Blood pressure pulsations modulate central neuronal activity via mechanosensitive ion channels

The transmission of the heartbeat through the cerebral vascular system causes intracranial pressure pulsations. We discovered that arterial pressure pulsations can directly modulate central neuronal activity. In a semi-intact rat brain preparation, vascular pressure pulsations elicited correlated local field oscillations in the olfactory bulb mitral cell layer. These oscillations did not require synaptic transmission but reflected baroreceptive transduction in mitral cells. This transduction was mediated by a fast excitatory mechanosensitive ion channel and modulated neuronal spiking activity. In awake animals, the heartbeat entrained the activity of a subset of olfactory bulb neurons within ~20 milliseconds. Thus, we propose that this fast, intrinsic interoceptive mechanism can modulate perception-for example, during arousal-within the olfactory bulb and possibly across various other brain areas.

Non-contact high precision pulse-rate monitoring system for moving subjects in different motion states

Remote photoplethysmography (rPPG) enables contact-free monitoring of the pulse rate by using a color camera. The fundamental limitation is that motion artifacts and changes in ambient light conditions greatly affect the accuracy of pulse-rate monitoring. We propose use of a high-speed camera and a motion suppression algorithm with high computational efficiency. This system incorporates a number of major improvements including reproduction of pulse wave details, high-precision pulse-rate monitoring of moving subjects, and excellent scene scalability. A series of quantization methods were used to evaluate the effect of different frame rates and different algorithms in pulse-rate monitoring of moving subjects. The experimental results show that use of 180-fps video and a Plane-Orthogonal-to-Skin (POS) algorithm can produce high-precision pulse-rate monitoring results with mean absolute error can be less than 5 bpm and the relative accuracy reaching 94.5%. Thus, it has significant potential to improve personal health care and intelligent health monitoring.

THE OUTCOME OF PULSELESS PINK HAND FOLLOWING CLOSED SUPRACONDYLAR FRACTURE HUMERUS IN PEDIATRICS

Management of children with supracondylar humeral fractures with pulseless pink hands is still controversial, whether to choose operative or conservative treatment. Proponents of conventional treatment mentioned that most patients can restore the motor and sensory function of the hand shortly after the injury without the need to restore distal pulse by surgery. Opponents of this treatment strategy claim that many patients will develop limb shortening a few years after the injury leading to functional and psychological problems. In this study, we made a comparison of the outcomes of each treatment to help in making policy for the treatment of such types of injuries in our center. This study answers the question "Which method is preferred for treating supracondylar humeral fracture with suspected vascular injury represented by pulseless pink hand, and what are the short and long-term outcomes of each treatment method. The main objective of the study is to settle a policy for the treatment of such types of injuries in our center. This study is a retrospective for the 10-year period from 2010 to 2020, it included 74 patients with blunt trauma to one upper extremity. All patients were children aged one year to fourteen years. Patients with penetrating trauma, combined penetrating and blunt trauma, victims of burns and explosions, and patients with other co-morbidities were excluded. We have two treatment strategies: Conservative (watchful waiting) and Operative exploration. We compared the outcomes of these two strategies regarding the short-term outcome (6 months follow-up) and the long-term outcome (5 years follow-up). We looked for acute and chronic limb ischemia and chronic pain syndrome as the short-term follow-up, while we took limb shortening and chronic limb ischemia and limb function as variables of the long-term follow-up. We don't have the ability to control patients for the psychological examination by a psychiatrist, therefore; we excluded this variable from our study.

Pulse rate variability estimation method based on imaging-photoplethysmography and application to telepsychiatry

The worldwide adoption of telehealth services may benefit people who otherwise would not be able to access mental health support. In this paper, we present a novel algorithm to obtain reliable pulse and respiration signals from non-contact facial image sequence analysis. The proposed algorithm involved a skin pixel extraction method in the image processing part and signal reconstruction using the spectral information of RGB signal in the signal processing part. The algorithm was tested on 15 healthy subjects in a laboratory setting. The results show that the proposed algorithm can accurately monitor respiration rate (RR), pulse rate (PR), and pulse rate variability (PRV) in rest conditions.Clinical Relevance- The main achievement of this study is enabling non-contact PR and RR signal extraction from facial image sequences, which has potential for future use and support for psychiatrists in telepsychiatry.

Intelligent Wearable Wrist Pulse Detection System Based on Piezoelectric Sensor Array

The human radial artery pulse carries a rich array of biomedical information. Accurate detection of pulse signal waveform and the identification of the corresponding pulse condition are helpful in understanding the health status of the human body. In the process of pulse detection, there are some problems, such as inaccurate location of radial artery key points, poor signal noise reduction effect and low accuracy of pulse recognition. In this system, the pulse signal waveform is collected by the main control circuit and the new piezoelectric sensor array combined with the wearable wristband, creating the hardware circuit. The key points of radial artery are located by an adaptive pulse finding algorithm. The pulse signal is denoised by wavelet transform, iterative sliding window and prediction reconstruction algorithm. The slippery pulse and the normal pulse are recognized by feature extraction and classification algorithm, so as to analyze the health status of the human body. The system has accurate pulse positioning, good noise reduction effect, and the accuracy of intelligent analysis is up to 98.4%, which can meet the needs of family health care.

Point-of-Care Ultrasound for Pulse Checks in Pediatric Cardiac Arrest: Two Illustrative Cases

ABSTRACT

Cardiac arrest is an infrequent but high-stakes scenario in pediatrics. Manual central pulse checks are unreliable. Point-of-care ultrasound is a noninvasive technique to visualize the heart and central vessels during resuscitation. We describe 2 cases in which point-of-care ultrasound helped aid management decisions in pediatric cardiac arrest.

A Flexible Pressure Sensor with a Mesh Structure Formed by Lost Hair for Human Epidermal Pulse Wave Monitoring

Flexible pressure sensors with the capability of monitoring human vital signs show broad application prospects in personalized healthcare. In this work, a hair-based flexible pressure sensor (HBPS) consisting of lost hair and polymer films was proposed for the continuous monitoring of the human epidermal arterial pulse waveform. A macroscale mesh structure formed by lost hair provides a simplified spacer that endows the triboelectric-based flexible pressure sensor with sufficient contact-separation space. Based on this mesh structure design, the hair-based flexible pressure sensor can respond to the slight pressure change caused by an object with 5 mg weight and hold a stable output voltage under 1-30 Hz external pressure excitation. Additionally, the hair-based flexible pressure sensor showed great sensitivity (0.9 V/kPa) and decent stability after 4500 cycles of operation. Given these compelling features, the HBPS can successfully measure the human epidermal arterial pulses with obvious details at different arteries. The proposed HBPS can also be used to monitor the pulse signals of different subjects. Furthermore, the three different pulse wave transmission time (PTT) values (PTT-foot, PTT-middle, and PTT-peak) can be obtained by simultaneously monitoring human pulse and electrocardiogram signals, which has enormous application potential for assessing cardiovascular system health.

