Non-Contact Measurement of Blood Oxygen Saturation Using Facial Video Without Reference Values.

The continuous measurement of percutaneous oxygen saturation (SpO2) enables diseases that cause hypoxemia to be detected early and patients' conditions to be monitored. Currently, SpO2 is mainly measured using a pulse oximeter, which, owing to its simplicity, can be used in clinical settings and at home. However, the pulse oximeter requires a sensor to be in contact with the skin; therefore, prolonged use of the pulse oximeter for neonates or patients with sensitive skin may cause local inflammation or stress due to restricted movement. In addition, owing to COVID-19, there has been a growing demand for the contactless measurement of SpO2. Several studies on measuring SpO2 without contact used skin video images have been conducted. However, in these studies, the SpO2 values were estimated using a linear regression model or a look-up table that required reference values obtained using a contact-type pulse oximeter. In this study, we propose a new technique for the contactless measurement of SpO2 that does not require reference values. Specifically, we used certain approaches that reduced the influence of non-pulsating components and utilized different light wavelengths of video images that penetrated subcutaneously to different depths. We experimentally investigated the accuracy of SpO2 measurements using the proposed methods. The results indicate that the proposed methods were more accurate than the conventional method.

Prediction and prevention system for Severe Acute Respiratory Syndrome CoronaVirus 2 infection by preempting the onset of a cough.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is fast becoming one of the most significant infections worldwide. Of all the causes of SARS-CoV-2 infection, airborne-droplet infection via coughing is the most common. Therefore, if predicting the onset of a cough and preventing infection were possible, it would have a globally positive impact. Here, we describe a new prediction and prevention system for SARS-CoV-2 infection. Usually, air is inhaled prior to coughing, and the cough, which contains droplets of the virus, then occurs during acute exhalation. Therefore, if we can predict the onset of a cough, we can prevent the spread of SARS-CoV-2. At Tohoku University, a diagnosis system for evaluating swallowing motions and peripheral circulation has already been developed, and our prediction system can be integrated into this system. Using three-dimensional human body imaging, we developed a prediction system for preempting the onset of a cough. If we can predict the onset a cough, we can prevent the spread of SARS-CoV-2 infection, by decreasing the shower of virally active airborne droplets. Here, we describe the newly developed prediction and prevention system for SARS-CoV-2 infection that preempts the onset of a cough.Clinical Relevance- If predicting the onset of a cough and preventing infection were possible, it would have a globally positive impact. Here, we describe the newly developed prediction and prevention system for SARS-CoV-2 infection.

A Deep Learning Aided Drowning Diagnosis for Forensic Investigations using Post-Mortem Lung CT Images.

Feasibility of computer-aided diagnosis (CAD) systems has been demonstrated in the field of medical image diagnosis. Especially, deep learning based CAD systems showed high performance thanks to its capability of image recognition. However, there is no CAD system developed for post-mortem imaging diagnosis and thus it is still unclear if the CAD system is effective for this purpose. Particulally, the drowning diagnosis is one of the most difficult tasks in the field of forensic medicine because findings of the post-mortem image diagnosis are not specific. To address this issue, we develop a CAD system consisting of a deep convolution neural network (DCNN) to classify post-mortem lung computed tomography (CT) images into two categories of drowning and non-drowning cases. The DCNN was trained by means of transfer learning and performance evaluation was conducted by 10-fold cross validation using 140 drowning cases and 140 non-drowning cases of the CT images. The area under the receiver operating characteristic curve (AUC-ROC) for the DCNN was achieved 0.88 in average. This high performance clearly demonstrated that the proposed DCNN based CAD system has a potential for post-mortem image diagnosis of drowning.

Comparison of Visible and Infrared Video Plethysmography Captured from Different Regions of the Human Face.

