Temporal and spatial properties of arterial pulsation measurement using pressure sensor array

An Arterial Pulse Signal Acquiring Wristwatch with Flexible Tactile Sensing Dense-Array

This study reports a wristwatch to automatically acquire the arterial pulse signal. A two-dimensional flexible tactile sensing dense-array is integrated in the watch. The dense-array consists of 29 × 3 ultra-small pressure sensing chips, enabling high-resolution tactile perception. The arterial pulse signal contains abundant information regarding cardiovascular conditions. Our wristwatch is able to measure the radial arterial pulse in all 8 dimensions: depth, strength, rate, uniformity, fluency, width, stiffness and stability. As far as we know, this is the first wearable system to record the pulse wave not only in time domain but also in cross-section concurrently. With such comprehensive information, physicians have better access to pulse signal in full aspects. The watch has a compact size, low energy consumption and real-time feedback, highlighting its great potential for ambulatory cardiovascular monitoring.

Visualizing a Cold Stress-Specific Pulse Wave in Traditional Pulse Diagnosis ('Tight Pulse') Correlated with Vascular Changes in the Radial Artery Induced by a Cold Pressor Trial

Radial pulse diagnosis is the most common method to examine the human health state in Traditional East Asian Medicine (TEAM). A cold stress-related suboptimal health state (subhealth) is often undetectable during routine medical examinations, however, it can be detected through the palpation of specific pulse waves, particularly a 'tight pulse', in TEAM. Therefore, this study examined a correlation between 'tight pulse' and vascular changes in the radial artery (RA) induced by a cold pressor trial (CPT). Twenty healthy subjects underwent sequentially control trial and CPT with room-temperature and ice-cold water, respectively, on the right forearm. The radial pulse and vascular changes were then examined on the left arm. The radial pulse scores for frequencies of 'tight pulse' with strong arterial tension increased after the CPT compared with the control trial. The pulse scores were reversely correlated with the RA thickness and volumes in ultrasonography, but not with changes in the systolic/diastolic blood pressure. The RA thickness-based vascular surface and three-dimensional images visualized a 'tight pulse' showing the vasoconstriction and bumpy-/rope-shaped vascular changes in the radial pulse diagnostic region after the CPT. These findings provide valuable insights into the potential integration of clinical radial pulse diagnosis with ultrasonography for cold-related subhealth.

A reliable evaluation approach for multichannel signal denoising algorithms based on a novel arterial pulse acquisition system

Background

Tactile sensors are utilized to measure multichannel pulse signals in pulse wave analysis (PWA). Owing to noise interferences, researchers have applied various denoising algorithms on multichannel pulse signals. To comprehensively assess these algorithms, numerous evaluation metrics have been proposed. However, these studies did not investigate the noise mechanisms in depth and lacked reference pulse signals, thus making the evaluations insufficiently objective.

Materials and methods

An applicable denoising evaluation approach for multichannel pulse signal algorithms based on an arterial pulse acquisition system is established by superimposing real-world multichannel noise to the reference signals. The system, comprising a SphygmoCor and a uniaxial noise acquisition device, allows us to acquire single-reference pulse signals as well as real-world multichannel noise.

Results

We assess eight popular denoising algorithms with three evaluation metrics, including amplitude relative error (ARE), mean square error (MSE) and increased percentage signal-noise ratio (SNR%). Our proposed approach provides accurate and objective evaluations of multichannel pulse signal denoising. Notably, classic algorithms for single-channel denoising are not recommended for multichannel denoising. Comparatively, RPCA-based algorithms can denoise pulse signals independently for each channel.

Conclusion

This study sets the stage for the establishment of accurate and objective pulse signal denoising evaluations and provides insights for data-driven clinical diagnoses in cardiovascular medicine.

Increasing the sensor channels: a solution for the pressing offsets that cause the physiological parameter inaccuracy in radial artery pulse signal acquisition

Introduction: In studies of pulse wave analysis, single-channel sensors only adopt single temporal pulse signals without spatial information to show pulse-feeling patterns. Multi-channel arterial pulse signals, also named as three-dimensional pulse images (3DPIs), provide the spatial and temporal characteristics of radial pulse signals. When involving single or few-channel sensors, pressing offsets have substantial impacts on obtaining inaccurate physiological parameters like tidal peak (P2). Methods: This study discovers the pressing offsets in multi-channel pulse signals and analyzes the relationship between the pressing offsets and time of P2 (T2) by qualifying the pressing offsets. First, we employ a data acquisition system to capture 3DPIs. Subsequently, the errorT2 is developed to qualify the pressing offsets. Results: The outcomes display a central low and peripheral high pattern. Additionally, the errorT2 increase as the distances from the artery increase, particularly at the radial ends of the blood flow direction. For every 1 mm increase in distances between sensing elements and center sensing elements, the errorT2 in the radial direction escalates by 4.87%. When the distance is greater than 3.42 mm, the errorT2 experiences a sudden increase. Discussion: The results show that increasing the sensor channels can overcome the pressing offsets in radial pulse signal acquisition.

