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Wang M, Hong Y, Fu X, Sun X. Advances and applications of biomimetic biomaterials for endogenous skin regeneration. Bioact Mater 2024; 39:492-520. [PMID: 38883311 PMCID: PMC11179177 DOI: 10.1016/j.bioactmat.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 06/18/2024] Open
Abstract
Endogenous regeneration is becoming an increasingly important strategy for wound healing as it facilitates skin's own regenerative potential for self-healing, thereby avoiding the risks of immune rejection and exogenous infection. However, currently applied biomaterials for inducing endogenous skin regeneration are simplistic in their structure and function, lacking the ability to accurately mimic the intricate tissue structure and regulate the disordered microenvironment. Novel biomimetic biomaterials with precise structure, chemical composition, and biophysical properties offer a promising avenue for achieving perfect endogenous skin regeneration. Here, we outline the recent advances in biomimetic materials induced endogenous skin regeneration from the aspects of structural and functional mimicry, physiological process regulation, and biophysical property design. Furthermore, novel techniques including in situ reprograming, flexible electronic skin, artificial intelligence, single-cell sequencing, and spatial transcriptomics, which have potential to contribute to the development of biomimetic biomaterials are highlighted. Finally, the prospects and challenges of further research and application of biomimetic biomaterials are discussed. This review provides reference to address the clinical problems of rapid and high-quality skin regeneration.
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Affiliation(s)
- Mengyang Wang
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department, PLA General Hospital and PLA Medical College, Beijing, 100853, PR China
- PLA Key Laboratory of Tissue Repair and Regenerative Medicine and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration, Beijing, 100089, PR China
| | - Yiyue Hong
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department, PLA General Hospital and PLA Medical College, Beijing, 100853, PR China
- PLA Key Laboratory of Tissue Repair and Regenerative Medicine and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration, Beijing, 100089, PR China
| | - Xiaobing Fu
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department, PLA General Hospital and PLA Medical College, Beijing, 100853, PR China
- PLA Key Laboratory of Tissue Repair and Regenerative Medicine and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration, Beijing, 100089, PR China
- Research Unit of Trauma Care, Tissue Repair and Regeneration, Chinese Academy of Medical Sciences, 2019RU051, Beijing, 100048, PR China
| | - Xiaoyan Sun
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department, PLA General Hospital and PLA Medical College, Beijing, 100853, PR China
- PLA Key Laboratory of Tissue Repair and Regenerative Medicine and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration, Beijing, 100089, PR China
- Research Unit of Trauma Care, Tissue Repair and Regeneration, Chinese Academy of Medical Sciences, 2019RU051, Beijing, 100048, PR China
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Gagnon J, Probst S, Chartrand J, Reynolds E, Lalonde M. Self-supporting wound care mobile applications for nurses: A scoping review. J Adv Nurs 2024; 80:3464-3480. [PMID: 38186080 DOI: 10.1111/jan.16052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/11/2023] [Accepted: 12/23/2023] [Indexed: 01/09/2024]
Abstract
AIM This study provides an overview of the literature to identify and map the types of available evidence on self-supporting mobile applications used by nurses in wound care regarding their development, evaluation and outcomes for patients, nurses and the healthcare system. DESIGN Scoping review. REVIEW METHOD Joanna Briggs Institute scoping review methodology was used. DATA SOURCES A search was performed using MEDLINE, Embase, CINAHL (via EBSCO), Web of Science, LiSSa (Littérature Scientifique en Santé), Cochrane Wounds, Érudit and grey literature, between April and October 2022, updated in April 2023, to identify literature published in English and French. RESULTS Eleven studies from 14 publications met the inclusion criteria. Mostly descriptive, the included studies presented mobile applications that nurses used, among other things, to assess wounds and support clinical decision-making. The results described how nurses were iteratively involved in the process of developing and evaluating mobile applications using various methods such as pilot tests. The three outcomes most frequently reported by nurses were as follows: facilitating care, documentation on file and access to evidence-based data. CONCLUSION The potential of mobile applications in wound care is within reach. Nurses are an indispensable player in the successful development of these tools. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE If properly developed and evaluated, mobile applications for wound care could enhance nursing practices and improve patient care. The development of ethical digital competence must be ensured during initial training and continued throughout the professional journey. IMPACT We identified a dearth of studies investigating applications that work without Internet access. More research is needed on the development of mobile applications in wound care and their possible impact on nursing practice in rural areas and the next generation of nurses. REPORTING METHOD The Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Review guidelines were used. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Julie Gagnon
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Département des sciences de la santé, Université du Québec à Rimouski, Rimouski, Québec, Canada
| | - Sebastian Probst
- HES-SO, University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
- Care Directorate, University Hospital Geneva, Geneva, Switzerland
- Faculty of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Julie Chartrand
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Emily Reynolds
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Michelle Lalonde
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, Ontario, Canada
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Kabir MA, Samad S, Ahmed F, Naher S, Featherston J, Laird C, Ahmed S. Mobile Apps for Wound Assessment and Monitoring: Limitations, Advancements and Opportunities. J Med Syst 2024; 48:80. [PMID: 39180710 PMCID: PMC11344716 DOI: 10.1007/s10916-024-02091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/22/2024] [Indexed: 08/26/2024]
Abstract
With the proliferation of wound assessment apps across various app stores and the increasing integration of artificial intelligence (AI) in healthcare apps, there is a growing need for a comprehensive evaluation system. Current apps lack sufficient evidence-based reliability, prompting the necessity for a systematic assessment. The objectives of this study are to evaluate the wound assessment and monitoring apps, identify limitations, and outline opportunities for future app development. An electronic search across two major app stores (Google Play store, and Apple App Store) was conducted and the selected apps were rated by three independent raters. A total of 170 apps were discovered, and 10 were selected for review based on a set of inclusion and exclusion criteria. By modifying existing scales, an app rating scale for wound assessment apps is created and used to evaluate the selected ten apps. Our rating scale evaluates apps' functionality and software quality characteristics. Most apps in the app stores, according to our evaluation, do not meet the overall requirements for wound monitoring and assessment. All the apps that we reviewed are focused on practitioners and doctors. According to our evaluation, the app ImitoWound got the highest mean score of 4.24. But this app has 7 criteria among our 11 functionalities criteria. Finally, we have recommended future opportunities to leverage advanced techniques, particularly those involving artificial intelligence, to enhance the functionality and efficacy of wound assessment apps. This research serves as a valuable resource for future developers and researchers seeking to enhance the design of wound assessment-based applications, encompassing improvements in both software quality and functionality.
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Affiliation(s)
- Muhammad Ashad Kabir
- School of Computing, Mathematics and Engineering, Charles Sturt University, Bathurst, 2795, NSW, Australia.
| | - Sabiha Samad
- Department of Computer Science and Engineering, Chittagong University of Engineering and Technology, Chattogram, 4349, Chattogram, Bangladesh
| | - Fahmida Ahmed
- Department of Computer Science and Engineering, Chittagong University of Engineering and Technology, Chattogram, 4349, Chattogram, Bangladesh
| | - Samsun Naher
- Department of Computer Science and Engineering, Chittagong University of Engineering and Technology, Chattogram, 4349, Chattogram, Bangladesh
| | - Jill Featherston
- School of Medicine, Cardiff University, Cardiff, CF14 4YS, Wales, United Kingdom
| | - Craig Laird
- Principal Pedorthist, Walk Easy Pedorthics Pty. Ltd., Tamworth, 2340, NSW, Australia
| | - Sayed Ahmed
- Principal Pedorthist, Foot Balance Technology Pty Ltd, Westmead, 2145, NSW, Australia
- Offloading Clinic, Nepean Hospital, Kingswood, 2750, NSW, Australia
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Taghdi MH, Muttiah B, Chan AML, Fauzi MB, Law JX, Lokanathan Y. Exploring Synergistic Effects of Bioprinted Extracellular Vesicles for Skin Regeneration. Biomedicines 2024; 12:1605. [PMID: 39062178 PMCID: PMC11275222 DOI: 10.3390/biomedicines12071605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/02/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Regenerative medicine represents a paradigm shift in healthcare, aiming to restore tissue and organ function through innovative therapeutic strategies. Among these, bioprinting and extracellular vesicles (EVs) have emerged as promising techniques for tissue rejuvenation. EVs are small lipid membrane particles secreted by cells, known for their role as potent mediators of intercellular communication through the exchange of proteins, genetic material, and other biological components. The integration of 3D bioprinting technology with EVs offers a novel approach to tissue engineering, enabling the precise deposition of EV-loaded bioinks to construct complex three-dimensional (3D) tissue architectures. Unlike traditional cell-based approaches, bioprinted EVs eliminate the need for live cells, thereby mitigating regulatory and financial obstacles associated with cell therapy. By leveraging the synergistic effects of EVs and bioprinting, researchers aim to enhance the therapeutic outcomes of skin regeneration while addressing current limitations in conventional treatments. This review explores the evolving landscape of bioprinted EVs as a transformative approach for skin regeneration. Furthermore, it discusses the challenges and future directions in harnessing this innovative therapy for clinical applications, emphasizing the need for interdisciplinary collaboration and continued scientific inquiry to unlock its full therapeutic potential.
