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: Population aging is now a universal trend. Many elderly persons can only conduct limited and short time walking because of age-related skeletal muscle decline of the lower limbs. The wearable device for walking assistance is beneficial to improve the life quality of the elderly. OBJECTIVE: This study aimed to propose a soft exosuit for walking assistance of the elderly and verify its feasibility. METHODS: The wearable structure and control strategy were presented. The performance of the soft exosuit was tested by force tracking evaluation and metabolic cost test. RESULTS:…The mean error of the measured and target peak force was 1.1%. The metabolic cost with assistance on while wearing the exosuit was reduced by 9.2% compared with that in locomotion assistance off. The reduction of assistance on was 7.1% compared with no exosuit. CONCLUSIONS: The proposed soft exosuit has the potential to improve the walking efficiency of the elderly.
Keywords: Soft exosuit, walking augment, hip assistance, lower limb exoskeleton
Abstract: BACKGROUND: Thyroid metabolism involves iodine, which allows us to use radioactive iodine for diagnostic and therapy purposes. The efficiency of radioiodine therapy depends on several parameters; the ability of thyroid tissue to uptake radioactive iodine is one of them. OBJECTIVE: The objective of this work is to quantify the radioactive iodine uptake on thyroid tissue. METHODS: In this work, we developed a method to quantify the in vivo uptake of iodine-131 on sections of thyroid glands removed by thyroidectomies. We performed an analysis of histological sections of the thyroid tissue by beta…imaging. We had the opportunity to quantify the fixed radioactivity and to analyze its distribution in the thyroid gland, thanks to the good spatial resolution available with the type of detector used. RESULTS: The results gave a high image resolution showing the heterogeneity of iodine-131 fixation by the thyroid tissue. We were able to quantify the tissue radioactivity in mega Becquerel (MBq) per volume unit. CONCLUSION: This work has shown that the direct quantification of the thyroid tissue uptake is possible using the beta imaging system.
Abstract: OBJECTIVE: To compare the spectral computed tomography (CT) imaging parameters between squamous cell carcinoma (SCC) and adenocarcinoma (AC) at the gastroesophageal junction (GEJ). METHODS: A total of 80 patients were enrolled in this retrospective study. Among them, 35 were diagnosed with SCC (SCC group) and 45 were diagnosed with AC (AC group). All patients underwent an enhanced scan with spectral CT. The following CT imaging parameters were evaluated: iodine concentration (IC), water content (WC), effective atomic number (Eff-Z) and slope of the spectral HU curve (λ HU ) of lesions. Receiver operating characteristic…(ROC) curve was used to analyze the predictive value of spectral CT imaging parameters for diagnosis of SCC and AC. RESULTS: Patients with SCC had lower IC, Eff-Z, and λ HU in arterial phase and venous phase compared with AC (p < 0.05). There were no significant differences in WC between the two groups. ROC curve analyses revealed that IC, Eff-Z, and λ HU in arterial phase and venous phase were predictors for diagnosis of SCC and AC (AUC > 0.5). Moreover, the IC, Eff-Z and λ HU in venous phase had better differential diagnostic performances than that in arterial phase. CONCLUSIONS: Spectral CT could be useful in the differential diagnosis of SCC and AC at the GEJ. Therefore, a routine spectral CT scan is recommended for patients with carcinoma of the GEJ.
Abstract: BACKGROUND: Implant specific complications and outcome for the use of proximal humeral nails in different fracture types are not well described. OBJECTIVE: Evaluation of adverse effects and outcome of patients treated with the new Targon PH+ implant for proximal humeral fractures in a geriatric population. METHODS: A consecutive series of patients from a single institution was retrospectively evaluated. Adverse events (AE) were assessed from patients’ files and during follow-up examination. Current pain level was evaluated using the Visual Analogue Scale (VAS). The disability score of arm, shoulder and hand (DASH)…as well as the Constant-Murley score were assessed. Patient satisfaction was evaluated by questionnaire. RESULTS: Forty-nine patients with a mean age of 72.0 ± 10.0 years were included with a follow-up of 2.2 years. Five patients showed twopart fractures (10%), 24 threepart fractures (50%) and 20 fourpart fractures (40%). Additional shaft fracture occurred in twelve cases (24%). Implant-related AE were recorded in six cases (12%). Pain under strain was moderate with a mean of 27.6 ± 27.1 mm. DASH score showed a mean of 25.9 ± 24.9. Constant score of the affected shoulder was 57 ± 23.8 with a mean difference of 16 points compared to reference shoulder. No significant differences in AE, VAS, DASH or Constant score could be found according to fracture groups. Most patients were satisfied with the surgical outcome (84%). CONCLUSIONS: The Targon PH+ nail demonstrated good functional results and low adverse events in geriatric patients. Additional studies including less experienced centres are required to further evaluate the possible benefits of this implant.