Objective Evaluation of Pulse Width Using an Array Pulse Diagram

BACKGROUND

Pulse width, which can reflect qi, blood excess, and deficiency, has been used for diagnosing diseases and determining the prognosis in traditional Chinese medicine (TCM). This study aimed to devise an objective method to measure the pulse width based on an array pulse diagram for objective diagnosis.

METHODS

The channel 6, the region wherein the pulse wave signal is the strongest, is located in the middle of the pulse sensor array and at the guan position of cunkou during data collection. Therefore, the main wave (h1) time of the pulse wave was collected from the channel 6 through calculation. The left h1 time was collected from the remaining 11 channels. The amplitudes at these time points were extracted as the h1 amplitudes for each channel. However, the pulse width could not be calculated accurately at 12 points. Consequently, a bioharmonic spline interpolation algorithm was used to interpolate the h1 amplitude data obtained from the horizontal and vertical points, yielding 651 (31 × 21) h1 amplitude data. The 651 data points were converted into a heat map to intuitively calculate the pulse width. The pulse width was calculated by multiplying the number of grids on the vertical axis with the unit length of the grid. The pulse width was determined by TCM doctors to verify the pulse width measurement accuracy. Meanwhile, a color Doppler ultrasound examination of the volunteers' radial arteries was performed and the intravascular meridian widths of the radial artery compared with the calculated pulse widths to determine the reliability.

RESULTS

The pulse width determined using the maximal h1 amplitude method was comparable with the radial artery intravascular meridian widths measured using color Doppler ultrasound. The h1 amplitude was higher in the high blood pressure group and the pulse width was greater.

CONCLUSIONS

The pulse width determined using the maximal h1 amplitude was objective and accurate. Comparison between the pulse widths of the normal and high blood pressure groups verified the reliability of the method.

Wearable Multi-Channel Pulse Signal Acquisition System Based on Flexible MEMS Sensor Arrays with TSV Structure

Micro-electro-mechanical system (MEMS) pressure sensors play a significant role in pulse wave acquisition. However, existing MEMS pulse pressure sensors bound with a flexible substrate by gold wire are vulnerable to crush fractures, leading to sensor failure. Additionally, establishing an effective mapping between the array sensor signal and pulse width remains a challenge. To solve the above problems, we propose a 24-channel pulse signal acquisition system based on a novel MEMS pressure sensor with a through-silicon-via (TSV) structure, which connects directly to a flexible substrate without gold wire bonding. Firstly, based on the MEMS sensor, we designed a 24-channel pressure sensor flexible array to collect the pulse waves and static pressure. Secondly, we developed a customized pulse preprocessing chip to process the signals. Finally, we built an algorithm to reconstruct the three-dimensional pulse wave from the array signal and calculate the pulse width. The experiments verify the high sensitivity and effectiveness of the sensor array. In particular, the measurement results of pulse width are highly positively correlated with those obtained via infrared images. The small-size sensor and custom-designed acquisition chip meet the needs of wearability and portability, meaning that it has significant research value and commercial prospects.

A Novel Pulse-Taking Device for Persian Medicine Based on Convolutional Neural Networks

Background

In Persian medicine (PM), measuring the wrist pulse is one of the main methods for determining a person's health status and temperament. One problem that can arise is the dependence of the diagnosis on the physician's interpretation of pulse wave features. Perhaps, this is one reason why this method has yet to be combined with modern medical methods. This paper addresses this concern and outlines a system for measuring pulse signals based on PM.

Methods

A system that uses data from a customized device that logs the pulse wave on the wrist was designed and clinically implemented based on PM. Seven convolutional neural networks (CNNs) have been used for classification.

Results

The pulse wave features of 34 participants were assessed by a specialist based on PM principles. Pulse taking was done on the wrist in the supine position (named Malmas in PM) under the supervision of the physician. Seven CNNs were implemented for each participant's pulse characteristic (pace, rate, vessel elasticity, strength, width, length, and height) assessment, and then, each participant was classified into three classes.

