuracy of RLC-Stacking2 improved to 0.8287, an improvement of 0.00165 compared to RLC-Stacking1. RLC-Stacking2 achieved an accuracy exceeding 0.85 for identifying each TCM constitution type, indicating excellent identification performance. CONCLUSION: The study provides a reliable method for the accurate and rapid identification of TCM constitutions and can assist clinicians in tailoring individualized medical treatments based on personal constitution types and guide daily health care. The information extracted from tongue images serves as an effective marker for objective TCM constitution identification. Show more

Keywords: Traditional Chinese Medicine Constitution, constitution identification, tongue features, machine learning, ensemble learning

DOI: 10.3233/THC-240128

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3393-3408, 2024

Authors: Chen, Ruijuan | Wang, Rui | Fei, Jieying | Huang, Lengjie | Bi, Xun | Wang, Jinhai

Article Type: Research Article

Abstract: BACKGROUND: Mental fatigue has become a non-negligible health problem in modern life, as well as one of the important causes of social transportation, production and life accidents. OBJECTIVE: Fatigue detection based on traditional machine learning requires manual and tedious feature extraction and feature selection engineering, which is inefficient, poor in real-time, and the recognition accuracy needs to be improved. In order to recognize daily mental fatigue level more accurately and in real time, this paper proposes a mental fatigue recognition model based on 1D Convolutional Neural Network (1D-CNN), which inputs 1D raw ECG sequences of 5 s duration …into the model, and can directly output the predicted fatigue level labels. METHODS: The fatigue dataset was constructed by collecting the ECG signals of 22 subjects at three time periods: 9:00–11:00 a.m., 14:00–16:00 p.m., and 19:00–21:00 p.m., and then inputted into the 19-layer 1D-CNN model constructed in the present study for the classification of mental fatigue in three grades. RESULTS: The results showed that the model was able to recognize the fatigue levels effectively, and its accuracy, precision, recall, and F1 score reached 98.44%, 98.47%, 98.41%, and 98.44%, respectively. CONCLUSION: This study further improves the accuracy and real-time performance of recognizing multi-level mental fatigue based on electrocardiography, and provides theoretical support for real-time fatigue monitoring in daily life. Show more

Keywords: Mental fatigue, short-time electrocardiographic sequence, deep learning, 1D convolutional neural network

DOI: 10.3233/THC-240129

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3409-3422, 2024

Authors: Ji, Jiajia | Zhu, Min | Bao, Mengqian | Xu, Lamei | Yuan, Hui

Article Type: Research Article

Abstract: BACKGROUND: To enhance the self-management ability of elderly diabetes mellitus (DM) patients, priority should be given to the accurate evaluation of their current self-management ability, and then provide corresponding guidance. OBJECTIVE: To explore the application value of Diabetes Self-Management Behaviors among Older Koreans (DSMB-O) in self-management of elderly patients with type 2 diabetes mellitus (T2DM). METHODS: Using convenient sampling, this study retrospectively collected the clinical data of 215 elderly patients with T2DM who were admitted to our hospital from June 2020 to June 2022. Enrolled patients were divided into an effective-control group (n …= 80) and an ineffective-control group (n = 135) based on whether the glycated hemoglobin (HbA1C) was < 7.5% for further comparison of the collected data. RESULTS: There were statistically significant differences in the comparison of the proportion of diabetes mellitus (DM) course (χ 2 = 26.000, P < 0.001), DSMB-O score (17.67 ± 4.07 VS 14.67 ± 4.70 points, t = 4.582, P < 0.001), and Summary Diabetes Self Care Activity (SDSCA) score (43.16 ± 11.17 VS 37.58 ± 12.47 points, t = 5.492, P < 0.001) between the two groups. The total score of DSMB-O was negatively correlated with both HbA1c (r = - 0.281, P < 0.001) and complications (r = - 0.193, P = 0.004); moreover, the total score of SDSCA was also negatively correlated with both HbA1c (r = - 0.234, P < 0.001) and complications (r = - 0.153, P = 0.025). Among various dimensions of DSMB-O, active exercise (OR = 0.699, 95%CI: 0.541 ∼ 0.902) and blood glucose monitoring (OR = 0.603, 95%CI: 0.431 ∼ 0.817) were protective factors for T2DM patients with HbA1c levels < 7.5%. The area under the curve (AUC) of SDSCA score and DSMB-O score predicting self-management level in elderly T2DM patients was 0.643 (95%CI: 0.611 ∼ 0.756) and 0.716 (95%CI: 0.689∼ 0.774), respectively. CONCLUSION: DSMB-O exhibits a higher accuracy in predicting the self-management level of elderly patients with T2DM than that of SDSCA. Regular exercise, medication, blood glucose monitoring, and reducing the risk of complications are all intimately associated with the control of blood glucose. Show more

Keywords: Elderly, Type 2 diabetes, self-management behavior, influencing factors, health effects

DOI: 10.3233/THC-240138

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3423-3432, 2024

Authors: Auer, Simon | Süß, Franz | Dendorfer, Sebastian

Article Type: Research Article

Abstract: BACKGROUND: This study presents a comprehensive comparison between a marker-based motion capture system (MMC) and a video-based motion capture system (VMC) in the context of kinematic analysis using musculoskeletal models. OBJECTIVE: Focusing on joint angles, the study aimed to evaluate the accuracy of VMC as a viable alternative for biomechanical research. METHODS: Eighteen healthy subjects performed isolated movements with 17 joint degrees of freedom, and their kinematic data were collected using both an MMC and a VMC setup. The kinematic data were entered into the AnyBody Modelling System, which enables the calculation of …joint angles. The mean absolute error (MAE) was calculated to quantify the deviations between the two systems. RESULTS: The results showed good agreement between VMC and MMC at several joint angles. In particular, the shoulder, hip and knee joints showed small deviations in kinematics with MAE values of 4.8∘ , 6.8∘ and 3.5∘ , respectively. However, the study revealed problems in tracking hand and elbow movements, resulting in higher MAE values of 13.7∘ and 27.7∘ . Deviations were also higher for head and thoracic movements. CONCLUSION: Overall, VMC showed promising results for lower body and shoulder kinematics. However, the tracking of the wrist and pelvis still needs to be refined. The research results provide a basis for further investigations that promote the fusion of VMC and musculoskeletal models. Show more

