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Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured.
The following types of contributions and areas are considered:
1. Original articles:
Technology development in medicine: New concepts, procedures and devices associated with the use of technology in medical research and clinical practice are presented to a readership with a widespread background in engineering and/or medicine.
Significance of medical technology and informatics for healthcare: The appropriateness, efficacy and usefulness deriving from the application of engineering methods, devices and informatics in medicine and with respect to public health are discussed.
2. Technical notes:
Short communications on novel technical developments with relevance for clinical medicine.
3. Reviews and tutorials (upon invitation only):
Tutorial and educational articles for persons with a primarily medical background on principles of engineering with particular significance for biomedical applications and vice versa are presented.
4. Minisymposia (upon invitation only):
Under the leadership of a Special Editor, controversial issues relating to healthcare are highlighted and discussed by various authors.
Abstract: Internal fixation techniques are in common used to stabilize vertebral fractures and correct severe scoliosis. Consolidation of injured vertebrae with neighbouring intact vertebra is the goal in the former case whilst fusion of the vertebrae in a corrected position is aimed at in the latter case. Degenerative spine diseases are not considered in this paper. Classical instrumentation consists of rods (e.g., Cotrel–Dubousset, Harrington, Luque–Galveston) attached to the bone by means of hooks or wires. More recently, transpedicular screws are introduced as an alternative bone/implant interface. Comparing the results of several studies, the posterior pedicle screw based devices demonstrate the ability…to produce the most rigid constructs. However, the insertion of pedicle screws implicates a relatively high complication risk and its succes strongly depends on the experience of the surgeon. Incorrect drilled holes or malplacement of the screws can result in nerve root injuries and fracture of the pedicle. Studies reported complication ratios up to 30% with substantial neurological implications. A certain degree of automation of the critical actions may be necessary to enhance the safety of pedicle screw insertion. Two techniques of computer assisted spine surgery are compared. Both techniques permit a computer assisted surgical planning based on CT images. During operation the first system permanently observes the position of the drill relative to the spine and informs the surgeon on the deviation of the actual drill path to the planned drill path. The second system uses a pre-operative surgical planning to design and construct a mechanical drill guide, fitting perfectly on the patient’s spine.
Abstract: The antithrombotic effect of six polymers was tested by weighing the amount of thrombus formed on polymer catheters of diameters 1.45–1.7 mm inserted in rat vein for one hour, and compared to that of platinum of diameter 0.5 mm. Ten observations were made of each polymer. The order of decreasing biocompatibility in μg thrombus/sq mm surface was polyetherurethane (14.6), polypropolene (17.9), polyvinylcloride DEHP (23.5), polyethylene (27.3), polyvinylchloride TOTM (37.8) and polymethylsiloxane (39.1). Deposit on platinum was 200 μg/sq mm. These levels correspond to those attained by 150âĂŞ333 iu heparin given intravenously, or warfarin from just inside the non-haemorrhagic…(15% factor II) to the high-risk haemorrhagic range (8% factor II). Current polymer surfaces may exceed the antithrombotic biocompatibility afforded by drugs to platinum surface.
Keywords: Polymer, biomaterials, implantation, vein, thrombogenicity, rat
Abstract: Thrombus deposits on foreign surfaces in contact with blood. Substances adsorbed on the surface can influence thrombus formation. Platelet activator substances and coagulation components thrombin and fibrinogen, were adsorbed onto respective series of platinum wire. A treated wire and a control untreated wire were inserted for one hour into the vena cava in groups of rats and the deposited thrombus was weighed. A control group of rats bore two untreated wires which attracted similar thrombus. Arachidonic acid and adenosine diphosphate negligibly affected thrombus. Collagen, fibrinogen, thrombin and egg albumin significantly reduced thrombus deposits by up to 85%.
Abstract: The cerebrospinal fluid (CSF) pressure patterns have been reported as one of the most relevant indexes for the diagnosis and treatment of idiopathic normal-pressure hydrocephalus (INPH). Forty consecutive patients coming from our observations with the classic Hakim’s triad underwent continuous CSF pressure monitoring via lumbar puncture for at least 12 hours. Twenty-eight patients were diagnosed as having INPH and underwent CSF shunt. A multi-layer neural network (perceptron) was employed to study the pressure patterns in order to try an alternative classification to the “expert” neurosurgeon one. Differences between expert and neural network classifications were indeed observed. Such differences may depend…on the small group studied or on the inadequacy of CFS pressure patterns in correctly individuating those INPH patients who benefit from shunt surgery. The authors think that neural network processing of INPH could add relevant information to select the “responder” patients to surgery: in fact neural networks represent a powerful methodology for aiding the expert to select the proper choice on the basis of “what learnt” by the networks themselves.