Conclusion

It appears that the design and construction of a customized device combined with the deep learning algorithm can measure the pulse wave features according to PM and it can increase the reliability and repeatability of the diagnostic results based on PM.

Integrated Piezoresistive Normal Force Sensors Fabricated Using Transfer Processes with Stiction Effect Temporary Handling

Tactile sensation is a highly desired function in robotics. Furthermore, tactile sensor arrays are crucial sensing elements in pulse diagnosis instruments. This paper presents the fabrication of an integrated piezoresistive normal force sensor through surface micromachining. The force sensor is transferred to a readout circuit chip via a temporary stiction effect handling process. The readout circuit chip comprises two complementary metal-oxide semiconductor operational amplifiers, which are redistributed to form an instrumentation amplifier. The sensor is released and temporarily bonded to the substrate before the transfer process due to the stiction effect to avoid the damage and movement of the diaphragm during subsequent flip-chip bonding. The released sensor is pulled off from the substrate and transferred to the readout circuit chip after being bonded to the readout circuit chip. The size of the transferred normal force sensor is 180 μm × 180 μm × 1.2 μm. The maximum misalignment of the flip-chip bonding process is approximately 1.5 μm, and sensitivity is 93.5 μV/μN/V. The routing of the piezoresistive Wheatstone bridge can be modified to develop shear force sensors; consequently, this technique can be used to develop tactile sensors that can sense both normal and shear forces.

Assessment Parameters for Arrayed Pulse Wave Analysis and Application in Hypertensive Disorders

Study on the objectivity of pulse diagnosis is inseparable from the instruments to obtain the pulse waves. The single-pulse diagnostic instrument is relatively mature in acquiring and analysing pulse waves, but the pulse information captured by single-pulse diagnostic instrument is limited. The sensor arrays can simulate rich sense of the doctor's fingers and catch multipoint and multiparameter array signals. How to analyse the acquired array signals is still a major problem in the objective research of pulse diagnosis. The goal of this study was to establish methods for analysing arrayed pulse waves and preliminarily apply them in hypertensive disorders. While a sensor array can be used for the real-time monitoring of twelve pulse wave channels, for each subject in this study, only the pulse wave signals of the left hand at the "guan" location were obtained. We calculated the average pulse wave (APW) per channel over a thirty-second interval. The most representative pulse wave (MRPW) and the APW were matched by their correlation coefficient (CC). The features of the MRPW and the features that corresponded to the array pulse volume (APV) parameters were identified manually. Finally, a clinical trial was conducted to detect these feature performance indicators in patients with hypertensive disorders. The independent-samples t-tests and the Mann-Whitney U-tests were performed to assess the differences in these pulse parameters between the healthy and hypertensive groups. We found that the radial passage (RP) APV h1, APV h3, APV h4, APV h3/h1 (P < 0.01), and APV h4/h1 (P < 0.05) were significantly higher in the hypertensive group than in the healthy group; the intermediate passage (IP) APV h4, APV h3/h1 (P < 0.05), and APV h4/h1 (P < 0.01) and the mean APV h3, APV h3/h1 (P < 0.05), and APV h4/h1 (P < 0.01) were significantly higher in the hypertensive group than in the healthy group, and the ulnar passage (UP) APV h4/h1 (P < 0.05) was clearly elevated in the hypertensive group. These results provide a preliminary validation of this novel approach for determining the APV by arrayed pulse wave analysis. In conclusion, we identified effective indicators of hypertensive vascular function. Traditional Chinese medicine (TCM) pulses comprise multidimensional information, and a sensor array could provide a better indication of TCM pulse characteristics. In this study, the validation of the arrayed pulse wave analysis demonstrates that the APV can reliably mirror TCM pulse characteristics.

Wearable multichannel pulse condition monitoring system based on flexible pressure sensor arrays

Pulse diagnosis is an irreplaceable part of traditional Chinese medical science. However, application of the traditional pulse monitoring method was restricted in the modernization of Chinese medical science since it was difficult to capture real signals and integrate obscure feelings with a modern data platform. Herein, a novel multichannel pulse monitoring platform based on traditional Chinese medical science pulse theory and wearable electronics was proposed. The pulse sensing platform simultaneously detected pulse conditions at three pulse positions (Chi, Cun, and Guan). These signals were fitted to smooth surfaces to enable 3-dimensional pulse mapping, which vividly revealed the shape of the pulse length and width and compensated for the shortcomings of traditional single-point pulse sensors. Moreover, the pulse sensing system could measure the pulse signals from different individuals with different conditions and distinguish the differences in pulse signals. In addition, this system could provide full information on the temporal and spatial dimensions of a person's pulse waveform, which is similar to the true feelings of doctors' fingertips. This innovative, cost-effective, easily designed pulse monitoring platform based on flexible pressure sensor arrays may provide novel applications in modernization of Chinese medical science or intelligent health care.