Keywords: Biomechanics, range of motion, musculoskeletal system, optical motion capture

DOI: 10.3233/THC-240202

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3433-3442, 2024

Authors: Njezic, Sasa | Zivic, Fatima | Savic, Slobodan | Petrovic, Nenad | Pesic, Zivana Jovanovic | Stefanovic, Anja | Milenkovic, Strahinja | Grujovic, Nenad

Article Type: Research Article

Abstract: BACKGROUND: The biological properties of silicone elastomers such as polydimethylsiloxane (PDMS) have widespread use in biomedicine for soft tissue implants, contact lenses, soft robots, and many other small medical devices, due to its exceptional biocompatibility. Additive manufacturing of soft materials still has significant challenges even with major advancements that have occurred in development of these technologies for customized medical devices and tissue engineering. OBJECTIVE: The aim of this study was to develop a mathematical model of tangential stress in relation to shear stress, shear rate, 3D printing pressure and velocity, for non-Newtonian gels and fluids that …are used as materials for 3D printing. METHOD: This study used FENE (finitely extensible nonlinear elastic model) model, for non-Newtonian gels and fluids to define the dependences between tangential stress, velocity, and pressure, considering viscosity, shear stress and shear rates as governing factors in soft materials friction and adhesion. Experimental samples were fabricated as showcases, by SLA and FDM 3D printing technologies: elastic polymer samples with properties resembling elastic properties of PDMS and thermoplastic polyurethane (TPU) samples. Experimental 3D printing parameters were used in the developed analytical solution to analyse the relationships between governing influential factors (tangential stress, printing pressure, printing speed, shear rate and friction coefficient). Maple software was used for numerical modelling. RESULTS: Analytical model applied on a printed elastic polymer, at low shear rates, exhibited numerical values of tangential stress of 0.208–0.216 N m - 2 at printing velocities of 0.9 to 1.2 mm s - 1 , while the coefficient of friction was as low as 0.09–0.16. These values were in accordance with experimental data in literature. Printing pressure did not significantly influence tangential stress, whereas it was slightly influenced by shear rate changes. Friction coefficient linearly increased with tangential stress. CONCLUSION: Simple analytical model of friction for elastic polymer in SLA 3D printing showed good correspondence with experimental literature data for low shear rates, thus indicating possibility to use it for prediction of printing parameters towards desired dimensional accuracy of printed objects. Further development of this analytical model should enable other shear rate regimes, as well as additional soft materials and printing parameters. Show more

Keywords: Soft materials, tangential stress model, shear rate, friction coefficient, FENE (finitely extensible nonlinear elastic model), 3D printing

DOI: 10.3233/THC-240209

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3443-3462, 2024

Authors: Miura, Takanori | Takahashi, Tsuneari | Ae, Ryusuke | Takeshita, Katsushi | Miyakoshi, Naohisa

Article Type: Research Article

Abstract: BACKGROUND: A gradually reducing radius (GRADIUS) design implant can facilitate a smooth transition from stability through full range of motion in total knee arthroplasty (TKA). Nonetheless, patient-specific factors associated with good knee flexion remain unclear. OBJECTIVE: This study aimed to determine the factors associated with good knee flexion after cruciate-retaining TKA with a GRADIUS prosthesis in an Asian population. METHODS: This retrospective study included 135 patients that were stratified according to postoperative knee flexion angle (KFA) into Group F (⩾ 120∘ ; 85 patients [63.2%]) and Group NF (< …120∘ ; 50 patients [36.8%]). RESULTS: Patients in Group F were taller and had a lower body mass index (BMI) smaller preoperative hipkneeankle angle and better preoperative extension and flexion angle than Group NF patients. The multivariable analysis revealed that patients’ height (odds ratio [OR]: 1.07, P = 0.0150), BMI (OR: 0.85, P = 0.0049), and preoperative flexion angle (OR: 1.06, P = 0.0008) predicted good KFA. The ROC curve analysis showed that the cutoff values of a good KFA were height 155.1 cm, BMI 22.1 kg/m2 , and preoperative KFA 120∘ . CONCLUSIONS: Patient height, BMI, and preoperative KFA were independent factors affecting good postoperative KFA in patients of Asian descent who underwent cruciate-retaining TKA with a GRADIUS design. Show more

Keywords: Total knee arthroplasty, posterior cruciate ligament retaining, knee flexion, body mass index, height, knee implant

DOI: 10.3233/THC-240212

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3463-3471, 2024

Authors: Sun, Yuyan | Li, Qian

Article Type: Research Article

Abstract: BACKGROUND: Dental extraction or tooth extraction is a common clinical radical treatment surgery. OBJECTIVE: To explore the efficacy and safety of remimazolam in tooth extraction surgery in a randomized, single-blind, multi-center clinical trial. METHOD: Patients who underwent tooth extraction surgery at Jinan Stomatological Hospital from April 2022 to March 2023 were selected as the research subjects, and they were divided into a control group and an observation group using the random arrangement table method. The patients in the control group were anesthetized with midazolam, and the patients in the observation group were anesthetized …with remimazolam. Collect the general demographic data of the patients, use the propensity score matching method (PSM) to balance the baseline data of the two groups, and use t -test, chi-square test, and analysis of variance to compare the hemodynamics, anesthesia maintenance period indicators, and alertness/Sedation scores and occurrence of adverse reactions. RESULT: PSM matching was performed according to a 1:1 ratio, and 40 patients were included in the observation and control groups. There was no statistical significance in the baseline data of the two groups. Compared with T0 , the hemodynamic indexes of both groups of patients increased at T1 , T2 , T3 , T4 , and T5 (P < 0.05), but the indexes at T0 and T2 were the same. The same (P > 0.05), and the indicators of the observation group at T1 , T3 , T4 , and T5 were higher than those of the control group (P < 0.05); the administration time of the two groups of patients was the same (P > 0.05), but the observation group The recovery time and onset of effect were shorter than those in the control group (P < 0.05); at T0 , the clinical behavior scores of the two groups of patients were the same (P > 0.05), and at T1 , the scores of the observation group were lower than those of the control group (P < 0.05); at T0 and T1 , the alertness/sedation scores of the patients in the observation group were lower than those in the control group, but at T2 , the scores of the patients in the observation group were higher than those in the control group (P < 0.05); the total clinical adverse reactions of the patients in the observation group were The incidence rate (5.00%) was lower than that of the control group (30.00%) (P < 0.05). CONCLUSION: The use of remimazolam during tooth extraction can stabilize the patient’s hemodynamics, shorten the recovery and onset time, stabilize the patient’s behavior, have an excellent soothing effect, have fewer adverse reactions, and be safer, so it is worthy of use. Show more