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Affiliation(s)
- Manal Hussein Taghdi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia; (M.H.T.); (B.M.); (M.B.F.); (J.X.L.)
- Department of Anaesthesia and Intensive Care, Faculty of Medical Technology, University of Tripoli, Tripoli P.O. Box 13932, Libya
| | - Barathan Muttiah
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia; (M.H.T.); (B.M.); (M.B.F.); (J.X.L.)
| | | | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia; (M.H.T.); (B.M.); (M.B.F.); (J.X.L.)
| | - Jia Xian Law
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia; (M.H.T.); (B.M.); (M.B.F.); (J.X.L.)
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia; (M.H.T.); (B.M.); (M.B.F.); (J.X.L.)
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Chen MY, Cao MQ, Xu TY. Progress in the application of artificial intelligence in skin wound assessment and prediction of healing time. Am J Transl Res 2024; 16:2765-2776. [PMID: 39114681 PMCID: PMC11301465 DOI: 10.62347/myhe3488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/22/2024] [Indexed: 08/10/2024]
Abstract
Since the 1970s, artificial intelligence (AI) has played an increasingly pivotal role in the medical field, enhancing the efficiency of disease diagnosis and treatment. Amidst an aging population and the proliferation of chronic disease, the prevalence of complex surgeries for high-risk multimorbid patients and hard-to-heal wounds has escalated. Healthcare professionals face the challenge of delivering safe and effective care to all patients concurrently. Inadequate management of skin wounds exacerbates the risk of infection and complications, which can obstruct the healing process and diminish patients' quality of life. AI shows substantial promise in revolutionizing wound care and management, thus enhancing the treatment of hospitalized patients and enabling healthcare workers to allocate their time more effectively. This review details the advancements in applying AI for skin wound assessment and the prediction of healing timelines. It emphasizes the use of diverse algorithms to automate and streamline the measurement, classification, and identification of chronic wound healing stages, and to predict wound healing times. Moreover, the review addresses existing limitations and explores future directions.
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Affiliation(s)
- Ming-Yao Chen
- Department of Anesthetic Pharmacology, School of Anesthesiology, Second Military Medical University/Naval Medical UniversityShanghai 200433, China
| | - Ming-Qi Cao
- Department of Anesthetic Pharmacology, School of Anesthesiology, Second Military Medical University/Naval Medical UniversityShanghai 200433, China
- College of Basic Medicine, Second Military Medical University/Naval Medical UniversityShanghai 200433, China
| | - Tian-Ying Xu
- Department of Anesthetic Pharmacology, School of Anesthesiology, Second Military Medical University/Naval Medical UniversityShanghai 200433, China
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Muller-Sloof E, de Laat E, Baljé-Volkers C, Hummelink S, Vermeulen H, Ulrich D. Inter-rater reliability among healthcare professionals in assessing postoperative wound photos for the presence or absence of surgical wound dehiscence: A Pretest - Posttest study. J Tissue Viability 2024:S0965-206X(24)00106-2. [PMID: 38991899 DOI: 10.1016/j.jtv.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/18/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Surgical wound dehiscence (SWD) has various definitions, which complicates accurate and uniform diagnosis. To address this, the World Union Wound Healing Societies (WUWHS) presented a consensus based definition and classification for SWD (2018). AIM This quasi-experimental pretest-posttest study investigates the inter-rater reliability among healthcare professionals (HCP) and wound care professionals (WCP) when assessing wound photos on the presence or absence of SWD before and after training on the WUWHS-definition. METHODS Wound expert teams compiled a set of twenty photos (SWD+: nineteen, SWD-: one), and a video training. Subsequently, 262 healthcare professionals received the pretest link to assess wound photos. After completion, participants received the posttest link, including a (video) training on the WUWHS-definition, and reassessment of fourteen photos (SWD+: thirteen, SWD-: one). PRIMARY OUTCOMES 1) pretest-posttest inter-rater-reliability among participants in assessing photos in congruence with the WUWHS-definition 2) the impact of training on assessment scores. SECONDARY OUTCOME familiarity with the WUWHS-definition. RESULTS One hundred thirty-one participants (65 HCPs, 66 WCPs) completed both tests. The posttest inter-rater reliability among participants for correctly identifying SWD was increased from 67.6 % to 76.2 %, reaching statistical significance (p-value: 0.001; 95 % Confidence Interval [1.8-2.2]). Sub-analyses per photo showed improved SWD posttest scores in thirteen photos, while statistical significance was reached in seven photos. Thirty-three percent of participants knew the WUWHS-definition. CONCLUSION The inter-rater reliability among participants increases after training on the WUWHS-definition. The definition provides diagnostic criteria for accurate SWD diagnosis. Widespread use of the definition may improve uniformity in care for patients with SWD.
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Affiliation(s)
- Emmy Muller-Sloof
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
| | - Erik de Laat
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
| | | | - Stefan Hummelink
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
| | - Hester Vermeulen
- Radboud Institute for Health Sciences Scientific Center for Quality of Healthcare, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, the Netherlands; HAN University Applied Sciences, Institute of Health, Kapittelweg 54, 6525 EP, Nijmegen, the Netherlands.
| | - Dietmar Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, P/O Box 9101, 6500 HB, Nijmegen, (634), the Netherlands.
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Zimmermann N, Sieberth T, Dobay A. Automated wound segmentation and classification of seven common injuries in forensic medicine. Forensic Sci Med Pathol 2024; 20:443-451. [PMID: 37378809 PMCID: PMC11297066 DOI: 10.1007/s12024-023-00668-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
In forensic medical investigations, physical injuries are documented with photographs accompanied by written reports. Automatic segmentation and classification of wounds on these photographs could provide forensic pathologists with a tool to improve the assessment of injuries and accelerate the reporting process. In this pilot study, we trained and compared several preexisting deep learning architectures for image segmentation and wound classification on forensically relevant photographs in our database. The best scores were a mean pixel accuracy of 69.4% and a mean intersection over union (IoU) of 48.6% when evaluating the trained models on our test set. The models had difficulty distinguishing the background from wounded areas. As an example, image pixels showing subcutaneous hematomas or skin abrasions were assigned to the background class in 31% of cases. Stab wounds, on the other hand, were reliably classified with a pixel accuracy of 93%. These results can be partially attributed to undefined wound boundaries for some types of injuries, such as subcutaneous hematoma. However, despite the large class imbalance, we demonstrate that the best trained models could reliably distinguish among seven of the most common wounds encountered in forensic medical investigations.
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Affiliation(s)
- Norio Zimmermann
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Till Sieberth
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
- 3D Centre Zurich, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Akos Dobay
- Zurich Institute of Forensic Medicine, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
- Forensic Machine Learning Technology Center, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland.
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Phokaewvarangkul O, Kantachadvanich N, Buranasrikul V, Sanyawut K, Phumphid S, Anan C, Bhidayasiri R. Integrating technology into a successful apomorphine delivery program in Thailand: a 10-year journey of achievements with a five-motto concept. Front Neurol 2024; 15:1379459. [PMID: 38645746 PMCID: PMC11026563 DOI: 10.3389/fneur.2024.1379459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Apomorphine, a potent dopamine agonist, is a therapeutic option for patients with Parkinson's disease and motor fluctuations. However, the adoption of and adherence to this therapy have been limited by the need for complex delivery devices and specialized care as well as resource consumption, posing challenges for new physicians. Thailand is a unique example of a developing nation that has successfully implemented and continued the use of this therapy by employing cooperative technology that has dramatically enhanced apomorphine delivery services. Methods Establishing apomorphine delivery services requires significant resources and step-by-step solutions. We began our services by implementing various strategies in three chronological stages: the initial stage (2013-2015), intermediate stage (2016-2019), and current stage (2020-present), each presenting unique challenges. Together, we also implemented a proposed set of five mottos to strengthen our apomorphine delivery service. Using additive technology, we developed a patient registry platform that combined electronic data acquisition, video and remote monitoring using wearable sensors, and in-house mobile applications to support our service. Results At the initial stage, we assembled a team to enhance the efficacy and confirm the safety of apomorphine treatment in our hospital. At the intermediate stage, we expanded our apomorphine delivery services beyond just the patients at our hospital. We supported other hospitals in Thailand in setting up their own apomorphine services by educating both physicians and nurses regarding apomorphine therapy. With this educational undertaking, increased apomorphine-related knowledge among medical professionals, and a greater number of hospitals providing apomorphine services, an increasing number of patients were administered apomorphine in subsequent years. Currently, we are providing effective apomorphine delivery to improve patient outcomes and are seamlessly integrating technology into clinical practice. Incorporating integrative technologies in our apomorphine delivery program yielded positive results in data collection and support throughout patient care, in tracking patients' statuses, in the long-term use of this treatment, and in increasing medication adherence rates. Conclusion This perspective paper describes how technology can help provide supportive healthcare services in resource-constrained environments, such as in Thailand, offering a step-by-step approach to overcoming several limitations. The valuable insights from our 10-year journey in successfully integrating technology into apomorphine delivery services can benefit new physicians seeking to replicate our success.