A Telecare System for Use in Traditional Persian Medicine

Background:

In Persian Medicine (PM), measuring the wrist temperature/humidity and pulse is one of the main methods for determining a person's health status and temperament. An important problem is the dependence of the diagnosis on the physician's interpretation of the above-mentioned criteria. Perhaps this is one reason why this method has yet to be combined with modern medical methods. Also, sometimes there is a need to use PM to diagnose patients remotely, especially during a pandemic. This brings up the question of how to implement PM into a telecare system. This study addresses these concerns and outlines a system for measuring pulse signals and temperament detection based on PM.

Methods:

A system was designed and clinically implemented based on PM that uses data from recorded thermal distribution, a temperament questionnaire, and a customized device that logs the pulse waves on the wrist. This system was used for patient care via telecare.

Results:

The temperaments of 34 participants were assessed by a PM specialist using the standardized Mojahedi Mizaj Questionnaire (MMQ). Thermal images of the wrist in the supine position (named Malmas in PM), the back of the hand, and the entire face were also recorded under the supervision of the physician. Also, the wrist pulse waves were evaluated by a customized pulse measurement device. Finally, the collected data could be sent to a physician via a telecare system for further interpretation and prescription of medications.

Conclusion:

This preliminary study focused on the implementation of a combinational hardware-software system for patient assessment based on PM. It appears that the design and construction of a customized device that can measure the pulse waves, and some other criteria, according to PM, is possible and can decrease the dependency of the diagnostic to PM specialists. Thus, it can be incorporated into a telemedicine system.

Three-Dimensional Arterial Pulse Signal Acquisition in Time Domain Using Flexible Pressure-Sensor Dense Arrays

In this study, we developed a radial artery pulse acquisition system based on finger-worn dense pressure sensor arrays to enable three-dimensional pulse signals acquisition. The finger-worn dense pressure-sensor arrays were fabricated by packaging 18 ultra-small MEMS pressure sensors (0.4 mm × 0.4 mm × 0.2 mm each) with a pitch of 0.65 mm on flexible printed circuit boards. Pulse signals are measured and recorded simultaneously when traditional Chinese medicine practitioners wear the arrays on the fingers while palpating the radial pulse. Given that the pitches are much smaller than the diameter of the human radial artery, three-dimensional pulse envelope images can be measured with the system, as can the width and the dynamic width of the pulse signals. Furthermore, the array has an effective span of 11.6 mm-3-5 times the diameter of the radial artery-which enables easy and accurate positioning of the sensor array on the radial artery. This study also outlines proposed methods for measuring the pulse width and dynamic pulse width. The dynamic pulse widths of three volunteers were measured, and the dynamic pulse width measurements were consistent with those obtained by color Doppler ultrasound. The pulse wave velocity can also be measured with the system by measuring the pulse transit time between the pulse signals at the brachial and radial arteries using the finger-worn sensor arrays.

A Noncontact Method for Locating Radial Artery above Radial Styloid Process in Thermal Image

A radial artery above the radial styloid process is called GUAN and is a critical position for collecting pulse wave in traditional Chinese medicine theory. Locating GUAN is a precondition for collecting radial pulse wave. However, existing methods for locating GUAN lead to large deviations. This paper proposes a novel nontouch method for locating GUAN based on thermal imaging and image processing. This method consists of three parts: the infrared thermal imaging location imaging platform, the wrist edge contour extraction algorithm based on arbitrary angle edge recognition, and radial protrusion recognition algorithm (x coordinate identification algorithm of GUAN) and radial artery fitting algorithm (y coordinate identification algorithm of GUAN). The infrared thermal imaging positioning imaging platform is used to ensure that the wrist of the subject enters the fixed imaging area in a fixed position during each measurement and transmits the thermal imaging images carrying the image information of radial processes and radial arteries to the upper computer. Arbitrary angle edge recognition algorithm is used to extract wrist contour and radial artery edge information. The x-axis coordinates of the radial artery were provided by the identification algorithm, and the y-axis coordinates of the radial artery were provided by the fitting algorithm. Finally, the x and y coordinates determine the GUAN position. The algorithm for locating GUAN could provide repeatable and reliable x and y coordinates. The proposed method shows that relative standard deviation (RSD) of x distance of GUAN is less than 9.0% and RSD of y distance of GUAN is less than 5.0%. The proposed method could provide valid GUAN coordinates and reduce deviations of locating GUAN.