Keywords: Remazolam, tooth extraction, sedation, safety, single-masked, multi-center

DOI: 10.3233/THC-240237

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3473-3484, 2024

Authors: Zhao, Tingting | Lv, Tian

Article Type: Research Article

Abstract: BACKGROUND: A significant proportion of interstitial lung disease (ILD) patients experience two or more comorbidities, leading to an increasing burden of disease, frequent hospitalizations, and premature death. OBJECTIVE: To investigate the causal relationship between serum metabolites and ILD in humans using Mendelian randomization. METHODS: Genetic loci closely related to human serum metabolites were selected as instrumental variables (IVs), with the inverse-variance weighted method (IVW) as the primary method and the weighted median method (WME) and MR-Egger regression as auxiliary methods for Mendelian randomization analysis of the data. Meanwhile, the causal relationship between human …serum metabolites and ILD was evaluated by OR, along with the assessment of the stability and reliability of the results via 3 methods, i.e., heterogeneity testing, gene pleiotropy testing, and sensitivity analysis. RESULTS: 8,234 single nucleotide polymorphism (SNP) loci were included as IV, among which 23 SNP loci were selected as IV. Specifically, IVW estimated that the risk of ILD in the anti-Jo-1 antibody-positive population was 4.122 times higher than that in the negative population (95% CI: 2.311–5.954, P < 0.001). IVW also supported a causal effect between anti-SSA antibody positivity and ILD (OR = 2.781, 95% CI: 1.413–4.350, P < 0.001). At the same time, MR-Egger fitted a linear relationship between erythrocyte sedimentation rate (ESR) (95% CI: 1.257–5.894, P = 0.002), C-reactive protein (CRP) (95% CI: 2.433–6.935, P = 0.001), and ILD. Additionally, heterogeneity testing with IVW and MR-Egger regression indicated no heterogeneity, and MR-Egger regression intercept and MR-PRESSO testing suggested minimal influence of gene pleiotropy on the results, without non-specific SNPs identified in the leave-one-out analysis. CONCLUSION: A positive causal relationship may exist between anti-Jo-1 antibody positivity, anti-SSA antibody positivity, elevated ESR, elevated CRP, and ILD. Show more

Keywords: Serum metabolites, interstitial lung disease, mendelian randomization, causal relationship

DOI: 10.3233/THC-240285

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3485-3496, 2024

Authors: Weber, Maximilian | Lenz, Maximilian | Wassenberg, Lena | Perera, Akanksha | Eysel, Peer | Scheyerer, Max Joseph

Article Type: Research Article

Abstract: BACKGROUND: Wound complications after lumbar spine surgery may result in prolonged hospitalization and increased morbidity. Early identification can trigger appropriate management. OBJECTIVE: The aim of this study was to investigate the efficacy of infrared-based wound assessment (FLIR) after lumbar spine surgery in the context of identifying wound healing disorders. METHODS: 62 individuals who underwent lumbar spine surgery were included. The immediate postoperative course was studied, and the patient’s sex, age, body mass index (BMI), heart rate, blood pressure, body temperature, numeric rating scale for pain (NRS), C-reactive protein (CRP), leukocyte, and hemoglobin levels …were noted and compared to thermographic measurement of local surface temperature in the wound area. RESULTS: Measurement of local surface temperature in the wound area showed a consistent temperature distribution while it was uneven in case of wound healing disorder. In this instance, the region of the wound where the wound healing disorder occured had a lower temperature than the surrounding tissue (p > 0.05). CONCLUSIONS: This study demonstrates the ongoing importance of clinical wound assessment for early detection of complications. While laboratory parameter measurement is crucial, FLIR may serve as a cost-effective supplemental tool in clinical wound evaluation. Patient safety risks appear minimal since local ST is measured without touch. Show more

Keywords: Infrared thermography, surgical site infection, spine surgery, skin, temperature

DOI: 10.3233/THC-240344

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3497-3504, 2024

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

Authors: Citak, Mustafa

Article Type: Editorial

DOI: 10.3233/THC-248051

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3623-3624, 2024

Authors: Hoveidaei, Amir Human | Esmaeili, Sina | Ghaseminejad-Raeini, Amirhossein | Pirahesh, Seyed Kasra | Hoveidaei, Armin | Sandiford, Nemandra A. | Lahner, Nina | Citak, Mustafa

Article Type: Review Article

Abstract: BACKGROUND: Unicompartmental knee arthroplasty (UKA) is a viable alternative to total knee arthroplasty (TKA) for osteoarthritis patients with single-compartment involvement, with advantages including accelerated recovery, reduced pain, and improved function. Robotic-assisted UKA (rUKA) is a promising development that ensures precise implant positioning and limb alignment. However, concerns about complications remain. OBJECTIVE: This study looks at patient satisfaction as a key metric for determining the efficacy of rUKA versus manual UKA (mUKA). METHODS: The search strategy for this study followed PRISMA. Using precise keywords, PubMed, Scopus, Web of Science, and the Cochrane library were …searched. English articles were searched until August 2, 2023. Selection criteria included mUKA and rUKA patient satisfaction studies. The NOS scale evaluated study quality. Meta-analysis was done with R and heterogeneity analysis. RESULTS: This systematic review examined 5 studies with 1060 UKAs (532 robotic-assisted and 528 manual). Variable satisfaction assessment methods were used. Three studies found no difference in patient satisfaction after robotic-assisted UKA, but two found a higher satisfaction. Meta-analysis showed robotic-assisted UKA improved patient satisfaction (OR = 1.72 [1.25–2.37]). Overall, most studies showed low risk of bias, except one with higher bias. CONCLUSION: This review suggests that robotic assistance may enhance patient satisfaction in UKA procedures. Show more

Keywords: Arthroplasty, replacement, knee, medical device, patient satisfaction, robotic surgical procedures