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Affiliation(s)
- Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nithinan Kantachadvanich
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Vijittra Buranasrikul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kanyawat Sanyawut
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Saisamorn Phumphid
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chanawat Anan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- The Academy of Science, The Royal Science of Thailand, Bangkok, Thailand
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Rippon MG, Fleming L, Chen T, Rogers AA, Ousey K. Artificial intelligence in wound care: diagnosis, assessment and treatment of hard-to-heal wounds: a narrative review. J Wound Care 2024; 33:229-242. [PMID: 38573907 DOI: 10.12968/jowc.2024.33.4.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The effective assessment of wounds, both acute and hard-to-heal, is an important component in the delivery by wound care practitioners of efficacious wound care for patients. Improved wound diagnosis, optimising wound treatment regimens, and enhanced prevention of wounds aid in providing patients with a better quality of life (QoL). There is significant potential for the use of artificial intelligence (AI) in health-related areas such as wound care. However, AI-based systems remain to be developed to a point where they can be used clinically to deliver high-quality wound care. We have carried out a narrative review of the development and use of AI in the diagnosis, assessment and treatment of hard-to-heal wounds. We retrieved 145 articles from several online databases and other online resources, and 81 of them were included in this narrative review. Our review shows that AI application in wound care offers benefits in the assessment/diagnosis, monitoring and treatment of acute and hard-to-heal wounds. As well as offering patients the potential of improved QoL, AI may also enable better use of healthcare resources.
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Affiliation(s)
- Mark G Rippon
- University of Huddersfield, Huddersfield, UK
- Daneriver Consultancy Ltd, Holmes Chapel, UK
| | - Leigh Fleming
- School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - Tianhua Chen
- School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | | | - Karen Ousey
- University of Huddersfield Department of Nursing and Midwifery, Huddersfield, UK
- Adjunct Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Australia
- Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Ireland
- Chair, International Wound Infection Institute
- President Elect, International Skin Tear Advisory Panel
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Lo ZJ, Mak MHW, Liang S, Chan YM, Goh CC, Lai T, Tan A, Thng P, Rodriguez J, Weyde T, Smit S. Development of an explainable artificial intelligence model for Asian vascular wound images. Int Wound J 2024; 21:e14565. [PMID: 38146127 PMCID: PMC10961881 DOI: 10.1111/iwj.14565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023] Open
Abstract
Chronic wounds contribute to significant healthcare and economic burden worldwide. Wound assessment remains challenging given its complex and dynamic nature. The use of artificial intelligence (AI) and machine learning methods in wound analysis is promising. Explainable modelling can help its integration and acceptance in healthcare systems. We aim to develop an explainable AI model for analysing vascular wound images among an Asian population. Two thousand nine hundred and fifty-seven wound images from a vascular wound image registry from a tertiary institution in Singapore were utilized. The dataset was split into training, validation and test sets. Wound images were classified into four types (neuroischaemic ulcer [NIU], surgical site infections [SSI], venous leg ulcers [VLU], pressure ulcer [PU]), measured with automatic estimation of width, length and depth and segmented into 18 wound and peri-wound features. Data pre-processing was performed using oversampling and augmentation techniques. Convolutional and deep learning models were utilized for model development. The model was evaluated with accuracy, F1 score and receiver operating characteristic (ROC) curves. Explainability methods were used to interpret AI decision reasoning. A web browser application was developed to demonstrate results of the wound AI model with explainability. After development, the model was tested on additional 15 476 unlabelled images to evaluate effectiveness. After the development on the training and validation dataset, the model performance on unseen labelled images in the test set achieved an AUROC of 0.99 for wound classification with mean accuracy of 95.9%. For wound measurements, the model achieved AUROC of 0.97 with mean accuracy of 85.0% for depth classification, and AUROC of 0.92 with mean accuracy of 87.1% for width and length determination. For wound segmentation, an AUROC of 0.95 and mean accuracy of 87.8% was achieved. Testing on unlabelled images, the model confidence score for wound classification was 82.8% with an explainability score of 60.6%. Confidence score was 87.6% for depth classification with 68.0% explainability score, while width and length measurement obtained 93.0% accuracy score with 76.6% explainability. Confidence score for wound segmentation was 83.9%, while explainability was 72.1%. Using explainable AI models, we have developed an algorithm and application for analysis of vascular wound images from an Asian population with accuracy and explainability. With further development, it can be utilized as a clinical decision support system and integrated into existing healthcare electronic systems.
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Affiliation(s)
- Zhiwen Joseph Lo
- Department of SurgeryWoodlands HealthSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | | | | | - Yam Meng Chan
- Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
| | - Cheng Cheng Goh
- Wound and Stoma Care, Nursing SpecialityTan Tock Seng HospitalSingaporeSingapore
| | - Tina Lai
- Wound and Stoma Care, Nursing SpecialityTan Tock Seng HospitalSingaporeSingapore
| | - Audrey Tan
- Wound and Stoma Care, Nursing SpecialityTan Tock Seng HospitalSingaporeSingapore
| | - Patrick Thng
- AITIS ‐ Advanced Intelligence and Technology InnovationsLondonUnited Kingdom
| | - Jorge Rodriguez
- AITIS ‐ Advanced Intelligence and Technology InnovationsLondonUnited Kingdom
| | - Tillman Weyde
- AITIS ‐ Advanced Intelligence and Technology InnovationsLondonUnited Kingdom
| | - Sylvia Smit
- AITIS ‐ Advanced Intelligence and Technology InnovationsLondonUnited Kingdom
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11
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Pereira FES, Jagatheesaperumal SK, Benjamin SR, Filho PCDN, Duarte FT, de Albuquerque VHC. Advancements in non-invasive microwave brain stimulation: A comprehensive survey. Phys Life Rev 2024; 48:132-161. [PMID: 38219370 DOI: 10.1016/j.plrev.2024.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
This survey provides a comprehensive insight into the world of non-invasive brain stimulation and focuses on the evolving landscape of deep brain stimulation through microwave research. Non-invasive brain stimulation techniques provide new prospects for comprehending and treating neurological disorders. We investigate the methods shaping the future of deep brain stimulation, emphasizing the role of microwave technology in this transformative journey. Specifically, we explore antenna structures and optimization strategies to enhance the efficiency of high-frequency microwave stimulation. These advancements can potentially revolutionize the field by providing a safer and more precise means of modulating neural activity. Furthermore, we address the challenges that researchers currently face in the realm of microwave brain stimulation. From safety concerns to methodological intricacies, this survey outlines the barriers that must be overcome to fully unlock the potential of this technology. This survey serves as a roadmap for advancing research in microwave brain stimulation, pointing out potential directions and innovations that promise to reshape the field.
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Affiliation(s)
| | - Senthil Kumar Jagatheesaperumal
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza, 60455-970, Ceará, Brazil; Department of Electronics and Communication Engineering, Mepco Schlenk Engineering College, Sivakasi, 626005, Tamilnadu, India
| | - Stephen Rathinaraj Benjamin
- Department of Pharmacology and Pharmacy, Laboratory of Behavioral Neuroscience, Faculty of Medicine, Federal University of Ceará, Fortaleza, 60430-160, Ceará, Brazil
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12
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Liu X, Cai Z, Pei M, Zeng H, Yang L, Cao W, Zhou X, Chen F. Bacterial Cellulose-Based Bandages with Integrated Antibacteria and Electrical Stimulation for Advanced Wound Management. Adv Healthc Mater 2024; 13:e2302893. [PMID: 38060694 DOI: 10.1002/adhm.202302893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/17/2023] [Indexed: 12/17/2023]
Abstract
Bandages for daily wounds are the most common medical supplies, but there are still ingrained defects in their appearance, comfort, functions, as well as environmental pollution. Here, novel bandages based on bacterial cellulose (BC) membrane for wound monitoring and advanced wound management are developed. The BC membrane is combined with silver nanowires (AgNWs) by using vacuum filtration method to achieve transparent, ultrathin (≈7 µm), breathable (389.98-547.79 g m-2 d-1 ), and sandwich-structured BC/AgNWs bandages with superior mechanical properties (108.45-202.35 MPa), antibacterial activities against Escherichia coli and Staphylococcus aureus, biocompatibility, and conductivity (9.8 × 103 -2.0 × 105 S m-1 ). Significantly, the BC/AgNWs bandage is used in the electrical stimulation (direct current, 600 microamperes for 1 h every other day) treatment of full-thickness skin defect in rats, which obviously promotes wound healing by increasing the secretion of vascular endothelial growth factor (VEGF). The BC bandage is used for monitoring wounds and achieve a high accuracy of 94.7% in classifying wound healing stages of hemostasis, inflammation, proliferation, and remodeling, by using a convolutional neural network. The outcomes of this study not only provide two BC-based bandages as multifunctional wound management, but also demonstrate a new strategy for the development of the next generation of smart bandage.