Kirigami-Inspired Pressure Sensors for Wearable Dynamic Cardiovascular Monitoring

Continuously and accurately monitoring pulse-wave signals is critical to prevent and diagnose cardiovascular diseases. However, existing wearable pulse sensors are vulnerable to motion artifacts due to the lack of proper adhesion and conformal interface with human skin during body movement. Here, a highly sensitive and conformal pressure sensor inspired by the kirigami structure is developed to measure the human pulse wave on different body artery sites under various prestressing pressure conditions and even with body movement. COMSOL multiphysical field coupling simulation and experimental testing are used to verify the unique advantages of the kirigami structure. The device shows a superior sensitivity (35.2 mV Pa^-1 ) and remarkable stability (>84 000 cycles). Toward practical applications, a wireless cardiovascular monitoring system is developed for wirelessly transmitting the pulse signals to a mobile phone in real-time, which successfully distinguished the pulse waveforms from different participants. The pulse waveforms measured by the kirigami inspired pressure sensor are as accurate as those provided by the commercial medical device. Given the compelling features, the sensor provides an ascendant way for wearable electronics to overcome motion artifacts when monitoring pulse signals, thus representing a solid advancement toward personalized healthcare in the era of the Internet of Things.

Wearable Pressure Sensors for Pulse Wave Monitoring

Cardiovascular diseases remain the leading cause of death worldwide. The rapid development of flexible sensing technologies and wearable pressure sensors have attracted keen research interest and have been widely used for long-term and real-time cardiovascular status monitoring. Owing to compelling characteristics, including light weight, wearing comfort, and high sensitivity to pulse pressures, physiological pulse waveforms can be precisely and continuously monitored by flexible pressure sensors for wearable health monitoring. Herein, an overview of wearable pressure sensors for human pulse wave monitoring is presented, with a focus on the transduction mechanism, microengineering structures, and related applications in pulse wave monitoring and cardiovascular condition assessment. The conceptualizations and methods for the acquisition of physiological and pathological information related to the cardiovascular system are outlined. The biomechanics of arterial pulse waves and the working mechanism of various wearable pressure sensors, including triboelectric, piezoelectric, magnetoelastic, piezoresistive, capacitive, and optical sensors, are also subject to systematic debate. Exemple applications of pulse wave measurement based on microengineering structured devices are then summarized. Finally, a discussion of the opportunities and challenges that wearable pressure sensors face, as well as their potential as a wearable intelligent system for personalized healthcare is given in conclusion.

Optimal opportunistic screening of atrial fibrillation using pulse palpation in cardiology outpatient clinics: Who and how

Background

Atrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care.

Objective

We aimed to find the parameters that optimize the diagnostic accuracy of pulse palpation to detect AF. We also aimed to create a simple algorithm for selecting which individuals would benefit from pulse palpation and, if positive, receive an ECG to detect AF.

Methods

Nurses from four Cardiology outpatient clinics palpated 7,844 pulses according to a randomized list of arterial territories and durations of measure and immediately followed by a 12-lead ECG, which we used as the reference standard. We calculated the sensitivity and specificity of the palpation parameters. We also assessed whether diagnostic accuracy depended on the nurse’s experience or on a list of clinical factors of the patients. With this information, we estimated the positive predictive values and false omission rates according to very few clinical factors readily available in primary care (age, sex, and diagnosis of heart failure) and used them to create the algorithm.

Results

The parameters associated with the highest diagnostic accuracy were palpation of the radial artery and classifying as irregular those palpations in which the nurse was uncertain about pulse regularity or unable to palpate pulse (sensitivity = 79%; specificity = 86%). Specificity decreased with age. Neither the nurse’s experience nor any investigated clinical factor influenced diagnostic accuracy. We provide the algorithm to select the ≥40 years old individuals that would benefit from a pulse palpation screening: a) do nothing in <60 years old individuals without heart failure; b) do ECG in ≥70 years old individuals with heart failure; c) do radial pulse palpation in the remaining individuals and do ECG if the pulse is irregular or you are uncertain about its regularity or unable to palpate it.

Conclusions

Opportunistic screening for AF using optimal pulse palpation in candidate individuals according to a simple algorithm may have high effectiveness in detecting AF in primary care.

A Wearable and Real-Time Pulse Wave Monitoring System Based on a Flexible Compound Sensor

Continuous monitoring of pulse waves plays a significant role in reflecting physical conditions and disease diagnosis. However, the current collection equipment cannot simultaneously achieve wearable and continuous monitoring under varying pressure and provide personalized pulse wave monitoring targeted different human bodies. To solve the above problems, this paper proposed a novel wearable and real-time pulse wave monitoring system based on a novel flexible compound sensor. Firstly, a custom-packaged pressure sensor, a signal stabilization structure, and a micro pressurization system make up the flexible compound sensor to complete the stable acquisition of pulse wave signals under continuously varying pressure. Secondly, a real-time algorithm completes the analysis of the trend of the pulse wave peak, which can quickly and accurately locate the best pulse wave for different individuals. Finally, the experimental results show that the wearable system can both realize continuous monitoring and reflecting trend differences and quickly locate the best pulse wave for different individuals with the 95% accuracy. The weight of the whole system is only 52.775 g, the working current is 46 mA, and the power consumption is 160 mW. Its small size and low power consumption meet wearable and portable scenarios, which has significant research value and commercialization prospects.

Bioinspired Self-Powered Piezoresistive Sensors for Simultaneous Monitoring of Human Health and Outdoor UV Light Intensity

The exact fabrication of precise three-dimensional structures for piezoresistive sensors necessitates superior manufacturing methods or tooling, which are accompanied by time-consuming processes and the potential for environmental harm. Herein, we demonstrated a method for in situ synthesis of zinc oxide nanorod (ZnO NR) arrays on graphene-treated cotton and paper substrates and constructed highly sensitive, flexible, wearable, and chemically stable strain sensors. Based on the structure of pine trees and needles in nature, the hybrid sensing layer consisted of graphene-attached cotton or paper fibers and ZnO NRs, and the results showed a high sensitivity of 0.389, 0.095, and 0.029 kPa^-1 and an ultra-wide linear range of 0-100 kPa of this sensor under optimal conditions. Our study found that water absorption and swelling of graphene fibers and the associated reduction of pore size and growth of zinc oxide were detrimental to pressure sensor performance. A random line model was developed to examine the effects of different hydrothermal times on sensor performance. Meanwhile, pulse detection, respiration detection, speech recognition, and motion detection, including finger movements, walking, and throat movements, were used to show their practical application in human health activity monitoring. In addition, monolithically grown ZnO NRs on graphene cotton sheets had been integrated into a flexible sensing platform for outdoor UV photo-indication, which is, to our knowledge, the first successful case of an integrated UV photo-detector and motion sensor. Due to its excellent strain detection and UV detection abilities, these strategies are a step forward in developing wearable sensors that are cost-controllable and high-performance.

