Technology and Health Care - Volume Pre-press, issue Pre-press
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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: BACKGROUND: Advances in digital dentistry lead to use of three-dimensional (3D) printed resin denture teeth. Fracture toughness of these teeth must be assessed. OBJECTIVE: This study aimed to compare the chipping and indirect tensile fracture resistance of denture teeth fabricated by 3D printing technique with traditionally fabricated resin denture teeth. METHOD: Four groups (Gr) were made (n = 50/group): Gr-1 3D printed denture teeth (denture teeth; Formlabs Inc., Somerville, MA, USA), Gr-2 SR-Orthosit-PE (Ivoclar Vivadent AG), Gr-3 Portrait IPN (Dentsply Sirona), Gr-4 Pala Premium 8 (Heraeus Kulzer GmbH).…Stereolithography 3D printing was used to create the methacrylate-based photopolymerized resin teeth models and remaining group teeth were collected commercially. A 1 mm/min chipping and indirect tensile fracture speed tests were carried out till fracture occurred. The data so obtained were statistically analysed using one-way analysis of variance with Tukey’s honestly significant difference multiple comparisons test (p < 0.05). At the end of the test, the fractured areas of the specimens were evaluated by the chief researcher to assess the fracture pattern of the teeth. RESULTS: The indirect tensile fracture values of the 3D printed teeth were more than that of Pala Premium-8 and SR-Orthosit-PE but it was lower than that of Portrait IPN teeth. In chipping test, buccal chipping of the loaded cusp was seen in 3D printed resin without distortion and in indirect tensile test in 3D printed resin teeth, line of fracture emerges near the loading point propagates from the inner incline of both cusps and extends cervically, unlike in other groups where first deformation occurs then fracture. CONCLUSION: Prosthetic teeth fabricated by the 3D printing technique using printable resin material provide adequate fracture resistance as denture teeth.
Keywords: 3D printing, CAD/CAM, resin, denture teeth, fracture resistance
Abstract: BACKGROUND: Wearable devices that monitor heart health of cardiac disease patients in real time are in great demand. OBJECTIVE: We propose an algorithm of improved segment periodical matrix construction for irregular electrocardiogram (ECG) signal denoising. METHOD: While splitting the heartbeat based on each RR interval for periodical segments matrix construction, the as-filtered ECG signal is reconstructed by the maximum singular value after a singular value decomposition. RESULTS: The results demonstrate a higher noise reduction effect with lower signal distortions of our methods compared to several singular value decomposition counterpart approaches.…CONCLUSION: Our method has great potential to enhance wearable devices diagnosis accuracy by denoising the complex noises such as electromyography artifacts in real-time ECG sensing.
Keywords: Segment periodical matrix, irregular ECG, singular value decomposition
Abstract: BACKGROUND: A fundamental challenge in medical ultrasound imaging is to improve the resolution accurately. Adaptive beamforming is often used to improve lateral resolution, such as minimum variance (MV) and phase coherence factor (PCF). However, it is difficult to improve the axial resolution due to the limitation of the spatial pulse length (SPL) of the transmitted signal. OBJECTIVE: A deconvolution recovery method combines two adaptive weighting techniques to improve axial resolution. METHODS: A deconvolution recovery (DR) technique is used to improve axial resolution with a shorter SPL. Then, the DR is combined with MV…and PCF (DR-MVPCF) to suppress the sidelobe. The influence of different transmission modes, regularization parameters, and the estimation of point spread function are discussed on the proposed algorithm. RESULTS: In simulation, DR-MVPCF improved axial resolution from 0.41 mm (0.98 λ ) to 0.09 mm (0.21 λ ) compared with MV-PCF. In the water bath experiment, DR-MVPCF provided improvement of axial resolution from 0.39 mm (0.93 λ ) to 0.07 mm (0.17 λ ) compared with MV-PCF. In-vivo data experiment, the DR-MVPCF method increased the speckle signal-to-noise ratio and visibility of the structure while the contrast ratio and contrast-noise ratio decreased. CONCLUSIONS: The proposed method can improve the axial resolution significantly.
Abstract: BACKGROUND: Human gait involves activities in nervous and musculoskeletal dynamics to modulate joint torques with time continuously for adapting to varieties of walking conditions. OBJECTIVE: The goal of this paper is to estimate the joint torques of lower limbs in human gait based on Gaussian process. METHOD: The potential uses of this study include optimization of exoskeleton assistance, control of the active prostheses, and modulating the joint torque for human-like robots. To achieve this, Gaussian process (GP) based data fusion algorithm is established with joint angles as the inputs. RESULTS:…The statistic nature of the proposed model can explore the correlations between joint angles and joint torques, and enable accurate joint-torque estimations. Experiments were conducted for 5 subjects at three walking speed (0.8 m/s, 1.2 m/s, 1.6 m/s). CONCLUSION: The results show that it is possible to estimate the joint torques at different scenarios.