Recently, video plethysmography (VPG) - a heart rate estimation technique using a video camera - has gained significant attention. Most studies of VPG have used a visible RGB camera; only a limited number of studies investigating near-infrared light (wavelength 750-2500 nm), which can be used even in a dark environment, have been performed. The purpose of this study was to investigate the differences between VPG data collected using visible light (VPGVIS) or near-infrared light (VPGNIR) from four facial areas (forehead, right cheek, left cheek, and nose). An experiment was conducted to obtain both VPGVIS and VPGNIR simultaneously by alternately irradiating the face with NIR and VIS lights. Experimental results showed that the root mean squared error of heart rate estimated using VPGNIR was 1 bpm higher than that of VPGVIS. However, contrary to our expectations, the power of the heartbeat-related component included in VPGNIR was not reduced despite the absorbance of hemoglobin in the NIR light range being 1/100 of that in the VIS light range. This result supports the hypothesis that a main factor in the generation of VPG waves was change in the optical properties caused by blood vessels compressing the subcutaneous tissue and the venous bed. Additionally, the accuracy of the heart rate estimation using VPG tended to be high when the nose was set as the ROI. This result was likely associated with the anatomical structure of the nose.

Evaluation of the Pulse wave in the face for the patients with rotary blood pump (RP) in the Outpatient clinic.

Rotary blood pump (RP) is one of the most important devices in the treatment of profound heart failure and is known to reduce the pulse in the blood pressure waveform, especially when it is used for axial flow. In an outpatient clinic, checking the pulse of a patient implanted with an RP can help diagnose the patient's condition. For that purpose, animal experiments with healthy adult goats implanted with the EVAHEART system were carried out after obtaining ethical committee approval. Visual imaging of the goats' faces was recorded using a video camera. The pulse waves were clearly recorded using the newly developed pulse diagnosis system with video imaging and compared with laser Doppler flowmeter and time series data. Spectral analysis of the time series data showed the usefulness of video imaging from outside the body. Clinical applications are planned, and this newly developed method is expected to be a useful diagnostic method for evaluating the cardiac function in patients implanted with RPs in the future.

Pulse rate variability: a new biomarker, not a surrogate for heart rate variability.

With the popularization of pulse wave signals by the spread of wearable watch devices incorporating photoplethysmography (PPG) sensors, many studies are reporting the accuracy of pulse rate variability (PRV) as a surrogate of heart rate variability (HRV). However, the authors are concerned about their research paradigm based on the assumption that PRV is a biomarker that reflects the same biological properties as HRV. Because PPG pulse wave and ECG R wave both reflect the periodic beating of the heart, pulse rate and heart rate should be equal, but it does not guarantee that the respective variabilities are also the same. The process from ECG R wave to PPG pulse wave involves several transformation steps of physical properties, such as those of electromechanical coupling and conversions from force to volume, volume to pressure, pressure impulse to wave, pressure wave to volume, and volume to light intensity. In fact, there is concreate evidence that shows discrepancy between PRV and HRV, such as that demonstrating the presence of PRV in the absence of HRV, differences in PRV with measurement sites, and differing effects of body posture and exercise between them. Our observations in adult patients with an implanted cardiac pacemaker also indicate that fluctuations in R-R intervals, pulse transit time, and pulse intervals are modulated differently by autonomic functions, respiration, and other factors. The authors suggest that it is more appropriate to recognize PRV as a different biomarker than HRV. Although HRV is a major determinant of PRV, PRV is caused by many other sources of variability, which could contain useful biomedical information that is neither error nor noise.

Noise Reduction Technique for Single-Color Video Plethysmography Using Singular Spectrum Analysis.

Recently, a contactless method for measuring a biological signal using a video camera has garnered attention. Especially, video plethysmography, a technique for obtaining a pulse wave from a video, is useful for managing the health of people on a daily basis. However, any body movement of a person subjected to the measurement leads to the generation of irregular noise in video plethysmography and reduces the accuracy of the recorded biological information, e.g., heart rate, during the measurement. Blind source separation is a popular technique for eliminating noise from the results of video plethysmography comprising different multiple-color channels. However, it is difficult to apply this technique to a single-color video such as a near-infrared video. Herein, a new method that combines singular spectrum analysis with the circular autocorrelation function is introduced to eliminate irregular noise in single-color video plethysmography. Applying the proposed method on videos collected from 39 individuals improved the estimation accuracy of instantaneous heart rate by approximately 44% over a conventional method using a linear filter. Furthermore, the proposed method also enabled more precise estimations of the heart rate than that achieved using multi-color video plethysmography.

