穿戴式心电:发展历程、核心技术与未来挑战

随着物联网、大数据、云计算、人工智能等先进科技的迅猛发展,动态心电监测近年来朝着可穿戴、智能化、便捷化的方向快速发展。穿戴式心电设备能够实现心电数据的个体化、实时、长程、连续监护,可为智慧医疗新模式提供重要载体和技术手段。回顾穿戴式心电的基本概念和发展历程,综述其信号感知和处理等方面的核心技术和当前代表性的穿戴式心电设备,并对穿戴式心电未来发展趋势和面临挑战进行剖析和展望。     

可穿戴式持续葡萄糖监测设备的研究现状

糖尿病已经成为当今世界的主要死因之一。虽然目前还没有治愈糖尿病的方法,但是可靠持续的葡萄糖监测结合有效的药物治疗,可以缓解症状、减少并发症以及提高治疗的效率。为了即时护理以及及时治疗,防止突发状况,持续葡萄糖监测设备便应运而生。本文首先简要介绍可穿戴式持续葡萄糖监测设备及其分类;其次介绍基于不同体液的无创的可穿戴式持续葡萄糖监测技术及其优点和缺点;最后概述可穿戴式持续葡萄糖监测技术设备的研究现状与前景。     

Building the Hospital Without Walls--a CSIRO home telecare initiative.

Aging populations and rising health costs have created the need to care for more patients in their own homes. Australia's Commonwealth Scientific and Industrial Research Organization (CSIRO) is developing a project, Hospital Without Walls, which aims to provide continuous monitoring of patients in certain diagnostic categories. The key technology is a miniature, wearable, low-power radio that can transmit vital sign and activity information to a home computer, from which data may be sent by telephone line and the Internet to appropriate medical professionals. The initial clinical scenario for this work is monitoring of elderly patients who have presented to hospitals following repeated falls. Accelerometers built into the radio sets will monitor activity and detect and characterise falls. Simultaneous measurement of heart rate will provide information about abnormalities of cardiovascular physiology at the time of a fall. The system has been tested in laboratory conditions and is being adapted for initial clinical trials.     

Smart wearable systems: Current status and future challenges

ObjectiveExtensive efforts have been made in both academia and industry in the research and development of smart wearable systems (SWS) for health monitoring (HM). Primarily influenced by skyrocketing healthcare costs and supported by recent technological advances in micro- and nanotechnologies, miniaturisation of sensors, and smart fabrics, the continuous advances in SWS will progressively change the landscape of healthcare by allowing individual management and continuous monitoring of a patient's health status. Consisting of various components and devices, ranging from sensors and actuators to multimedia devices, these systems support complex healthcare applications and enable low-cost wearable, non-invasive alternatives for continuous 24-h monitoring of health, activity, mobility, and mental status, both indoors and outdoors. Our objective has been to examine the current research in wearable to serve as references for researchers and provide perspectives for future research.MethodsHerein, we review the current research and development of and the challenges facing SWS for HM, focusing on multi-parameter physiological sensor systems and activity and mobility measurement system designs that reliably measure mobility or vital signs and integrate real-time decision support processing for disease prevention, symptom detection, and diagnosis. For this literature review, we have chosen specific selection criteria to include papers in which wearable systems or devices are covered.ResultsWe describe the state of the art in SWS and provide a survey of recent implementations of wearable health-care systems. We describe current issues, challenges, and prospects of SWS.ConclusionWe conclude by identifying the future challenges facing SWS for HM.     

Optimizing usability and signal capture: a proactive risk assessment for the implementation of a wireless vital sign monitoring system

Wearable vital sign monitors are a promising step towards optimal patient surveillance, providing continuous data to allow for early detection and treatment of patient deterioration. However, as wearable monitors become more widely adopted in healthcare, there is a corresponding need to carefully design the implementation of these tools to promote their integration into clinical workflows and defend against potential misuse and patient harm. Prior to the roll-out of these monitors, our multidisciplinary team of clinicians, clinical engineers, information technologists and research investigators conducted a modified Healthcare Failure Mode and Effect Analysis (HFMEA), a proactive evaluation of potential problems which could be encountered in the use of a wireless vital signs monitoring system. This evaluation was accomplished by focussing on the identification of procedures and actions that would be required during the devices’ regular usage, as well as the implementation of the system as a comprehensive process. Using this method, the team identified challenges that would arise throughout the lifecycle of the device and developed recommendations to address them. This proactive risk assessment can guide the implementation of wearable patient monitors, optimising the use of innovative health information technology.     

