Technology and Health Care

The global community is faced with aging societies, which will result in increased health care costs. we have been introducing our International Organization for Standardization (ISO)-certified health education system in Thailand and Indonesia.

The purpose of this study was to collect data on the effects of this ISO-certified health education system, to extend the healthy life expectancy and to study the feasibility of implementing this program and in new social contexts.

We implemented the health education program recruiting 43, 114 and 119 participants, respectively, in Japan, Thailand and Indonesia. The participants’ conditions before and after the program were determined through anthropometry, physical fitness tests, blood chemistry tests, brain function tests and pedometry.

Regarding pedometry, the Japanese participants took the highest number of daily steps on average, followed by the Indonesian and Thai participants. In the 10-m obstacle walk, the Thai and Indonesian participants had significantly increased times. Furthermore, the differentiation reaction time, reverse differentiation reaction time, total number of “misses”, total number of “mistakes” and total number of errors significantly improved.

It is possible to implement a program of an ISO-certified health education system, but how to develop exercise habits is important.

To develop wearable healthcare sensors that use fiber Bragg grating (FBG) sensors, a stretch textile product with an embedded FBG sensor is required.

The FBG sensor, which is an optical fiber, was embedded into a textile product following a wavy pattern by using a warp knitting machine.

When an optical fiber is embedded in a textile product, the effect of the cycle length of wavy pattern and the number of cycles on the optical loss is verified. The shorter the cycle length of the wavy pattern of the optical fiber, and more increase in the number of cycles, the longer the textile product in which the optical fiber is embedded can expand and contract. However, when the cycle length of the wave pattern is 30 mm (shortest), large in optical loss, the pulse wave signal cannot be measured. If the cycle length of the wavy pattern is 50 mm or more, small in optical loss, the pulse wave signal is measured.

Compared with a straight pattern embedding FBG sensor, the amplitude value of the pulse wave signal measured with a cycle length of 50 mm is large, therefore the sensor sensitivity in this state is greater. This result is consistent with the measurement sensitivity depending on the angle of installation with respect to the direction of the artery.

With a cycle length of wavy pattern of 50 mm and 4 cycles, a stretch textile product with an embedded FBG sensor can be fabricated. Pulse wave signals are measured with this textile product, and the development of wearable healthcare sensors is expected.

Alveolar echinococcosis is an epidemic disease caused by the parasitism of Echinococcus multilocularis (Em) larvae in the intermediate or final host.

To identify and analyze B-cell and T-cell (Th1, Th2, and Th17) epitopes of the Em antigen protein thrombospondin 3 (TSP3).

The amino acid sequence of TSP3 was obtained, and the secondary structural characteristics of TSP3 were predicted using bioinformatics software to further predict its potential T-cell and B-cell epitopes. The spleen lymphocytes of BALB/c mice, which were immunized with the TSP3 protein, were collected for co-culture with B-cell and T-cell antigen small peptides. The B-cell epitopes and T-cell epitope subtypes Th1, Th2, and Th17 were identified as having good immunogenicity.

After identification, it was found that the predominant epitopes of B cells existing in TSP3 were T18-33, T45-55, and T110-122. Furthermore, the predominant epitopes of T cells existing in TSP3 were T33-42, T45-55, T80-90, and T110-122 in the T1 subtype, T45-55, T68-77, and T92-104 in the Th2 subtype, and T53-63 and T80-90 in the Th17 subtype.

Six T-cell and eight B-cell dominant epitopes of the TSP3 antigen were revealed; these results may be applied in the development of a dominant epitope vaccine.

Preservation of quality of life regarding fecal continence after abdominoperineal excision (APE) in cancer is challenging. Simultaneous soft tissue coverage and restoration of continence mechanism can be provided through an interdisciplinary collaboration of colorectal and plastic reconstructive surgery.

Evaluation of surgical procedure and outcome combining soft tissue reconstruction using a central perforated vertical rectus abdominis myocutaneous flap (VRAM), implementing a perineostoma and restoring anorectal angle augmenting the levator ani by neurostimulated graciloplasty.