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Affiliation(s)
- Xiaohao Liu
- Department of Orthopaedics, Center for Orthopaedic Science and Translational Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Yanchang Road, Shanghai, 200072, P. R. China
| | - Zhuyun Cai
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, P. R. China
| | - Manman Pei
- Department of Orthopaedics, Center for Orthopaedic Science and Translational Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Yanchang Road, Shanghai, 200072, P. R. China
| | - Hua Zeng
- Department of Orthopaedics, Center for Orthopaedic Science and Translational Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Yanchang Road, Shanghai, 200072, P. R. China
| | - Lijuan Yang
- Baidu, Inc., 701 Naxian Road, Shanghai, 201210, P. R. China
| | - Wentao Cao
- Department of Orthopaedics, Center for Orthopaedic Science and Translational Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Yanchang Road, Shanghai, 200072, P. R. China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, 200001, P. R. China
| | - Xuhui Zhou
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, P. R. China
| | - Feng Chen
- Department of Orthopaedics, Center for Orthopaedic Science and Translational Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Yanchang Road, Shanghai, 200072, P. R. China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Stomatological Hospital and School of Stomatology, Fudan University, Shanghai, 200001, P. R. China
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13
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Kivity S, Rajuan E, Arbeli S, Alcalay T, Shiri L, Orvieto N, Alon Y, Saban M. Optimising wound monitoring: Can digital tools improve healing outcomes and clinic efficiency. J Clin Nurs 2024. [PMID: 38379311 DOI: 10.1111/jocn.17084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/01/2024] [Accepted: 02/11/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Chronic wounds present significant challenges for patients and nursing care teams worldwide. Digital health tools offer potential for more standardised and efficient nursing care pathways but require further rigorous evaluation. OBJECTIVE This retrospective matched cohort study aimed to compare the impacts of a digital tracking application for wound documentation versus traditional manual nursing assessments. METHODS Data from 5236 patients with various wound types were analysed. Propensity score matching balanced groups, and bivariate tests, correlation analyses, linear regression, and Hayes' Process Macro Model 15 were utilised for a mediation-moderation model. RESULTS Digital wound tracking was associated with significantly shorter healing durations (15 vs. 35 days) and fewer clinic nursing visits (3 vs. 5.8 visits) compared to standard nursing monitoring. Digital tracking demonstrated improved wound size reduction over time. Laboratory values tested did not consistently predict healing outcomes. Digital tracking exhibited moderate negative correlations with the total number of nursing visits. Regression analysis identified wound complexity, hospitalizations, and initial wound size as clinical predictors for more nursing visits in patients with diabetes mellitus (p < .01). Digital tracking significantly reduced the number of associated nursing visits for patients with peripheral vascular disease. CONCLUSION These findings suggest that digital wound management may streamline nursing care and provide advantages, particularly for comorbid populations facing treatment burdens. REPORTING METHOD This study adhered to STROBE guidelines in reporting this observational research. RELEVANCE TO CLINICAL PRACTICE By streamlining documentation and potentially shortening healing times, digital wound tracking could help optimise nursing resources, enhance wound care standards, and improve patient experiences. This supports further exploration of digital health innovations to advance evidence-based nursing practice. PATIENT OR PUBLIC CONTRIBUTION This study involved retrospective analysis of existing patient records and did not directly include patients or the public in the design, conduct, or reporting of the research.
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Affiliation(s)
- Sara Kivity
- Maccabi healthcare services, Tel Aviv-Jaffa, Israel
| | - Ella Rajuan
- Maccabi healthcare services, Tel Aviv-Jaffa, Israel
| | - Sima Arbeli
- Maccabi healthcare services, Tel Aviv-Jaffa, Israel
| | | | - Lior Shiri
- Maccabi healthcare services, Tel Aviv-Jaffa, Israel
| | - Noam Orvieto
- Maccabi healthcare services, Tel Aviv-Jaffa, Israel
| | - Yaniv Alon
- Nursing Department, School of Health Sciences, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Saban
- Nursing Department, School of Health Sciences, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Mackenzie SC, Sainsbury CAR, Wake DJ. Diabetes and artificial intelligence beyond the closed loop: a review of the landscape, promise and challenges. Diabetologia 2024; 67:223-235. [PMID: 37979006 PMCID: PMC10789841 DOI: 10.1007/s00125-023-06038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
The discourse amongst diabetes specialists and academics regarding technology and artificial intelligence (AI) typically centres around the 10% of people with diabetes who have type 1 diabetes, focusing on glucose sensors, insulin pumps and, increasingly, closed-loop systems. This focus is reflected in conference topics, strategy documents, technology appraisals and funding streams. What is often overlooked is the wider application of data and AI, as demonstrated through published literature and emerging marketplace products, that offers promising avenues for enhanced clinical care, health-service efficiency and cost-effectiveness. This review provides an overview of AI techniques and explores the use and potential of AI and data-driven systems in a broad context, covering all diabetes types, encompassing: (1) patient education and self-management; (2) clinical decision support systems and predictive analytics, including diagnostic support, treatment and screening advice, complications prediction; and (3) the use of multimodal data, such as imaging or genetic data. The review provides a perspective on how data- and AI-driven systems could transform diabetes care in the coming years and how they could be integrated into daily clinical practice. We discuss evidence for benefits and potential harms, and consider existing barriers to scalable adoption, including challenges related to data availability and exchange, health inequality, clinician hesitancy and regulation. Stakeholders, including clinicians, academics, commissioners, policymakers and those with lived experience, must proactively collaborate to realise the potential benefits that AI-supported diabetes care could bring, whilst mitigating risk and navigating the challenges along the way.
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Affiliation(s)
- Scott C Mackenzie
- Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Chris A R Sainsbury
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Deborah J Wake
- Usher Institute, The University of Edinburgh, Edinburgh, UK.
- Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK.
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15
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Basiri R, Manji K, LeLievre PM, Toole J, Kim F, Khan SS, Popovic MR. Protocol for metadata and image collection at diabetic foot ulcer clinics: enabling research in wound analytics and deep learning. Biomed Eng Online 2024; 23:12. [PMID: 38287324 PMCID: PMC10826077 DOI: 10.1186/s12938-024-01210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The escalating impact of diabetes and its complications, including diabetic foot ulcers (DFUs), presents global challenges in quality of life, economics, and resources, affecting around half a billion people. DFU healing is hindered by hyperglycemia-related issues and diverse diabetes-related physiological changes, necessitating ongoing personalized care. Artificial intelligence and clinical research strive to address these challenges by facilitating early detection and efficient treatments despite resource constraints. This study establishes a standardized framework for DFU data collection, introducing a dedicated case report form, a comprehensive dataset named Zivot with patient population clinical feature breakdowns and a baseline for DFU detection using this dataset and a UNet architecture. RESULTS Following this protocol, we created the Zivot dataset consisting of 269 patients with active DFUs, and about 3700 RGB images and corresponding thermal and depth maps for the DFUs. The effectiveness of collecting a consistent and clean dataset was demonstrated using a bounding box prediction deep learning network that was constructed with EfficientNet as the feature extractor and UNet architecture. The network was trained on the Zivot dataset, and the evaluation metrics showed promising values of 0.79 and 0.86 for F1-score and mAP segmentation metrics. CONCLUSIONS This work and the Zivot database offer a foundation for further exploration of holistic and multimodal approaches to DFU research.
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Affiliation(s)
- Reza Basiri
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada.
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.
| | - Karim Manji
- Zivot Limb Preservation Centre, Peter Lougheed Centre, Calgary, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Philip M LeLievre
- Zivot Limb Preservation Centre, Peter Lougheed Centre, Calgary, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - John Toole
- Zivot Limb Preservation Centre, Peter Lougheed Centre, Calgary, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Faith Kim
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Shehroz S Khan
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
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16
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Tabja Bortesi JP, Ranisau J, Di S, McGillion M, Rosella L, Johnson A, Devereaux PJ, Petch J. Machine Learning Approaches for the Image-Based Identification of Surgical Wound Infections: Scoping Review. J Med Internet Res 2024; 26:e52880. [PMID: 38236623 PMCID: PMC10835585 DOI: 10.2196/52880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/09/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Surgical site infections (SSIs) occur frequently and impact patients and health care systems. Remote surveillance of surgical wounds is currently limited by the need for manual assessment by clinicians. Machine learning (ML)-based methods have recently been used to address various aspects of the postoperative wound healing process and may be used to improve the scalability and cost-effectiveness of remote surgical wound assessment. OBJECTIVE The objective of this review was to provide an overview of the ML methods that have been used to identify surgical wound infections from images. METHODS We conducted a scoping review of ML approaches for visual detection of SSIs following the JBI (Joanna Briggs Institute) methodology. Reports of participants in any postoperative context focusing on identification of surgical wound infections were included. Studies that did not address SSI identification, surgical wounds, or did not use image or video data were excluded. We searched MEDLINE, Embase, CINAHL, CENTRAL, Web of Science Core Collection, IEEE Xplore, Compendex, and arXiv for relevant studies in November 2022. The records retrieved were double screened for eligibility. A data extraction tool was used to chart the relevant data, which was described narratively and presented using tables. Employment of TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) guidelines was evaluated and PROBAST (Prediction Model Risk of Bias Assessment Tool) was used to assess risk of bias (RoB). RESULTS In total, 10 of the 715 unique records screened met the eligibility criteria. In these studies, the clinical contexts and surgical procedures were diverse. All papers developed diagnostic models, though none performed external validation. Both traditional ML and deep learning methods were used to identify SSIs from mostly color images, and the volume of images used ranged from under 50 to thousands. Further, 10 TRIPOD items were reported in at least 4 studies, though 15 items were reported in fewer than 4 studies. PROBAST assessment led to 9 studies being identified as having an overall high RoB, with 1 study having overall unclear RoB. CONCLUSIONS Research on the image-based identification of surgical wound infections using ML remains novel, and there is a need for standardized reporting. Limitations related to variability in image capture, model building, and data sources should be addressed in the future.