DOI: 10.3233/THC-231216

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3625-3634, 2024

Authors: De Mauro, Domenico | Salber, Jochen | Stimolo, Davide | Florian, Ende | Citak, Mustafa

Article Type: Review Article

Abstract: BACKGROUND: In periprosthetic joint infections (PJIs), the surgeon’s role becomes pivotal in addressing the infection locally, necessitating the surgical removal of infected and necrotic tissue. Opportunity to enhance the visualization of infected tissue during surgery could represent a game-changing innovation. OBJECTIVE: The aim of this narrative review is to delineate the application of intraoperative fluorescence imaging for targeting infected tissues in PJIs. METHODS: A systematic review, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, was carried out. The search included multiple online database; MEDLINE, Scopus, and Web of …Science. For data extraction the following were evaluated: (i) diagnosis of musculoskeletal infection; (ii) use of intraoperative fluorescence imaging; (iii) infected or necrotic tissues as target. RESULTS: Initially, 116 studies were identified through online database searches and reference investigations. The search was narrowed down to a final list of 5 papers for in-depth analysis at the full-text level. Subsequently, 2 studies were included in the review. The study included a total of 13 patients, focusing on cases of fracture-related infections of the lower limbs. CONCLUSION: The primary and crucial role for orthopedic surgeons in PJIs is the surgical debridement and precise removal of necrotic and infected tissue. Technologies that enable clear and accurate visualization of the tissue to be removed can enhance the eradication of infections, thereby promoting healing. A promising avenue for the future involves the potential application of intraoperative fluorescence imaging in pursuit of this objective. Show more

Keywords: Intraoperative fluorescence imaging, periprosthetic joint infections, total joint arthroplasty, necrotic tissue, 5-aminolevulinic acid

DOI: 10.3233/THC-240479

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3635-3641, 2024

Authors: Kara, Seher | Nokay, Aziz Emre

Article Type: Review Article

Abstract: BACKGROUND: Total knee arthroplasty (TKA) is a common procedure for treating end-stage degenerative knee osteoarthritis (OA). Despite the generally excellent outcomes, postoperative complications such as loss of muscle strength and joint limitation can occur. Therefore, postoperative physical rehabilitation is crucial for regaining strength, functionality, and managing pain. Various rehabilitation strategies employ different methods to reduce pain severity, regain muscle strength, assist patients in returning to daily activities, and increase functionality. In recent years, technological advancements have transformed rehabilitation methods. In addition to traditional applications, new methods have been incorporated into treatment plans. OBJECTIVE: This study aimed …to evaluate novel physical rehabilitation methods and options following OA. METHODS: A literature review was conducted to identify and investigate recent and commonly used novel rehabilitation methods. The search terms “Total Knee Arthroplasty,” “New Rehabilitation TKA,” “Novel Rehabilitation” “Novel Rehabilitation in Arthroplasty” and “Technology Knee Rehabilitation” were searched across PubMed and Google Scholar databases, covering literature from the past 15 years. Studies on telerehabilitation, functional electric stimulation, virtual reality, yoga, and their reported outcomes were evaluated using specific keywords. The results of various studies on novel rehabilitation methods were gathered and compared to traditional treatment plans based on functionality and applicability. RESULTS: Several studies reported that telerehabilitation was not inferior to traditional rehabilitation, with some showing positive outcomes. Telerehabilitation following TKA demonstrated positive effects on functionality and patient satisfaction. Functional electric stimulation showed significant improvements in muscle strength and pain reduction. Virtual reality demonstrated superior effects on proprioception and posture outcomes. The use of yoga in rehabilitation also resulted in improved proprioception and pain reduction. CONCLUSION: In addition to traditional rehabilitation methods, new approaches have shown significant positive outcomes for patients who have received TKA. We are in an era of digital development, and as such, new rehabilitation techniques, particularly those involving digital advancements, will continue to emerge. With the trend toward personalized approaches in medicine, more new techniques or methods will be incorporated into rehabilitation plans, leading to better recovery outcomes from TKA. Show more

Keywords: TKA, rehabilitation, technology, telerehabilitation, virtual reality, functional electric stimulation, novel methods in rehabilitation

DOI: 10.3233/THC-240628

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3643-3648, 2024

Authors: Tekeli, Seçkin Özgür | Köse, Özkan | Yapar, Dilek | Tekeli, Feyza Yağmur | Asoğlu, Mehmet Melih | Kartal, Emre Mücahit

Article Type: Research Article

Abstract: BACKGROUND: The extent of the association between vitamin D deficiency and knee osteoarthritis remains inadequately understood. OBJECTIVE: This study aimed to elucidate the relationship between vitamin D levels and knee osteoarthritis through a cross-sectional analysis. METHODS: This retrospective study involved an analysis of knee radiographs and serum 25-hydroxyvitamin D3 (25-(OH) vitamin D3) levels in a cohort of 3424 individuals (2901 women and 523 men). Knee osteoarthritis severity was evaluated using the Kellgren-Lawrence radiological scoring system. RESULTS: Of the participants, 49.2% (n = 1,683) were diagnosed …with knee osteoarthritis. Among these patients, the levels of adjusted 25-(OH) vitamin D3 were significantly lower (p < 0.001). Regression analysis revealed a significant association between vitamin D deficiency and knee osteoarthritis, with an adjusted odds ratio (OR) of 1.7 (95% CI: 1.5–2.0; p < 0.001). Notably, a stronger association was observed between vitamin D deficiency and knee osteoarthritis in women under 65 compared to those aged 65 and above. CONCLUSIONS: The findings of this study indicate a higher prevalence of vitamin D deficiency in patients with knee osteoarthritis. Maintaining adequate serum 25-(OH) vitamin D3 levels may prevent knee osteoarthritis, especially in women below 65. Show more

Keywords: Vitamin D, knee, osteoarthritis, female sex, biomedical imaging, elderly healthcare, orthopedic surgery

DOI: 10.3233/THC-230802

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3649-3658, 2024

Authors: Akçaalan, Serhat | Akbulut, Batuhan | Çağlar, Ceyhun | Innocenti, Matteo | Uğurlu, Mahmut | Dogan, Metin | Akkaya, Mustafa