Abstract: BACKGROUND: The protective role of helmet accessories in moderating stress load generated by explosion shock waves of explosive devices is usually neglected. OBJECTIVE: In the presented study, the protective role of the helmet chinstrap against the impulse and overpressure experienced by the maxillofacial region were examined. METHODS: The explosion shock wave and skull interaction were investigated under three different configurations: (1) unprotected skull, (2) skull with helmet (3) skull with helmet and chinstrap. For this purpose, a 3D finite element model (FEM) was constructed to mimic the investigated biomechanics module. Three working conditions were…set according to different explosive charges and distances to represent different load conditions. Case 1: 500 mg explosive trinitrotoluene (TNT), 3 cm, case 2: 1000 mg TNT, 3 cm, and case 3: 1000 mg TNT and 6 cm distance to the studied object. The explosion effect was discussed by examining the shock wave stress flow pattern. Three points were selected on the skull and the stress curve of each point position were illustrated for each case study. RESULTS: The results showed that the helmet chinstrap can reduce the explosive injuries and plays a protective role in the maxillofacial region, especially for the mandible.
Keywords: Maxillofacial injury, blast wave, finite element method
Abstract: BACKGROUND: The increased strength of zirconia has resulted in its widespread application in clinical dentistry. Nevertheless, the fracture of veneering porcelains remains one of the key reasons of failure. OBJECTIVE: The objective of this study was to compare and analyze the influence of surface conditioning methods on the core-veneer bond strength of zirconia restorations. METHODS: Thirty specimens of zirconia core with sizes 10 × 5 × 5 mm were layered with porcelain of sizes 5 × 3 × 3 mm. On the…basis of different surface conditioning methods, four groups were made: Group I: abrasion with airborne alumina particles of 110 μ m size, Group II: sandblasting with silica coated alumina particles of 50 μ m in size, Group III (modified group): alteration with a coating of zirconia powder prior to sintering, and Group IV (control group): metal core specimens. The shear force of all specimens was tested using a universal testing machine with a 0.5 mm/min crosshead speed. One-way analysis of variance (ANOVA) and Tukey’s post hoc pair wise comparison (p = 0.05) were performed to analyze the shear bond strength. A scanning electron microscope was used to assess the fractured specimens. RESULTS: A statistically significant difference was noted between the groups. The mean value of shear bond strength was 40.25 MPa for Group I, 41.93 MPa for Group II, 48.08 MPa for Group III and 47.01 MPa for Group IV. CONCLUSIONS: The modified zirconia group and control group demonstrated a significantly higher mean bond strength than that of Group I, where airborne particle abrasion was used. The scanning electron microscope showed that cohesive fracture in the porcelain veneers was the main problem of failure in altered zirconia. The modified zirconia specimens in Group III demonstrated significantly improved values of shear bond strength.
Keywords: CAD/CAM zirconia, shear bond strength, veneering porcelain, surface treatment
Abstract: BACKGROUND: Monitoring patients’ position is important, but there have been few studies related to validation. OBJECTIVE: The objective of this study was to assess the validity of position monitoring measured using a wearable device by comparing the device’s measurements to a patient’s actual position. METHODS: We constructed a wearable device with a three-axis gyroscope and applied it to 10 patients who were unable to change their position independently. We compared the actual angle of the position and the angle transmitted from the wearable device using a Bland-Altman plot and a receiver operating characteristic…curve. RESULTS: We compared the actual angle of the position and the angle transmitted from the wearable device using a Bland-Altman plot, but it was difficult to observe statistical similarity. The angles transmitted from the wearable device in the lateral and supine positions showed significant differences. The cutoff value separating the lateral and supine positions was found to be 27.1 ∘ (sensitivity = 100%, specificity = 99.9%). CONCLUSIONS: Through our method, the measured values from the gyroscope-based wearable device did not accurately reflect the patient’s actual position. However, the wearable device was able to distinguish the lateral position from the supine position.
