Extracting physiological information in experimental biology via Eulerian video magnification.

BACKGROUND: Videographic material of animals can contain inapparent signals, such as color changes or motion that hold information about physiological functions, such as heart and respiration rate, pulse wave velocity, and vocalization. Eulerian video magnification allows the enhancement of such signals to enable their detection. The purpose of this study is to demonstrate how signals relevant to experimental physiology can be extracted from non-contact videographic material of animals. RESULTS: We applied Eulerian video magnification to detect physiological signals in a range of experimental models and in captive and free ranging wildlife. Neotenic Mexican axolotls were studied to demonstrate the extraction of heart rate signal of non-embryonic animals from dedicated videographic material. Heart rate could be acquired both in single and multiple animal setups of leucistic and normally colored animals under different physiological conditions (resting, exercised, or anesthetized) using a wide range of video qualities. Pulse wave velocity could also be measured in the low blood pressure system of the axolotl as well as in the high-pressure system of the human being. Heart rate extraction was also possible from videos of conscious, unconstrained zebrafish and from non-dedicated videographic material of sand lizard and giraffe. This technique also allowed for heart rate detection in embryonic chickens in ovo through the eggshell and in embryonic mice in utero and could be used as a gating signal to acquire two-phase volumetric micro-CT data of the beating embryonic chicken heart. Additionally, Eulerian video magnification was used to demonstrate how vocalization-induced vibrations can be detected in infrasound-producing Asian elephants. CONCLUSIONS: Eulerian video magnification provides a technique to extract inapparent temporal signals from videographic material of animals. This can be applied in experimental and comparative physiology where contact-based recordings (e.g., heart rate) cannot be acquired.

The POCUS Pulse Check: A Case Series on a Novel Method for Determining the Presence of a Pulse Using Point-of-Care Ultrasound.

BACKGROUND: During cardiopulmonary resuscitation, pulse checks must be rapid and accurate. Despite the importance placed on the detection of a pulse, several studies have shown that health care providers have poor accuracy for detection of central pulses by palpation. To date, the use of point-of-care ultrasound (POCUS) in cardiac arrest has focused on the presence of cardiac standstill and diagnosing reversible causes of the arrest. OBJECTIVE: This case series highlights a simple, novel approach to determine whether pulses are present or absent by using POCUS compression of the central arteries. DISCUSSION: Using this technique, we found that a POCUS pulse check can be consistently performed in < 5 s and is clearly determinate, even when palpation yields indeterminate results. CONCLUSIONS: In this case series, the POCUS pulse check was a valuable adjunct that helped to change management for critically ill patients. Future prospective studies are required to determine the accuracy of this technique and the impact on patient outcomes in a larger cohort.

Highly Sensitive and Durable Structured Fibre Sensors for Low-Pressure Measurement in Smart Skin.

Precise measurements of low pressure are highly necessary for many applications. This study developed novel structured fibre sensors embedded in silicone, forming smart skin with high sensitivity, high durability, and good immunity to crosstalk for precise measurement of pressure below 10 kPa. The transduction principle is that an applied pressure leads to bending and stretching of silicone and optical fibre over a purposely made groove and induces the axial strain in the gratings. The fabricated sensor showed high pressure sensitivity up to 26.8 pm/kPa and experienced over 1,000,000 cycles compression without obvious variation. A theoretical model of the sensor was presented and verified to have excellent agreement with experimental results. The prototype of smart leg mannequin and wrist pulse measurements indicated that such optical sensors can precisely measure low-pressure and can easily be integrated for smart skins for mapping low pressure on three-dimensional surfaces.

Using the Pulse Contour Method to Measure the Changes in Stroke Volume during a Passive Leg Raising Test.