14 Patients underwent APE due to cancer. In all patients coverage was achieved by pedicled VRAM and simultaneous pull-through descendostomy (perineostoma). 10 of those patients received a levator augmentation additionally. Postoperative complications, functional measures of continence as well as quality of life were obtained.

Perineal minor complication rate was 43% without need of surgical intervention. All but one VRAM survived. Continence measures and disease specific life quality showed a good preservation of continence in most patients.

The results present a complex therapy option accomplished by a collaboration of two highly specialized partners (visceral and plastic surgery) after total loss of the sphincter function and consecutive fecal insufficiency after APE.

Addressing intensity inhomogeneity is critical in magnetic resonance imaging (MRI) because associated errors can adversely affect post-processing and quantitative analysis of images (i.e., segmentation, registration, etc.), as well as the accuracy of clinical diagnosis. Although several prior methods have been proposed to eliminate or correct intensity inhomogeneity, some significant disadvantages have remained, including alteration of tissue contrast, poor reliability and robustness of algorithms, and prolonged acquisition time.

In this study, we propose an intensity inhomogeneity correction method based on volume and surface coils simultaneous reception (VSSR).

The VSSR method comprises of two major steps: 1) simultaneous image acquisition from both volume and surface coils and 2) denoising of volume coil images and polynomial surface fitting of bias field. Extensive in vivo experiments were performed considering various anatomical structures, acquisition sequences, imaging resolutions, and orientations. In terms of correction performance, the proposed VSSR method was comparatively evaluated against several popular methods, including multiplicative intrinsic component optimization and improved nonparametric nonuniform intensity normalization bias correction methods.

Experimental results show that VSSR is more robust and reliable and does not require prolonged acquisition time with the volume coil.

The VSSR may be considered suitable for general implementation.

Hemodynamics and their clinical outcome of cerebral aneurysms treated with flow diverter (FD) stents have thus far been investigated using computational fluid dynamics (CFD) simulations. Although human blood is characterized as a non-Newtonian patientspecific fluid, non-patient-specific blood properties (PSBP) were applied in most extant studies.

To investigate the hemodynamic effects caused by PSBPs in aneurysms treated with FD stents.

We measured blood properties (density and viscosity) for 12 patients who underwent FD stent deployment. We conducted CFD simulations with the measured PSBPs and non-PSBPs quoted from previous studies. The average blood flow velocity and wall shear stress within the aneurysms were calculated and two simulation patterns were compared.

The velocity and wall shear stress changed by 2.93% and 3.16% on average, respectively, without an FD stent deployed. Conversely, with the FD stents deployed, the change rates increased to 11.1% and 9.06% on average, respectively.

The change in hemodynamic parameters if PSBPs are considered, may not be negligible when conducting CFD simulations of FD stent deployed aneurysms To obtain an adequate hemodynamic environment for cerebral aneurysms with FD stents deployed, it is recommended to use PSBPs for CFD simulations.

Catheter jamming is an emerging and possibly underrated complication.

To find the criteria for determining if the catheter cannot be removed through the mechanical analysis of fracture tension and fracture strain ( ε f) of Peripheral Inserted Central Catheters (PICC).

We removed 30 pieces of PICC catheters from patients and recorded the indwelling time. Those with an indwelling time shorter than 12 weeks belonged to the short-term group. Those with an indwelling time longer than 12 weeks belonged to the long-term group. The first half of the same catheter is section A, and the second half is section B. The fraction tension and fracture strain of the catheter were measured, and statistical analysis was conducted.

The fracture tension of catheter in sections A and B were 5.8917 ± 1.0095 and 6.0670 ± 0.8066 Newtons respectively ( p = 0.393) and the fracture strain of catheter in sections A and B were 6.0611 ± 1.0810 and 6.2543 ± 0.7187 Newtons respectively ( p = 0.343). The fracture tension of catheter in short-term and long-term group were 6.0696 ± 0.9414 and 5.9192 ± 0.8972 Newtons respectively ( p = 0.535) and the fracture strain of catheter in short-term and long-term group were 6.0067 ± 0.7227 and 6.2584 ± 1.0212 respectively ( p = 0.301).