Parasympathetic activity correlates with subjective and brain responses to rectal distension in healthy subjects but not in non-constipated patients with irritable bowel syndrome.

The nociceptive and autonomic nervous systems (ANS) are significantly intertwined. Decoupling of these systems may occur in pathological pain conditions, including irritable bowel syndrome (IBS). We investigated ANS activity and its association with visceral perception and brain activity during rectal distention in 27 patients with non-constipated IBS and 33 controls by assessing heart rate variability (HRV) using electrocardiography at rest, before, and during colorectal distention. Brain responses to colorectal distention were measured using functional magnetic resonance imaging and correlated with individual ANS function parameters. The IBS group displayed blunted sympathovagal balance [low/high-frequency ratio (LF:HF) of HRV] in response to colorectal distention compared with controls (P = 0.003). In controls, basal parasympathetic tone (HF component of HRV) was significantly negatively correlated with toleration threshold to the rectal distention, but not in patients with IBS (group comparison P = 0.04). Further, a positive correlation between baseline HF values and neural responses to rectal distension was found in the right caudate, bilateral dorsolateral anterior cingulate cortex, and pregenual anterior cingulate cortex in the control group but not in the IBS group. The results indicate abnormal interactions between ANS activity and the brain mechanisms underlying visceral perception in patients with IBS.

Estimation of Absolute Blood Pressure Using Video Images Captured at Different Heights from the Heart.

The risk of cardiovascular diseases is related to the absolute level of blood pressure as well as its fluctuation while sleeping or during daily activities. To assess the risk, a simpler method to monitor daily blood pressure is desirable. In recent years, there has been a focus on developing a method to obtain pulse waves from video images of the human body. This is a promising technique to acquire biometric information without contact. In this study, we propose a new method to estimate the absolute level of blood pressure by using two video images of human hands captured at different heights from the heart. We focus on the amplitude difference of pulse waves obtained from the video images and derive an equation to estimate blood pressure based on the relationship between the internal pressure and the cross-sectional area of the blood vessel. The accuracy of the estimation was evaluated using data obtained from 5 healthy subjects performing cycling exercises that change their blood pressure. The average value of the root mean square error between the real value and the estimated value was 25.7 mmHg, while that of correlation coefficient was 0.66. There were large individual differences, particularly in the estimation of the absolute value of blood pressure. This result suggests the need for individual correction of the compliance curve, which represents the relationship between the internal pressure and the cross-sectional area of the blood vessel.

Altered brain and gut responses to corticotropin-releasing hormone (CRH) in patients with irritable bowel syndrome.

Stress is a known trigger of irritable bowel syndrome (IBS) and exacerbates its gastrointestinal symptoms. However, underlying the physiological mechanism remains unknown. Here, we investigated hypothalamic-pituitary-adrenal (HPA) axis, colonic motility, and autonomic responses to corticotropin-releasing hormone (CRH) administration as well as brain activity alterations in IBS. The study included 28 IBS patients and 34 age and sex-matched healthy control subjects. IBS patients demonstrated greater adrenocorticotropic hormone (ACTH) responses to CRH than control subjects. Male IBS patients had greater increases in colonic motility than male HCs after CRH. Female IBS patients showed altered sympathovagal balance and lower basal parasympathetic tone relative to female control subjects. Brain responses to rectal distention were measured in the same subjects using functional magnetic resonance imaging, and their associations with individual ACTH responses to CRH were tested. A negative association between ACTH response to CRH and activity in the pregenual anterior cingulate cortex (pACC) during rectal distention was identified in controls but not in IBS patients. Impaired top-down inhibitory input from the pregenual ACC to the HPA axis may lead to altered neuroendocrine and gastrointestinal responses to CRH. Centrally acting treatments may dampen the stress induced physical symptoms in IBS.

Sensorless cardiac phase detection for synchronized control of ventricular assist devices using nonlinear kernel regression model.