The pulse contour method is often used with the Windkessel model to measure stroke volume. We used a digital pressure and flow sensors to detect the parameters of the Windkessel model from the pulse waveform. The objective of this study was to assess the stability and accuracy of this method by making use of the passive leg raising test. We studied 24 healthy subjects (40 ± 9.3 years), and used the Medis® CS 1000, an impedance cardiography, as the comparing reference. The pulse contour method measured the waveform of the brachial artery by using a cuff. The compliance and resistance of the peripheral artery was detected from the cuff characteristics and the blood pressure waveform. Then, according to the method proposed by Romano et al., the stroke volume could be measured. This method was implemented in our designed blood pressure monitor. A passive leg raising test, which could immediately change the preloading of the heart, was done to certify the performance of our method. The pulse contour method and impedance cardiography simultaneously measured the stroke volume. The measurement of the changes in stroke volume using the pulse contour method had a very high correlation with the Medis® CS 1000 measurement, the correlation coefficient of the changed ratio and changed differences in stroke volume were r² = 0.712 and r² = 0.709, respectively. It was shown that the stroke volume measured by using the pulse contour method was not accurate enough. But, the changes in the stroke volume could be accurately measured with this pulse contour method. Changes in stroke volume are often used to understand the conditions of cardiac preloading in the clinical field. Moreover, the operation of the pulse contour method is easier than using impedance cardiography and echocardiography. Thus, this method is suitable to use in different healthcare fields.

Validation of noninvasive MOEMS-assisted measurement system based on CCD sensor for radial pulse analysis.

Examination of wrist radial pulse is a noninvasive diagnostic method, which occupies a very important position in Traditional Chinese Medicine. It is based on manual palpation and therefore relies largely on the practitioner's subjective technical skills and judgment. Consequently, it lacks reliability and consistency, which limits practical applications in clinical medicine. Thus, quantifiable characterization of the wrist pulse diagnosis method is a prerequisite for its further development and widespread use. This paper reports application of a noninvasive CCD sensor-based hybrid measurement system for radial pulse signal analysis. First, artery wall deformations caused by the blood flow are calibrated with a laser triangulation displacement sensor, following by the measurement of the deformations with projection moiré method. Different input pressures and fluids of various viscosities are used in the assembled artificial blood flow system in order to test the performance of laser triangulation technique with detection sensitivity enhancement through microfabricated retroreflective optical element placed on a synthetic vascular graft. Subsequently, the applicability of double-exposure whole-field projection moiré technique for registration of blood flow pulses is considered: a computational model and representative example are provided, followed by in vitro experiment performed on a vascular graft with artificial skin atop, which validates the suitability of the technique for characterization of skin surface deformations caused by the radial pulsation.

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

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

Influence of periodic heartbeat reversal and abdominal movements on hemocoelic and tracheal pressure in resting blowflies Calliphora vicina.

In Calliphoridae and Drosophilidae, the dorsal vessel (heart and aorta with associated venous channels) is the only connection between the thorax and the abdomen. Hemolymph oscillates between the compartments by periodic heartbeat reversal, but both the mechanism and its influence on hemocoelic and tracheal pressure have remained unclear. The pumping direction of the heart regularly reverses, with a higher pulse rate during backward compared with forward pumping. A sequence of forward and backward pulse periods lasts approximately 34 s. Pulse rate, direction, velocity and the duration of heartbeat periods were determined by thermistor and electrophysiological measurements. For the first time, heartbeat-induced pressure changes were measured in the hemocoel and in the tracheal system of the thorax and the abdomen. The tracheal pressure changed from sub-atmospheric during backward heartbeat to supra-atmospheric during forward heartbeat in the thorax and inversely in the abdomen. The heartbeat reversals were coordinated with slow abdominal movements with a pumping stroke at the beginning of the forward pulse period. The pressure effect of the pumping stroke was visible only in the abdomen. Periodic hemolymph shift and abdominal movements resulted in pressure changes in the hemocoel and tracheal system alternating in the thorax and abdomen, suggesting an effect on respiratory gas exchange.

Use of PC mouse components for continuous measuring of human heartbeat.