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Affiliation(s)
| | - Jonathan Ranisau
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shuang Di
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - P J Devereaux
- Population Health Research Institute, Hamilton, ON, Canada
| | - Jeremy Petch
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Cardiology, McMaster University, Hamilton, ON, Canada
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Curti N, Merli Y, Zengarini C, Starace M, Rapparini L, Marcelli E, Carlini G, Buschi D, Castellani GC, Piraccini BM, Bianchi T, Giampieri E. Automated Prediction of Photographic Wound Assessment Tool in Chronic Wound Images. J Med Syst 2024; 48:14. [PMID: 38227131 DOI: 10.1007/s10916-023-02029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/22/2023] [Indexed: 01/17/2024]
Abstract
Many automated approaches have been proposed in literature to quantify clinically relevant wound features based on image processing analysis, aiming at removing human subjectivity and accelerate clinical practice. In this work we present a fully automated image processing pipeline leveraging deep learning and a large wound segmentation dataset to perform wound detection and following prediction of the Photographic Wound Assessment Tool (PWAT), automatizing the clinical judgement of the adequate wound healing. Starting from images acquired by smartphone cameras, a series of textural and morphological features are extracted from the wound areas, aiming to mimic the typical clinical considerations for wound assessment. The resulting extracted features can be easily interpreted by the clinician and allow a quantitative estimation of the PWAT scores. The features extracted from the region-of-interests detected by our pre-trained neural network model correctly predict the PWAT scale values with a Spearman's correlation coefficient of 0.85 on a set of unseen images. The obtained results agree with the current state-of-the-art and provide a benchmark for future artificial intelligence applications in this research field.
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Affiliation(s)
- Nico Curti
- Department of Physics and Astronomy, University of Bologna, 40127, Bologna, Italy
- Data Science and Bioinformatics Laboratory, IRCCS Institute of Neurological Sciences of Bologna, 40139, Bologna, Italy
| | - Yuri Merli
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Corrado Zengarini
- Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy.
| | - Michela Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Luca Rapparini
- Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Emanuela Marcelli
- Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
- eDIMESLab, Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Gianluca Carlini
- Data Science and Bioinformatics Laboratory, IRCCS Institute of Neurological Sciences of Bologna, 40139, Bologna, Italy
| | - Daniele Buschi
- Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Gastone C Castellani
- Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
| | | | - Enrico Giampieri
- Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy
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Farid Y, Fernando Botero Gutierrez L, Ortiz S, Gallego S, Zambrano JC, Morrelli HU, Patron A. Artificial Intelligence in Plastic Surgery: Insights from Plastic Surgeons, Education Integration, ChatGPT's Survey Predictions, and the Path Forward. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5515. [PMID: 38204870 PMCID: PMC10781127 DOI: 10.1097/gox.0000000000005515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/02/2023] [Indexed: 01/12/2024]
Abstract
Background Artificial intelligence (AI) is emerging as a transformative technology with potential applications in various plastic surgery procedures and plastic surgery education. This article examines the views of plastic surgeons and residents on the role of AI in the field of plastic surgery. Methods A 34-question survey on AI's role in plastic surgery was distributed to 564 plastic surgeons worldwide, and we received responses from 153 (26.77%) with the majority from Latin America. The survey explored various aspects such as current AI experience, attitudes toward AI, data sources, ethical considerations, and future prospects of AI in plastic surgery and education. Predictions from AI using ChatGPT for each question were compared with the actual survey responses. Results The study found that most participants had little or no prior AI experience. Although some believed AI could enhance accuracy and visualization, opinions on its impact on surgical time, patient recovery, and satisfaction were mixed. Concerns included patient privacy, data security, costs, and informed consent. Valuable AI training data sources were identified, and there was agreement on the importance of standards and transparency. Respondents expected AI's increasing role in reconstructive and aesthetic surgery, suggesting its integration into residency programs, addressing administrative challenges, and patient complications. Confidence in the enduring importance of human professionals was expressed, with interest in further AI research. Conclusion The survey's findings underscore the need to harness AI's potential while preserving human professionals' roles through informed consent, standardization, and AI education in plastic surgery.
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Affiliation(s)
- Yasser Farid
- From the Department of Plastic and Reconstructive Surgery, University of Antioquia, Medellin, Colombia
- Department of Plastic and Reconstructive Surgery, Université Libre de Bruxelles, Brussels, Belgium
- Department of Plastic and Reconstructive Surgery, Brugmann Hospital Brussels, Brussels, Belgium
| | | | - Socorro Ortiz
- Department of Plastic and Reconstructive Surgery, Université Libre de Bruxelles, Brussels, Belgium
- Department of Plastic and Reconstructive Surgery, Brugmann Hospital Brussels, Brussels, Belgium
| | - Sabrina Gallego
- From the Department of Plastic and Reconstructive Surgery, University of Antioquia, Medellin, Colombia
| | - Juan Carlos Zambrano
- Department of Plastic and Reconstructive Surgery, University of Pontificia Javeriana, Bogota, Colombia
| | | | - Alfredo Patron
- From the Department of Plastic and Reconstructive Surgery, University of Antioquia, Medellin, Colombia
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Sarp S, Kuzlu M, Zhao Y, Gueler O. Digital Twin in Healthcare: A Study for Chronic Wound Management. IEEE J Biomed Health Inform 2023; 27:5634-5643. [PMID: 37549083 DOI: 10.1109/jbhi.2023.3299028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Although the concept of digital twin technology has been in existence for nearly half a century, its application in healthcare is a relatively recent development. In healthcare, the utilization of digital twin and data-driven models has proven to enhance clinical decision support, particularly in the treatment and assessment of chronic wounds, leading to improved clinical outcomes. This article proposes the implementation of a digital twin in the domain of healthcare, specifically in the management of chronic wounds, by leveraging artificial intelligence techniques. The digital twin is composed of data collection, data processing, and AI models dedicated to wound healing. A novel AI pipeline is utilized to track the healing of chronic wounds. The digital twin, serving as a virtual representation of the actual wound, simulates and replicates the healing process. Furthermore, the proposed wound-healing prediction model effectively guides the treatment of chronic wounds. Additionally, by comparing the actual wound with its digital twin, the system enables early identification of non-healing wounds, facilitating timely adjustments and modifications to the treatment plan. By incorporating a digital twin in healthcare, the proposed system enables personalized and tailored treatments, potentially playing a crucial role in proactive problem identification.
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Jaganathan Y, Sanober S, Aldossary SMA, Aldosari H. Validating Wound Severity Assessment via Region-Anchored Convolutional Neural Network Model for Mobile Image-Based Size and Tissue Classification. Diagnostics (Basel) 2023; 13:2866. [PMID: 37761233 PMCID: PMC10529166 DOI: 10.3390/diagnostics13182866] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Evaluating and tracking the size of a wound is a crucial step in wound assessment. The measurement of various indicators on wounds over time plays a vital role in treating and managing crucial wounds. This article introduces the concept of utilizing mobile device-captured photographs to address this challenge. The research explores the application of digital technologies in the treatment of chronic wounds, offering tools to assist healthcare professionals in enhancing patient care and decision-making. Additionally, it investigates the use of deep learning (DL) algorithms along with the use of computer vision techniques to enhance the validation results of wounds. The proposed method involves tissue classification as well as visual recognition system. The wound's region of interest (RoI) is determined using superpixel techniques, enabling the calculation of its wounded zone. A classification model based on the Region Anchored CNN framework is employed to detect and differentiate wounds and classify their tissues. The outcome demonstrates that the suggested method of DL, with visual methodologies to detect the shape of a wound and measure its size, achieves exceptional results. By utilizing Resnet50, an accuracy of 0.85 percent is obtained, while the Tissue Classification CNN exhibits a Median Deviation Error of 2.91 and a precision range of 0.96%. These outcomes highlight the effectiveness of the methodology in real-world scenarios and its potential to enhance therapeutic treatments for patients with chronic wounds.