Keywords: GP, human gait, joint torque, prostheses, robots, mechanics
Abstract: BACKGROUND: Medical devices (MDs) represent the backbone of the modern healthcare system. Considering their importance in daily medical practice, the process of manufacturing, marketing and usage has to be regulated at all levels. Harmonized evidence-based conformity assessment of MDs during PMS relying on traceability of medical device measurements can contribute to higher reliability of MD performance and consequently to higher reliability of diagnosis and treatments. OBJECTIVE: This paper discusses issues within MD post-market surveillance (PMS) mechanisms in order to set a path to harmonization of MD PMS. METHODS: Medline (1980–2021), EBSCO (1991–2021), and…PubMed (1980–2021) as well as national and international legislation and standard databases along with reference lists of eligible articles and guidelines of relevant regulatory authorities such as European Commission, Food and Drug Administration were searched for relevant information. Journal articles that contain information regarding PMS methodologies concerning stand-alone medical devices. National and international legislation, standards and guidelines concerning the topic. RESULTS: The search strategy resulted in 2282 papers. Out of those only 24 articles satisfied the eligibility criteria and were finally included in the review. Papers were grouped per categories: medical device registry, medical device adverse event reporting, and medical device performance evaluation. In addition to journal articles, national and international legislation, standards, and guidelines were reviewed to assess the state of PMS in different regions of the world. CONCLUSION: Although the regulatory framework prescribes PMS of medical devices, the process itself is not harmonized with international standards. Particularly, conformity assessment of MDs, as an important part of PMS, is not measured and managed in a traceable, evidence-based manner. The lack of harmonization within PMS results in an environment of increased adverse events involving MDs and overall mistrust in medical device diagnosis and treatment results.
Keywords: Medical device, post-market surveillance, conformity assessment, performance inspection, standardization
Abstract: BACKGROUND: Carotid atherosclerosis plaque rupture is an important cause of myocardial infarction and stroke. The effective segmentation of ultrasound images of carotid atherosclerotic plaques aids clinicians to accurately assess plaque stability. At present, this procedure relies mainly on the experience of the medical practitioner to manually segment the ultrasound image of the carotid atherosclerotic plaque. This method is also time-consuming. OBJECTIVE: This study intends to establish an automatic intelligent segmentation method of ultrasound images of carotid plaque. METHODS: The present study combined the U-Net and DenseNet networks, to automatically segment the ultrasound images…of carotid atherosclerotic plaques. The same test set was selected and segmented using the traditional U-Net network and the ResUNet network. The prediction results of the three network models were compared using Dice (Dice similarity coefficient), and VOE (volumetric overlap error) coefficients. RESULTS: Compared with the existing U-Net network and ResUNet network, the Dense-UNet network exhibited an optimal effect on the automated segmentation of the ultrasound images. CONCLUSION: The Dense-UNet network could realize the automatic segmentation of atherosclerotic plaque ultrasound images, and it could assist medical practitioners in plaque evaluation.
Abstract: BACKGROUND: Macrophages commonly exist in two distinct subsets in different microenvironments: classically activated macrophages (M1) and alternatively activated macrophages (M2). The imbalance of M1-M2 macrophage polarization is often related to various diseases or inflammatory states. OBJECTIVE: The purpose of this study was to determine whether there is an imbalance in the expression of M1 and M2 macrophage-related cytokines in severe chronic periodontitis. METHODS: A total of 30 clinical specimens, including severe chronic periodontitis tissues (n = 15) and healthy control tissues (n =…15), were used in this study. Reverse transcription polymerase chain reaction (RT-PCR) and Western blot methods were used to detect the mRNA and protein expression levels of M1 macrophage-related cytokines (inducible nitric oxide synthase (iNOS) and signal transducer and activator of transcription 1 (STAT1)) and M2 macrophage-related cytokines (arginase-1 (Arg-1) and STAT6), respectively. RESULTS: The mRNA and protein expression levels of M1 macrophage-related cytokines (iNOS and STAT1) and M2 macrophage-related cytokines (Arg-1 and STAT6) were significantly increased in severe chronic periodontitis patients. In addition, the ratios of iNOS/Arg-1 and STAT1/STAT6 in the severe chronic periodontitis group were also significantly increased (P < 0.01). CONCLUSION: The imbalance of M1/M2 macrophages exists in the pathogenesis of severe chronic periodontitis, and has a tendency towards M1 polarization. Therefore, maintaining the immune balance of M1/M2 macrophages may be a novel therapeutic alternative for the management of severe chronic periodontitis.