A new technology for remote measuring of vibration sources was recently developed for industrial, medical, and security-related applications [Int. Appl. Patent No: PCT/IL2008/001008]. It requires relatively expensive equipment, such as high-speed complementary metal oxide semiconductor (CMOS) sensors and customized optics. In this paper, we demonstrate how the usage of a simple personal computer (PC) mouse as an optical system composed of a low-power laser and a CMOS circuitry on the same integrated circuit package, can be used to monitor heartbeat from the wrist. The method is based on modifying the mouse optical system in such a way that it will recognize temporal change in skin's vibration profile, generated due to the heart pulses, as mouse movement. The tests that were carried out show a very good correlation between the heartbeat rate measured from human skin and the reference values taken manually.

Phantom with pulsatile arteries to investigate the influence of blood vessel depth on pulse oximeter signal strength.

This paper describes a three-layer head phantom with artificial pulsating arteries at five different depths (1.2 mm, 3.7 mm, 6.8 mm, 9.6 mm and 11.8 mm). The structure enables formation of spatially and temporally varying tissue properties similar to those of living tissues. In our experiment, pressure pulses were generated in the arteries by an electronically controlled pump. The physical and optical parameters of the layers and the liquid in the artificial arteries were similar to those of real tissues and blood. The amplitude of the pulsating component of the light returning from the phantom tissues was measured at each artery depth mentioned above. The build-up of the in-house-developed pulse oximeter used for performing the measurements and the physical layout of the measuring head are described. The radiant flux generated by the LED on the measuring head was measured to be 1.8 mW at 910 nm. The backscattered radiant flux was measured, and found to be 0.46 nW (0.26 ppm), 0.55 nW (0.31 ppm), and 0.18 nW (0.10 ppm) for the 1.2 mm, 3.7 mm and 6.8 mm arteries, respectively. In the case of the 9.6 mm and 11.8 mm arteries, useful measurement data were not obtained owing to weak signals. We simulated the phantom with the arteries at the above-mentioned five depths and at two additional ones (2.5 mm and 5.3 mm in depth) using the Monte Carlo method. The measurement results were verified by the simulation results. We concluded that in case of 11 mm source-detector separation the arteries at a depth of about 2.5 mm generate the strongest pulse oximeter signal level in a tissue system comprising three layers of thicknesses: 1.5 mm (skin), 5.0 mm (skull), and >50 mm (brain).

Comparison of a non-invasive arterial pulse contour technique and echo Doppler aorta velocity-time integral on stroke volume changes in optimization of cardiac resynchronization therapy.

AIMS: We investigated the accuracy and feasibility of a non-invasive arterial pulse contour technique for continuous measurement of stroke volume (SV) in optimization of atrioventricular (AV) delay in cardiac resynchronization therapy (CRT), by comparing SV changes assessed by Nexfin CO-Trek® (Nexfin) and echo Doppler aortic velocity-time integral (VTIao). Furthermore, we investigated whether AV-delay optimization increases the effect of CRT when compared with a default AV delay (120 ms). METHODS AND RESULTS: In 23 CRT patients, biventricular pacing (BiVP) was applied at various AV delays, while recording 10 beats preceding BiVP (baseline) and the first 10 BiVP beats, for both methods in parallel. Agreement between Nexfin and VTIao measurements was evaluated (Bland-Altman) on beat-to-beat changes in SV, as well as on effects of BiVP (averaged over 8 beats) at various AV delays. Individual optimal AV delays, for Nexfin (AVopt-n) and VTIao (AVopt-ao), were derived from the second-order polynomial fitted to the effect measurements of 20 patients. In 252 episodes assessed, the difference between measurements (= Nexfin - VTIao) was -0.6 ± 8.1% for beat-to-beat SV changes and -1.3 ± 7.3% for effects of BiVP. Optimal AV delays for Nexfin were well related to AVopt-ao (R(2) = 0.69). The effect (%) of BiVP at the optimal AV delay was significantly larger than at the default AV delay: median difference (range) being +6.3% (0.1-14.4%; P < 0.001) for VTIao and +4.7% (0.0-14.0%; P < 0.001) for Nexfin. CONCLUSION: Individual AV optimization increases the effect of CRT. Nexfin is a promising tool in individual CRT optimization, as Nexfin agrees with VTIao on measuring beat-to-beat SV changes and on assessing relative effects of BiVP on SV at various AV delays.

