Associations between Aging and Vitamin D Status with Whole-Body Nitric Oxide Production and Markers of Endothelial Function.

BACKGROUND: Aging and vitamin D deficiency have been associated with reduced nitric oxide (NO) synthesis and impaired endothelial function (EF) but the evidence in humans remains weak. OBJECTIVES: Two independent cross-sectional studies were designed to evaluate the association between age, sex, and plasma vitamin D concentrations with physiological and biochemical biomarkers of NO synthesis and EF in young and older healthy participants (Study 1) and in overweight and obese postmenopausal females (Study 2). METHODS: In Study 1, 40 young (20-49 y) and older (50-75 y) males and females (10 participants per age and sex group) were included. Resting blood pressure and ear-to-finger peripheral pulse wave velocity (PWV) were measured. A stable-isotopic method was used to determine whole-body NO production. Plasma 25-hydroxyvitamin D (25(OH)D), nitrate, nitrite, and asymmetric dimethylarginine (ADMA) concentrations were determined. In Study 2, 80 older overweight and obese females (age 61.2 ± 6.2 y, body mass index 29.5 ± 4.4 kg/m2) were recruited. Postocclusion reactive hyperemia (PORH) and peripheral PWV were measured. Plasma concentrations of 25(OH)D, nitrate, cyclic guanosine monophosphate, 3-nitrotyrosine (3-NT), endothelin-1, vascular endothelial growth factor, and ADMA were determined. RESULTS: In Study 1, whole-body NO production was significantly greater in young compared with older participants (0.61 ± 0.30 µmol·h-1·kg-1 compared with 0.39 ± 0.10 µmol·h-1·kg-1, P = 0.01) but there was no evidence of a sex difference (P = 0.81). Plasma 25(OH)D concentration was not associated with PWV (r = 0.18, P = 0.28) or whole-body NO production (r = -0.20, P = 0.22). Plasma ADMA concentration was associated positively with age (r = 0.35, P = 0.03) and negatively with whole-body NO production (r = -0.33, P = 0.04). In Study 2, age was associated with lower PORH (r = -0.28, P = 0.02) and greater ADMA concentrations (r = 0.22, P = 0.04). Plasma 25(OH)D concentration was inversely associated with 3-NT concentrations (r = -0.31, P = 0.004). CONCLUSIONS: Older age was associated with lower whole-body NO production. Plasma vitamin D concentrations were not associated with NO production or markers of EF but showed a weak, significant correlation with oxidative stress in postmenopausal overweight females.

Real-Time Evaluation of Time-Domain Pulse Rate Variability Parameters in Different Postures and Breathing Patterns Using Wireless Photoplethysmography Sensor: Towards Remote Healthcare in Low-Resource Communities.

Photoplethysmography (PPG) signals have been widely used in evaluating cardiovascular biomarkers, however, there is a lack of in-depth understanding of the remote usage of this technology and its viability for underdeveloped countries. This study aims to quantitatively evaluate the performance of a low-cost wireless PPG device in detecting ultra-short-term time-domain pulse rate variability (PRV) parameters in different postures and breathing patterns. A total of 30 healthy subjects were recruited. ECG and PPG signals were simultaneously recorded in 3 min using miniaturized wearable sensors. Four heart rate variability (HRV) and PRV parameters were extracted from ECG and PPG signals, respectively, and compared using analysis of variance (ANOVA) or Scheirer-Ray-Hare test with post hoc analysis. In addition, the data loss was calculated as the percentage of missing sampling points. Posture did not present statistical differences across the PRV parameters but a statistical difference between indicators was found. Strong variation was found for the RMSSD indicator in the standing posture. The sitting position in both breathing patterns demonstrated the lowest data loss (1.0 ± 0.6 and 1.0 ± 0.7) and the lowest percentage of different factors for all indicators. The usage of commercial PPG and BLE devices can allow the reliable extraction of the PPG signal and PRV indicators in real time.

Statistical Analysis of the Consistency of HRV Analysis Using BCG or Pulse Wave Signals.