Recently, driving methods for synchronizing ventricular assist devices (VADs) with heart rhythm of patients suffering from severe heart failure have been receiving attention. Most of the conventional methods require implanting a sensor for measurement of a signal, such as electrocardiogram, to achieve synchronization. In general, implanting sensors into the cardiovascular system of the patients is undesirable in clinical situations. The objective of this study was to extract the heartbeat component without any additional sensors, and to synchronize the rotational speed of the VAD with this component. Although signals from the VAD such as the consumption current and the rotational speed are affected by heartbeat, these raw signals cannot be utilized directly in the heartbeat synchronization control methods because they are changed by not only the effect of heartbeat but also the change in the rotational speed itself. In this study, a nonlinear kernel regression model was adopted to estimate the instantaneous rotational speed from the raw signals. The heartbeat component was extracted by computing the estimation error of the model with parameters determined by using the signals when there was no effect of heartbeat. Validations were conducted on a mock circulatory system, and the heartbeat component was extracted well by the proposed method. Also, heartbeat synchronization control was achieved without any additional sensors in the test environment.

Blood perfusion display based on video pulse wave.

In this study, an easy system for monitoring dynamic blood perfusion patterns and the pulse wave velocity (PWV) has been developed by processing video images of a human body to assess blood circulation for daily management of physical conditions or for detecting persons in poor physical condition in public places. The experiment suggested that this tool can be used to easily evaluate the PWV; however, the obtained value from the video image of the face was about 1/10 of the standard value calculated from thick vessels. This difference may be related to the difference between thick vessels and thin-branched arterioles.

The Pilot Study of Evaluating Fluctuation in the Blood Flow Volume of the Radial Artery, a Site for Traditional Pulse Diagnosis.

BACKGROUND: Radial artery (RA) pulse diagnosis has been used in traditional Asian medicine. Blood pressure (BP) and pulse rate related to heart rate variability (HRV) can be monitored via the RA. The fluctuation in these parameters has been assessed using fast Fourier transform (FFT) analytical methods that calculate power spectra. METHODS: We measured blood flow volume (Volume) in the RA and evaluated its fluctuations. Normal participants (n = 34) were enrolled. We measured the hemodynamics of the right RA for approximately 50 s using ultrasonography. RESULTS: The parameters showed the center frequency (CF) of the power spectrum at low frequency (LF) and high frequency (HF). More than one spectral component indicated that there were fluctuations. The CF at LF for Volume was significantly different from that for vessel diameter (VD); however, it was significantly correlated with blood flow velocity (Velocity). On the other hand, the CF at HF for Volume was significantly different from that for Velocity; however, it was significantly correlated with VD. CONCLUSION: It is suggested that fluctuation in the Volume at LF of RA is influenced by the fluctuation in Velocity; on the other hand, fluctuation in the Volume at HF is influenced by the fluctuation in VD.

Estimation of heart rate variability using a compact radiofrequency motion sensor.

Physiological indices that reflect autonomic nervous activity are considered useful for monitoring peoples' health on a daily basis. A number of such indices are derived from heart rate variability, which is obtained by a radiofrequency (RF) motion sensor without making physical contact with the user's body. However, the bulkiness of RF motion sensors used in previous studies makes them unsuitable for home use. In this study, a new method to measure heart rate variability using a compact RF motion sensor that is sufficiently small to fit in a user's shirt pocket is proposed. To extract a heart rate related component from the sensor signal, an algorithm that optimizes a digital filter based on the power spectral density of the signal is proposed. The signals of the RF motion sensor were measured for 29 subjects during the resting state and their heart rate variability was estimated from the measured signals using the proposed method and a conventional method. A correlation coefficient between true heart rate and heart rate estimated from the proposed method was 0.69. Further, the experimental results showed the viability of the RF sensor for monitoring autonomic nervous activity. However, some improvements such as controlling the direction of sensing were necessary for stable measurement.

The effects of short-term hypoxia on human mesenchymal stem cell proliferation, viability and p16(INK4A) mRNA expression: Investigation using a simple hypoxic culture system with a deoxidizing agent.