Measurement of blood pressure using an arterial pulsimeter equipped with a Hall device.

To measure precise blood pressure (BP) and pulse rate without using a cuff, we have developed an arterial pulsimeter consisting of a small, portable apparatus incorporating a Hall device. Regression analysis of the pulse wave measured during testing of the arterial pulsimeter was conducted using two equations of the BP algorithm. The estimated values of BP obtained by the cuffless arterial pulsimeter over 5 s were compared with values obtained using electronic or liquid mercury BP meters. The standard deviation between the estimated values and the measured values for systolic and diastolic BP were 8.3 and 4.9, respectively, which are close to the range of values of the BP International Standard. Detailed analysis of the pulse wave measured by the cuffless radial artery pulsimeter by detecting changes in the magnetic field can be used to develop a new diagnostic algorithm for BP, which can be applied to new medical apparatus such as the radial artery pulsimeter.

Singing greeting card beeper as a finger pulse sensor.

We constructed a robust and low-priced finger pulse sensor from a singing greeting card beeper. The beeper outputs the plethysmographic signal, which is indistinguishable from that of commercial grade sensors. The sensor can be used in school for a number of experiments in human cardiovascular physiology.

Biodegradable and flexible arterial-pulse sensor for the wireless monitoring of blood flow.

The ability to monitor blood flow is critical to patient recovery and patient outcomes after complex reconstructive surgeries. Clinically available wired implantable monitoring technology requires careful fixation for accurate detection and needs to be removed after use. Here, we report the design of a pressure sensor, made entirely of biodegradable materials and based on fringe-field capacitor technology, for measuring arterial blood flow in both contact and non-contact modes. The sensor is operated wirelessly through inductive coupling, has minimal hysteresis, fast response times, excellent cycling stability, is highly robust, allows for easy mounting and eliminates the need for removal, thus reducing the risk of vessel trauma. We demonstrate the operation of the sensor with a custom-made artificial artery model and in vivo in rats. This technology may be advantageous in real-time post-operative monitoring of blood flow after reconstructive surgery.

A Wearable Multifunctional Pulse Monitor Using Thermosensation-Based Flexible Sensors.

OBJECTIVE: This study proposes a novel wearable pulse monitoring system, which can realize the synchronous measurements of pulse wave, skin, temperature, and pulse wave velocity (PWV). METHODS: A flexible sensor based on thermosensation is used to detect pressure and temperature stimuli simultaneously. A total of two sensors are integrated to detect pulse transit along two specific points of the artery, e.g., Cun and Chi at a wrist, the data of which are subsequently used to figure out the PWV by using a tailor-designed algorithm conducted in a microprocessor. Calibration experiments and application cases are conducted to validate the effectiveness of the monitor. RESULTS: The developed monitor detects the physiological signals of pulse wave, PWV, and skin temperature simultaneously. In addition, the monitor can measure the pulse changes before and after exercises and track skin temperature variations when warming and cooling. Moreover, the monitor can be also used to detect the local PWV at the wrist. CONCLUSION: The synchronous measurements of pulse wave, skin temperature, and PWV using a wearable monitor are feasible. SIGNIFICANCE: The monitor is small, simple-structured, with multifunction, and thus provides a promising auxiliary approach for traditional Chinese medicine pulse diagnosis.

A New Blood Pulsation Simulator Platform Incorporating Cardiovascular Physiology for Evaluating Radial Pulse Waveform.