Fourier Series Analysis for Novel Spatiotemporal Pulse Waves: Normal, Taut, and Slippery Pulse Images

In this article, a three-dimensional pulse image (3DPI) instead of a one-dimensional temporal pulse wave is studied to elucidate its spatiotemporal characteristics. To check the spatial and temporal properties of 3DPI, adopted is Fourier series, in which a ratio (r) is defined as one amplitude divided by the sum of the first three amplitudes of harmonics. A ratio sequence is constituted from 70 to 90 ratios in a heartbeat with 70–90 3DPIs by sampling. Twenty-four subjects (14 males and 10 females with age of 22.2 ± 3.7 years, 20.4 ± 1.4 BMI, and 112.1 ± 4.7 mmHg systolic blood pressure) are involved in this research. There are significant statistical differences in the groups of the normal, taut, and slippery 3DPIs by the first harmonic ratio average (r1¯) and ratio difference (Δr₁) produced from the ratio sequence. The proposed method of this study gives us a novel viewpoint to clarify the spatiotemporal characteristics of pulse images, which can translate and quantize the pulse feeling in Chinese medicine texts.

A 3D Wrist Pulse Signal Acquisition System for Width Information of Pulse Wave

During pulse signal collection, width information of pulse waves is essential for the diagnosis of disease. However, currently used measuring instruments can only detect the amplitude while can't acquire the width information. This paper proposed a novel wrist pulse signal acquisition system, which could realize simultaneous measurements of the width and amplitude of dynamic pulse waves under different static forces. A tailor-packaged micro-electro-mechanical system (MEMS) sensor array was employed to collect pulse signals, a conditioning circuit was designed to process the signals, and a customized algorithm was developed to compute the width. Experiments were carried out to validate the accuracy of the sensor array and system effectiveness. The results showed the system could acquire not only the amplitude of pulse wave but also the width of it. The system provided more information about pulse waves, which could help doctors make the diagnosis.

Radial Artery Tonometry to Monitor Blood Pressure and Hemodynamics in Ambulatory Left Ventricular Assist Device Patients in Comparison With Doppler Ultrasound and Transthoracic Echocardiography: A Pilot Study

Noninvasive measurements of blood pressure (BP) and cardiac output (CO) are crucial in the follow-up of continuous-flow left ventricular assist device (CF-LVAD) patients. For our pilot study, we sought to compare BP measurements between a tonometry blood pressure pulse analyzer (BPPA) (DMP-Life, DAEYOMEDI Co., Ltd., Gyeonggi-do, South Korea) and Doppler ultrasound in CF-LVAD patients, as well as to compare the BPPA estimated CO to LVAD calculated blood flow and to the patient's intrinsic CO estimated with transthoracic echocardiography (TTE). Ambulatory CF-LVAD patients (6 HeartMate, 26 HeartMate II), were included. According to TTE findings, patients were then subdivided in two groups: patients with an opening aortic valve (OAV) [n = 21] and those with an intermittent opening aortic valve (IOAV) [n = 11]. We found a very good correlation of systolic BP (SBP) measurements between the two methods, BPPA and Doppler ultrasound (r = 0.87, P < 0.0001). Bland-Altman plots for SBP revealed a low bias of -4.6 mm Hg and SD of ±4.7 mm Hg. In CF-LVAD patients with IOAV, the BPPA-CO had a good correlation with the LVAD-flow (r = 0.78, P < 0.0001), but in OAV patients, there was no correlation. After adding the patient's intrinsic CO, estimated from TTE in patients with OAV to the LVAD-flow, we found a very good correlation between the BPPA-CO and LVAD-flow + TTE-CO (r = 0.81, P = 0.002). Our study demonstrated that compared with the standard clinical method, Doppler ultrasound, the BPPA measured BP noninvasively with good accuracy and precision of agreement. In addition, tonometry BPPA provided further valuable information regarding the CF-LVAD patient's intrinsic CO.