It is objective and consistent to take the catheter fracture tension as the standard. This standard would be able to accurately define the concept of catheter failure and reduce the risk of catheter fracture and the misdiagnosis of catheter failure. The catheter fracture tension and fracture strain was not affected by the catheter indwelling time. It is recommended to set the tensile force as 5 Newtons and carry it out at a speed of 100 mm/min for the catheter drawing of the PICC single-lumen silicone catheter (4.0F) from Budd Company.

Analysis of the reactions of different organs to external stimuli is an important area of research in physiological science.

In this paper, we investigated the correlation between the brain and facial muscle activities by information-based analysis of electroencephalogram (EEG) signals and electromyogram (EMG) signals using Shannon entropy.

The EEG and EMG signals of thirteen subjects were recorded during rest and auditory stimulations using relaxing, pop, and rock music. Accordingly, we calculated the Shannon entropy of these signals.

The results showed that rock music has a greater effect on the information of EEG and EMG signals than pop music, which itself has a greater effect than relaxing music. Furthermore, a strong correlation ( r = 0.9980) was found between the variations of the information of EEG and EMG signals.

The activities of the facial muscle and brain are correlated in different conditions. This technique can be utilized to investigate the correlation between the activities of different organs versus brain activity in different situations.

Stereotactic radiotherapy (SBRT) is widely used in the treatment of thoracic cancer.

To evaluate the efficacy of a non-rebreather mask (NRBM) and high-flow nasal cannula (HFNC) in patients with radiation pneumonia complicated with respiratory failure.

This was a single-center randomized controlled study. Patients admitted to the EICU of the Fourth Hospital of Hebei Medical University were selected and divided into NRBM and HFNC group. Arterial blood gas analysis, tidal volume, respiratory rates and the cases of patients receiving invasive assisted ventilation were collected at 0, 4, 8, 12, 24, 48, and 72 h after admission.

(1) The PaO2/FiO2, respiratory rates, and tidal volume between the two groups at 0, 4, 8, 12, 24, 48, and 72 h were different, with F values of 258.177, 294.121, and 134.372, all P < 0.01. These indicators were different under two modes of oxygenation, with F values of 40.671, 168.742, and 55.353, all P < 0.01, also varied with time, with an F value of 7.480, 9.115, and 12.165, all P < 0.01. (2) The incidence of trachea intubation within 72 h between HFNC and NRBM groups (23 [37.1%] vs. 34 [54.0%], P < 0.05). The transition time to mechanical ventilation in the HFNC and NRBM groups (55.3 ± 3.2 h vs. 45.9 ± 3.6 h, P < 0.05). (3) The risk of intubation in patients with an APACHE-II score > 23 was 2.557 times than score ⩽ 23, and the risk of intubation in the NRBM group was 1.948 times more than the HFNC group ( P < 0.05).

Compared with the NRBM, HFNC can improve the oxygenation state of patients with radiation pneumonia complicated with respiratory failure in a short time, and reduce the incidence of trachea intubation within 72 h.

The exoskeleton for lower limb rehabilitation is an uprising field of robot technology. However, since it is difficult to achieve all the optimal design values at the same time, each lower extremity exoskeleton has its own focus.

This study aims to develop a modular lightweight lower extremity exoskeleton (MOLLEE) with novel compliant ankle joints, and evaluate the movement performance through kinematics analysis.

The overall structure of the exoskeleton was proposed and the adjustable frames, active joint modules, and compliant ankle joints were designed. The forward and inverse kinematics models were established based on the geometric method. The theoretical models were validated by numerical simulations in ADAMS, and the kinematic performance was demonstrated through walking experiments.

The proposed lower extremity offers six degrees of freedom (DoF). The exoskeleton frame was designed adjustable to fit wearers with a height between 1.55 m and 1.80 m, and waist width from 37 cm to 45 cm. The joint modules can provide maximum torque at 107 Nm for adequate knee and hip joint motion forces. The compliant ankle can bear large flexible deformation, and the relationship between its angular deformation and the contact force can be fitted with a quadratic polynomial function. The kinematics models were established and verified through numerical simulations, and the walking experiments in different action states have shown the expected kinematic characteristics of the designed exoskeleton.