To meet the need for "standard" testing system for wearable blood pressure sensors, this study intends to develop a new radial pulsation simulator that can generate age-dependent reference radial artery pressure waveforms reflecting the physiological characteristics of human cardiovascular system. To closely duplicate a human cardiovascular system, the proposed simulator consists of a left ventricle simulation module, an aorta simulation module, a peripheral resistance simulation module, and a positive/negative pressure control reservoir module. Simulating physiologies of blood pressure, the compliance chamber in the simulator can control arterial stiffness to produce age-dependent pressure waveforms. The augmentation index was used to assess the pressure waveforms generated by the simulator. The test results show that the simulator can generate and control radial pressure waveforms similar to human pulse signals consisting of early systolic pressure, late systolic pressure, and dicrotic notch. Furthermore, the simulator's left ventricular pressure-volume loop results demonstrate that the simulator exhibits mechanical characteristics of the human cardiovascular system. The proposed device can be effectively used as a "standard" radial artery pressure simulator to calibrate the wearable sensor's measurement characteristics and to develop more advanced sensors. The simulator is intended to serve as a platform for the development, performance verification, and calibration of wearable blood pressure sensors. It will contribute to the advancement of the wearable blood pressure sensor technology, which enables real-time monitoring of users' radial artery pressure waveforms and eventually predicting cardiovascular diseases.

Pulseless electrical activity following traumatic cardiac arrest: Sign of life or death?

BACKGROUND: Generally considered a sign of life, PEA is the most common arrhythmia encountered following pre-hospital traumatic cardiac arrest. Some recommend cardiac ultrasound (CUS) to determine cardiac wall motion (CWM) prior to terminating resuscitation efforts. This purpose of this study was to evaluate the outcomes of patients with traumatic cardiac arrest presenting with PEA, with and without CWM. METHODS: Trauma patients who underwent pre-hospital CPR were identified from the registries of two level-1 trauma centers. Pre-hospital management by emergency medical transport services was guided by advanced life support protocols. The on-duty trauma surgeon directed the resuscitations and performed or supervised CUS and determined CWM. RESULTS: Among 277 patients who underwent pre-hospital CPR, 110 patients had PEA on arrival to ED. 69 (62.7%) were injured by blunt mechanisms. Median CPR duration was 20.0 and 8.0 min for pre-hospital and ED, respectively. Sixty-three patients (22.7%) underwent resuscitative thoracotomy. One hundred seventy-two patients (62.1%) received CUS and of these 32 (18.6%) had CWM. CWM was significantly associated with survival to hospital admission (21.9% vs. 1.4%; P < 0.001); however, no patient with CUS survived to hospital discharge. Overall, only one patient with PEA on arrival survived to discharge. CONCLUSION: Following pre-hospital traumatic cardiac arrest, PEA on arrival portends death. Although CWM is associated with survival to admission, it is not associated with meaningful survival. Heroic resuscitative measures may be unwarranted for PEA following pre-hospital traumatic arrest, regardless of CWM.

Comparative study of methodologies for pulse wave velocity estimation.

Arterial stiffness, estimated by pulse wave velocity (PWV), is an independent predictor of cardiovascular mortality and morbidity. However, the clinical applicability of these measurements and the elaboration of reference PWV values are difficult due to differences between the various devices used. In a population of 50 subjects aged 20-84 years, we compared PWV measurements with three frequently used devices: the Complior and the PulsePen, both of which determine aortic PWV as the delay between carotid and femoral pressure wave and the PulseTrace, which estimates the Stiffness Index (SI) by analyzing photoplethysmographic waves acquired on the fingertip. PWV was measured twice by each device. Coefficient of variation of PWV was 12.3, 12.4 and 14.5% for PulsePen, Complior and PulseTrace, respectively. These measurements were compared with the reference method, that is, a simultaneous acquisition of pressure waves using two tonometers. High correlation coefficients with the reference method were observed for PulsePen (r = 0.99) and Complior (r = 0.83), whereas for PulseTrace correlation with the reference method was much lower (r = 0.55). Upon Bland-Altman analysis, mean differences of values +/- 2s.d. versus the reference method were -0.15 +/- 0.62 m/s, 2.09 +/- 2.68 m/s and -1.12 +/- 4.92 m/s, for PulsePen, Complior and Pulse-Trace, respectively. This study confirms the reliability of Complior and PulsePen devices in estimating PWV, while the SI determined by the PulseTrace device was found to be inappropriate as a surrogate of PWV. The present results indicate the urgent need for evaluation and comparison of the different devices to standardize PWV measurements and establish reference values.