Ballistocardiography (BCG) is considered a good alternative to HRV analysis with its non-contact and unobtrusive acquisition characteristics. However, consensus about its validity has not yet been established. In this study, 50 healthy subjects (26.2 ± 5.5 years old, 22 females, 28 males) were invited. Comprehensive statistical analysis, including Coefficients of Variation (CV), Lin's Concordance Correlation Coefficient (LCCC), and Bland-Altman analysis (BA ratio), were utilized to analyze the consistency of BCG and ECG signals in HRV analysis. If the methods gave different answers, the worst case was taken as the result. Measures of consistency such as Mean, SDNN, LF gave good agreement (the absolute value of CV difference < 2%, LCCC > 0.99, BA ratio < 0.1) between J-J (BCG) and R-R intervals (ECG). pNN50 showed moderate agreement (the absolute value of CV difference < 5%, LCCC > 0.95, BA ratio < 0.2), while RMSSD, HF, LF/HF indicated poor agreement (the absolute value of CV difference ≥ 5% or LCCC ≤ 0.95 or BA ratio ≥ 0.2). Additionally, the R-R intervals were compared with P-P intervals extracted from the pulse wave (PW). Except for pNN50, which exhibited poor agreement in this comparison, the performances of the HRV indices estimated from the PW and the BCG signals were similar.

Clinical Evaluation of Respiratory Rate Measurements on COPD (Male) Patients Using Wearable Inkjet-Printed Sensor.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that causes long-term breathing problems. The reliable monitoring of respiratory rate (RR) is very important for the treatment and management of COPD. Based on inkjet printing technology, we have developed a stretchable and wearable sensor that can accurately measure RR on normal subjects. Currently, there is a lack of comprehensive evaluation of stretchable sensors in the monitoring of RR on COPD patients. We aimed to investigate the measurement accuracy of our sensor on COPD patients. METHODOLOGY: Thirty-five patients (Mean ± SD of age: 55.25 ± 13.76 years) in different stages of COPD were recruited. The measurement accuracy of our inkjet-printed (IJPT) sensor was evaluated at different body postures (i.e., standing, sitting at 90°, and lying at 45°) on COPD patients. The RR recorded by the IJPT sensor was compared with that recorded by the reference e-Health sensor using paired T-test and Wilcoxon signed-rank test. Analysis of variation (ANOVA) was performed to investigate if there was any significant effect of individual difference or posture on the measurement error. Statistical significance was defined as p-value less than 0.05. RESULTS: There was no significant difference between the RR measurements collected by the IJPT sensor and the e-Health reference sensor overall and in three postures (p > 0.05 in paired T-tests and Wilcoxon signed-rank tests). The sitting posture had the least measurement error of -0.0542 ± 1.451 bpm. There was no significant effect of posture or individual difference on the measurement error or relative measurement error (p > 0.05 in ANOVA). CONCLUSION: The IJPT sensor can accurately measure the RR of COPD patients at different body postures, which provides the possibility for reliable monitoring of RR on COPD patients.

Clinical evaluation of stretchable and wearable inkjet-printed strain gauge sensor for respiratory rate monitoring at different measurements locations.

The respiration rate (RR) is a vital sign in physiological measurement and clinical diagnosis. RR can be measured using stretchable and wearable strain gauge sensors which detect the respiratory movements in the abdomen or thorax areas caused by volumetric changes. In different body locations, the accuracy of RR detection might differ due to different respiratory movement amplitudes. Few studies have quantitatively investigated the effect of the measurement location on the accuracy of new sensors in RR detection. Using a stretchable and wearable inkjet-printed strain gauge (IPSG) sensor, RR was measured from five body locations (umbilicus, upper abdomen, xiphoid process, upper thorax, and diagonal) on 30 healthy test subjects while sitting on an armless chair. At each location, reference RR was simultaneously detected by the e-Health sensor, and the measurement was repeated twice. Subjects were asked about the comfortableness of locations. Based on Levene's test, ANOVA was performed to investigate if there is a significant difference in RR between sensors, measurement locations, and two repeated measurements. Bland-Altman analysis was applied to the RR measurements at different locations. The effects of measurement site and measurement trials on RR difference between sensors were also investigated. There was no significant difference between IPSG and reference sensors, between any locations, and between the two measurements (all p > 0.05). As to the RR deviation between IPSG and reference sensors, there was no significant difference between any locations, or between two measurements (all p > 0.05). All the 30 subjects agreed that diagonal and upper thorax positions were the most uncomfortable and most comfortable locations for measurement, respectively. The IPSG sensor could accurately detect RR at five different locations with good repeatability. Upper thorax was the most comfortable location.