Abstract: In recent years, bright light treatment of seasonal affective disorder (SAD), recurrent depressions in fall and winter, has been discovered. Newer applications include circadian sleep phase disorder, shift work and jet lag. Apart from creating the visual signal, light can modify retinal structure and physiology. UV and visible light lead to distinct lesions of ocular tissues under certain experimental und naturalistic conditions. In light therapy, a large variety of fixtures is used but the spectral emission of lamps is mostly unknown to the user and clinician leading to the potential hazard of ocular lesions. Therefore, we have analyzed a wide…selection of light sources commonly used for treatment. We measured the spectral emission and calculated irradiant doses for several light therapy regimens. Based on these measurements, potential hazards are analyzed, physiological mechanisms of light action are discussed and safety measures for bright light therapy are proposed. They include recommendations for lamps devoid of damaging spectral emissions and standardized therapy fixtures, ophthalmological monitoring of patients with eye diseases and control by optometrists for patients with healthy eyes who are likely to undergo light treatment for extended periods.
Abstract: The airway occlusion pressure, P0.1, is the negative airway pressure generated during the first 100 msec of an occluded inspiration. P0.1 is a parameter for the neuro-muscular activation of the respiratory system, which is an important determinant for the work of breathing. It has been shown to be a good predictor for successful weaning from mechanical ventilation. Standard P0.1 measurement techniques are based on a total occlusion of the inspiration for more than 100 msec. These measurements are technically complex and therefore not useful for clinical purposes. Furthermore, a significant breath-by-breath variability has been shown for P0.1, which is neglected…by any single point measurement technique. Therefore, we have developed a continuous on-line measurement for breath-by-breath determination of P0.1 using the Siemens Servo 900C respirator. In triggered mechanical ventilation the delay time between the onset of the patient’s inspiration and flow delivery from the respirator is more than 100 msec for this respirator. During that time the inspiration is occluded. Therefore, the trigger effort was proposed to be a good estimate of P0.1. Based on this, we calculated P0.1 as follows: airway pressure (Paw) was registered at the endotracheal tube site of the respiratory tubing, digitized and acquired by a personal computer at 100 Hz. The recorder output of the Servo 900C was connected to the same computer, delivering the electronical signal for the inspiratory valve to open when the inspiratory effort has exceeded the trigger threshold, which needs a minimal delay time of 80 msec. Around 20 msec after this signal flow is delivered from the respirator. The computer runs an algorithm, which recognizes this signal and calculates P0.1 (Servo P0.1) as the slope of the pressure drop during this 100 msec. Paw tracings and the calculated P0.1 values were displayed on the computer screen and stored on disk. This method was validated by comparing it to the standard technique, using a Hans-Rudolph valve for inspiratory occlusion and calculating P0.1 from Paw tracings during the occluded inspiration. For validation we used a mechanical lung model which generated P0.1 values ranging between 1.1–10.3 mbar. For a given adjustment of the lung model two standard measurements (standard P0.1) were made and compared to the Servo P0.1. In a total of 21 measurements the mean Servo P0.1 was 4.9 ± 2.9 mbar; the mean standard P0.1 was 4.3 ± 2.5 mbar. The mean difference between Servo P0.1 and standard P0.1 was 0.6 ± 0.6 mbar (range: -0.3–1.8 mbar). The regression equation for linear regression analysis was: Servo P0.1 = 1.15 * standard P0.1–0.05. This correlation was significant (r = 0.99, p < 0.01). From these data we conclude that the described method for continuous P0.1 measurement provides reliable values with the advantage of a maneuver-free, breath-by-breath measurement technique. It thereby opens the possibility for monitoring the neuro-muscular activation of the respiratory system at the bedside, which is shown as an example for a patient during weaning from mechanical ventilation.
Abstract: One may consider the clad silica fibre cutting probe as a cheap alternative of the popular sapphire probe, sharing some of its properties. Made of silica, the scalpels have a fair heat tolerance and may be used without cooling by liquids or gas as is necessary with sapphire blades. The laser scalpel described here is driven (powered) with a 10 W cw Nd:YAG laser energy source (1064 nm) and possesses good cutting and haemostatic properties. It may also be used with lasers emitting other wavelengths. One may assume that a diode laser emitting in the near infrared (800–810 nm) may…have very similar, although not analogous cutting properties when used with the described scalpel.