Erratum: Functional Near-Infrared Spectroscopy as a Personalized Digital Healthcare Tool for Brain Monitoring.

This corrects the article on p. 115 in vol. 19, PMID: 36854332.

Clinical application of functional near-infrared spectroscopy for burn assessment.

Significance: Early assessment of local tissue oxygen saturation is essential for clinicians to determine the burn wound severity. Background: We assessed the burn extent and depth in the skin of the extremities using a custom-built 36-channel functional near-infrared spectroscopy system in patients with burns. Methods: A total of nine patients with burns were analyzed in this study. All second-degree burns were categorized as superficial, intermediate, and deep burns; non-burned skin on the burned side; and healthy skin on the contralateral non-burned side. Hemodynamic tissue signals from functional near-infrared spectroscopy attached to the burn site were measured during fNIRS using a blood pressure cuff. A nerve conduction study was conducted to check for nerve damage. Results: All second-degree burns were categorized into superficial, intermediate, and deep burns; non-burned skin on the burned side and healthy skin on the contralateral non-burned side showed a significant difference distinguishable using functional near-infrared spectroscopy. Hemodynamic measurements using functional near-infrared spectroscopy were more consistent with the diagnosis of burns 1 week later than that of the degree of burns diagnosed visually at the time of admission. Conclusion: Functional near-infrared spectroscopy may help with the early judgment of burn extent and depth by reflecting differences in the oxygen saturation levels in the skin.

Functional Near-Infrared Spectroscopy as a Personalized Digital Healthcare Tool for Brain Monitoring.

The sustained growth of digital healthcare in the field of neurology relies on portable and cost-effective brain monitoring tools that can accurately monitor brain function in real time. Functional near-infrared spectroscopy (fNIRS) is one such tool that has become popular among researchers and clinicians as a practical alternative to functional magnetic resonance imaging, and as a complementary tool to modalities such as electroencephalography. This review covers the contribution of fNIRS to the personalized goals of digital healthcare in neurology by identifying two major trends that drive current fNIRS research. The first major trend is multimodal monitoring using fNIRS, which allows clinicians to access more data that will help them to understand the interconnection between the cerebral hemodynamics and other physiological phenomena in patients. This allows clinicians to make an overall assessment of physical health to obtain a more-detailed and individualized diagnosis. The second major trend is that fNIRS research is being conducted with naturalistic experimental paradigms that involve multisensory stimulation in familiar settings. Cerebral monitoring of multisensory stimulation during dynamic activities or within virtual reality helps to understand the complex brain activities that occur in everyday life. Finally, the scope of future fNIRS studies is discussed to facilitate more-accurate assessments of brain activation and the wider clinical acceptance of fNIRS as a medical device for digital healthcare.

Multichannel near-infrared spectroscopy brain imaging system for small animals in mobile conditions.

Significance: We propose a customized animal-specific head cap and an near-infrared spectroscopy (NIRS) system to obtain NIRS signals in mobile small animals. NIRS studies in mobile small animals provide a feasible solution for comprehensive brain function studies. Aim: We aim to develop and validate a multichannel NIRS system capable of performing functional brain imaging along with a closed-box stimulation kit for small animals in mobile conditions. Approach: The customized NIRS system uses light-weight long optical fibers, along with a customized light-weight head cap to securely attach the optical fibers to the mouse. A customized stimulation box was designed to perform various stimuli in a controlled environment. The system performance was tested in a visual stimulation task on eight anesthetized mice and eight freely moving mice. Results: Following the visual stimulation task, we observed a significant stimulation-related oxyhemoglobin (HbO) increase in the visual cortex of freely moving mice during the task. In contrast, HbO concentration did not change significantly in the visual cortex of anesthetized mice. Conclusions: We demonstrate the feasibility of a wearable, multichannel NIRS system for small animals in a less confined experimental design.

Spirally Wrapped Carbon Nanotube Microelectrodes for Fiber Optoelectronic Devices beyond Geometrical Limitations toward Smart Wearable E-Textile Applications.