Microaneurysms detection in color fundus images using machine learning based on directional local contrast.

BACKGROUND: As one of the major complications of diabetes, diabetic retinopathy (DR) is a leading cause of visual impairment and blindness due to delayed diagnosis and intervention. Microaneurysms appear as the earliest symptom of DR. Accurate and reliable detection of microaneurysms in color fundus images has great importance for DR screening. METHODS: A microaneurysms' detection method using machine learning based on directional local contrast (DLC) is proposed for the early diagnosis of DR. First, blood vessels were enhanced and segmented using improved enhancement function based on analyzing eigenvalues of Hessian matrix. Next, with blood vessels excluded, microaneurysm candidate regions were obtained using shape characteristics and connected components analysis. After image segmented to patches, the features of each microaneurysm candidate patch were extracted, and each candidate patch was classified into microaneurysm or non-microaneurysm. The main contributions of our study are (1) making use of directional local contrast in microaneurysms' detection for the first time, which does make sense for better microaneurysms' classification. (2) Applying three different machine learning techniques for classification and comparing their performance for microaneurysms' detection. The proposed algorithm was trained and tested on e-ophtha MA database, and further tested on another independent DIARETDB1 database. Results of microaneurysms' detection on the two databases were evaluated on lesion level and compared with existing algorithms. RESULTS: The proposed method has achieved better performance compared with existing algorithms on accuracy and computation time. On e-ophtha MA and DIARETDB1 databases, the area under curve (AUC) of receiver operating characteristic (ROC) curve was 0.87 and 0.86, respectively. The free-response ROC (FROC) score on the two databases was 0.374 and 0.210, respectively. The computation time per image with resolution of 2544×1969, 1400×960 and 1500×1152 is 29 s, 3 s and 2.6 s, respectively. CONCLUSIONS: The proposed method using machine learning based on directional local contrast of image patches can effectively detect microaneurysms in color fundus images and provide an effective scientific basis for early clinical DR diagnosis.

Effect of temporal misalignment on understanding Mandarin sentences in simulated combined electric-and-acoustic stimulation.

The present work assessed Mandarin sentence understanding when the electric and acoustic portions are not temporally aligned in simulated combined electric-and-acoustic stimulation (EAS). A relative time shift was added between the electric and acoustic portions, simulating the temporal misalignment effect in EAS processing. The processed stimuli were played to normal-hearing listeners to recognize. Experimental results showed a significant decrease of the intelligibility score caused by the temporal misalignment in the two portions of EAS processing, suggesting the need to avoid temporal misalignment in EAS. The preceding acoustic-portion more significantly decreased the understanding of EAS-processed Mandarin stimuli than the preceding electric-portion.

Effect of band power weighting on understanding sentences synthesized with temporal information.

This work examined the effect of band power weighting on understanding stimuli synthesized with temporal envelope or Hilbert-fine-structure (HFS) waveforms. The power of modulated carrier in a vocoder model or HFS waveform was level-matched to that of the bandpass filtered signal (matched condition) or equalized across bands (flat condition). The processed stimuli were played to normal-hearing listeners to recognize. For both vocoded and HFS stimuli, there was no significant performance difference between the matched and flat power-weighting conditions, suggesting that band power weighting did not notably influence the intelligibility of stimuli synthesized with temporal information from a few bands.

Factors affecting the intelligibility of high-intensity-level-based speech.

The present work examined factors affecting the intelligibility of high-intensity-level-based speech. Mandarin sentences were processed to contain only high-intensity segments confined by a 5-dB selected intensity range (SIR), with other segments replaced by noise. The processed stimuli were presented to normal-hearing listeners to recognize. The greatest intensity density occurred in the SIR with an upper boundary 3 dB below the peak intensity level, and this SIR yielded the highest intelligibility score in quiet. The SIR with the upper boundary at the peak intensity level yielded better intelligibility performance under noisy conditions, due largely to the relatively high effective signal-to-noise ratio.