Graded Microstructured Flexible Pressure Sensors with High Sensitivity and an Ultrabroad Pressure Range for Epidermal Pulse Monitoring

Precisely detecting epidermal pulse waves with pressure sensors is crucial for pulse-based personalized health-monitoring technologies. However, developing a pressure sensor that simultaneously demonstrates high sensitivity and an ultrabroad pressure range and a convenient fabrication process for large-scale production is a considerable challenge. Herein, by utilizing a commercial conductive fabric (CF) and a silica gel film, we develop a high-performance pressure sensor (HPPS) for the monitoring of human physiological signals. Based on convenient turnover formwork technology, the silica gel film was fabricated by replicating the microstructure of the sandpaper surface. This microstructure and the plain weave structure on the CF surface together provide a sharp increase in the contact-separation area and structural compressibility, which are beneficial for the enhancement of output performance. Made of these two materials, the graded microstructured HPPS holds high sensitivity (4.5 mV/Pa), an ultrabroad pressure range (0-30 kPa), a wide working frequency bandwidth (up to 35 Hz), decent stability (>50,000 cycles), and a simple fabrication process that is suitable for large-scale production. Given these noticeable features, the developed HPPS not only succeeds in precisely detecting subtle pulse waves on various positions of different people but can also objectively capture changes in cardiovascular parameters caused by exercise training at different intensities in real time. These findings exhibit the enormous potential application of HPPS in tracking an individual's health status and comprehensively evaluating exercise intensity.

Pulse arrival time as a surrogate of blood pressure

Various models have been proposed for the estimation of blood pressure (BP) from pulse transit time (PTT). PTT is defined as the time delay of the pressure wave, produced by left ventricular contraction, measured between a proximal and a distal site along the arterial tree. Most researchers, when they measure the time difference between the peak of the R-wave in the electrocardiogram signal (corresponding to left ventricular depolarisation) and a fiducial point in the photoplethysmogram waveform (as measured by a pulse oximeter attached to the fingertip), describe this erroneously as the PTT. In fact, this is the pulse arrival time (PAT), which includes not only PTT, but also the time delay between the electrical depolarisation of the heart's left ventricle and the opening of the aortic valve, known as pre-ejection period (PEP). PEP has been suggested to present a significant limitation to BP estimation using PAT. This work investigates the impact of PEP on PAT, leading to a discussion on the best models for BP estimation using PAT or PTT. We conducted a clinical study involving 30 healthy volunteers (53.3% female, 30.9 ± 9.35 years old, with a body mass index of 22.7 ± 3.2 kg/m[Formula: see text]). Each session lasted on average 27.9 ± 0.6 min and BP was varied by an infusion of phenylephrine (a medication that causes venous and arterial vasoconstriction). We introduced new processing steps for the analysis of PAT and PEP signals. Various population-based models (Poon, Gesche and Fung) and a posteriori models (inverse linear, inverse squared and logarithm) for estimation of BP from PTT or PAT were evaluated. Across the cohort, PEP was found to increase by 5.5 ms ± 4.5 ms from its baseline value. Variations in PTT were significantly larger in amplitude, - 16.8 ms ± 7.5 ms. We suggest, therefore, that for infusions of phenylephrine, the contribution of PEP on PAT can be neglected. All population-based models produced large BP estimation errors, suggesting that they are insufficient for modelling the complex pathways relating changes in PTT or PAT to changes in BP. Although PAT is inversely correlated with systolic blood pressure (SBP), the gradient of this relationship varies significantly from individual to individual, from - 2946 to - 470.64 mmHg/s in our dataset. For the a posteriori inverse squared model, the root mean squared errors (RMSE) for systolic and diastolic blood pressure (DBP) estimation from PAT were 5.49 mmHg and 3.82 mmHg, respectively. The RMSEs for SBP and DBP estimation by PTT were 4.51 mmHg and 3.53 mmHg, respectively. These models take into account individual calibration curves required for accurate blood pressure estimation. The best performing population-based model (Poon) reported error values around double that of the a posteriori inverse squared model, and so the use of population-based models is not justified.

The Dietary Guidelines for Americans (2020-2025): Pulses, Dietary Fiber, and Chronic Disease Risk-A Call for Clarity and Action

The 2020-2025 Dietary Guidelines for Americans (DGA) were recently released [...].

Modified Camera Setups for Day-and-Night Pulse-rate Monitoring

Camera systems have been studied as a means for ubiquitous remote photoplethysmography. It was first considered for daytime applications using ambient light. However, main applications for continuous monitoring are in dark or low-light conditions (e.g. sleep monitoring) and, more recently, suitable light sources and simple camera adaptations have been considered for infrared-based solutions. This paper explores suitable camera configurations for pulse-rate monitoring during both day and night (24/7). Various configurations differing in the recorded spectral range are defined, i.e. straight-forward adaptations of a standard RGB camera by choosing proper optical filters. These systems have been studied in a benchmark involving day and night monitoring with various degrees of motion disturbances. The results indicate that, for the 24/7 monitoring, it is best to deploy the full spectral band of an RGB camera, and this can be done without compromising the monitoring performance at night.

A Transfer Function Model Development for Reconstructing Radial Pulse Pressure Waveforms Using Non-Invasively Measured Pulses by a Robotic Tonometry System

The primary goal of this study is to develop a mathematical model that can establish a transfer function relationship between the “external” pulse pressures measured by a tonometer and the “internal” pulse pressure in the artery. The purpose of the model is to accurately estimate and rebuild the internal pulse pressure waveforms using arterial tonometry measurements. To develop and validate a model without human subjects and operators for consistency, this study employs a radial pulse generation system, a robotic tonometry system, and a write model with an artificial skin and vessel. A transfer function model is developed using the results of the pulse testing and the mechanical characterization testing of the skin and vessel. To evaluate the model, the pulse waveforms are first reconstructed for various reference pulses using the model with tonometry data. They are then compared with pulse waveforms acquired by internal measurement (by the built-in pressure sensor in the vessel) the external measurement (the on-skin measurement by the robotic tonometry system). The results show that the model-produced pulse waveforms coinciding well with the internal pulse waveforms with small relative errors, indicating the effectiveness of the model in reproducing the actual pulse pressures inside the vessel.

Strategy of pulseless pink supracondylar humerus fracture treatment in children: a comparison of two approaches

PURPOSE

The appropriate treatment of pulseless pink supracondylar humerus fractures (SCHF) remains controversial. In this study, the outcomes of two treatment approaches (with and without vascular surgery) were compared.

MATERIAL AND METHODS

This was a retrospective multicenter study of patients with pulseless pink SCHFs treated in ten pediatric surgery, trauma, or orthopedics departments in the Czech and Slovak Republic between 2014 and 2018.

RESULTS

Of the total 3608 cases of displaced SCHF, 125 had the pulseless pink SCHF. Of those, 91% (114/125) did not undergo vascular surgery and 9% (11/125) underwent vascular surgery. The patients who did undergo vascular surgery had radial artery pulsation restored more frequently in the operating room (73% vs. 36%; p = 0.02), within 6 h (91% vs. 45%; p = 0.004), and within 24 h of surgery (91% vs. 57%; p = 0.05). However, 72 h after surgery, there was no significant difference in palpable radial artery pulsation between the vascular surgery and the non-vascular surgery groups (91% vs. 74%; p = 0.24). Additionally, no significant differences in long-term neurological (9% vs. 22%; p = 0.46) or circulatory (9% vs. 7%; p = 0.57) deficits were found between the two groups.