The proposed MOLLEE exoskeleton is adjustable, modular, and compliant. The designed adjustable frame and compliant ankle can ensure comfort and safety for different wearers. In addition, the kinematics characteristics of the exoskeleton can meet the needs of daily rehabilitation activities.

Resting tremor is an essential characteristic in patients suffering from Parkinson’s disease (PD).

Quantification and monitoring of tremor severity is clinically important to help achieve medication or rehabilitation guidance in daily monitoring.

Wrist-worn tri-axial accelerometers were utilized to record the long-term acceleration signals of PD patients with different tremor severities rated by Unified Parkinson’s Disease Rating Scale (UPDRS). Based on the extracted features, three kinds of classifiers were used to identify different tremor severities. Statistical tests were further designed for the feature analysis.

The support vector machine (SVM) achieved the best performance with an overall accuracy of 94.84%. Additional feature analysis indicated the validity of the proposed feature combination and revealed the importance of different features in differentiating tremor severities.

The present work obtains a high-accuracy classification in tremor severity, which is expected to play a crucial role in PD treatment and symptom monitoring in real life.

Cyclergometry with functional electrical stimulation (FES-cycling) is a feasible method for rehabilitation. The concept is to promote exercise induced by depolarization of the motoneuron and muscular contraction.

To measure acute physiological responses to FES-cycling.

Retrospective study of data from ten healthy volunteers who performed FES-cycling, passive cycling and neuromuscular electrical stimulation (NMES) alone. Metabolic, ventilatory and cardiovascular parameters were analyzed.

Oxygen uptake enhanced 97 ± 15% during FES-cycling, with medium effect size compared to NMES and large effect size compared to passive cycling. Energy expenditure enhanced 102 ± 15% during FES-cycling, with medium effect size compared to NMES and large effect size compared to passive cycling. Minute ventilation enhanced 115 ± 26% during FES-cycling, with small effect size compared to NMES and medium effect size compared to passive cycling. Cardiac output enhanced 21 ± 4% during FES-cycling, with medium effect size compared to NMES and passive cycling. Arterial – mixed venous oxygen content difference enhanced 60 ± 8% during FES-cycling, with a medium effect size compared to NMES and large effect size compared to passive cycling.

FES-cycling enhances metabolic, ventilatory and cardiovascular demands and the physiological responses are higher than NMES and passive cycling.

Gynecological diseases threaten women’s health, and vaginal microecological testing is a common method for detecting gynecological diseases. Efficient and accurate microecological testing methods have always been the goal pursued by gynecologists.

In order to automatically identify different types of microbial images in vaginal micromorphology detection, this paper proposes a vaginal microecological image recognition method based on Gabor texture analysis combined with long and short-term memory network (LSTM) model.

Firstly, we denoise the microecological morphological im-ages, which selects the area of interest and sets the label of the microorganism according to the doctors label. Secondly, texture analysis is carried out for the region of interest, which uses Gabor filters with 8 directions and 5 scales to filter the region of interest to extract the texture features on the image. Comparing the differences between different microbial image features, and screening suitable features to reduce the number of features. Then, we design an LSTM model to analyze the relationship of image features in different categories of microorganisms. Finally, we use the full connection layer and Softmax function to realize the automatic recognition of different microbial images.

The experimental results show that the image classification accuracy of 8 common microorganisms is 81.26%.

Texture analysis combined with LSTM network strategy can identify different kinds of vaginal micro ecological images. Gabor-LSTM model has better classification effect on imbalanced data sets.

Emotional intelligence plays a vital role in human-computer interaction, and EEG signals are an objective response to human emotions.

We propose a method to extract the energy means of detail coefficients as feature values for emotion recognition helps to improve EEG signal-based emotion recognition accuracy.

We used movie clips as the eliciting material to stimulate the real emotions of the subjects, preprocessed the collected EEG signals, extracted the feature values, and classified the emotions based on them using Support Vector Machine (SVM) and Stacked Auto-Encoder (SAE). The method was verified based on the SJTU emotion EEG database (SEED) and the self-acquisition experiment.