Gaussian modelling characteristics changes derived from finger photoplethysmographic pulses during exercise and recovery.

Gaussian modelling method has been reported as a useful method to analyze arterial pulse waveform changes. This study aimed to provide scientific evidence on Gaussian modelling characteristics changes derived from the finger photoplethysmographic (PPG) pulses during exercise and recovery. 65 healthy subjects (18 female and 47 male) were recruited. Finger PPG pulses were digitally recorded with 5 different exercise loads (0, 50, 75, 100, 125W) as well as during each of 4minute (min) recovery period. The PPG pulses were normalized in both width and amplitude for each recording, which were decomposed into three independent Gaussian waves with nine parameters determined, including the peak amplitude (H1, H2, H3), peak time position (N1, N2, N3) and half-width (W1, W2, W3) from each Gaussian wave, and four extended parameters determined, including the peak time interval (T1,2, T1,3) and amplitude ratio (R1,2, R1,3) between 1st Gaussian wave and 2nd, 3rd Gaussian waves. These derived parameters were finally compared between different exercise loads and recovery phases. With gradually increased exercise loads, the peak amplitude H2, peak time position N1, N2, N3, and half-width W1, W2 increased, peak amplitude H3 decreased significantly (all P<0.05). The peak time interval T1,2 and T1,3 increased significantly from 10.6±1.2 and 36.0±4.4 at rest to 14.4±2.3 and 45.1±6.5 at 100W exercise load, respectively (both P<0.05). The amplitude ratio R1,2 also increased from 1.07±0.2 at rest to 1.22±0.2 at 100W, and the amplitude ratio R1,3 decreased from 1.10±0.3 at rest to 0.42±0.2 at 125W (all P<0.05). An opposite changing trend of these parameters was observed during recovery phases. In conclusion, this study has quantitatively demonstrated significant changes of Gaussian modelling characteristics derived from finger PPG pulse with exercise and during recovery, providing scientific evidence for the physiological mechanism that exercise increases cardiac ejection and vasodilation, and reduces the total peripheral vascular resistance.

Understanding low-pass-filtered Mandarin sentences: Effects of fundamental frequency contour and single-channel noise suppression.

The present work assessed the effects of flattening the fundamental frequency (F0) contour and processing by single-channel noise suppression on the intelligibility of low-pass (LP)-filtered (LPF) sentences. The original F0 contour was replaced by an average flat F0 contour or treated by single-channel noise suppression, followed by application of LP filtering to Mandarin sentences. Processed stimuli were presented to normal-hearing listeners to recognize. Flattening the F0 contour significantly affected the understanding of LPF sentences. Noise suppression by existing single-channel algorithms did not improve the intelligibility of LPF sentences.

Effects of noise suppression and envelope dynamic range compression on the intelligibility of vocoded sentences for a tonal language.

Vocoder simulation studies have suggested that the carrier signal type employed affects the intelligibility of vocoded speech. The present work further assessed how carrier signal type interacts with additional signal processing, namely, single-channel noise suppression and envelope dynamic range compression, in determining the intelligibility of vocoder simulations. In Experiment 1, Mandarin sentences that had been corrupted by speech spectrum-shaped noise (SSN) or two-talker babble (2TB) were processed by one of four single-channel noise-suppression algorithms before undergoing tone-vocoded (TV) or noise-vocoded (NV) processing. In Experiment 2, dynamic ranges of multiband envelope waveforms were compressed by scaling of the mean-removed envelope waveforms with a compression factor before undergoing TV or NV processing. TV Mandarin sentences yielded higher intelligibility scores with normal-hearing (NH) listeners than did noise-vocoded sentences. The intelligibility advantage of noise-suppressed vocoded speech depended on the masker type (SSN vs 2TB). NV speech was more negatively influenced by envelope dynamic range compression than was TV speech. These findings suggest that an interactional effect exists between the carrier signal type employed in the vocoding process and envelope distortion caused by signal processing.

Respiratory modulation of oscillometric cuff pressure pulses and Korotkoff sounds during clinical blood pressure measurement in healthy adults.