CONCLUSION

While vascular surgery in patients with pulseless pink SCHFs is associated with a more prompt restoration of radial artery pulsation, no statistical significant differences in terms of the restoration of neurological deficits or the risks of long-term neurological or circulatory deficits were found between patients with and without vascular surgery.

Pulse Rate Variability Analysis Using Remote Photoplethysmography Signals

Pulse rate variability (PRV) refers to the change in the interval between pulses in the blood volume pulse (BVP) signal acquired using photoplethysmography (PPG). PRV is an indicator of the health status of an individual’s autonomic nervous system. A representative method for measuring BVP is contact PPG (CPPG). CPPG may cause discomfort to a user, because the sensor is attached to the finger for measurements. In contrast, noncontact remote PPG (RPPG) extracts BVP signals from face data using a camera without the need for a sensor. However, because the existing RPPG is a technology that extracts a single pulse rate rather than a continuous BVP signal, it is difficult to extract additional health status indicators. Therefore, in this study, PRV analysis is performed using lab-based RPPG technology that can yield continuous BVP signals. In addition, we intended to confirm that the analysis of PRV via RPPG can be performed with the same quality as analysis via CPPG. The experimental results confirmed that the temporal and frequency parameters of PRV extracted from RPPG and CPPG were similar. In terms of correlation, the PRVs of RPPG and CPPG yielded correlation coefficients between 0.98 and 1.0.

Coronary artery disease and its impact on the pulsatile brain: A functional NIRS study

Recent studies have reported that optical indices of cerebral pulsatility are associated with cerebrovascular health in older adults. Such indices, including cerebral pulse amplitude and the pulse relaxation function (PRF), have been previously applied to quantify global and regional cerebral pulsatility. The aim of the present study was to determine whether these indices are modulated by cardiovascular status and whether they differ between individuals with low or high cardiovascular risk factors (LCVRF and HCVRF) and coronary artery disease (CAD). A total of 60 older adults aged 57-79 were enrolled in the study. Participants were grouped as LCVRF, HCVRF, and CAD. Participants were asked to walk freely on a gym track while a near-infrared spectroscopy (NIRS) device recorded hemodynamics data. Low-intensity, short-duration walking was used to test whether a brief cardiovascular challenge could increase the difference of pulsatility indices with respect to cardiovascular status. Results indicated that CAD individuals have higher global cerebral pulse amplitude compared with the other groups. Walking reduced global cerebral pulse amplitude and PRF in all groups but did not increase the difference across the groups. Instead, walking extended the spatial distribution of cerebral pulse amplitude to the anterior prefrontal cortex when CAD was compared to the CVRF groups. Further research is needed to determine whether cerebral pulse amplitude extracted from data acquired with NIRS, which is a noninvasive, inexpensive method, can provide an index to characterize the cerebrovascular status associated with CAD.

Ionic Network Based on Dynamic Ionic Liquids for Electronic Tattoo Application

Electronic tattoos as an emerging epidermal electronic are alluring in the field of wearable electronics for their lightweight and noninvasive properties. However, the combination of flexibility, skin biocompatibility, adhesion, repairability, and erasability remains a challenge for fabricating electronic tattoos. Hence, a dynamic ionic liquid is prepared which is ideally suited for making an electronic tattoo with these challenging features at the same time. Such an intrinsically flexible electronic tattoo can be firmly attached to human skin with negligible irritation. More importantly, the existence of dynamic covalent chemistry provides the electronic tattoo with healing and erasable abilities under mild redox conditions. Owing to the high ionic conductivity of ionic liquids, the electronic tattoo exhibits excellent sensing performance in response to the temperature variation and tensile strain, which can intelligently monitor body temperature, pulse, and movement. As an extension of the application, a specially designed quadrilateral electronic tattoo can sense and distinguish multiple signals simultaneously. This concept of electronic tattoo based on the dynamic ionic liquid shows great potentials in the applications of intelligent wearable electronics.

Portable Interactive Pulse Tactile Recorder and Player System

Pulse palpation is an effective method for diagnosing arterial diseases. However, most pulse measurement devices use preconfigured pressures to collect pulse signals, and most pulse tactile simulators can only display standard or predefined pulse waveforms. Here, a portable interactive human pulse measurement and reproduction system was developed that allows users to take arbitrary pulses and experience realistic simulated pulse tactile feedback in real time by using their natural pulse-taking behaviors. The system includes a pulse tactile recorder and a pulse tactile player. Pulse palpation forces and vibrations can be recorded and realistically replayed for later tactile exploration and examination. To retain subtle but vital pulse information, empirical mode decomposition was used to decompose pulse waveforms into several intrinsic mode functions. Artificial neural networks were then trained based on intrinsic mode functions to determine the relationship between the driving signals of the pulse tactile player and the resulting vibration waveforms. Experimental results indicate that the average normalized root mean square error and the average R-squared values between the reproduced and original pulses were 0.0654 and 0.958 respectively, which indicate that the system can reproduce high-fidelity pulse tactile vibrations.

Photoplethysmographic Waveform and Pulse Rate Variability Analysis in Hyperbaric Environments

The main aim of this work is to identify alterations in the morphology of the pulse photoplethysmogram (PPG) signal, due to the exposure of the subjects to a hyperbaric environment. Additionally, their Pulse Rate Variability (PRV) is analysed to characterise the response of their Autonomic Nervous System (ANS). To do that, 28 volunteers are introduced into a hyperbaric chamber and five sequential stages with different atmospheric pressures from 1 atm to 5 atm are performed. In this work, nineteen morphological parameters of the PPG signal are analysed: the pulse amplitude; eight parameters related to pulse width; eight parameters related to pulse area; and the two two pulse slopes. Also, classical time and frequency parameters of PRV are computed. Notable widening of the pulses width is observed in the stages analysed. The PPG area increases with pressure, with no significant changes when the initial pressure is recovered. These changes in PPG waveform may be caused by an increase in the systemic vascular resistance as a consequence of of vasoconstriction in the extremities, suggesting a sympathetic activation. However, the PRV results show an augmented parasympathetic activity and a reduction in the parameters that characterise the sympathetic response. So, only a sympathetic activation is detected in the peripheral region, as reflected by PPG morphology. The information regarding the ANS and the cardiovascular response that can be extracted from the PPG signal, as well as its compatibility with wet conditions make this signal the most suitable for studying the physiological response in hyperbaric environments.