Pulse wave response characteristics for thickness and hardness of the cover layer in pulse sensors to measure radial artery pulse

Background

Piezo-resistive pressure sensors are widely used for measuring pulse waves of the radial artery. Pulse sensors are generally fabricated with a cover layer because pressure sensors without a cover layer are fragile when they come into direct contact with the skin near the radial artery. However, no study has evaluated the dynamic pulse wave response of pulse sensors depending on the thickness and hardness of the cover layer. This study analyzed the dynamic pulse wave response according to the thickness and hardness of the cover layer and suggests an appropriate thickness and hardness for the design of pulse sensors with semiconductor device-based pressure sensors.

Methods

Pulse sensors with 6 different cover layers with various thicknesses (0.8 mm, 1 mm, 2 mm) and hardnesses (Shore type A; 30, 43, 49, 71) were fabricated. Experiments for evaluating the dynamic pulse responses of the fabricated sensors were performed using a pulse simulator to transmit the same pulse wave to each of the sensors. To evaluate the dynamic responses of the fabricated pulse sensors, experiments with the pulse sensors were conducted using a simulator that artificially generated a constant pulse wave. The pulse wave simulator consisted of a motorized cam device that generated the artificial radial pulse waveform by adjusting the stroke of the cylindrical air pump and an air tube that conveyed the pulse to the artificial wrist.

Results

The amplitude of the measured pulse pressure decreased with increasing thickness and hardness of the cover layer. Normalized waveform analysis showed that the thickness rather than the hardness of the cover layer contributed more to waveform distortion. Analysis of the channel distribution of the pulse sensor with respect to the applied constant dynamic pressure showed that the material of the cover layer had a large effect.

Conclusions

In this study, in-line array pulse sensors with various cover layers were fabricated, the dynamic pulse wave responses according to the thickness and the hardness of the cover layer were analyzed, and an appropriate thickness and hardness for the cover layer were suggested. The dynamic pulse wave responses of pulse sensors revealed in this study will contribute to the fabrication of improved pulse sensors and pulse wave analyses.

Precise Detection of Wrist Pulse Using Digital Speckle Pattern Interferometry

Pulse diagnosis is one of the four diagnostic methods of traditional Chinese medicine. However it suffers from the lack of objective and efficient detection method. We propose a noncontact optical method to detect human wrist pulse, aiming at the precise determination of the temporal and spatial distributions of pulse. The method uses the spatial-carrier digital speckle pattern interferometry (DSPI) to measure the micro/nanoscale skin displacement dynamically. Significant improvements in DSPI measurement have been made to allow the DSPI to detect the comprehensive information of the arterial pulsation at locations of Cun, Guan, and Chi. The experimental results prove that the spatiotemporal distributions of pulse can be obtained by the proposed method. The obtained data can be further used to describe most of the pulse parameters such as rate, rhythm, depth, length, width, and contour.

Comparison between radial artery tonometry pulse analyzer and pulsed-Doppler echocardiography derived hemodynamic parameters in cardiac surgery patients: a pilot study

Background

Bedside non-invasive techniques, such as radial artery tonometry, to estimate hemodynamic parameters have gained increased relevance as an attractive alternative and efficient method to measure hemodynamics in outpatient departments. For our pilot study, we sought to compare cardiac output (CO), and stroke volume (SV) estimated from a radial artery tonometry blood pressure pulse analyzer (BPPA) (DMP-Life, DAEYOMEDI Co., Gyeonggi-do, South Korea) to pulsed-wave Doppler (PWD) echocardiography derived parameters.

Methods

From January 2015 to December 2016, all patients scheduled for coronary artery bypass (CABG) surgery at our department were screened. Exclusion criteria were, inter alia, moderate to severe aortic- or Mitral valve disease and peripheral arterial disease (PAD) > stage II. One hundred and seven patients were included (mean age 66.1 ± 9.9, 15 females, mean BMI 27.2 ± 4.1 kg/m²). All patients had pre-operative transthoracic echocardiography (TTE). We measured the hemodynamic parameters with the BPPA from the radial artery, randomly before or after TTE. For the comparison between the measurement methods we used the Bland-Altman test and Pearson correlation.

Results

Mean TTE-CO was 5.1 ± 0.96 L/min, and the mean BPPA-CO was 5.2 ± 0.85 L/min. The Bland-Altman analysis for CO revealed a bias of −0.13 L/min and SD of 0.90 L/min with upper and lower limits of agreement of −1.91 and +1.64 L/min. The correlation of CO measurements between DMP-life and TTE was poor (r = 0.501, p < 0.0001). The mean TTE-SV was 71.3 ± 16.2 mL and the mean BPPA-SV was 73.8 ± 19.2 mL. SV measurements correlated very well between the two methods (r = 0.900, p < 0.0001). The Bland-Altman analysis for SV revealed a bias of −2.54 mL and SD of ±8.42 mL and upper and lower limits of agreement of −19.05 and +13.96 mL, respectively.