BACKGROUND: Accurate blood pressure (BP) measurement depends on the reliability of oscillometric cuff pressure pulses (OscP) and Korotkoff sounds (KorS) for automated oscillometric and manual techniques. It has been widely accepted that respiration is one of the main factors affecting BP measurement. However, little is known about how respiration affects the signals from which BP measurement is obtained. The aim was to quantify the modulation effect of respiration on oscillometric pulses and KorS during clinical BP measurement. METHODS: Systolic and diastolic BPs were measured manually from 40 healthy subjects (from 23 to 65 years old) under normal and regular deep breathing. The following signals were digitally recorded during linear cuff deflation: chest motion from a magnetometer to obtain reference respiration, cuff pressure from an electronic pressure sensor to derive OscP, and KorS from a digital stethoscope. The effects of respiration on both OscP and KorS were determined from changes in their amplitude associated with respiration between systole and diastole. These changes were normalized to the mean signal amplitude of OscP and KorS to derive the respiratory modulation depth. Reference respiration frequency, and the frequencies derived from the amplitude modulation of OscP and KorS were also calculated and compared. RESULTS: Respiratory modulation depth was 14 and 40 % for OscP and KorS respectively under normal breathing condition, with significant increases (both p < 0.05) to 16 and 49 % with deeper breathing. There was no statistically significant difference between the reference respiration frequency and those derived from the oscillometric and Korotkoff signals (both p > 0.05) during deep breathing, and for the oscillometric signal during normal breathing (p > 0.05). CONCLUSIONS: Our study confirmed and quantified the respiratory modulation effect on the oscillometric pulses and KorS during clinical BP measurement, with increased modulation depth under regular deeper breathing.

Design and implementation of an automatic nursing assessment system based on CDSS technology.

BACKGROUND: Various quantitative and quality assessment tools are currently used in nursing to evaluate a patient's physiological, psychological, and socioeconomic status. The results play important roles in evaluating the efficiency of healthcare, improving the treatment plans, and lowing relevant clinical risks. However, the manual process of the assessment imposes a substantial burden and can lead to errors in digitalization. To fill these gaps, we proposed an automatic nursing assessment system based on clinical decision support system (CDSS). The framework underlying the CDSS included experts, evaluation criteria, and voting roles for selecting electronic assessment sheets over paper ones. METHODS: We developed the framework based on an expert voting flow to choose electronic assessment sheets. The CDSS was constructed based on a nursing process workflow model. A multilayer architecture with independent modules was used. The performance of the proposed system was evaluated by comparing the adverse events' incidence and the average time for regular daily assessment before and after the implementation. RESULTS: After implementation of the system, the adverse nursing events' incidence decreased significantly from 0.43 % to 0.37 % in the first year and further to 0.27 % in the second year (p-value: 0.04). Meanwhile, the median time for regular daily assessments further decreased from 63 s to 51 s. CONCLUSIONS: The automatic assessment system helps to reduce nurses' workload and the incidence of adverse nursing events.

Age-Related Changes in Blood Volume Pulse Wave at Fingers and Ears.

OBJECTIVE: The decline in vascular elasticity with aging can be manifested in the shape of pulse wave. The study investigated the pulse wave features that are sensitive to age and the pattern of these features change with increasing age were examined. METHODS: Five features were proposed and extracted from the photoplethysmography (PPG)-based pulse wave or its first derivative wave. The correlation between these PPG features and ages was studied in 100 healthy subjects with a wide range of ages (20-71 years). Piecewise regression coefficients were calculated to examine the rates of change of the PPG features with age at different age stages. RESULTS: The proposed PPG features obtained from the finger showed a strong and significant correlation with age (with r = 0.76 - 0.77, p < 0.01), indicating higher sensitivity to age changes compared to the PPG features reported in previous studies (with r = 0.66 - 0.75). The correlation remained significant even after correcting for other clinical variables. The rate of change of the PPG feature values was found to be significantly faster in subjects aged ≥40 years compared to those aged < 40 years in the healthy population. This rate of change was similar to the age-related progression of arterial stiffness evaluated by pulse wave velocity (PWV), which is considered a gold standard for evaluating vascular stiffness. CONCLUSIONS: The proposed PPG features showed a high correlation with chronological age in healthy subjects and exhibited a similar age-related change trend as PWV. SIGNIFICANCE: With the convenience of PPG measures, the proposed age-related features have the potential to be used as biomarkers for vascular aging and estimating the risk of cardiovascular disease.