Classification of patients with Alzheimer's disease using the arterial pulse spectrum and a multilayer-perceptron analysis

Cerebrovascular atherosclerosis has been identified as a prominent pathological feature of Alzheimer's disease (AD); the link between vessel pathology and AD risk may also extend to extracranial arteries. This study aimed to determine the effectiveness of using arterial pulse-wave measurements and multilayer perceptron (MLP) analysis in distinguishing between AD and control subjects. Radial blood pressure waveform (BPW) and finger photoplethysmography signals were measured noninvasively for 3 min in 87 AD patients and 74 control subjects. The 5-layer MLP algorithm employed evaluated the following 40 harmonic pulse indices: amplitude proportion and its coefficient of variation, and phase angle and its standard deviation. The BPW indices differed significantly between the AD patients (6247 pulses) and control subjects (6626 pulses). Significant intergroup differences were found between mild, moderate, and severe AD (defined by Mini-Mental-State-Examination scores). The hold-out test results indicated an accuracy of 82.86%, a specificity of 92.31%, and a 0.83 AUC of ROC curve when using the MLP-based classification between AD and Control. The identified differences can be partly attributed to AD-induced changes in vascular elastic properties. The present findings may be meaningful in facilitating the development of a noninvasive, rapid, inexpensive, and objective method for detecting and monitoring the AD status.

Cardiometabolic risks of SARS-CoV-2 hospitalization using Mendelian Randomization

Many cardiometabolic conditions have demonstrated associative evidence with COVID-19 hospitalization risk. However, the observational designs of the studies in which these associations are observed preclude causal inferences of hospitalization risk. Mendelian Randomization (MR) is an alternative risk estimation method more robust to these limitations that allows for causal inferences. We applied four MR methods (MRMix, IMRP, IVW, MREgger) to publicly available GWAS summary statistics from European (COVID-19 GWAS n = 2956) and multi-ethnic populations (COVID-19 GWAS n = 10,908) to better understand extant causal associations between Type II Diabetes (GWAS n = 659,316), BMI (n = 681,275), diastolic and systolic blood pressure, and pulse pressure (n = 757,601 for each) and COVID-19 hospitalization risk across populations. Although no significant causal effect evidence was observed, our data suggested a trend of increasing hospitalization risk for Type II diabetes (IMRP OR, 95% CI 1.67, 0.96-2.92) and pulse pressure (OR, 95% CI 1.27, 0.97-1.66) in the multi-ethnic sample. Type II diabetes and Pulse pressure demonstrates a potential causal association with COVID-19 hospitalization risk, the proper treatment of which may work to reduce the risk of a severe COVID-19 illness requiring hospitalization. However, GWAS of COVID-19 with large sample size is warranted to confirm the causality.

[Full-information Force Sensor for Pulse Condition Diagnose]

According to the collection principles and characteristics of the pulse physiological signals of traditional Chinese medicine, combined with the international standard requirements of the pulse graph force transducer (ISO 19614:2017-05), a special force sensor component that can be used for a complete and objective collection of pulse signals has been developed, this sensor meets the requirements of industrialization. The sensor can measure the pulse amplitude and width signals of the cunpart of the human body. In addition, three sensors can be placed at the cun, guan, chi part at the same time, so that the "three body parts and nine pulse-taking sites" can be realized synchronously. After the sensor has been verified, the results meet the relevant requirements of international standard. The consistency of the result can be reached to 92.3% compared with the diagnosis result of clinical TCM experts.

Elite Athletes and Pregnancy Outcomes: A Systematic Review and Meta-analysis

PURPOSE

The purpose of this systematic review was to evaluate fetal and maternal pregnancy outcomes of elite athletes who had participated in competitive sport immediately before conception.

METHODS

Online databases were searched up to March 24, 2020. Studies of any design and language were eligible if they contained information on the relevant population (pregnant women), exposure (engaged in elite sport immediately before pregnancy), and outcomes (birth weight, low birth weight, macrosomia, preterm birth, fetal heart rate and pulse index, cesarean sections, instrumental deliveries, episiotomies, duration of labor, perineal tears, pregnancy-induced low back pain, pelvic girdle pain, urinary incontinence, miscarriages, prenatal weight gain, inadequate/excess prenatal weight gain, maternal depression or anxiety).

RESULTS

Eleven unique studies (n = 2256 women) were included. We identified "low" certainty evidence demonstrating lower rates of low back pain in elite athletes compared with active/sedentary controls (n = 248; odds ratio, 0.38; 95% confidence interval, 0.20-0.73; I2 = 0%) and "very low" certainty evidence indicating an increased odds of excessive prenatal weight gain in elite athletes versus active/sedentary controls (n = 1763; odds ratio, 2.47; 95% confidence interval, 1.26-4.85; I2 = 0%). Low certainty evidence from two studies (n = 7) indicated three episodes of fetal bradycardia after high-intensity exercise that resolved within 10 min of cessation of activity. No studies reported inadequate gestational weight gain or maternal depression or anxiety. There were no differences between elite athletes and controls for all other outcomes.

CONCLUSIONS

There is "low" certainty of evidence that elite athletes have reduced odds of experiencing pregnancy-related low back pain and "very low"certainty of evidence that elite athletes have increased the odds of excessive weight gain compared with active/sedentary controls. More research is needed to provide strong evidence of how elite competitive sport before pregnancy affects maternal and fetal outcomes.PROSPERO Registration: CRD42020167382.

Pulse Wave Modeling Using Bio-Impedance Simulation Platform Based on a 3D Time-Varying Circuit Model

Cardiovascular disease (CVD) threatens the lives of many and affects their productivity. Wearable sensors can enable continuous monitoring of hemodynamic parameters to improve the diagnosis and management of CVD. Bio-Impedance (Bio-Z) is an effective non-invasive sensor for arterial pulse wave monitoring based on blood volume changes in the artery due to the deep penetration of its current signal inside the tissue. However, the measured data are significantly affected by the placement of electrodes relative to the artery and the electrode configuration. In this work, we created a Bio-Z simulation platform that models the tissue, arterial pulse wave, and Bio-Z sensing configuration using a 3D circuit model based on a time-varying impedance grid. A new method is proposed to accurately simulate the different tissue types such as blood, fat, muscles, and bones in a 3D circuit model in addition to the pulsatile activity of the arteries through a variable impedance model. This circuit model is simulated in SPICE and can be used to guide design decisions (i.e. electrode placement relative to the artery and electrode configuration) to optimize the monitoring of pulse wave prior to experimentation. We present extensive simulations of the arterial pulse waveform for different sensor locations, electrode sizes, current injection frequencies, and artery depths. These simulations are validated by experimental Bio-Z measurements.

Resumption of Cardiac Activity after Withdrawal of Life-Sustaining Measures

BACKGROUND

The minimum duration of pulselessness required before organ donation after circulatory determination of death has not been well studied.

METHODS

We conducted a prospective observational study of the incidence and timing of resumption of cardiac electrical and pulsatile activity in adults who died after planned withdrawal of life-sustaining measures in 20 intensive care units in three countries. Patients were intended to be monitored for 30 minutes after determination of death. Clinicians at the bedside reported resumption of cardiac activity prospectively. Continuous blood-pressure and electrocardiographic (ECG) waveforms were recorded and reviewed retrospectively to confirm bedside observations and to determine whether there were additional instances of resumption of cardiac activity.