Article Type: Research Article

Abstract: BACKROUND: Periprosthetic joint infection (PJI) is a very important complication that occurs after total joint replacement. Diagnosing PJI is at least as difficult as this disease. There is no biomarker that alone can diagnose PJI. OBJECTIVE: This study aimed to evaluate the effectiveness of large unstained cell percentage (%LUC) in diagnosing PJI and deciding on re-implantation in two stage septic exchange arthroplasty. METHODS: Patients who underwent revision arthroplasty between 2019 and 2023 were screened retrospectively. These patients were grouped as those who underwent two-stage septic exchange and those who underwent aseptic exchange. Prosthesis …removal from the patients who underwent two-stage septic exchange, before spacer application, and on the 3rd post-operative day after spacer application, Blood parameters were collected at the 1st month and before the second stage after the spacer application, and before the revision surgery from the patients who underwent aseptic exchange. White blood cell, neutrophil percentage, %LUC, albumin, sedim and CRP values were checked and recorded one by one from all patients. RESULTS: The data of a total of 233 patients, including 133 patients in the two stage septic exchange group and 100 patients in the aseptic exchange group, were included in the study. When the predictive value of %LUC in PJI was accepted as cut-off 1.75, the sensitivity was 69.2% and the specificity was 73%. The change in %LUC over time in patients who underwent two-stage septic exchange was statistically significant (p = 0.0001). A positive correlation was found between the value of .%LUC after spacer application and the value of CRP before prosthesis protrusion/spacer application surgery, and the Spearman correlation coefficient was found to be 0.005. CONCLUSION: %LUC value can be a promising biomarker for the diagnosis of PJI by considering both sensitivity and specificity rates. Apart from this, it is an easily accessible and effective biomarker for re-implantation decision making and evaluation of response to treatment, especially in two-stage septic exchange surgeries. Show more

Keywords: Periprosthetic joint infection, %LUC, biomarker, two stage, septic exchange

DOI: 10.3233/THC-230903

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3659-3667, 2024

Authors: Fink, Bernd | Hoyka, Marius | Blersch, Benedikt Paul | Baum, Hannsjörg | Sax, Florian Hubert

Article Type: Research Article

Abstract: BACKGROUND: Graphic type differentiation of cell count data of synovial aspirates is a new method for the diagnosis of early and late periprosthetic joint infection. OBJECTIVE: The aim of the study was to analyse if the same 6 LMNE-types can be differentiated in the new Yumizen H500 cell counter as it was the case for the old cell counter ABX Pentra XL 80 of previous publications, to verify if the erythrocyte and thrombocyte curves of the new device give additional information and to calculate the difference of cell count in LMNE-type I and III (with abrasion) …in the cell counter and in the manual counting chamber (Neubauer improved). METHODS: 450 aspirates of 152 total hip arthroplasties and 298 knee arthroplasties obtained for the diagnosis of periprosthetic joint infection were analysed with the Yumizen H500. RESULTS: All LMNE-matrices of the 450 aspirates could assigned to one of the six LMNE-types. There were 76 LMNE-type I, 72 LMNE-type II, 14 LMNE-type III, 241 LMNE-type IV, 36 LMNE-type V and 12 LMNE-type VI. The erythrocyte and thrombocyte distribution curves were very helpful for differentiation of hematoma and infection. The cell count in the manual counting procedure was lower than in the cell counter: for the LMNE-type I (abrasion type) the median of the difference was 925/μ L (median) and for the LMNE-type III (combined type of infection and abrasion) 3570/μ L (median). CONCLUSION: The described graphic type differentiation is a new and helpful method for differentiation of hematoma and early PJI as well as abrasion and late PJI. Show more

Keywords: Leucocyte count, synovia, periprosthetic joint infection, cell counter

DOI: 10.3233/THC-231006

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3669-3680, 2024

Authors: Incesoy, Mustafa Alper | Yildiz, Fatih | Pulatkan, Mehmet Anil | Yesiller, Omer Faruk | Toluk, Ozlem | Erdem, Ahmet Can | Tuncay, Ibrahim

Article Type: Research Article

Abstract: BACKGROUND: With the restoration of the natural hip biomechanics, a successful total hip arthroplasty (THA) and long-term survival is pursued. Although robotic THA (rTHA) has been developed to increase accuracy of implant positioning, leg lengths and offsets, discussions about its radiological and clinical advantages over conventional THA (cTHA) continues. OBJECTIVE: The aim of this study was to compare clinical and radiological outcomes of robotic and conventional THA. METHODS: This retrospective study compares functional and radiological outcomes of 82 rTHA with a matched group of 82 cTHA in terms of age, sex, body mass …index and preoperative functional scores. The minimum follow up was 12 months for all patients. Functional outcomes were Harris Hip Score (HHS) and the Western Ontario and McMaster University Osteoarthritis index (WOMAC) evaluated pre- and postoperatively. Radiological evaluations included position of cup placement according to Lewinnek and Callanan safe zones, Canal Fill Ratio (CFR), Leg Length Discrepancy (LLD), Lateral offset (LO) and Femoral Component Alignment (FCA). Complications were also evaluated. RESULTS: In the rTHA group, 91.5% (75 out of 82) of the acetabular cups were positioned within the safe zone whereas it was 63.4% (52 out of 82) for the cTHA group (p < 0.001). According to Callanan, they were 84.1% and 50%, respectively (p < 0.001). Between the groups, no statistically significant difference was found in CFR, LLD, HO, FCA, AI, AA, WOMAC, HHS and major complication rates. CONCLUSION: rTHA is superior to cTHA in terms of accuracy and reproducibility of the cup placement, however no apparent clinical benefit was found in short term follow. Show more

Keywords: Total hip arthroplasty, robot-assisted surgery, component positioning, robotic total hip replacement

DOI: 10.3233/THC-231111

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3681-3691, 2024

Authors: Ong, Christian B. | Buchan, Graham B.J. | Hecht II, Christian J. | Homma, Yasuhiro | Harmon, Daniel J. | Kendoff, Daniel O. | Petterwood, Joshua | Kamath, Atul F.