Fiber optoelectronics technology has recently attracted attention as enabling various form factors of wearable electronics, and the issue of how to control and optimize the configuration and physical properties of the electrode micropatterns in the microfiber devices has become important. Here, spirally wrapped carbon nanotube (CNT) microelectrodes with a controlled dimension are demonstrated for high-performance fiber optoelectronic devices. Inkjet-printed CNT microelectrodes with the desired dimension on an agarose hydrogel template are rolling-transferred onto a microfiber surface with an efficient electrical interface. A fiber organic field-effect transistor with spirally wrapped CNT microelectrodes verifies the feasibility of this strategy, where the transferred microelectrodes intimately contact the organic semiconductor active layer and the output current characteristics are simply controlled, resulting in characteristics that exceed the previous structural limitations. Furthermore, a fiber organic photodiode with spirally wrapped CNT microelectrodes, when used as a transparent electrode, exhibits a high Ilight/Idark ratio and good durability of bending. This fiber photodiode can be successfully incorporated into a textile photoplethysmography bandage for the real-time monitoring of human vital signals. This work offers a promising and efficient strategy to overcome the geometric factors limiting the performance of fiber-optic optoelectronic devices.

Regional analysis of cerebral hemodynamic changes during the head-up tilt test in Parkinson's disease patients with orthostatic intolerance.

Significance: Cerebral oxygenation changes in the superior, middle, and medial gyri were used to elucidate spatial impairments of autonomic hemodynamic recovery during the head-up tilt table test (HUTT) in Parkinson's disease (PD) patients with orthostatic intolerance (OI) symptoms. Aim: To analyze dynamic oxygenation changes during the HUTT and classify PD patients with OI symptoms using clinical and oxygenation features. Approach: Thirty-nine PD patients with OI symptoms [10: orthostatic hypotension (PD-OH); 29: normal HUTT results (PD-NOR)] and seven healthy controls (HCs) were recruited. Prefrontal oxyhemoglobin (HbO) changes during the HUTT were reconstructed with diffuse optical tomography and segmented using the automated anatomical labeling system. Decision trees were used for classification. Results: HCs and PD-NOR patients with positive rates of HbO change (PD-POS) showed the greatest HbO recovery in the superior frontal gyrus (SFG) during tilt. PD-OH and PD-NOR patients with negative rates of HbO change (PD-NEG) showed asymmetric reoxygenation. The classification accuracy was 89.4% for PD-POS versus PD-NEG, 71% for PD-NOR versus PD-OH, and 55.8% for PD-POS versus PD-NEG versus PD-OH. The oxygenation features were more discriminative than the clinical features. Conclusions: PD-OH showed decreased right SFG function, which may be associated with impaired compensatory autonomic responses to orthostatic stress.

Hemodynamic Activity and Connectivity of the Prefrontal Cortex by Using Functional Near-Infrared Spectroscopy during Color-Word Interference Test in Korean and English Language.

In daily living, people are challenged to focus on their goal while eliminating interferences. Specifically, this study investigated the pre-frontal cortex (PFC) activity while attention control was tested using the self-made color-word interference test (CWIT) with a functional near-infrared spectroscopy device (fNIRS). Among 11 healthy Korean university students, overall the highest scores were obtained in the congruent Korean condition 1 (CKC-1) and had the least vascular response (VR) as opposed to the incongruent Korean condition 2 (IKC-2). The individual's automatic reading response caused less brain activation while IKC-2 involves color suppression. Across the three trials per each condition, no significant differences (SD) in scores and in VR since there was no intervention did. Meanwhile, SD was observed between CKC-1 and English Congruent Condition 3 (ECC-3) across trials. However, SD was only observed on the third trial of VR. In the connectivity analysis, right and left PFC are activated on ECC-3. In CKC-1 and IKC-2, encompassing dorsomedial and dorsolateral although CKC-1 has less connection and connectivity due to less brain activation as compared. Therefore, aside from VR, brain connectivity could be identified non-invasively using fNIRS without ionizing radiation and at low-cost.