Dual-Stream Contrastive Learning for Channel State Information Based Human Activity Recognition.

WiFi-based human activity recognition (HAR) has been extensively studied due to its far-reaching applications in health domains, including elderly monitoring, exercise supervision and rehabilitation monitoring, etc. Although existing supervised deep learning techniques have achieved remarkable performances for these tasks, they are however data-hungry and hence are notoriously difficult due to the privacy and incomprehensibility of WiFi-based HAR data. Existing contrastive learning models, mainly designed for computer vision, cannot guarantee their performance on channel state information (CSI) data. To this end, we propose a new dual-stream contrastive learning model that can process and learn the raw WiFi CSI data in a self-supervised manner. More specifically, our proposed method, coined as DualConFi, takes raw WiFI CSI data as input and incorporates channel and temporal streams to learn highly-discriminative spatiotemporal features under a mutual information constraint using unlabeled data. We exhibit the effectiveness of our model on three publicly available CSI data sets in various experiment settings, including linear evaluation, semi-supervised, and transfer learning. We show that DualConFi is able to perform favourably against challenging baselines in each setting. Moreover, by studying the effects of different transform functions on CSI data, we finally verify the effectiveness of highly-discriminative features.

Filtering-induced changes of pulse transmit time across different ages: a neglected concern in photoplethysmography-based cuffless blood pressure measurement.

Background: Pulse transit time (PTT) is a key parameter in cuffless blood pressure measurement based on photoplethysmography (PPG) signals. In wearable PPG sensors, raw PPG signals are filtered, which can change the timing of PPG waveform feature points, leading to inaccurate PTT estimation. There is a lack of comprehensive investigation of filtering-induced PTT changes in subjects with different ages. Objective: This study aimed to quantitatively investigate the effects of aging and PTT definition on the infinite impulse response (IIR) filtering-induced PTT changes. Methods: One hundred healthy subjects in five different ranges of age (i.e., 20-29, 30-39, 40-49, 50-59, and over 60 years old, 20 subjects in each) were recruited. Electrocardiogram (ECG) and PPG signals were recorded simultaneously for 120 s. PTT was calculated from the R wave of ECG and PPG waveform features. Eight PTT definitions were developed from different PPG waveform feature points. The raw PPG signals were preprocessed then further low-pass filtered. The difference between PTTs derived from preprocessed and filtered PPG signals, and the relative difference, were calculated and compared among five age groups and eight PTT definitions using the analysis of variance (ANOVA) or Scheirer-Ray-Hare test with post hoc analysis. Linear regression analysis was used to investigate the relationship between age and filtering-induced PTT changes. Results: Filtering-induced PTT difference and the relative difference were significantly influenced by age and PTT definition (p < 0.001 for both). Aging effect on filtering-induced PTT changes was consecutive with a monotonous trend under all PTT definitions. The age groups with maximum and minimum filtering-induced PTT changes depended on the definition. In all subjects, the PTT defined by maximum peak of PPG had the minimum filtering-induced PTT changes (mean: 16.16 ms and 5.65% for PTT difference and relative difference). The changes of PTT defined by maximum first PPG derivative had the strongest linear relationship with age (R-squared: 0.47 and 0.46 for PTT difference relative difference). Conclusion: The filtering-induced PTT changes are significantly influenced by age and PTT definition. These factors deserve further consideration to improve the accuracy of PPG-based cuffless blood pressure measurement using wearable sensors.

Multi-constraint point set registration with redundant point removal for the registration of coronary arteries.