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Affiliation(s)
- Yogapriya Jaganathan
- Department of Computer Science and Engineering, Kongunadu College of Engineering and Technology, Trichy 621215, India
| | - Sumaya Sanober
- Department of Computer Science, Prince Sattam Bin Abdulaziz University, Wadi al dwassir 1190, Saudi Arabia;
| | - Sultan Mesfer A Aldossary
- Department of Computer Sciences, College of Arts and Sciences, Prince Sattam Bin Abdulaziz University, Wadi al dwassir 1190, Saudi Arabia;
| | - Huda Aldosari
- Department of Computer Science, Prince Sattam Bin Abdulaziz University, Wadi al dwassir 1190, Saudi Arabia;
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Chang CW, Ho CY, Lai F, Christian M, Huang SC, Chang DH, Chen YS. Application of multiple deep learning models for automatic burn wound assessment. Burns 2023; 49:1039-1051. [PMID: 35945064 DOI: 10.1016/j.burns.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Accurate assessment of the percentage of total body surface area (%TBSA) burned is crucial in managing burn injuries. It is difficult to estimate the size of an irregular shape by inspection. Many articles reported the discrepancy of estimating %TBSA burned by different doctors. We set up a system with multiple deep learning (DL) models for %TBSA estimation, as well as the segmentation of possibly poor-perfused deep burn regions from the entire wound. METHODS We proposed boundary-based labeling for datasets of total burn wound and palm, whereas region-based labeling for the dataset of deep burn wound. Several powerful DL models (U-Net, PSPNet, DeeplabV3+, Mask R-CNN) with encoders ResNet101 had been trained and tested from the above datasets. With the subject distances, the %TBSA burned could be calculated by the segmentation of total burn wound area with respect to the palm size. The percentage of deep burn area could be obtained from the segmentation of deep burn area from the entire wound. RESULTS A total of 4991 images of early burn wounds and 1050 images of palms were boundary-based labeled. 1565 out of 4994 images with deep burn were preprocessed with superpixel segmentation into small regions before labeling. DeeplabV3+ had slightly better performance in three tasks with precision: 0.90767, recall: 0.90065 for total burn wound segmentation; precision: 0.98987, recall: 0.99036 for palm segmentation; and precision: 0.90152, recall: 0.90219 for deep burn segmentation. CONCLUSION Combining the segmentation results and clinical data, %TBSA burned, the volume of fluid for resuscitation, and the percentage of deep burn area can be automatically diagnosed by DL models with a pixel-to-pixel method. Artificial intelligence provides consistent, accurate and rapid assessments of burn wounds.
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Affiliation(s)
- Che Wei Chang
- Graduate Institute of Biomedical Electronics & Bioinformatics, National Taiwan University, Taipei, Taiwan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan.
| | - Chun Yee Ho
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics & Bioinformatics, National Taiwan University, Taipei, Taiwan; Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Mesakh Christian
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Shih Chen Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Dun Hao Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan; Department of Information Management, Yuan Ze University, Taiwan
| | - Yo Shen Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei, Taiwan
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22
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Londoño S, Viloria C, Pérez-Buitrago S, Murillo J, Botina D, Zarzycki A, Garzón J, Torres-Madronero MC, Robledo SM, Marzani F, Treuillet S, Castaneda B, Galeano J. Temporal Evaluation of the Surface Area of Treated Skin Ulcers Caused by Cutaneous Leishmaniasis and Relation with Optical Parameters in an Animal Model: A Proof of Concept. SENSORS (BASEL, SWITZERLAND) 2023; 23:5861. [PMID: 37447709 DOI: 10.3390/s23135861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
Cutaneous leishmaniasis (CL) is a neglected disease caused by an intracellular parasite of the Leishmania genus. CL lacks tools that allow its understanding and treatment follow-up. This article presents the use of metrical and optical tools for the analysis of the temporal evolution of treated skin ulcers caused by CL in an animal model. Leishmania braziliensis and L. panamensis were experimentally inoculated in golden hamsters, which were treated with experimental and commercial drugs. The temporal evolution was monitored by means of ulcers' surface areas, as well as absorption and scattering optical parameters. Ulcers' surface areas were obtained via photogrammetry, which is a procedure that allowed for 3D modeling of the ulcer using specialized software. Optical parameters were obtained from a spectroscopy study, representing the cutaneous tissue's biological components. A one-way ANOVA analysis was conducted to identify relationships between both the ulcers' areas and optical parameters. As a result, ulcers' surface areas were found to be related to the following optical parameters: epidermis thickness, collagen, keratinocytes, volume-fraction of blood, and oxygen saturation. This study is a proof of concept that shows that optical parameters could be associated with metrical ones, giving a more reliable concept during the assessment of a skin ulcer's healing.
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Affiliation(s)
- Sergio Londoño
- Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Medellín 050034, Colombia
| | - Carolina Viloria
- Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Medellín 050034, Colombia
| | - Sandra Pérez-Buitrago
- Grupo de Investigación en Dispositivos Médicos, Departamento de Ingeniería, Pontificia Universidad Católica del Perú, Lima 15088, Peru
| | - Javier Murillo
- Programa de Estudio y Control de Enfermedades Tropicales-PECET, Facultad de Medicina, Universidad de Antioquia, Medellín 050010, Colombia
| | - Deivid Botina
- Laboratoire ImViA, Université de Bourgogne, BP 47870, 21078 Dijon Cedex, France
| | | | - Johnson Garzón
- Grupo de Óptica y Espectroscopía, Universidad Pontificia Bolivariana, Medellín 050031, Colombia
| | - Maria C Torres-Madronero
- Research Group on Smart Machine and Pattern Recognition, MIRP Laboratory, Instituto Tecnológico Metropolitano, Medellín 050013, Colombia
| | - Sara M Robledo
- Programa de Estudio y Control de Enfermedades Tropicales-PECET, Facultad de Medicina, Universidad de Antioquia, Medellín 050010, Colombia
| | - Franck Marzani
- Laboratoire ImViA, Université de Bourgogne, BP 47870, 21078 Dijon Cedex, France
| | - Sylvie Treuillet
- Laboratoire Pluridisciplinaire de Recherche Ingénierie des Systèmes, Mécanique, Énergétique-PRISME, Université d'Orléans, 45072 Orléans, France
| | - Benjamin Castaneda
- Grupo de Investigación en Dispositivos Médicos, Departamento de Ingeniería, Pontificia Universidad Católica del Perú, Lima 15088, Peru
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14620, USA
| | - July Galeano
- Grupo de Investigación Materiales Avanzados y Energía MatyEr, Instituto Tecnológico Metropolitano, Medellín 050013, Colombia
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23
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Zheng XT, Yang Z, Sutarlie L, Thangaveloo M, Yu Y, Salleh NABM, Chin JS, Xiong Z, Becker DL, Loh XJ, Tee BCK, Su X. Battery-free and AI-enabled multiplexed sensor patches for wound monitoring. SCIENCE ADVANCES 2023; 9:eadg6670. [PMID: 37327328 PMCID: PMC10275586 DOI: 10.1126/sciadv.adg6670] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/11/2023] [Indexed: 06/18/2023]
Abstract
Wound healing is a dynamic process with multiple phases. Rapid profiling and quantitative characterization of inflammation and infection remain challenging. We report a paper-like battery-free in situ AI-enabled multiplexed (PETAL) sensor for holistic wound assessment by leveraging deep learning algorithms. This sensor consists of a wax-printed paper panel with five colorimetric sensors for temperature, pH, trimethylamine, uric acid, and moisture. Sensor images captured by a mobile phone were analyzed by neural network-based machine learning algorithms to determine healing status. For ex situ detection via exudates collected from rat perturbed wounds and burn wounds, the PETAL sensor can classify healing versus nonhealing status with an accuracy as high as 97%. With the sensor patches attached on rat burn wound models, in situ monitoring of wound progression or severity is demonstrated. This PETAL sensor allows early warning of adverse events, which could trigger immediate clinical intervention to facilitate wound care management.