Keywords: Severe chronic periodontitis, macrophages, cytokine, M1, M2
Abstract: BACKGROUND: Telehealth evaluations of musculoskeletal conditions have increased due to the stay-at-home policies enacted during the COVID-19 pandemic. Back pain is one of the most common complaints in primary care. While telehealth may never supplant in-person evaluation of back pain, it is imperative in a changing world to learn to perform this evaluation via telephone or video. Virtual visits rely on history-taking and patient self-reported descriptions of pain elicited from self-palpation or specific movements while on the telephone with the clinician. Video examinations provide a unique way of evaluating the lower back compared to telephone because of the ability…to visualize the actions of the patient. OBJECTIVE: To create an evaluation pathway for examination of the lumbar spine via telehealth. METHODS: Our group has created a step-by-step evaluation pathway to help physicians direct their patients through typical lumbar examination elements, including inspection, palpation, range of motion, and strength, special, and functional testing. RESULTS: We have developed a table of questions and instructions and a glossary of images of each maneuver to facilitate lumbar spine examination via telemedicine. CONCLUSIONS: This paper provides a guide for extracting clinically relevant information while performing telemedicine examinations of the lumbar spine.
Keywords: Lumbar, back pain, telehealth, virtual encounter, exam guide
Abstract: BACKGROUND: Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when non-operative treatment has failed. Apart from acute complications such as hematoma and infections, same-level recurrent lumbar stenosis and adjacent-segment disease (ASD) are factors that can occur after index lumbar spine surgery. OBJECTIVE: The aim of this retrospective case series was to evaluate the outcome of surgery and the odds of necessary revisions. METHODS: Patients who had undergone either decompressive lumbar laminotomy or laminotomy and spinal fusion due to lumbar spinal stenosis (LSS) between 2000 and 2011 were included in…this analysis. Demographic, perioperative and radiographic data were collected. Clinical outcome was evaluated using numeric rating scale (NRS), the symptom subscale of the adapted version of the german Spinal Stenosis Measure (SSM) and patient-sreported ability to walk. RESULTS: Within the LSS- cohort of 438 patients, 338 patients underwent decompression surgery only, while instrumentation in addition to decompression was performed in 100 cases (22.3%). 38 patients had prior spinal operations (decompression, disc herniation, fusion) either at our hospital or elsewhere. Thirty-five intraoperative complications were documented with dural tear with CSF leak being the most common (33/35; 94.3%). Postoperative complications were defined as complications that needed surgery and differentiated between immediate postoperative complications (⩽ 3 weeks post operation) and complications that needed revisions surgery at a later date. Within all patients 51 revisions were classified as immediate complications of the index operation with infections, neurological deficits and hematoma being the most common. Within this group only 22 patients had fusion surgery in the first place, while 29 were treated by decompression. Revision surgery was indicated by 53 patients at a later date. While 4 patients decided against surgery, 49 revision surgeries were planned. 28 were performed at the same level, 10 at the same level plus an adjacent level, and 10 were executed at index level with indications of adjacent level spinal stenosis, adjacent level spinal stenosis plus instability and stand-alone instability. Pre- operative VAS score and ability to walk improved significantly in all patients. CONCLUSIONS: While looking for predictors of revision surgery due to re-stenosis, instability or same/adjacent segment disease none of these were found. Within our cohort no significant differences concerning demographic, peri-operative and radiographic data of patients with or without revision wer noted. Patients, who needed revision surgery were older but slightly healthier while more likely to be male and smoking. Surprisingly, significant differences were noted regarding the distribution of intraoperative and early postoperative complications among the 6 main surgeons while these weren’t obious within the intial index group of late revisions.
Abstract: BACKGROUND: Increases in the numbers of surgical procedures for primary total hip arthroplasty (THA) inevitably lead to increases in the requirements for revision THA. The achievement of long-term stability is difficult or impossible by conventional implants in patients with severe destruction of the acetabulum. OBJECTIVE: This case report presents a successful treatment using a specific three-dimensional (3D)-printed porous titanium acetabular composite component without a flange in the management of Paprosky type IIIB acetabular defects. METHOD: A 65-year-old female diagnosed with right hip prosthetic loosening with a huge acetabular defect presented to our hospital.…We designed the 3D model of the pelvis and created an individualized 3D-printed porous titanium acetabular composite component for revision THA. The procedure was performed through a posterolateral approach, and the component was implanted in the defect and fixed with cup screws using the drill guides. RESULTS: At the last follow-up at 2 years, the patient had a satisfactory hip joint function and no signs of loosening or other complications were found. CONCLUSIONS: The 3D-printed porous titanium acetabular composite component without a flange is showing promising clinical and radiological outcomes in the management of Paprosky type III acetabular defects.
Keywords: Revision hip arthroplasty, acetabular defects, 3D printing, porous titanium, composite component, custom-made, case report