Conclusion

Our study shows for the first time that the DMP-life tonometry device measures SV and CO with reasonable accuracy and precision of agreement compared with TTE in preoperative cardiothoracic surgery patients. Tonometry BPPA are relatively quick and simple measuring devices, which facilitate the collection of cardiac and hemodynamic information. Further studies with a larger number of patients and with repeated measurements are in progress to test the reliability and repeatability of DMP-Life system.

Development of a Tonometric Sensor with a Decoupled Circular Array for Precisely Measuring Radial Artery Pulse

The radial artery pulse is one of the major diagnostic indices used clinically in both Eastern and Western medicine. One of the prominent methods for measuring the radial artery pulse is the piezoresistive sensor array. Independence among channels and an appropriate sensor arrangement are important for effectively assessing the spatial-temporal information of the pulse. This study developed a circular-type seven-channel piezoresistive sensor array using face-down bonding (FDB) as one of the sensor combination methods. The three-layered housing structure that included independent pressure sensor units using the FDB method not only enabled elimination of the crosstalk among channels, but also allowed various array patterns to be created for effective pulse measurement. The sensors were arranged in a circular-type arrangement such that they could estimate the direction of the radial artery and precisely measure the pulse wave. The performance of the fabricated sensor array was validated by evaluating the sensor sensitivity per channel, and the possibility of estimating the blood vessel direction was demonstrated through a radial artery pulse simulator. We expect the proposed sensor to allow accurate extraction of the pulse indices for pulse diagnosis.

Comparison of Three Different Types of Wrist Pulse Signals by Their Physical Meanings and Diagnosis Performance

Increasing interest has been focused on computational pulse diagnosis where sensors are developed to acquire pulse signals, and machine learning techniques are exploited to analyze health conditions based on the acquired pulse signals. By far, a number of sensors have been employed for pulse signal acquisition, which can be grouped into three major categories, i.e., pressure, photoelectric, and ultrasonic sensors. To guide the sensor selection for computational pulse diagnosis, in this paper, we analyze the physical meanings and sensitivities of signals acquired by these three types of sensors. The dependence and complementarity of the different sensors are discussed from both the perspective of cardiovascular fluid dynamics and comparative experiments by evaluating disease classification performance. Experimental results indicate that each sensor is more appropriate for the diagnosis of some specific disease that the changes of physiological factors can be effectively reflected by the sensor, e.g., ultrasonic sensor for diabetes and pressure sensor for arteriosclerosis, and improved diagnosis performance can be obtained by combining three types of signals.

New assessment model of pulse depth based on sensor displacement in pulse diagnostic devices

An accurate assessment of the pulse depth in pulse diagnosis is vital to determine the floating and sunken pulse qualities (PQs), which are two of the four most basic PQs. In this work, we proposed a novel model of assessing the pulse depth based on sensor displacement (SD) normal to the skin surface and compared this model with two previous models which assessed the pulse depth using contact pressure (CP). In contrast to conventional stepwise CP variation tonometry, we applied a continuously evolving tonometric mechanism at a constant velocity and defined the pulse depth index as the optimal SD where the largest pulse amplitude was observed. By calculating the pulse depth index for 18 volunteers, we showed that the pulse was deepest at Cheok (significance level: P < 0.01), while no significant difference was found between Chon and Gwan. In contrast, the two CP-based models estimated that the pulse was shallowest at Gwan (P < 0.05). For the repeated measures, the new SD-based model showed a smaller coefficient of variation (CV ≈ 7.6%) than the two CP-based models (CV ≈ 13.5% and 12.3%, resp.). The SD-based pulse depth assessment is not sensitive to the complex geometry around the palpation locations and temperature variation of contact sensors, which allows cost-effective sensor technology.