A Novel Singular Value Decomposition-Based Denoising Method in 4-Dimensional Computed Tomography of the Brain in Stroke Patients with Statistical Evaluation.

Computed tomography (CT) is a widely used medical imaging modality for diagnosing various diseases. Among CT techniques, 4-dimensional CT perfusion (4D-CTP) of the brain is established in most centers for diagnosing strokes and is considered the gold standard for hyperacute stroke diagnosis. However, because the detrimental effects of high radiation doses from 4D-CTP may cause serious health risks in stroke survivors, our research team aimed to introduce a novel image-processing technique. Our singular value decomposition (SVD)-based image-processing technique can improve image quality, first, by separating several image components using SVD and, second, by reconstructing signal component images to remove noise, thereby improving image quality. For the demonstration in this study, 20 4D-CTP dynamic images of suspected acute stroke patients were collected. Both the images that were and were not processed via the proposed method were compared. Each acquired image was objectively evaluated using contrast-to-noise and signal-to-noise ratios. The scores of the parameters assessed for the qualitative evaluation of image quality improved to an excellent rating (p < 0.05). Therefore, our SVD-based image-denoising technique improved the diagnostic value of images by improving their quality. The denoising technique and statistical evaluation can be utilized in various clinical applications to provide advanced medical services.

Cerebral hemodynamic monitoring of Parkinson's disease patients with orthostatic intolerance during head-up tilt test.

Significance: Monitoring of cerebral perfusion rather than blood pressure changes during a head-up tilt test (HUTT) is proposed to understand the pathophysiological effect of orthostatic intolerance (OI), including orthostatic hypotension (OH), in Parkinson's disease (PD) patients. Aim: We aim to characterize and distinguish the cerebral perfusion response to a HUTT for healthy controls (HCs) and PD patients with OI symptoms. Approach: Thirty-nine PD patients with OI symptoms [10 PD patients with OH (PD-OH) and 29 PD patients with normal HUTT results (PD-NOR)], along with seven HCs participated. A 108-channel diffuse optical tomography (DOT) system was used to reconstruct prefrontal oxyhemoglobin (HbO), deoxyhemoglobin (Hb), and total hemoglobin (HbT) changes during dynamic tilt (from supine to 70-deg tilt) and static tilt (remained tilted at 70 deg). Results: HCs showed rapid recovery of cerebral perfusion in the early stages of static tilt. PD-OH patients showed decreasing HbO and HbT during dynamic tilt, continuing into the static tilt period. The rate of HbO change from dynamic tilt to static tilt is the distinguishing feature between HCs and PD-OH patients. Accordingly, PD-NOR patients were subgrouped based on positive-rate and negative-rate of HbO change. PD patients with a negative rate of HbO change were more likely to report severe OI symptoms in the COMPASS questionnaire. Conclusions: Our findings showcase the usability of DOT for sensitive detection and quantification of autonomic dysfunction in PD patients with OI symptoms, even those with normal HUTT results.

Hemodynamic correlation imaging of the mouse brain for application in unilateral neurodegenerative diseases.

We developed a single-camera two-channel hemodynamic imaging system that uses near-infrared light to monitor the mouse brain in vivo with an exposed, un-thinned, and intact skull to explore the effect of Parkinson's disease on the resting state functional connectivity of the brain. To demonstrate our system's ability to monitor cerebral hemodynamics, we first performed direct electrical stimulation of an anesthetized healthy mouse brain and detected hemodynamic changes localized to the stimulated area. Subsequently, we developed a unilaterally lesioned 6-hydroxydopamine (hemi-parkinsonian) mouse model and detected the differences in functional connectivity between the normal and hemi-parkinsonian mouse brains by comparing the hemispheric hemodynamic correlations during the resting state. Seed-based correlation for the oxy-hemoglobin channel from the left and right hemispheres of healthy mice was much higher and more symmetric than in hemi-parkinsonian mice. Through a k-means clustering of the hemodynamic signals, the healthy mouse brains were segmented according to brain region, but the hemi-parkinsonian mice did not show a similar segmentation. Overall, this study highlights the development of a spatial multiplexing hemodynamic imaging system that reveals the resting state hemodynamic connectivity in healthy and hemi-parkinsonian mice.