Keywords: Wearable device, validation, monitoring, position change, patients
Abstract: BACKGROUND: Assessment of buccal alveolar bone thickness (ABT) and crown-to-root dimensions are essential in implant density; therefore, three-dimensional evaluation of these parameters provides a superior visualization than conventional radiographs. OBJECTIVE: The present cross-sectional cohort study aims to investigate the relationship between buccal ABT and crown-to-root dimensions around the mandibular first and second molars using cone-beam-computed tomography (CBCT). METHODS: Initially, CBCT-based scans from 271 individuals were assessed. Based on the inclusion and exclusion criteria, 171 CBCT-based scans were excluded. In total, 100 CBCT-scans were included in the present investigation and processed for data extraction.…On the mandibular first and second molars, the mesial and distal root lengths and mesiodistal diameter of the crowns were measured. The pulpal floor served as a reference point for assessment of root length. The buccal ABT was measured at the coronal, middle and apical one-third of the root. Statistical analysis was performed and the level of significance was set at P < 0.01. One-hundred CBCT-scans from 294 mandibular teeth (137 first molars and 157 second molars) were included. One hundred and eighty-nine and 105 teeth were from males and females, respectively. RESULTS: The normality plot showed a normal data distribution. The mesiodistal crown width showed a weak yet significant correlation with mesial root length (r = 0.137), bone thickness at mesial apical third (r = 0.180), distal apical (r = 0.157) and distal coronal third (r = 0.161). Bone thickness at mesial, middle and apical third correlated significantly with one other (r = 0.786). CONCLUSION: There is a direct correlation between the buccal ABT and tooth dimensions around the mandibular first and second molars.
Keywords: Alveolar bone thickness, tooth dimensions, crown width, root length, and CBCT
Abstract: BACKGROUND: The aging population brings the problem of healthcare and dyskinesia. The lack of mobility extremely affects stroke patient’s activities of daily living (ADL) and decreases their quality of life. To assist these mobility-limited people, a robotic walker is designed to facilitate gait rehabilitation training. OBJECTIVE: The aim of this paper is to present the implementation of a novel motion control method to assist disabled people based on their motion intention. METHODS: The kinematic framework of the robotic walker is outlined. We propose an intention recognition algorithm based on the interactive force signal.…A novel motion control method combined with T-S fuzzy controller and PD controller is proposed. The motion controller can recognize the intention of the user through the interactive force, which allows the user to move or turn around as usual, instead of using their hands to control the walker. RESULTS: Preliminary experiments with healthy individuals and simulated patients are carried out to verify the effectiveness of the algorithm. The results show that the proposed motion control approach can recognize the user’s intention, is easy to control and has a higher precision than the traditional proportional–integral–derivative controller. CONCLUSION: The results show that users could achieve the task with acceptable error, which indicates the potential of the proposed control method for gait training.
Keywords: Motion control, intention recognition, robotic walker, lower rehabilitation robot, stroke, gait training, kinematics, disability, mobility, stroke patients, activities of daily living, quality of life
Abstract: BACKGROUND: Minimally invasive total knee arthroplasty (TKA) has been actively advertised by the orthopedic industry. The purpose of this network meta-analysis was to comprehensively compare the effectiveness of four minimally invasive surgery (MIS) approaches and the medial parapatellar (MPP) approach to improve the American Knee Society Score (KSS) in primary TKA. MATERIALS AND METHODS: Studies were comprehensively searched on PubMed, Embase, Cochrane Library (CENTRAL), Web of Science and Science Direct up to June 2018 with a major focus on the outcome of KSS. Risk of bias was assessed using the Cochrane risk of bias tool. Quality…assessment was performed using the GRADE system. Both pair-wise and network meta-analyses are calculated to comprehensively compare the effectiveness of four MIS and TKA approaches. RESULTS: Eleven trials with 1025 knees undergoing TKA were included. Our analysis showed that both MPP and MIS approaches provided improvement in terms of short-term (four-eight weeks) total, objective and functional KSS score. The network-meta analysis revealed that MIS approaches showed a trend towards superior KSS improvement over standard MPP approaches. However, statistical advantages were only observed in the mini-MPP group for functional KSS scores when compared with conventional MPP and quadriceps-sparing (QS) group. CONCLUSIONS: Evidence shows that MIS TKA approaches are effective alternatives to MPP approaches. However, orthopedic surgeons should be cautiously optimistic about minimally invasive TKA in terms of KSS improvement.
Keywords: Minimally invasive surgery, total knee arthroplasty, total knee replacement, network meta-analysis, bayesian model