RESULTS

A total of 1999 patients were screened, and 631 were included in the study. Clinically reported resumption of cardiac activity, respiratory movement, or both that was confirmed by waveform analysis occurred in 5 patients (1%). Retrospective analysis of ECG and blood-pressure waveforms from 480 patients identified 67 instances (14%) with resumption of cardiac activity after a period of pulselessness, including the 5 reported by bedside clinicians. The longest duration after pulselessness before resumption of cardiac activity was 4 minutes 20 seconds. The last QRS complex coincided with the last arterial pulse in 19% of the patients.

CONCLUSIONS

After withdrawal of life-sustaining measures, transient resumption of at least one cycle of cardiac activity after pulselessness occurred in 14% of patients according to retrospective analysis of waveforms; only 1% of such resumptions were identified at the bedside. These events occurred within 4 minutes 20 seconds after a period of pulselessness. (Funded by the Canadian Institutes for Health Research and others.).

Graph Based Multichannel Feature Fusion for Wrist Pulse Diagnosis

It is well known in Traditional Chinese Medicine (TCM) that a person's wrist pulse signal can reflect their health condition. Recently, many computerized wrist pulse AI systems have been proposed to simulate a practitioner's three fingers in order to acquire the wrist pulse signals (three positions/channels) from a candidate's wrist dynamically, before evaluating their health status based on the various feature extraction and detection methods. However, few works have investigated the correlation of the extracted features from the three wrist channels and comprehensively fused the various features together, which can improve the performance of wrist pulse diagnosis. In this paper, we propose a graph based multichannel feature fusion (GBMFF) method to utilize the multichannel features of the wrist pulse signals effectively. In detail, two different sensors, i.e., pressure and photoelectricity are used to capture the three channels of the wrist pulse signals. These are used to generate two different features by applying the stacked sparse autoencoder and wavelet scattering. Each feature of one wrist pulse sample is regarded as a node associated with its corresponding feature vector, and used to construct a graph for one candidate. A novel algorithm is implemented to construct different graphs for different candidates, which are used for wrist pulse diagnosis by developing graph convolutional networks. Experimental results indicate that our proposed AI-based method can obtain superior performances compared to other state-of-the-art approaches.

[Neurological symptoms associated with aortoiliac occlusive disease: Leriche syndrome]

Leriche syndrome was diagnosed in three patients aged 63, 71 and 73. They presented with a wide range of neurological symptoms such as impotence, pain or dysfunction of the lower extremities. Because a neurological diagnosis was initially suspected, there was a delay in two of the three patients before palpation for a distal pulse in the lower extremities was performed. A pulse was absent in all three patients. Duplex sonography, MR angiography and CT angiography revealed that a pulse was absent due to aortoiliac occlusive disease, also known as Leriche syndrome. They underwent treatment with covered endovascular reconstruction of the aortic bifurcation (CERAB), aortobifemoral bypass or intravenous thrombolysis. All patients significantly improved after treatment. Physicians should always consider aortoiliac occlusive disease in patients who present with neurological symptoms of the lower extremities and must check for a distal pulse in these patients.

Brain Tissue Pulsation in Healthy Volunteers

It is well known that the brain pulses with each cardiac cycle, but interest in measuring cardiac-induced brain tissue pulsations (BTPs) is relatively recent. This study was aimed at generating BTP reference data from healthy patients for future clinical comparisons and modelling. BTPs were measured through the forehead and temporal positions as a function of age, sex, heart rate, mean arterial pressure and pulse pressure. A multivariate regression model was developed based on transcranial tissue Doppler BTP measurements from 107 healthy adults (56 male) aged from 20-81 y. A subset of 5 participants (aged 20-49 y) underwent a brain magnetic resonance imaging scan to relate the position of the ultrasound beam to anatomy. BTP amplitudes were found to vary widely between patients (from ∼4 to ∼150 µm) and were strongly associated with pulse pressure. Comparison with magnetic resonance images confirmed regional variations in BTP with depth and probe position.

Analysis of accelerated 4D flow MRI in the murine aorta by radial acquisition and compressed sensing reconstruction

Preclinical 4D flow MRI remains challenging and is restricted for parallel imaging acceleration due to the limited number of available receive channels. A radial acquisition with combined parallel imaging and temporal compressed sensing reconstruction was implemented to achieve accelerated preclinical 4D flow MRI. In order to increase the accuracy of the measured velocities, a quantitative evaluation of different temporal regularization weights for the compressed sensing reconstruction based on velocity instead of magnitude data is performed. A 3D radial retrospectively triggered phase contrast sequence with a combined parallel imaging and compressed sensing reconstruction with temporal regularization was developed. It was validated in a phantom and in vivo (C57BL/6 J mice), against an established fully sampled Cartesian sequence. Different undersampling factors (USFs [12, 15, 20, 30, 60]) were evaluated, and the effect of undersampling was analyzed in detail for magnitude and velocity data. Temporal regularization weights λ were evaluated for different USFs. Acceleration factors of up to 20 compared with full Nyquist sampling were achieved. The peak flow differences compared with the Cartesian measurement were the following: USF 12, 3.38%; USF 15, 4.68%; USF 20, 0.95%. The combination of 3D radial center-out trajectories and compressed sensing reconstruction is robust against motion and flow artifacts and can significantly reduce measurement time to 30 min at a resolution of 180 μm³ . Concisely, radial acquisition with combined compressed sensing and parallel imaging proved to be an excellent method for analyzing complex flow patterns in mice.

Impact of obstructive sleep apnea on cardiopulmonary performance, endothelial dysfunction, and pulmonary hypertension during exercise

RATIONALE

OSA has been associated with reduced exercise capacity. Endothelial dysfunction and exercise-induced pulmonary hypertension (ePH) may be mediators of this impairment. We hypothesized that OSA severity would be associated with impaired exercise performance, endothelial dysfunction, and ePH.

METHODS

Subjects with untreated OSA were recruited. Subjects underwent endothelial function, and cardiopulmonary exercise testing with an echocardiogram immediately before and following exercise.

RESULTS

22 subjects were recruited with mean age 56 ± 8 years, 74 % male, BMI 29 ± 3 kg/m², and AHI 22 ± 12 events/hr. Peak V˙O₂ did not differ from normal (99.7 ± 17.3 % predicted; p = 0.93). There was no significant association between OSA severity (as AHI, ODI) and exercise capacity, endothelial function, or pulmonary artery pressure. However, ODI, marker of RV diastolic dysfunction, and BMI together explained 59.3 % of the variability of exercise performance (p < 0.001) via our exploratory analyses.

CONCLUSIONS

Exercise capacity was not impaired in this OSA cohort. Further work is needed to elucidate mechanisms linking sleep apnea, obesity, endothelial dysfunction and exercise impairment.

Neutrophil-to-Lymphocyte Ratios Are Closely Associated With the Severity and Course of Non-mild COVID-19

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is spreading worldwide. Measuring the prevention and control of the disease has become a matter requiring urgent focus.