Cerebral Perfusion Monitoring Using Near-Infrared Spectroscopy During Head-Up Tilt Table Test in Patients With Orthostatic Intolerance.

The head-up tilt table test (HUT) is one of the primary clinical examinations for evaluating orthostatic intolerance (OI). HUT can be divided into three phases: dynamic tilt phase (supine to tilt up), static tilt phase (remain tilted at 70°), and post tilt phase (tilt down back to supine position). Commonly, blood pressure (BP) and heart rate (HR) are monitored to observe for OI symptoms, but are indirect measurements of cerebral perfusion and can lead to inaccurate HUT evaluation. In this study, we implemented a 108-channel near-infrared spectroscopy (NIRS) probe to characterize HUT performance by monitoring cerebral hemodynamic changes for healthy controls (HCs), OI patients with normal HUT results, and OI patients with positive HUT results: vasovagal syncope (VS), postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), and orthostatic hypertension (OHT). By the end of the static tilt phase, OI patients typically did not show a complete recovery back to baseline cerebral oxygenation and total blood volume compared to HCs. We characterized the return to cerebral homeostasis by polynomial fitting total blood volume changes and determining the inflection point. The OI patients with normal HUT results, VS, OH, or OHT showed a delay in the return to cerebral homeostasis compared to the HC group during HUT.

Prefrontal hemodynamic changes measured using near-infrared spectroscopy during the Valsalva maneuver in patients with orthostatic intolerance.

The Valsalva maneuver (VM) with beat-to-beat blood pressure and heart rate monitoring are used to evaluate orthostatic intolerance (OI). However, they lack the ability to detect cerebral hemodynamic changes, which may be a cause of OI symptoms. Therefore, we utilized near-infrared spectroscopy during VM. Patients with OI symptoms and normal healthy subjects were recruited. Patients were subgrouped according to VM results: patients with normal VM (NVM) and abnormal VM (AbVM). Oxyhemoglobin (HbO), deoxyhemoglobin, and total hemoglobin changes were measured at four different source-detector distances (SD) (15, 30, 36, and 45 mm), and latency, amplitude, duration, and integrated total signal were calculated. Those parameters were compared between a normal healthy control (HC) group and the two OI patient subgroups. We found that HbO increment latency at 30-mm SD in the HC, NVM, and AbVM groups was as follows: [Formula: see text], [Formula: see text], and [Formula: see text], respectively ([Formula: see text]). Among the four parameters we evaluated, latency of HbO increment was the best marker for differentiating OI.

Encapsulated, High-Performance, Stretchable Array of Stacked Planar Micro-Supercapacitors as Waterproof Wearable Energy Storage Devices.

We report the fabrication of an encapsulated, high-performance, stretchable array of stacked planar micro-supercapacitors (MSCs) as a wearable energy storage device for waterproof applications. A pair of planar all-solid-state MSCs with spray-coated multiwalled carbon nanotube electrodes and a drop-cast UV-patternable ion-gel electrolyte was fabricated on a polyethylene terephthalate film using serial connection to increase the operation voltage of the MSC. Additionally, multiple MSCs could be vertically stacked with parallel connections to increase both the total capacitance and the areal capacitance owing to the use of a solid-state patterned electrolyte. The overall device of five parallel-connected stacked MSCs, a microlight-emitting diode (µ-LED), and a switch was encapsulated in thin Ecoflex film so that the capacitance remained at 82% of its initial value even after 4 d in water; the µ-LED was lit without noticeable decrease in brightness under deformation including bending and stretching. Furthermore, an Ecoflex encapsulated oximeter wound around a finger was operated using the stored energy of the MSC array attached to the hand (even in water) to give information on arterial pulse rate and oxygen saturation in the blood. This study suggests potential applications of our encapsulated MSC array in wearable energy storage devices especially in water.