Article Type: Research Article

Abstract: BACKGROUND: Robotic assistance in total hip arthroplasty (RA-THA) has been shown to minimize laterality-based differences in acetabular cup positioning. OBJECTIVE: To determine if the use of a novel, fluoroscopy-based RA-THA system mitigates differences in acetabular cup placement between left (L) and right (R) side hip procedures, when compared to manual, fluoroscopic-assisted technique. METHODS: We conducted a retrospective review of 106 consecutive mTHA (40 L/66 R) and 102 RA-THA (48 L/54 R) primary direct anterior approach procedures. All cases were performed by a single right-hand-dominant surgeon, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, …or rheumatoid arthritis. Outcomes included acetabular cup inclination and anteversion, and the proportion of cups within the Lewinnek safe-zone. RESULTS: The average inclination of mTHA L cases was smaller than that of mTHA R cases (41.10∘ ± 7.38 vs. 43.97∘ ± 6.27; p = 0.04). For RA-THA, L and R cup angles were similar. There were fewer overall mTHA hips within the Lewinnek safe-zone compared to RA-THA (0.59 vs. 0.78; p = 0.003), as well as fewer mTHA R cases than RA-THA R cases (0.59 vs. 0.80; p = 0.03) within safe zone. CONCLUSION: Use of a novel, fluoroscopy-based robotic system mitigates laterality-based differences in acetabular cup placement that were observed in a manual, fluoroscopic-assisted cohort. Show more

Keywords: Arthroplasty, hip, acetabulum, robotic-assisted surgery, functional laterality

DOI: 10.3233/THC-231126

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3693-3701, 2024

Authors: Ong, Christian B. | Buchan, Graham B.J. | Hecht II, Christian J. | Kendoff, Daniel O. | Homma, Yasuhiro | Kamath, Atul F.

Article Type: Research Article

Abstract: BACKGROUND: Patient obesity is a risk factor for poor acetabular cup positioning in total hip arthroplasty (THA). OBJECTIVE: To assess the impact of using a novel, fluoroscopy-based robotic THA system on acetabular cup placement in obese versus non-obese patients. METHODS: A review of 105 consecutive manual unassisted (mTHA) (47 Obese/58 Non-obese) and 102 robotic-assisted (RA-THA) (50 Obese/52 Non-obese) primary, direct anterior approach THA procedures was conducted. All cases were performed by a single surgeon, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Obesity was defined as a Body Mass Index …(BMI) ⩾ 30 kg/m2 . Outcomes included acetabular cup inclination and anteversion, and the proportion of cups within the Lewinnek safe-zone. RESULTS: Obese patients in the mTHA cohort had larger cup inclination angles on average compared to non-obese patients (44.82∘ ± 6.51 vs. 41.39∘ ± 6.75; p = 0.009). Obese mTHA patients were less likely to have cup placement within the Lewinnek zone compared to non-obese mTHA patients (0.48 vs. 0.67; p = 0.027). Obesity had no effect on the accuracy of RA-THA. CONCLUSION: Obesity affects the placement of the acetabular component in manual THA. The novel, fluoroscopy-based robotic THA system in this study demonstrated accurate cup placement regardless of obesity status. Show more

Keywords: Arthroplasty, hip, acetabulum, robotic-assisted surgery, obesity

DOI: 10.3233/THC-231127

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3703-3712, 2024

Authors: DeClaire, Jeffrey H. | Wakelin, Edgar A. | Chattinger, Kayla | Plaskos, Christopher

Article Type: Research Article

Abstract: BACKGROUND: Early complications in total knee arthroplasty (TKA) associated with modern robotics platforms integrated with digital balancing technology have not been investigated. OBJECTIVE: The objective was to compare 90-day complication rates between a manual technique and a modern robotic-assisted ligament balancing TKA platform. METHODS: 895 primary TKA procedures from a single surgeon were retrospectively reviewed (614 manual TKA, 281 using a modern robotics platform with an integrated digitally controlled ligament balancing device). Post-operative complications within the 90-day episode of care were recorded by the Michigan Arthroplasty Registry Collaborative Quality Initiative. Differences in complication …rates between techniques were further divided into inpatient hospital, outpatient hospital, and ambulatory surgery center (ASC) cohorts. RESULTS: In the pooled hospital cohort and inpatient hospital cohort, ‘Return to OR’ was significantly lower for the robotic assisted group (1.3% vs 5.2% and 0% vs 4.9%, respectively, p < 0.0370). Specifically, the need for manipulation under anesthesia (MUA) was reduced for the robotics group (0.0% vs 2.5%, p = 0.0352). No differences in overall complication rate or cause of complication was found between manual and robotics cases for the hospital outpatient and ASC cohorts (p ⩾ 0.68). CONCLUSION: Within the hospital setting, robotic assisted ligament balancing technology was associated with reduced 90-day postoperative complications for ‘Return to OR’ and MUA. Show more

Keywords: Total knee arthroplasty, robotics, soft tissue, complications, hospital, ambulatory surgical center, ASC

DOI: 10.3233/THC-231198

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3713-3725, 2024

Authors: Orsi, Alexander D. | Mathew, Manu | Plaskos, Christopher | Wakelin, Edgar A. | Slotkin, Eric M. | Coffey, Simon | Ponder, Corey E. | Keggi, John K. | McMahon, Stephen J.

Article Type: Research Article

Abstract: BACKGROUND: Passive smartphone-based apps are becoming more common for measuring patient progress after total hip arthroplasty (THA). Optimum activity levels during early THA recovery have not been well documented. OBJECTIVES: Correlations between step-count and patient reported outcome measures (PROMs) during early recovery were explored. This study also investigated how demographics impact step-count during early post-operative recovery. METHODS: Smartphone captured step-count data from 666 THA patients was retrospectively reviewed. Mean age was 64 ± 11 years. 55% were female. Mean BMI was 29 ± 8kg/m2 . Mean daily …step-count was calculated for each patient over four time-windows: 60 days prior to surgery (preop), 42–49 days postop (6 weeks), 91–98 days postop (3 months), and 183–197 days postop (6 months). Spearman correlation coefficients and linear regression were used to assess the association between PROMs (HOOS-12, HOOS-Jr, and UCLA) and step-count. Patients were separated into three step-count levels: low (< 2500 steps/day), medium (2500–5500 steps/day), and high (> 5500 steps/day). Age > 65 years, BMI > 35 kg/m2 , and sex were used for demographic comparisons. Post hoc analyses were performed using Welch’s unequal variances t -tests, or Wilcoxon rank-sum tests, both with Bonferroni corrections, where appropriate when comparing between groups. Chi-squared analyses were also used when comparing categorical variables. RESULTS: UCLA correlated with step-count at all time-windows (p < 0.001). HOOS12-Function correlated with step-count preoperatively, at 6 weeks, and at 3 months (p < 0.001). High step-count individuals had improved UCLA scores compared to low step-count individuals preoperatively (Δ 1.5, p < 0.001), at 6 weeks (Δ 0.9, p < 0.001), at 3 months (Δ 1.4, p < 0.001), and at 6 months (Δ 1.4, p < 0.001). High step-count individuals had improved HOOS12-Function scores compared to low step-count individuals preoperatively (Δ 9.6, p < 0.001), at 6 weeks (Δ 5.3, p < 0.001), and at 3 months (Δ 6.1, p < 0.001). Males had greater step-count at all time points (p < 0.001). Younger patients and low BMI patients had greater step-count across all time points (p < 0.001). CONCLUSION: High step-count improved PROMs scores compared to low step-count. Early post-operative step-count was significantly impacted by age, sex, and BMI. Generic recovery profiles may not be appropriate across diverse populations. Show more