BACKGROUND: Coronary artery disease (CAD) is the leading cause of death worldwide. The registration of the coronary artery at different phases can help radiologists explore the motion patterns of the coronary artery and assist in the diagnosis of CAD. However, there is no automatic and easy-to-execute method to solve the missing data problem that occurs at the endpoints of the coronary artery tree. This paper proposed a non-rigid multi-constraint point set registration with redundant point removal (MPSR-RPR) algorithm to tackle this challenge. METHODS: Firstly, the MPSR-RPR algorithm roughly registered two coronary artery point sets with the pre-set smoothness regularization parameter and Gaussian filter width value. The moving coherent, local feature, and the corresponding relationship between bifurcation point pairs were exploited as the constraints. Next, the spatial geometry information of the coronary artery was utilized to automatically recognize the vessel endpoints and to delete the redundant points of the coronary artery. Finally, the algorithm continued carrying out the multi-constraint registration with another group of the pre-set parameters to improve the alignment performance. RESULTS: The experimental results demonstrated that the MPSR-RPR algorithm achieved a significantly lower mean value of the modified Hausdorff distance (MHD) compared to the other state-of-the-art methods for addressing the serious missing data in the left and right coronary arteries. CONCLUSION: This study demonstrated the effectiveness of the proposed algorithm in aligning coronary arteries, providing significant value in assisting in the diagnosis of coronary artery and myocardial lesions.

Effect of intracranial pressure on photoplethysmographic waveform in different cerebral perfusion territories: A computational study.

Background: Intracranial photoplethysmography (PPG) signals can be measured from extracranial sites using wearable sensors and may enable long-term non-invasive monitoring of intracranial pressure (ICP). However, it is still unknown if ICP changes can lead to waveform changes in intracranial PPG signals. Aim: To investigate the effect of ICP changes on the waveform of intracranial PPG signals of different cerebral perfusion territories. Methods: Based on lump-parameter Windkessel models, we developed a computational model consisting three interactive parts: cardiocerebral artery network, ICP model, and PPG model. We simulated ICP and PPG signals of three perfusion territories [anterior, middle, and posterior cerebral arteries (ACA, MCA, and PCA), all left side] in three ages (20, 40, and 60 years) and four intracranial capacitance conditions (normal, 20% decrease, 50% decrease, and 75% decrease). We calculated following PPG waveform features: maximum, minimum, mean, amplitude, min-to-max time, pulsatility index (PI), resistive index (RI), and max-to-mean ratio (MMR). Results: The simulated mean ICPs in normal condition were in the normal range (8.87-11.35 mm Hg), with larger PPG fluctuations in older subject and ACA/PCA territories. When intracranial capacitance decreased, the mean ICP increased above normal threshold (>20 mm Hg), with significant decreases in maximum, minimum, and mean; a minor decrease in amplitude; and no consistent change in min-to-max time, PI, RI, or MMR (maximal relative difference less than 2%) for PPG signals of all perfusion territories. There were significant effects of age and territory on all waveform features except age on mean. Conclusion: ICP values could significantly change the value-relevant (maximum, minimum, and amplitude) waveform features of PPG signals measured from different cerebral perfusion territories, with negligible effect on shape-relevant features (min-to-max time, PI, RI, and MMR). Age and measurement site could also significantly influence intracranial PPG waveform.

Entropy-based reliable non-invasive detection of coronary microvascular dysfunction using machine learning algorithm.

PURPOSE: Coronary microvascular dysfunction (CMD) is emerging as an important cause of myocardial ischemia, but there is a lack of a non-invasive method for reliable early detection of CMD. AIM: To develop an electrocardiogram (ECG)-based machine learning algorithm for CMD detection that will lay the groundwork for patient-specific non-invasive early detection of CMD. METHODS: Vectorcardiography (VCG) was calculated from each 10-second ECG of CMD patients and healthy controls. Sample entropy (SampEn), approximate entropy (ApEn), and complexity index (CI) derived from multiscale entropy were extracted from ST-T segments of each lead in ECGs and VCGs. The most effective entropy subset was determined using the sequential backward selection algorithm under the intra-patient and inter-patient schemes, separately. Then, the corresponding optimal model was selected from eight machine learning models for each entropy feature based on five-fold cross-validations. Finally, the classification performance of SampEn-based, ApEn-based, and CI-based models was comprehensively evaluated and tested on a testing dataset to investigate the best one under each scheme. RESULTS: ApEn-based SVM model was validated as the optimal one under the intra-patient scheme, with all testing evaluation metrics over 0.8. Similarly, ApEn-based SVM model was selected as the best one under the intra-patient scheme, with major evaluation metrics over 0.8. CONCLUSIONS: Entropies derived from ECGs and VCGs can effectively detect CMD under both intra-patient and inter-patient schemes. Our proposed models may provide the possibility of an ECG-based tool for non-invasive detection of CMD.