Objective

Based on coronavirus disease 2019 (COVID-19) clinical data from Wuhan, we conducted an in-depth analysis to clarify some of the pathological mechanisms of the disease and identify simple measures to predict its severity early on.

Methods

A total of 230 patients with non-mild COVID-19 were recruited, and information on their clinical characteristics, inflammatory cytokines, and T lymphocyte subsets was collected. Risk factors for severity were analyzed by binary logistic regression, and the associations of neutrophil-to-lymphocyte ratios (N/LRs) with illness severity, disease course, CT grading, inflammatory cytokines, and T lymphocyte subsets were evaluated.

Results

Our results showed that the N/LRs were closely related to interleukin (IL)-6 and IL-10 (P < 0.001, P = 0.024) and to CD3+ and CD8+ T lymphocytes (P < 0.001, P = 0.046). In particular, the N/LRs were positively correlated with the severity and course of the disease (P = 0.021, P < 0.001). Compared to the values at the first test after admission, IL-6 and IL-10 were significantly decreased and increased, respectively, as of the last test before discharge (P = 0.006, P < 0.001). More importantly, through binary logistic regression, we found that male sex, underlying diseases (such as cardiovascular disease), pulse, and N/LRs were all closely related to the severity of the disease (P = 0.004, P = 0.012, P = 0.013, P = 0.028).

Conclusions

As a quick and convenient marker of inflammation, N/LRs may predict the disease course and severity level of non-mild COVID-19; male sex, cardiovascular disease, and pulse are also risk factors for the severity of non-mild COVID-19.

Bioinspired, Self-Powered, and Highly Sensitive Electronic Skin for Sensing Static and Dynamic Pressures

Flexible piezoresistive pressure sensors obtain global research interest owing to their potential applications in healthcare, human-robot interaction, and artificial nerves. However, an additional power supply is usually required to drive the sensors, which results in increased complexity of the pressure sensing system. Despite the great efforts in pursuing self-powered pressure sensors, most of the self-powered devices can merely detect the dynamic pressure and the reliable static pressure detection is still challenging. With the help of redox-induced electricity, a bioinspired graphite/polydimethylsiloxane piezoresistive composite film acting both as the cathode and pressure sensing layer, a neoteric electronic skin sensor is presented here to detect not only the dynamic forces but also the static forces without an external power supply. Additionally, the sensor exhibits a fascinating pressure sensitivity of ∼10³ kPa^-1 over a broad sensing range from 0.02 to 30 kPa. Benefiting from the advanced performance of the device, various potential applications including arterial pulse monitoring, human motion detecting, and Morse code generation are successfully demonstrated. This new strategy could pave a way for the development of next-generation self-powered wearable devices.

Pulsus alternans in a critically ill dog hospitalized for xylitol toxicity

A 2-year-old spayed female Great Pyrenees cross dog was presented following the consumption of pure xylitol sweetener. Blood tests revealed hepatocellular leakage and cholestasis, hyperlactatemia, thrombocytopenia, and prolonged prothrombin and activated partial thromboplastin times. Thoracic radiographs on day 2 of hospitalization were consistent with pulmonary hemorrhage. Prior to death, the dog developed pulsus alternans suggestive of myocardial dysfunction secondary to severe systemic inflammation. This is the first report of pulsus alternans in a critically ill dog prior to clinical deterioration and death. This is also the first documentation of pulsus alternans with a high-definition oscillometric device. Key clinical message: Increased recognition of pulsus alternans and its potential implications in veterinary medicine may contribute to the identification of cardiovascular complications associated with systemic disease.

Multi-source Multi-frequency Bio-impedance Measurement Method for Localized Pulse Wave Monitoring

Continuous monitoring of cardiac parameters such as blood pressure (BP) and pulse transit time (PTT) from wearable devices can improve the diagnosis and management of the cardiovascular disease. Continuous monitoring of these parameters depends on monitoring arterial pulse wave based on the blood volume changes in the artery using non-invasive sensors such as bio-impedance (Bio-Z). PTT and BP monitoring require the measurement of multiple pulse signals along the artery through the placement of multiple sensors within a small distance. Conventionally, these Bio-Z sensors are excited by a single shared current source, which results in low directivity and distortion of pulse signal due to the interaction of the different sensors together. For a localized pulse sensing, each sensor should focus on a certain point on the artery to provide the most accurate arterial pulse wave, which improves PTT and BP readings. In this paper, we propose a multi-source multi-frequency method for multi-sensor Bio-Z measurement that relies on using separate current sources for each sensor with different frequencies to allow the separation of these signals in the frequency domain, which results in isolation in the spatial domain. The effectiveness of the new method was demonstrated by a reduction in the inter-beat-interval (IBI) root mean square error (RMSE) by 19% and an increase of average PTT by 15% compared to the conventional method.

Making collapsing pulse user-friendly

Collapsing pulse is generally elicited by elevating the patient's arm. However, the pulse becoming stronger on arm elevation is a physiological phenomenon, which is bound to create confusion, if routine lifting of the arm in search of collapsing pulse is practiced. The name 'collapsing pulse' represents only the second component of this sign. It masks the more important first component - the slapping, bounding upstroke, characterised by its other name 'water-hammer pulse'. It is possible to elicit this sign by appreciating the slapping character on routine pulse examination. The insistence on arm lifting in medical school teaching is better avoided.

Printed, Soft, Nanostructured Strain Sensors for Monitoring of Structural Health and Human Physiology

Soft strain sensors that are mechanically flexible or stretchable are of significant interest in the fields of structural health monitoring, human physiology, and human-machine interfaces. However, existing deformable strain sensors still suffer from complex fabrication processes, poor reusability, limited adhesion strength, or structural rigidity. In this work, we introduce a versatile, high-throughput fabrication method of nanostructured, soft material-enabled, miniaturized strain sensors for both structural health monitoring and human physiology detection. Aerosol jet printing of polyimide and silver nanowires enables multifunctional strain sensors with tunable resistance and gauge factor. Experimental study of soft material compositions and multilayered structures of the strain sensor demonstrates the capabilities of strong adhesion and conformal lamination on different surfaces without the use of conventional fixtures and/or tapes. A two-axis, printed strain gauge enables the detection of force-induced strain changes on a curved stem valve for structural health management while offering reusability over 10 times without losing the sensing performance. Direct comparison with a commercial film sensor captures the advantages of the printed soft sensor in enhanced gauge factor and sensitivity. Another type of a stretchable strain sensor in skin-wearable applications demonstrates a highly sensitive monitoring of a subject's motion, pulse, and breathing, validated by comparing it with a clinical-grade system. Overall, the presented comprehensive study of materials, mechanics, printing-based fabrication, and interfacial adhesion shows a great potential of the printed soft strain sensor for applications in continuous structural health monitoring, human health detection, machine-interfacing systems, and environmental condition monitoring.