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Affiliation(s)
- Xin Ting Zheng
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Zijie Yang
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576, Republic of Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, MD6, 14 Medical Drive, Singapore 117599, Republic of Singapore
| | - Laura Sutarlie
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Moogaambikai Thangaveloo
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Republic of Singapore
- Skin Research Institute of Singapore (SRIS), Agency for Science Technology and Research (A*STAR), 11 Mandalay Road, Singapore 308232, Republic of Singapore
| | - Yong Yu
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Nur Asinah Binte Mohamed Salleh
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Jiah Shin Chin
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Republic of Singapore
- A*Star Skin Research Laboratory (ASRL), Agency for Science Technology and Research (A*STAR), 11 Mandalay Road, Singapore 308232, Republic of Singapore
| | - Ze Xiong
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, MD6, 14 Medical Drive, Singapore 117599, Republic of Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore 117576, Republic of Singapore
- Wireless and Smart Bioelectronics Lab, School of Biomedical Engineering, ShanghaiTech University, Shanghai 201210, China
| | - David Lawrence Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Republic of Singapore
- Skin Research Institute of Singapore (SRIS), Agency for Science Technology and Research (A*STAR), 11 Mandalay Road, Singapore 308232, Republic of Singapore
| | - Xian Jun Loh
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
| | - Benjamin C. K. Tee
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576, Republic of Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, MD6, 14 Medical Drive, Singapore 117599, Republic of Singapore
- The N.1 Institute for Health, National University of Singapore, 28 Medical Drive. #05-COR, Singapore 117456, Republic of Singapore
- Department of Electrical and Computer Engineering, National University of Singapore, Block E4, 4 Engineering Drive 3, Singapore 117583, Republic of Singapore
| | - Xiaodi Su
- Institute of Materials Research and Engineering (IMRE), Agency for Science Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Republic of Singapore
- Department of Chemistry, National University of Singapore, Block S8, level 3, 3 Science Drive 3, Singapore 117543, Republic of Singapore
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24
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Dabas M, Schwartz D, Beeckman D, Gefen A. Application of Artificial Intelligence Methodologies to Chronic Wound Care and Management: A Scoping Review. Adv Wound Care (New Rochelle) 2023; 12:205-240. [PMID: 35438547 DOI: 10.1089/wound.2021.0144] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Significance: As the number of hard-to-heal wound cases rises with the aging of the population and the spread of chronic diseases, health care professionals struggle to provide safe and effective care to all their patients simultaneously. This study aimed at providing an in-depth overview of the relevant methodologies of artificial intelligence (AI) and their potential implementation to support these growing needs of wound care and management. Recent Advances: MEDLINE, Compendex, Scopus, Web of Science, and IEEE databases were all searched for new AI methods or novel uses of existing AI methods for the diagnosis or management of hard-to-heal wounds. We only included English peer-reviewed original articles, conference proceedings, published patent applications, or granted patents (not older than 2010) where the performance of the utilized AI algorithms was reported. Based on these criteria, a total of 75 studies were eligible for inclusion. These varied by the type of the utilized AI methodology, the wound type, the medical record/database configuration, and the research goal. Critical Issues: AI methodologies appear to have a strong positive impact and prospects in the wound care and management arena. Another important development that emerged from the findings is AI-based remote consultation systems utilizing smartphones and tablets for data collection and connectivity. Future Directions: The implementation of machine-learning algorithms in the diagnosis and managements of hard-to-heal wounds is a promising approach for improving the wound care delivered to hospitalized patients, while allowing health care professionals to manage their working time more efficiently.
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Affiliation(s)
- Mai Dabas
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Schwartz
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.,Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.,The Herbert J. Berman Chair in Vascular Bioengineering, Tel Aviv University, Tel Aviv, Israel
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25
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Kairys A, Pauliukiene R, Raudonis V, Ceponis J. Towards Home-Based Diabetic Foot Ulcer Monitoring: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3618. [PMID: 37050678 PMCID: PMC10099334 DOI: 10.3390/s23073618] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 06/19/2023]
Abstract
It is considered that 1 in 10 adults worldwide have diabetes. Diabetic foot ulcers are some of the most common complications of diabetes, and they are associated with a high risk of lower-limb amputation and, as a result, reduced life expectancy. Timely detection and periodic ulcer monitoring can considerably decrease amputation rates. Recent research has demonstrated that computer vision can be used to identify foot ulcers and perform non-contact telemetry by using ulcer and tissue area segmentation. However, the applications are limited to controlled lighting conditions, and expert knowledge is required for dataset annotation. This paper reviews the latest publications on the use of artificial intelligence for ulcer area detection and segmentation. The PRISMA methodology was used to search for and select articles, and the selected articles were reviewed to collect quantitative and qualitative data. Qualitative data were used to describe the methodologies used in individual studies, while quantitative data were used for generalization in terms of dataset preparation and feature extraction. Publicly available datasets were accounted for, and methods for preprocessing, augmentation, and feature extraction were evaluated. It was concluded that public datasets can be used to form a bigger, more diverse datasets, and the prospects of wider image preprocessing and the adoption of augmentation require further research.
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Affiliation(s)
- Arturas Kairys
- Automation Department, Electrical and Electronics Faculty, Kaunas University of Technology, 51368 Kaunas, Lithuania
| | - Renata Pauliukiene
- Department of Endocrinology, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania
| | - Vidas Raudonis
- Automation Department, Electrical and Electronics Faculty, Kaunas University of Technology, 51368 Kaunas, Lithuania
| | - Jonas Ceponis
- Institute of Endocrinology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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26
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Filko D, Nyarko EK. 2D/3D Wound Segmentation and Measurement Based on a Robot-Driven Reconstruction System. SENSORS (BASEL, SWITZERLAND) 2023; 23:3298. [PMID: 36992009 PMCID: PMC10058897 DOI: 10.3390/s23063298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 06/19/2023]
Abstract
Chronic wounds, are a worldwide health problem affecting populations and economies as a whole. With the increase in age-related diseases, obesity, and diabetes, the costs of chronic wound healing will further increase. Wound assessment should be fast and accurate in order to reduce possible complications and thus shorten the wound healing process. This paper describes an automatic wound segmentation based on a wound recording system built upon a 7-DoF robot arm with an attached RGB-D camera and high-precision 3D scanner. The developed system represents a novel combination of 2D and 3D segmentation, where the 2D segmentation is based on the MobileNetV2 classifier and the 3D component is based on the active contour model, which works on the 3D mesh to further refine the wound contour. The end output is the 3D model of only the wound surface without the surrounding healthy skin and geometric parameters in the form of perimeter, area, and volume.
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27
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Construction and Validation of an Image Discrimination Algorithm to Discriminate Necrosis from Wounds in Pressure Ulcers. J Clin Med 2023; 12:jcm12062194. [PMID: 36983198 PMCID: PMC10057569 DOI: 10.3390/jcm12062194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Artificial intelligence (AI) in medical care can raise diagnosis accuracy and improve its uniformity. This study developed a diagnostic imaging system for chronic wounds that can be used in medically underpopulated areas. The image identification algorithm searches for patterns and makes decisions based on information obtained from pixels rather than images. Images of 50 patients with pressure sores treated at Kobe University Hospital were examined. The algorithm determined the presence of necrosis with a significant difference (p = 3.39 × 10−5). A threshold value was created with a luminance difference of 50 for the group with necrosis of 5% or more black pixels. In the no-necrosis group with less than 5% black pixels, the threshold value was created with a brightness difference of 100. The “shallow wounds” were distributed below 100, whereas the “deep wounds” were distributed above 100. When the algorithm was applied to 24 images of 23 new cases, there was 100% agreement between the specialist and the algorithm regarding the presence of necrotic tissue and wound depth evaluation. The algorithm identifies the necrotic tissue and wound depth without requiring a large amount of data, making it suitable for application to future AI diagnosis systems for chronic wounds.
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28
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Automated Wound Image Segmentation: Transfer Learning from Human to Pet via Active Semi-Supervised Learning. Animals (Basel) 2023; 13:ani13060956. [PMID: 36978498 PMCID: PMC10044392 DOI: 10.3390/ani13060956] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Wound management is a fundamental task in standard clinical practice. Automated solutions already exist for humans, but there is a lack of applications regarding wound management for pets. Precise and efficient wound assessment is helpful to improve diagnosis and to increase the effectiveness of treatment plans for chronic wounds. In this work, we introduced a novel pipeline for the segmentation of pet wound images. Starting from a model pre-trained on human-based wound images, we applied a combination of transfer learning (TL) and active semi-supervised learning (ASSL) to automatically label a large dataset. Additionally, we provided a guideline for future applications of TL+ASSL training strategy on image datasets. We compared the effectiveness of the proposed training strategy, monitoring the performance of an EfficientNet-b3 U-Net model against the lighter solution provided by a MobileNet-v2 U-Net model. We obtained 80% of correctly segmented images after five rounds of ASSL training. The EfficientNet-b3 U-Net model significantly outperformed the MobileNet-v2 one. We proved that the number of available samples is a key factor for the correct usage of ASSL training. The proposed approach is a viable solution to reduce the time required for the generation of a segmentation dataset.
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29
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Hernandez-Guedes A, Arteaga-Marrero N, Villa E, Callico GM, Ruiz-Alzola J. Feature Ranking by Variational Dropout for Classification Using Thermograms from Diabetic Foot Ulcers. SENSORS (BASEL, SWITZERLAND) 2023; 23:757. [PMID: 36679552 PMCID: PMC9867159 DOI: 10.3390/s23020757] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Diabetes mellitus presents a high prevalence around the world. A common and long-term derived complication is diabetic foot ulcers (DFUs), which have a global prevalence of roughly 6.3%, and a lifetime incidence of up to 34%. Infrared thermograms, covering the entire plantar aspect of both feet, can be employed to monitor the risk of developing a foot ulcer, because diabetic patients exhibit an abnormal pattern that may indicate a foot disorder. In this study, the publicly available INAOE dataset composed of thermogram images of healthy and diabetic subjects was employed to extract relevant features aiming to establish a set of state-of-the-art features that efficiently classify DFU. This database was extended and balanced by fusing it with private local thermograms from healthy volunteers and generating synthetic data via synthetic minority oversampling technique (SMOTE). State-of-the-art features were extracted using two classical approaches, LASSO and random forest, as well as two variational deep learning (DL)-based ones: concrete and variational dropout. Then, the most relevant features were detected and ranked. Subsequently, the extracted features were employed to classify subjects at risk of developing an ulcer using as reference a support vector machine (SVM) classifier with a fixed hyperparameter configuration to evaluate the robustness of the selected features. The new set of features extracted considerably differed from those currently considered state-of-the-art but provided a fair performance. Among the implemented extraction approaches, the variational DL ones, particularly the concrete dropout, performed the best, reporting an F1 score of 90% using the aforementioned SVM classifier. In comparison with features previously considered as the state-of-the-art, approximately 15% better performance was achieved for classification.