Keywords: Total hip arthroplasty, smartphone, step-count, PROMs, remote patient monitoring

DOI: 10.3233/THC-231203

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3727-3736, 2024

Authors: Rossi, Stefano Marco Paolo | Sangaletti, Rudy | Andriollo, Luca | Matascioli, Luca | Benazzo, Francesco

Article Type: Research Article

Abstract: BACKGROUND: Robotic-assisted total knee arthroplasty (TKA) have shown promising results in recent years with improved clinical outcomes using standard primary implants. OBJECTIVE: The purpose of this study was to assess the experience of a single center in correcting severe coronal deformities with the use of a robotic-assisted TKA system and an increased constrained implant. METHODS: Between July 2020 and December 2022, 30 knees in 28 patients with a major deformity and an associated ligament laxity requiring an increased constrained implant treated using an imageless robotic-assisted TKA were prospectively enrolled. Patients included in the …study showed a minimum 15 degrees varus or 10 degrees valgus deviation. RESULTS: 20 cases were varus knees and 10 cases were valgus knees. Postoperative neutral alignment was defined as 0∘ ± 2.5∘ . A CCK implant was used in 20 cases while a Constrained Posterior Stabilized implant was used in 10 cases. A neutral alignment was achieved in all patients. At a minimum 6 months follow up (f-u 6–30 months) clinical outcomes including ROM, KSS, HSS, OKS and WOMAC showed significant improvement and no major complications were registered. CONCLUSIONS: The robotic system showed the achievement of a mechanical alignment with reliable radiographic outcomes and clinical results in the treatment of major deformities of the lower limb with the use of higher constrained implants at short term follow up. Further follow up and studies are necessary to confirm and verify these promising outcomes. Show more

Keywords: Robotics, knee, major deformities, varus, valgus, constaint, computer-aided surgical planning, orthopedic surgery

DOI: 10.3233/THC-231261

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3737-3746, 2024

Authors: Rullán, Pedro J. | Oyem, Precious C. | Pumo, Thomas J. | Khan, Shujaa T. | Pasqualini, Ignacio | Klika, Alison K. | Barsoum, Wael K. | Molloy, Robert M. | Piuzzi, Nicolas S.

Article Type: Research Article

Abstract: BACKGROUND: It is crucial to understand weight trends in patients undergoing total hip arthroplasty (THA). OBJECTIVE: To evaluate preoperative and postoperative weight trends for patients undergoing primary THA and factors associated with clinically significant weight change. METHODS: A prospective cohort who underwent primary unilateral THA (n = 3,011) at a tertiary healthcare system (January 2016 to December 2019) were included in the study. The primary outcomes were clinically significant weight change (> 5% change in body mass index [BMI]) during the one-year preoperative and one-year …postoperative periods. RESULTS: Preoperatively, 66.6% maintained a stable weight, 16.0% gained and 17.4% lost weight, respectively. Postoperatively, 64.0% maintained a stable weight, while 22.6% gained and 13.4% lost weight, respectively. Female sex, Black race, obesity, higher Charlson Comorbidity Index (CCI) scores, and older age were associated with preoperative weight loss. Female sex, obesity, higher CCI scores, and Medicare insurance were associated with postoperative weight loss. Preoperative weight loss was associated with postoperative weight gain (OR = 3.37 [CI: 2.67 to 4.25]; p < 0.001), and preoperative weight gain was associated with postoperative weight loss (OR = 1.74 [CI: 1.30 to 2.3]; p < 0.001). CONCLUSION: Most patients maintained a stable BMI one-year before and one-year after THA. Several factors are associated with weight loss before and after THA. Preoperative weight changes were associated with a reciprocal rebound in BMI post-operatively. Show more

Keywords: THA, BMI, weight change, trends, predictors

DOI: 10.3233/THC-231404

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3747-3760, 2024

Authors: Barberis, Luca | Sabatini, Luigi | Pellegrino, Andrea | Galletta, Claudia | Risitano, Salvatore | Capella, Marcello | Massè, Alessandro | Schiraldi, Marco | Indelli, Pier Francesco

Article Type: Research Article

Abstract: BACKGROUND: Bicruciate-retaining (BCR) total knee arthroplasty (TKA) has seen renewed interest due to the potential for more natural knee kinematics with anterior cruciate ligament (ACL) retention. OBJECTIVE: The present study attempts to determine differences in the 2-year survivorship and patient-reported outcomes between two surgical strategies (traditional instrumentation versus robotics) applied to the extensive use of a modern, 2nd generation BCR TKA design. METHODS: We performed a retrospective study with prospectively collected data of 113 patients who underwent primary TKA between 2018 and 2020 using a 2nd generation BCR TKA implant. Patient …demographics, PROMS, and intra/post-operative complications were collected. Patients were also evaluated according to the use or not of robotics. A Kaplan-Meier analysis was used to evaluate revision-free survival at follow up. RESULTS: 102 patients were enrolled: 90 received traditional surgery and 12 robotic-assisted surgery. The mean age was 68 years (SD 7.76) with an average BMI of 29.6 kg/m2 (SD 3.56). The mean follow up (FU) was 32.4 ± 6.2 months (range 24–45 months). Survivorship at 2 years was 98% (95% CI: 92.4–99.5). Revisions/reoperations were performed for anterior cruciate ligament (ACL) tear (1/4), pain (1/4), arthrofibrosis (1/4) and acute periprosthetic joint infection (PJI) (1/4). At final FU, 92 patients (90.2%) considered themselves satisfied, showing a mean OKS of 40.6 (SD 5.1) and a mean FKS of 76.7 (SD 11.8). No differences in the outcome were found between traditional and robotic-assisted procedures. CONCLUSION: The modern BCR design evaluated in this study achieved excellent results in terms of implant survivorship, low rate of reoperation and clinical results, independently from the use of enabling technologies. Show more