P(VDF-TrFE) polymer-based thin films deposited on stainless steel substrates treated using water dissociation for flexible tactile sensor development

In this work, deionized (DI) water dissociation was used to treat and change the contact angle of the surface of stainless steel substrates followed by the spin coating of P(VDF-TrFE) material for the fabrication of tactile sensors. The contact angle of the stainless steel surface decreased 14° at −30 V treatment; thus, the adhesion strength between the P(VDF-TrFE) thin film and the stainless steel substrate increased by 90%. Although the adhesion strength was increased at negative voltage treatment, it is observed that the crystallinity value of the P(VDF-TrFE) thin film declined to 37% at −60 V. In addition, the remanent polarization value of the P(VDF-TrFE) thin film declined from 5.6 μC/cm² to 4.61 μC/cm² for treatment voltages between −5 V and −60 V. A maximum value of approximately 1000 KV/cm of the coercive field value was obtained with the treatment at −15 V. The d33 value was approximately −10.7 pC/N for the substrate treated at 0 V and reached a minimum of −5 pC/N for treatment at −60 V. By using the P(VDF-TrFE) thin-film as the sensing material for tactile sensors, human pulse measurements were obtained from areas including the carotid, brachial, ankle, radial artery, and apical regions. In addition, the tactile sensor is suitable for monitoring the Cun, Guan, and Chi acupoints located at the radial artery region in Traditional Chinese Medicine (TCM). Waveform measurements of the Cun, Guan, and Chi acupoints are crucial because, in TCM, the various waveforms provided information regarding the health conditions of organs.

Pulse waveform analysis as a bridge between pulse examination in Chinese medicine and cardiology

Pulse examination was probably the earliest attempt to distinguish between health and illnesses. Starting at the pre-Hippocratic era, Chinese medicine practitioners developed techniques for pulse examination and defined pulse images based on their perceptions of pulse waveforms at the radial artery. Pulse images were described using basic variables (frequency, rhythm, wideness, length, deepness, and qualities) developed under philosophical trends such as Taoism and Confucianism. Recent advances in biomedical instrumentation applied to cardiology opened possibilities to research on pulse examination based on ancient Chinese medical theories: the pulse wave analysis. Although strongly influenced by philosophy, some characteristics used to describe a pulse image are interpretable as parameters obtained by pulse waveform analysis such as pulse wave velocity and augmentation index. Those clinical parameters reflect concepts unique to Chinese medicine - such as yinyang - while are based on wave reflection and resonance theories of fluids mechanics. Major limitations for integration of Chinese and Western pulse examination are related to quantitative description of pulse images and pattern differentiation based on pulse examination. Recent evidence suggests that wave reflection and resonance phenomena may bridge Chinese medicine and cardiology to provide a more evidence-based medical practice.

How to standardize the pulse-taking method of traditional Chinese medicine pulse diagnosis

The aim of this report is to propose standard pulse taking procedure of Traditional Chinese Medicine Pulse Diagnosis. In order to acquire full information from taking a wrist pulse, this proposal adopts a tactile sensor with 12 sensing points at one sensing position, such as Cun, Guan, or Chi. Simultaneously Palpation (SP) and Pressing with One Finger (PWOF) are adopted to explore their differences of the detected pulse signals. According to vertical dynamic characteristics, the results of a Pearson product moment reveal that the correlation coefficients of PWOF and SP are highly correlated from Fu to Chen. In addition, according to unique characteristics of body state, the results of a paired samples t test reveal that the SP and PWOF are indifferent at a specific pulse taking depth. Hence, if using the pulse-taking instrument with tactile sensors, it is concluded that pulse signals taken by familiar SP and PWOF methods are shown in statistical indifferences among seven parameters (Vppmean,Vppmax, HR, LENGTH, WIDTH, AS, and DS).

Stringlike pulse quantification study by pulse wave in 3D pulse mapping

BACKGROUND

A stringlike pulse is highly related to hypertension, and many classification approaches have been proposed in which the differentiation pulse wave (dPW) can effectively classify the stringlike pulse indicating hypertension. Unfortunately, the dPW method cannot distinguish the spring stringlike pulse from the stringlike pulse so labeled by physicians in clinics.

DESIGN

By using a Bi-Sensing Pulse Diagnosis Instrument (BSPDI), this study proposed a novel Plain Pulse Wave (PPW) to classify a stringlike pulse based on an array of pulse signals, mimicking a Traditional Chinese Medicine physician's finger-reading skill.

RESULTS

In comparison to PPWs at different pulse taking positions, phase delay Δθand correlation coefficient r can be elucidated as the quantification parameters of stringlike pulse. As a result, the recognition rates of a hypertensive stringlike pulse, spring stringlike pulse, and non-stringlike pulse are 100%, 100%, 77% for PPW and 70%, 0%, 59% for dPW, respectively.

CONCLUSIONS

Integrating dPW and PPW can unify the classification of stringlike pulse including hypertensive stringlike pulse and spring stringlike pulse. Hence, the proposed novel method, PPW, enhances quantification of stringlike pulse.