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Affiliation(s)
- Abian Hernandez-Guedes
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Microelectrónica Aplicada (IUMA), Universidad de Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain
| | - Natalia Arteaga-Marrero
- Grupo Tecnología Médica IACTEC, Instituto de Astrofísica de Canarias (IAC), 38205 San Cristóbal de La Laguna, Spain
| | - Enrique Villa
- Grupo Tecnología Médica IACTEC, Instituto de Astrofísica de Canarias (IAC), 38205 San Cristóbal de La Laguna, Spain
| | - Gustavo M. Callico
- Instituto Universitario de Microelectrónica Aplicada (IUMA), Universidad de Las Palmas de Gran Canaria, 35017 Las Palmas de Gran Canaria, Spain
| | - Juan Ruiz-Alzola
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Grupo Tecnología Médica IACTEC, Instituto de Astrofísica de Canarias (IAC), 38205 San Cristóbal de La Laguna, Spain
- Departamento de Señales y Comunicaciones, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
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30
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Birkner M, Schalk J, von den Driesch P, Schultz ES. Computer-Assisted Differential Diagnosis of Pyoderma Gangrenosum and Venous Ulcers with Deep Neural Networks. J Clin Med 2022; 11:jcm11237103. [PMID: 36498674 PMCID: PMC9740900 DOI: 10.3390/jcm11237103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
(1) Background: Pyoderma gangrenosum (PG) is often situated on the lower legs, and the differentiation from conventional leg ulcers (LU) is a challenging task due to the lack of clear clinical diagnostic criteria. Because of the different therapy concepts, misdiagnosis or delayed diagnosis bears a great risk for patients. (2) Objective: to develop a deep convolutional neural network (CNN) capable of analysing wound photographs to facilitate the PG diagnosis for health professionals. (3) Methods: A CNN was trained with 422 expert-selected pictures of PG and LU. In a man vs. machine contest, 33 pictures of PG and 36 pictures of LU were presented for diagnosis to 18 dermatologists at two maximum care hospitals and to the CNN. The results were statistically evaluated in terms of sensitivity, specificity and accuracy for the CNN and for dermatologists with different experience levels. (4) Results: The CNN achieved a sensitivity of 97% (95% confidence interval (CI) 84.2−99.9%) and outperformed dermatologists, with a sensitivity of 72.7% (CI 54.4−86.7%) significantly (p < 0.03). However, dermatologists achieved a slightly higher specificity (88.9% vs. 83.3%). (5) Conclusions: For the first time, a deep neural network was demonstrated to be capable of diagnosing PG, solely on the basis of photographs, and with a greater sensitivity compared to that of dermatologists.
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Affiliation(s)
- Mattias Birkner
- Institute of Medical Physics, Paracelsus Medical University Nuremberg, City Hospital of Nuremberg, 90419 Nürnberg, Germany
- Correspondence:
| | - Julia Schalk
- Department of Dermatology, Paracelsus Medical University Nuremberg, City Hospital of Nuremberg, 90419 Nürnberg, Germany
| | - Peter von den Driesch
- Department of Dermatology, Klinikum Stuttgart, Bad Cannstatt, 70174 Stuttgart, Germany
| | - Erwin S. Schultz
- Department of Dermatology, Paracelsus Medical University Nuremberg, City Hospital of Nuremberg, 90419 Nürnberg, Germany
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31
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Amin J, Anjum MA, Sharif A, Sharif MI. A modified classical-quantum model for diabetic foot ulcer classification. INTELLIGENT DECISION TECHNOLOGIES 2022. [DOI: 10.3233/idt-210017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
DFU is one of the most spreading diseases now day approximately more than one million patients suffer due to this disease. Undergo the procedure of removing their lower limb of the body due to the reason that they are not able enough to recognize this disease and get proper treatment from the doctors or physicians. Therefore, there is an urgent need of developing a Computer-Aided Design (CAD) system that can easily detect Diabetic Foot Ulcer (DFU). Therefore, in this study, a pre-trained ResNet-50 model and modified classical-quantum model are utilized for diabetic foot ulcer classification into corresponding classes such as normal/abnormal and ischaemia/non-ischaemia. The presented approach achieved classification accuracy is greater than 0.90 on abnormal/normal, ischaemia/non-ischaemia, and infection and non-infection foot images. The reported results depict that the proposed method outperformed as compared to recently published work in the domain of diabetic foot ulcers.
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Affiliation(s)
- Javeria Amin
- Department of Computer Science, University of Wah, Wah Cantt, Pakistan
| | | | - Abida Sharif
- Department of Computer Science, COMSATS University Islamabad, Vehari Campus, Pakistan
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32
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Wound Detection by Simple Feedforward Neural Network. ELECTRONICS 2022. [DOI: 10.3390/electronics11030329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic wounds are a heavy burden on medical facilities, so any help in treating them is most welcome. Current research focuses on wound analysis, especially wound tissue classification, wound measurement, and wound healing prediction to assist medical personnel in wound treatment, with the main goal of reducing wound healing time. The first phase of wound analysis is wound segmentation, where the task is to extract wounds from the healthy tissue and image background. In this work, a standard feedforward neural network was developed for the purpose of wound segmentation using data from the MICCAI 2021 Foot Ulcer Segmentation (FUSeg) Challenge. It proved to be a simple yet efficient method for extracting wounds from images. The proposed algorithm is part of a compact system that analyzes chronic wounds using a robotic manipulator, RGB-D camera and 3D scanner. The feedforward neural network consists of only five fully connected layers, the first four with Rectified Linear Unit (ReLU) activation functions and the last with sigmoid activation functions. Three separate models were trained and tested using images provided as part of the challenge. The predicted images were post-processed and merged to improve the final segmentation performance.The accuracy metrics observed during model training and selection were Precision, Recall and F1 score. The experimental results of the proposed network provided a recall value of 0.77, precision value of 0.72, and an F1 score (Dice score) of 0.74.
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33
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Annadatha S, Hua Q, Fridberg M, Lindstrøm Jensen T, Liu J, Kold S, Rahbek O, Shen M. Preparing infection detection technology for hospital at home after lower limb external fixation. Digit Health 2022; 8:20552076221109502. [PMID: 35783467 PMCID: PMC9243585 DOI: 10.1177/20552076221109502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Patients with severe bone fractures and complex bone deformities are treated by orthopedic surgeons with external fixation for several months. During this long treatment period, there is a high risk of inflammation and infection at the superficial skin area (pin site). This can develop into a devastating, sometimes fatal, and always costly condition of deep bone infection. Objective For pin site infection surveillance, thermography technology could be the solution to build an objective and continuous home-based remote monitoring tool to avoid frequent nursing care and hospital visits. However, future studies of infection monitoring require a preliminary step to automate the process of locating and detecting the pin sites in thermal images reliably for temperature measurement, and this step is the aim of this study. Methods This study presents an automatic approach for identifying and annotating pin sites on visible images using bounding boxes and transferring them to the corresponding thermal images for temperature measurement. The pin site is detected by applying deep learning-based object detection architecture YOLOv5 with a novel loss evaluation and regression method, control distance intersection over union. Furthermore, we address detecting pin sites in a practical environment (home setting) accurately through transfer learning. Results and conclusion The proposed model offers the pin site detection in 1.8 ms with a high precision of 0.98 and enables temperature information extraction. Our work for automatic pin site annotation on thermography paves the way for future research on infection assessment on thermography.
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Affiliation(s)
- Sowmya Annadatha
- Department of Electronic Systems, Aalborg University, Aalborg, Denmark
| | - Qirui Hua
- Department of Electronic Systems, Aalborg University, Aalborg, Denmark
| | | | | | - Jianan Liu
- Vitalent Consulting, Gothenburg Sweden and Silo AI, Stockholm,
Sweden
| | - Søren Kold
- Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Aalborg University Hospital, Aalborg, Denmark
| | - Ming Shen
- Department of Electronic Systems, Aalborg University, Aalborg, Denmark
- Ming Shen, Department of Electronic
Systems, Aalborg University, Aalborg, Denmark Ole Rahbek, Aalborg University
Hospital, Aalborg, Denmark.
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Foltynski P, Ciechanowska A, Ladyzynski P. Wound surface area measurement methods. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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