A hypoxic environment is thought to be important for the maintenance of stemness and suppressing cell senescence, in stem cells. Therefore, a hypoxic condition is induced during cell expansion and/or induction of intended differentiation. However, the induction of these conditions requires a specially equipped hypoxia chamber and expensive gas mixtures, which are expensive and space-consuming. Owing to these restrictions, appropriate hypoxic conditions cannot be provided during cell transportation, which is increasingly required for regenerative medicine. Hence, a simple and economical culture system is required. The purpose of this study was to investigate the effects of short-term hypoxic conditions on human mesenchymal stem cell (MSC) proliferation, viability, and senescence, utilizing the CulturePal system (CulturePal-Zero and CulturePal-Five), a novel and simple hypoxic culture system with a built-in deoxidizing agent. The O2 concentration in the CulturePal-Zero was observed to reduce to <0.1% within 1 h, and to 5% within 24h in the CulturePal-Five system. Cell proliferation under these hypoxic conditions showed a sharp increase at 5% O2 concentration, and no noticeable cell death was observed even at severe hypoxic conditions (<0.1% O2) up to 72h. The p16(INK4A) (cell senescence marker) mRNA expression was retained under hypoxic conditions up to 72h, but it was up-regulated under normoxic conditions. Interestingly, the p16(INK4A) expression altered proportionately to the O2 concentration. These results indicated that the short-term hypoxic condition, at an approximate O2 concentration of 5%, would be suitable for promoting cell proliferation and repressing cell senescence, without aggravating the MSC viability. Therefore, the CulturePal systems may be suitable for providing an appropriate hypoxic condition in stem cell research and transportation.

Tracking tumor boundary in MV-EPID images without implanted markers: A feasibility study.

PURPOSE: To develop a markerless tracking algorithm to track the tumor boundary in megavoltage (MV)-electronic portal imaging device (EPID) images for image-guided radiation therapy. METHODS: A level set method (LSM)-based algorithm is developed to track tumor boundary in EPID image sequences. Given an EPID image sequence, an initial curve is manually specified in the first frame. Driven by a region-scalable energy fitting function, the initial curve automatically evolves toward the tumor boundary and stops on the desired boundary while the energy function reaches its minimum. For the subsequent frames, the tracking algorithm updates the initial curve by using the tracking result in the previous frame and reuses the LSM to detect the tumor boundary in the subsequent frame so that the tracking processing can be continued without user intervention. The tracking algorithm is tested on three image datasets, including a 4-D phantom EPID image sequence, four digitally deformable phantom image sequences with different noise levels, and four clinical EPID image sequences acquired in lung cancer treatment. The tracking accuracy is evaluated based on two metrics: centroid localization error (CLE) and volume overlap index (VOI) between the tracking result and the ground truth. RESULTS: For the 4-D phantom image sequence, the CLE is 0.23 ± 0.20 mm, and VOI is 95.6% ± 0.2%. For the digital phantom image sequences, the total CLE and VOI are 0.11 ± 0.08 mm and 96.7% ± 0.7%, respectively. In addition, for the clinical EPID image sequences, the proposed algorithm achieves 0.32 ± 0.77 mm in the CLE and 72.1% ± 5.5% in the VOI. These results demonstrate the effectiveness of the authors' proposed method both in tumor localization and boundary tracking in EPID images. In addition, compared with two existing tracking algorithms, the proposed method achieves a higher accuracy in tumor localization. CONCLUSIONS: In this paper, the authors presented a feasibility study of tracking tumor boundary in EPID images by using a LSM-based algorithm. Experimental results conducted on phantom and clinical EPID images demonstrated the effectiveness of the tracking algorithm for visible tumor target. Compared with previous tracking methods, the authors' algorithm has the potential to improve the tracking accuracy in radiation therapy. In addition, real-time tumor boundary information within the irradiation field will be potentially useful for further applications, such as adaptive beam delivery, dose evaluation.

Techniques for estimating blood pressure variation using video images.