An automated carotid pulse assessment approach using Doppler ultrasound.

During cardiac arrest emergencies, lay rescuers are required to manually check the patient's carotid pulse after the delivery of defibrillation shocks to assess the cardiac resuscitation progress of the patient. As a more automated way of monitoring the resuscitation progress, a new Doppler-ultrasound-based carotid pulse assessment approach is presented in this paper. The method works by analyzing the temporal aperiodicity of Doppler shifts seen in the ultrasound echoes returned from the patient's carotid arteries. As a quantitative investigation with this method, we derived a new measure called the pulselessness indicator to assess whether a carotid pulse is absent based on the given Doppler information. To study the performance of the new carotid pulse checking method, we built a multi-channel CW Doppler prototype device to acquire Doppler data in vivo during cardiac arrest experiments conducted on five different swines and computed pulselessness indicator estimates with these data. Our results indicated that the Doppler-based pulse checking approach has good sensitivity and specificity: it had a pulselessness detection rate greater than 0.9 for a given false alarm rate of 0.05. As a further analysis, the prototype device was applied to other experiments where the swine had suffered cardiac arrest for over five minutes. It showed a consistent assessment performance on the monitoring of the swine's resuscitation progress after defibrillation and chest compressions.

Development of a wearable system module for monitoring physical and mental workload.

The population of most developed countries is rapidly aging, which has created a growing demand for home care. A key issue in medicine is supporting the increasing number of elderly patients, both physically and mentally. In this study, we developed a wearable computer that contained modules for measuring electrocardiograms (ECGs) and femoral artery pulse waves using an accelerometer. This system has several benefits: (a) it can provide a database server in each patient's home; (b) its high extendibility and flexibility facilitate adaptation to a patient's needs; and (c) it allows patients to keep their own data, thus protecting the privacy of personal information. To clarify the capabilities and reliability of the system, we applied it to 8 healthy young volunteers during states of physical and mental work. This system successfully detected clear ECGs and femoral artery pulse waves to calculate important bioinformation, including heart rate, pulse wave velocity, and the power spectral density of spontaneous beat-to-beat oscillations in the R-R interval. In this study, we proposed the way to provide an assessment of the physical and mental condition of the subject using analysis of the bio-information with respect to the physical and mental workloads. The present study provides useful knowledge for the development of a wearable computer designed to monitor the physical and mental conditions of older persons and patients.

Analysis of a Pulse Rate Variability Measurement Using a Smartphone Camera.

Background: Heart rate variability (HRV) provides information about the activity of the autonomic nervous system. Because of the small amount of data collected, the importance of HRV has not yet been proven in clinical practice. To collect population-level data, smartphone applications leveraging photoplethysmography (PPG) and some medical knowledge could provide the means for it. Objective: To assess the capabilities of our smartphone application, we compared PPG (pulse rate variability (PRV)) with ECG (HRV). To have a baseline, we also compared the differences among ECG channels. Method: We took fifty parallel measurements using iPhone 6 at a 240 Hz sampling frequency and Cardiax PC-ECG devices. The correspondence between the PRV and HRV indices was investigated using correlation, linear regression, and Bland-Altman analysis. Results: High PPG accuracy: the deviation of PPG-ECG is comparable to that of ECG channels. Mean deviation between PPG-ECG and two ECG channels: RR: 0.01 ms-0.06 ms, SDNN: 0.78 ms-0.46 ms, RMSSD: 1.79 ms-1.21 ms, and pNN50: 2.43%-1.63%. Conclusions: Our iPhone application yielded good results on PPG-based PRV indices compared to ECG-based HRV indices and to differences among ECG channels. We plan to extend our results on the PPG-ECG correspondence with a deeper analysis of the different ECG channels.