Highly Wearable, Breathable, and Washable Sensing Textile for Human Motion and Pulse Monitoring

At present, pressure sensor textiles are of great significance in the area of wearable electronics, especially for making smart or intelligent textiles. However, the design of these textile-based devices with sensitive ability, simple fabrication, and low cost is still challenging. In this study, we developed a triboelectric sensing textile constructed with core-shell yarns. Nylon filament and polytetrafluoroethylene filament were selected as the positive and negative layers, respectively, in the woven structure while the built-in helical stainless steel yarn was serving as the inner electrode layer. The sensitivity of the sensing textile can reach up to 1.33 V·kPa^-1 and 0.32 V·kPa^-1 in the pressure range of 1.95-3.13 kPa and 3.20-4.61 kPa, respectively. This sensing textile presented good mechanical stability and sensing capability even after 4200 cycles of continuous operation or after 4 h continuous water washing. Benefiting from the favorable merits of being highly flexible, breathable, lightweight, and even dyeable, the fabricated device was capable of being placed on any desired body parts for quantifying the dynamic human motions. It can be effectively used to measure and monitor various human movements associated with different joints, such as the hand, elbow, knee, and underarm. Moreover, the sensing textile was able to capture real-time pulse signals and reflect the current health status for human beings. This study affords an innovative and promising track for multifunctional pressure sensor textiles with wide applications in smart textiles and personalized healthcare.

Cardiovascular and Autonomic Dysfunction in Murine Ligature-Induced Periodontitis

The present study examined the hemodynamics [arterial pressure (AP), AP variability (APV), heart rate (HR), and heart rate variability (HRV)], cardiac function (echocardiographycally), and myocardial inflammation in Balb/c mice submitted to Periodontitis, through the ligation of the left first molar, or Sham surgical procedure. The first protocol indicated that the AP was similar (136 ± 2 vs. 132 ± 3 mmHg in Sham), while the HR was higher in mice with Periodontitis (475 ± 20 vs. 412 ± 18 bpm in Sham), compared to their Sham counterparts. The APV was higher in mice with Periodontitis when evaluated in the time domain (4.5 ± 0.3 vs. 3.4 ± 0.2 mmHg in Sham), frequency domain (power of the LF band of systolic AP), or through symbolic analysis (patterns 0V + 1V), indicating a sympathetic overactivity. The HRV was similar in the mice with Periodontitis, as compared to their Sham counterparts. In the second protocol, the mice with Periodontitis showed decreased cardiac output (10 ± 0.8 vs. 15 ± 1.4 mL/min in Sham) and ejection fraction (37 ± 3 vs. 47 ± 2% in Sham) associated with increased myocardial cytokines (Interleukin-17, Interleukin-6, and Interleukin-4). This study shows that experimental Periodontitis caused cardiac dysfunction, increased heart cytokines, and sympathetic overactivity, in line with epidemiological studies indicating an increased risk of cardiovascular events in clinical Periodontitis.

Automatic Artifact Detection in Impedance Cardiogram Using Pulse Similarity Index

Impedance cardiography (ICG) is a noninvasive technique for evaluation of cardiac hemodynamic parameters such as cardiac output and pre-ejection period. However, the sensitivity of the technique to motion artifact, electrode displacement, and cardiovascular pathologies can severely impact the accuracy of hemodynamic parameter estimates. In this paper, we proposed a new algorithm for the automatic detection and exclusion of corrupted ICG cardiac cycles by defining a pulse similarity index that quantifies the level of pulse corruption and its diversion from a typical-shaped pulse. The index considers different features (activity, structure, shape, and pattern) of the ICG cardiac cycles. The algorithm is compared on sleep data collected from 20 participants against expert identified corrupted cycles. The artifact rejection algorithm achieved a high accuracy of 96% in detection of expert-identified corrupted ICG cycles, including those with normal amplitude as well as out-of-range values, and was robust to different types and levels of artifact. The algorithm shows promise toward applications requiring accurate and reliable automatic measurement of cardiac hemodynamic parameters from prolonged data sets.

Machine-knitted washable sensor array textile for precise epidermal physiological signal monitoring

Wearable textile electronics are highly desirable for realizing personalized health management. However, most reported textile electronics can either periodically target a single physiological signal or miss the explicit details of the signals, leading to a partial health assessment. Furthermore, textiles with excellent property and comfort still remain a challenge. Here, we report a triboelectric all-textile sensor array with high pressure sensitivity and comfort. It exhibits the pressure sensitivity (7.84 mV Pa^-1), fast response time (20 ms), stability (>100,000 cycles), wide working frequency bandwidth (up to 20 Hz), and machine washability (>40 washes). The fabricated TATSAs were stitched into different parts of clothes to monitor the arterial pulse waves and respiratory signals simultaneously. We further developed a health monitoring system for long-term and noninvasive assessment of cardiovascular disease and sleep apnea syndrome, which exhibits great advancement for quantitative analysis of some chronic diseases.

Impact of initial heart failure emergence on clinical outcomes of atrial fibrillation patients in the AFFIRM trial

BACKGROUND

Heart failure (HF) emergence in atrial fibrillation (AF) patients undergoing different treatment strategies has not been studied.

METHODS

AFFIRM trial subjects with no history of HF, without clinical HF and normal left ventricular ejection fraction at enrollment were identified. The principal outcome was time to development of a composite of New York Heart Association class ≥II HF and/or cardiovascular (CV) death. It was compared for rate and rhythm strategies and correlated with electrocardiographic parameters on follow-up (FU).

RESULTS

A total of 1,771 patients (880 rate, 891 rhythm) were evaluated. The principal outcome occurred in 21.4% of rate and 16.8% of rhythm subjects at 5 years (hazard ratio [HR] 1.32, 95% CI 1.04-1.69, P = .024). HF increment by 2 classes increased total mortality (HR 2.83, 95% CI 1.91-4.18, P < .0001), cardiac mortality, (HR 4.27, 95% CI 2.03-9.04, P = .0001), and CV hospitalizations (HR 3.04, 95% CI 2.15-4.29, P < .0001). HF emergence during FU was associated with AF (P = .0004), ventricular rate >80 beats/min (P = .0106), and higher frequency of recorded AF in the rhythm arm (25%-75% vs <25%, HR 1.69, 95% CI 1.09-2.64, P = .020; >75% vs <25%, HR 3.15, 95% CI 1.87-5.34, P =< .001).

CONCLUSIONS

(1) In AF patients without HF, symptomatic HF emergence was more frequent with rate control than with rhythm control. (2) HF appearance presages increased mortality risk. (3) Delaying HF emergence is associated with effective rhythm control with documented sinus rhythm during >75% of FU visits as well as ventricular rate control.

Evaluation of Facial Pulse Signals using Deep Neural Net Models

The reliable measurement of the pulse rate using remote photoplethysmography (PPG) is very important for many medical applications. In this paper we present how deep neural networks (DNNs) models can be used in the problem of PPG signal classification and pulse rate estimation. In particular, we show that the DNN-based classification results correspond to parameters describing the PPG signals (e.g. peak energy in the frequency domain, SNR, etc.). The results show that it is possible to identify regions of a face, for which reliable PPG signals can be extracted. The accuracy obtained for the classification task and the mean absolute error achieved for the regression task proved the usefulness of the DNN models.