It is important to know about a sudden blood pressure change that occurs in everyday life and may pose a danger to human health. However, monitoring the blood pressure variation in daily life is difficult because a bulky and expensive sensor is needed to measure the blood pressure continuously. In this study, a new non-contact method is proposed to estimate the blood pressure variation using video images. In this method, the pulse propagation time difference or instantaneous phase difference is calculated between two pulse waves obtained from different parts of a subject's body captured by a video camera. The forehead, left cheek, and right hand are selected as regions to obtain pulse waves. Both the pulse propagation time difference and instantaneous phase difference were calculated from the video images of 20 healthy subjects performing the Valsalva maneuver. These indices are considered to have a negative correlation with the blood pressure variation because they approximate the pulse transit time obtained from a photoplethysmograph. However, the experimental results showed that the correlation coefficients between the blood pressure and the proposed indices were approximately 0.6 for the pulse wave obtained from the right hand. This result is considered to be due to the difference in the transmission depth into the skin between the green and infrared light used as light sources for the video image and conventional photoplethysmogram, respectively. In addition, the difference in the innervation of the face and hand may be related to the results.

A kernel-based method for markerless tumor tracking in kV fluoroscopic images.

Markerless tracking of respiration-induced tumor motion in kilo-voltage (kV) fluoroscopic image sequence is still a challenging task in real time image-guided radiation therapy (IGRT). Most of existing markerless tracking methods are based on a template matching technique or its extensions that are frequently sensitive to non-rigid tumor deformation and involve expensive computation. This paper presents a kernel-based method that is capable of tracking tumor motion in kV fluoroscopic image sequence with robust performance and low computational cost. The proposed tracking system consists of the following three steps. To enhance the contrast of kV fluoroscopic image, we firstly utilize a histogram equalization to transform the intensities of original images to a wider dynamical intensity range. A tumor target in the first frame is then represented by using a histogram-based feature vector. Subsequently, the target tracking is then formulated by maximizing a Bhattacharyya coefficient that measures the similarity between the tumor target and its candidates in the subsequent frames. The numerical solution for maximizing the Bhattacharyya coefficient is performed by a mean-shift algorithm. The proposed method was evaluated by using four clinical kV fluoroscopic image sequences. For comparison, we also implement four conventional template matching-based methods and compare their performance with our proposed method in terms of the tracking accuracy and computational cost. Experimental results demonstrated that the proposed method is superior to conventional template matching-based methods.

Discrimination ability and reproducibility of a new index reflecting autonomic nervous function based on pulsatile amplitude of photoplethysmography.

A new physiological index (µ(PA)) is proposed to represent the autonomic nervous system (ANS) function. The index µ(PA) is defined as the natural logarithm of the ratio between two different frequency components of the pulsatile amplitude of the photoplethysmogram (PPG) signal. The discrimination ability and the reproducibility of µ(PA) have been compared with other traditional ANS indices. In the experiment, the electrocardiogram, the PPG and continuous blood pressure were measured in 59 healthy young subjects (age 25.7 ± 6.3) and 86 healthy elderly subjects (age 70.2 ± 4.1) at rest. The discrimination ability and the reproducibility were evaluated by Cohen's d between young and elderly groups and by the interclass correlation coefficient, respectively. The results showed that the elderly subjects were significantly (p<;0.001) lower than young subjects in µ(PA) and a few traditional indices introduced to be compared with µ(PA). Therefore, it suggests that µ(PA) is associated with the decrease in the ANS function accompanied by aging. Moreover, it showed that the discrimination ability and the reproducibility of the proposed index are comparable or larger than those of traditional indices. The proposed index based on the PPG signal will be applied to tele-healthcare systems for monitoring people's health in daily life in combination with the ratio of the standard deviation of the R-R intervals to their average value (CVRR).

Evaluation of motor performances of hemiplegic patients using a virtual cycling wheelchair: an exploratory trial.

Cycling is known to be an effective rehabilitation exercise for hemiplegic patients who face difficulty during walking because of stroke or other brain disorders. A cycling wheelchair (CWC) is a useful tool to provide exercise for these patients and improve their quality of life. In previous studies, our group developed a system that allows patients to safely practice driving a CWC in a virtual environment. However, it has been difficult to check their motor performances and determine the effects of the exercise on a daily basis. This study is an exploratory trial for developing a method to evaluate the motor performances of users based on their CWC pedaling patterns. An experiment with some hemiplegic patients and healthy subjects was conducted and their pedaling patterns were analyzed. Results showed a significant difference between the hemiplegic patients and healthy subjects in an index that reflects pedaling balance between the feet. This result indicates a possible method of evaluating the motor performances of users based on their pedaling patterns.