Keywords: Arthroplasty, replacement, knee, anterior cruciate ligament, TKA, BCR, instability

DOI: 10.3233/THC-231608

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3761-3768, 2024

Authors: Rogers, Nathan | Rullán, Pedro J. | Pasqualini, Ignacio | Khan, Shujaa T. | Klika, Alison K. | Surace, Peter A. | Molloy, Robert M. | Piuzzi, Nicolas S. | Bloomfield, Michael

Article Type: Research Article

Abstract: BACKGROUND: The value of robotic-assisted total hip arthroplasty (rTHA) has yet to be determined compared to conventional manual THA (mTHA). OBJECTIVE: Evaluate 90-day inpatient readmission rates, rates of reoperation, and clinically significant improvement of patient-reported outcome measures (PROMs) at 1-year in a cohort of patients who underwent mTHA or rTHA through a direct anterior (DA) approach. METHODS: A single-surgeon, prospective institutional cohort of 362 patients who underwent primary THA for osteoarthritis via the DA approach between February 2019 and November 2020 were included. Patient demographics, surgical time, discharge disposition, length of stay, acetabular …cup size, 90-day inpatient readmission, 1-year reoperation, and 1-year PROMs were collected for 148 manual and 214 robotic THAs, respectively. RESULTS: Patients undergoing rTHA had lower 90-day readmission (3.74% vs 9.46%, p = 0.04) and lower 1-year reoperation (0.93% vs 4.73% mTHA, p = 0.04). rTHA acetabular cup sizes were smaller (rTHA median 52, interquartile range [IQR] 50; 54, mTHA median 54, IQR 52; 58, p < 0.001). Surgical time was longer for rTHA (114 minutes vs 101 minutes, p < 0.001). At 1-year post-operatively, there was no difference in any of the PROMs evaluated. CONCLUSION: Robotic THA demonstrated lower 90-day readmissions and 1-year reoperation rates than manual THA via the DA approach. PROMs were not significantly different between the two groups at one year. Show more

Keywords: THA, direct anterior approach, HOOS, satisfaction, value of robotics

DOI: 10.3233/THC-231646

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3769-3781, 2024

Authors: Álvarez Valdivielso, Ainhoa | Akkaya, Mustafa | Mau, Hans | Luo, T. David | Gehrke, Thorsten | Citak, Mustafa

Article Type: Research Article

Abstract: BACKGROUND: Surgeons still face difficulties when performing aseptic acetabular revision on patients with extensive defects. Advances in three-dimensional printing technology (3DP) have afforded to the surgeons to create a patient-specific implant matching the morphology and topography of the defect. OBJECTIVE: The aim of the current research was to determine the survivorship in the treatment of acetabular bone defects with pelvic discontinuity (PD). METHODS: In order to reconstruct Paprosky type III defects with PD, twenty-three patients underwent revision total hip arthroplasty (THA) utilizing 3D-printed implants (Mobelife). The primary outcomes were the implant-associated failure rate …correlated with survivorship. As secondary variables, complications and the effect of age, sex, comorbidities, history of infections and the presence of other lower limb arthroplasties on a new revision were analyzed. RESULTS: Patients were followed out to a mean of 67.22 ± 39.44 months (range, 0.9–127 months). Mobelife implant mean survival was 102.57 ± 9.90 months (95% CI 83.17–121.96). The cohort’s implant one-year survival rate was 87%; at ten years, it dropped to 78.3%. There were four revisions: three due to periprosthetic joint infection (PJI) and one case due to aseptic loosening. Cox regression analysis did not identify any variable as predictor of failure. CONCLUSION: The use of 3DP patient-specific acetabular components has shown encouraging results and it is a viable treatment option for addressing acetabular defects with combined PD in aseptic THA revision. Show more

Keywords: Acetabular bone loss, Paprosky type III bone defect, pelvic discontinuity, patient-specific implants, 3D printing

DOI: 10.3233/THC-231647

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3783-3792, 2024

Authors: Ciloglu, Osman | Karaali, Evren | Yilmaz, Ahmet | Çetinkaya, Pelin Duru | Unlu, Nurdan | Kaya, Hatice | Unal, Nevzat | Keklikcioglu, Burak

Article Type: Research Article

Abstract: BACKGROUND: It has not yet been fully established that there is coronavirus disease 2019 (COVID-19) involvement in the synovial fluid and it remains a topic of debate. OBJECTIVE: The aim of this study was to evaluate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in knee joint synovial fluid of patients with COVID-19. METHODS: This retrospective study was conducted with an initial screening of patients who were admitted to a tertiary pandemic hospital due to COVID-19 symptoms, and underwent treatment for COVID-19 between March and June 2020. RESULTS: …A total of 2476 patients were hospitalized or received treatment for a possible diagnosis of COVID-19. While the RT-PCR test was positive in 318 patients (12.8%), 2158 (87.2%) were computed tomography positive but reverse transcription-polymerase chain reaction (RT-PCR) negative. Twelve patients were consulted due to acute joint effusion. Of five patients with knee joint effusion and a positive RT-PCR test, the synovial tissue RT-PCR test was positive in only one patient. CONCLUSION: This paper is the first to show the presence of SARS-CoV-2 in synovial fluid. This can be considered of importance for the determination and elimination of the route of transmission, thereby preventing further development and spread of the disease. Show more

Keywords: Coronavirus, COVID-19, SARS-CoV-2, knee arthritis

DOI: 10.3233/THC-240317

Citation: Technology and Health Care, vol. 32, no. 5, pp. 3793-3800, 2024