The results show that the accuracy is better using SVM. The results based on the SEED database are 89.06% and 79.90% for positive-negative and positive-neutral-negative, respectively. The results based on the self-acquisition data are 98.05% and 89.83% for the same, with an average recognition rate of 86.57% for the four categories of fear, sad (negative), peace (neutral) and happy (positive).

The results demonstrate the validity of the feature values and provide a theoretical basis for implementing human-computer interaction.

Timely and accurate diagnosis of genetic diseases can lead to proper action and prevention of irreparable events.

In this work we propose an integrated genetic-neural network (GNN) to improve the prediction risk of trisomy diseases including Down’s syndrome (T21), Edwards’ syndrome (T18) and Patau’s Syndrome (T13).

A dataset including 561 pregnant were created. In this integrated model, the structure and input parameters of the proposed multilayer feedforward network (MFN) were optimized.

The results of execution of the GNN on the testing dataset showed that the developed model can be accurately classify the anomalies from healthy fetus with 97.58% accuracy rate, and 99.44% and 85.65% sensitivity, and specificity, respectively. In the proposed GNN model, the Levenberg Merquident (LM) algorithm, the Radial Basis (Radbas) function from various types of functions were selected by the proposed GA. Moreover, maternal age, Nuchal Translucency (NT), Crown-rump length (CRL), Pregnancy-associated plasma protein A (PAPP-A) were selected by the proposed GA as the most effective factors for classifying the healthfetuses from the cases with fetal disorders.

The proposed computerized model increases the diagnostic performance of the physicians especially in the accurate detection of healthy fetus with non – invasive and low – cost treatments.

Middle cerebral artery (MCA) occlusion is extremely common, especially unilateral artery, which can result in a significant incidence of cerebral infarction.

To assess the value of whole-brain computed tomography perfusion (CTP) imaging combined with dynamic CT angiography (dCTA) in the evaluation of pial collateral circulation in patients with MCA occlusion.

Whole-brain CTP and dCTA images were acquired in 58 patients with unilateral MCA occlusion. All patients were divided into three groups according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score (by CTA). The CTP parameters were analysed, including relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT), and relative time to peak (rTTP). Patients were followed up with the modified Rankin scale (mRS). All cases in this study were confirmed by DSA.

The CTP parameters of the MCA blood supply area on the affected side of patients with different degrees of stenosis were significantly different from those on the unaffected side. There are significant differences in the CTP parameters and openings of the Willis circle in patients with different degrees of stenosis. Significant differences were found in the number of patients with good prognosis.

Whole-brain CT perfusion combined with dynamic CTA can structurally and functionally evaluate the establishment of pial collateral circulation and its effect on cerebral hemodynamic changes.

Early mobilization is important to improve critically ill patients’ outcomes, but barriers to its implementation are common. A suitable in-bed device to exercise patients’ legs might facilitate early mobilization.

The aim of this study was to develop an in-bed leg press that would facilitate early mobilization and enhance strength training of patients in acute care settings.

A user-centered design approach was applied to develop the device. The process was assessed by different instruments: the system usability scale (SUS) questionnaire, the Kano model questionnaire and interviews with end-users.

Through several iterations of a user-centered design process, the prototype of an in-bed leg press was developed and tested. The assessment, based on SUS, Kano and interviews, indicates high usability and demonstrates the advantages of a user-centered design process.

An interprofessional user-centered design approach was successfully implemented to develop a medical device. The early involvement of end-users resulted in a design that already shows a high degree of production readiness. The resulting device fulfilled all core requirements from a therapeutic point of view and included key features related to its practical use.

Brainwaves studies on pain are gaining more attention in recent years. However, the target group in a similar study on collegiate athletes with musculoskeletal pain is still under explore.

The objective is to investigate the differences of the brainwaves response and its association with pain interference of the collegiate athletes with and without musculoskeletal pain.

Collegiate athletes ( n = 49) were recruited and categorized into pain group (PG) ( n = 25) and no-pain group (NPG) ( n = 24). Brainwaves were recorded for 2 minutes with eyes closed in a resting state using EEG. Pain intensity and pain interference were documented using visual analogue scale and brief pain inventory, respectively. Independent t -test was used to compare brainwaves of PG and NPG, and Spearman’s correlation was used to find the association between brain waves and pain interference.

Findings showed a significant decrease ( p < 0.05) in brain waves in PG on left temporal regions as compared to NPG. Frontal beta, theta, and gamma waves were found to be negatively correlated with participants’ pain interference.

This outcome potentially contributes EEG as an alternative non-invasive tool for an objective pain assessment method in health care technology to aid in the rehabilitation process.

In the past, various efforts have been made to investigate diagnostic tools for periprosthetic-joint-infection (PJI). It is little-known about the diagnostic utility of polymerase-chain-reaction (PCR) in this context, especially concerning the role of multiplex-PCR assays comparing with conventional tissue culture.

Evaluation of an automated-multiplex-PCR cartridge system for patients with suspicion of PJI in comparison with conventional microbiological culture and 16S-rDNA-PCR.

On suspicion of PJI synovial fluid specimen were taken preoperatively or periprosthetic tissue was collected intraoperatively. Microbiological analysis included conventional culture, 16S-rDNA-PCR and automated-multiplex-PCR (Unyvero-i60-ITI ® ). The European-Bone-and-Joint-Infection-Society (EBJIS) criteria were used for PJI diagnosis. Positive and negative percent agreement was calculated. Total percentage agreement and Cohen’s kappa coefficient were calculated. Sensitivity, specificity and positive predictive value of conventional culture, 16S-rDNA-PCR and multiplex-PCR were calculated. Ten specimens of proved PJI were used as control group.

Fifty specimen were suitable for culture. 14 (28%) were classified as PJI, 36 (72%) were aseptic. Coagulase-negative staphylococci was the most frequent detected pathogen. Concordance-rate between mPCR and culture results was 75.6% with a Cohen’s kappa of 0.28. Concordance-rate between mPCR and 16S-rDNA was 82.9%, Cohen’s kappa was 0.13. Concordance analysis between culture results and 16S-rDNA lead to a concordance-rate of 88.9%. Cohen’s kappa was calculated with 0.6. With regard to the microbiological culture as reference, sensitivity of the mPCR was 0.33 and specificity was 0.91. Sensitivity and specificity of the 16S-rDNA-PCR was 0.55 and 0.97. The positive predictive value was 0.57 for the mPCR and 0.83 for the 16S-rDNA-PCR.

Due to fair agreement between mPCR and conventional microbiological culture, the tested multiplex-PCR could be an additional instrument for the detection of PJI but is not superior over the conventional culture.

Customized prosthetic joint replacements have crucial applications in severe temporomandibular joint problems, and the combined use of porous titanium scaffold is a potential method to rehabilitate the patients.

The objective of the study was to develop a design method to obtain a titanium alloy porous condylar prosthesis with good function and esthetic outcomes for mandibular reconstruction.

A 3D virtual mandibular model was created from CBCT data. A condylar defect model was subsequently created by virtual condylectomy on the initial mandibular model. The segmented condylar defect model was reconstructed by either solid or porous condyle with a fixation plate. The porous condyle was created by a density-driven modeling scheme with an inhomogeneous tetrahedral lattice structure. The porous condyle, supporting fixation plate, and screw locations were topologically optimized. Biomechanical behaviors of porous and solid condylar prostheses made of Ti-6Al-4V alloy were compared. Finite element analysis (FEA) was used to evaluate maximum stress distribution on both prostheses and the remaining mandibular ramus.

The FEA results showed levels of maximum stresses were 6.6%, 36.4% and 47.8% less for the porous model compared to the solid model for LCI, LRM, and LBM loading conditions. Compared to the solid prosthesis, the porous prosthesis had a weight reduction of 57.7% and the volume of porosity of the porous condyle was 65% after the topological optimization process.

A custom-made porous condylar prosthesis with fixation plate was designed in this study. The 3D printed Ti-6Al-4V porous condylar prosthesis had reduced weight and effective modulus of elasticity close to that of cortical bone. The