Presenting phenotype and clinical evaluation in a cohort of 22 Williams-Beuren syndrome patients

Williams-Beuren syndrome (WS) is a rare multi-system genomic disorder, caused by 7q11.23 microdeletion with a prevalence of 1/7500-1/20,000 live births. Clinical phenotype includes typical facial dysmorphism (elfin face), mental retardation associated with a peculiar neuropsychological profile and congenital heart defects. We investigated 22 WS patients (mean age of 9.7 years, range 1 day to 39 years) with a multi-specialist follow-up protocol comprehensive of neuropsychological, cardiologic, nephrologic, ophthalmologic, endocrinologic, gastroenterologic, odontostomatologic and orthopaedic evaluations. The mean age at diagnosis was 5.38 years, being 1.02 years when genetic evaluation was requested for congenital heart defects (CHD) and 10.68 years in case of mental retardation and/or abnormal neuropsychological profile without an evident CHD. All patients showed facial dysmorphisms, with supravalvular aortic stenosis (SVAS) as the most common cardiovascular anomaly (12/22), followed by peripheral pulmonary stenosis (9/22); interestingly, in one patient we detected a total anomalous pulmonary venous return (TAPVR), confirming the possible association of this rare CHD with WS. Hypertension was detected by 24-h ambulatory blood pressure monitoring in 7/22 cases. A cognitive assessment was performed in 13 patients older than 6 years, showing various degrees of mental retardation in 12 and a normal intelligence quotient (IQ) in a single patient; evaluation of developmental milestones revealed various grades of developmental delay in all the patients younger than 6 years. Chiari malformation type 1 was found in 3 patients. Our study underlines a remarkable diagnostic delay in patients who present to genetic evaluation because of mental retardation and/or peculiar neuropsychological profile lacking an evident cardiopathy and confirms the multi-systemic nature of WS leading to a high clinical presentation's variability and complex follow-up strategies.     

Analysis of microsatellite instability and hypermutation of immunoglobulin variable genes in Werner syndrome

Werner syndrome (WS) is a human premature aging syndrome, which is associated with high frequencies of neoplasia and genetic instability. We have examined the occurrence of microsatellite instability, which may result from defective mismatch repair, in lymphoblastoid cell lines derived from nine WS patients. Instability was measured at the D2S123 locus by gel analysis of PCR products. Three WS cell lines had 4-13% altered alleles, compared with 0% in the other six lines. The increased frequency of microsatellite instability could not readily be associated with overt cancer or any other known clinical condition in the three patients. To examine whether the WS defect affected the humoral immune system, we measured the hypermutation of immunoglobulin variable genes in peripheral blood cells from the WS patient who donated the cell line with the highest frequency of microsatellite instability. The frequency and pattern of mutation was similar to that from normal individuals, suggesting that the Werner protein is not involved in generating hypermutation.     

Monitoring Obstructive Sleep Apnea by means of a real-time mobile system based on the automatic extraction of sets of rules through Differential Evolution

Real-time Obstructive Sleep Apnea (OSA) episode detection and monitoring are important for society in terms of an improvement in the health of the general population and of a reduction in mortality and healthcare costs. Currently, to diagnose OSA patients undergo PolySomnoGraphy (PSG), a complicated and invasive test to be performed in a specialized center involving many sensors and wires. Accordingly, each patient is required to stay in the same position throughout the duration of one night, thus restricting their movements.This paper proposes an easy, cheap, and portable approach for the monitoring of patients with OSA, which collects single-channel ElectroCardioGram (ECG) data only. It is easy to perform from the patient’s point of view because only one wearable sensor is required, so the patient is not restricted to keeping the same position all night long, and the detection and monitoring can be carried out in any place through the use of a mobile device.Our approach is based on the automatic extraction, from a database containing information about the monitored patient, of explicit knowledge in the form of a set of IF…THEN rules containing typical parameters derived from Heart Rate Variability (HRV) analysis. The extraction is carried out off-line by means of a Differential Evolution algorithm. This set of rules can then be exploited in the real-time mobile monitoring system developed at our Laboratory: the ECG data is gathered by a wearable sensor and sent to a mobile device, where it is processed in real time. Subsequently, HRV-related parameters are computed from this data, and, if their values activate some of the rules describing the occurrence of OSA, an alarm is automatically produced.This approach has been tested on a well-known literature database of OSA patients. The numerical results show its effectiveness in terms of accuracy, sensitivity, and specificity, and the achieved sets of rules evidence the user-friendliness of the approach. Furthermore, the method is compared against other well known classifiers, and its discrimination ability is shown to be higher.     

穿戴式呼吸感应体积描记用于睡眠呼吸事件检测

可穿戴式呼吸感应体积描记(背心式RIP)系统是我们根据呼吸感应体积描记技术的基本原理研发的一种可穿戴、低负荷的呼吸监测系统.在实现通气量无创测量的基础上,我们将该系统用于睡眠期呼吸事件检测,将该系统与多导睡眠图仪(PSG)对9例疑似睡眠呼吸暂停低通气综合症(SAHS)病人和7名健康男性志愿者进行同步对照检测与分析.通过对比实验,根据背心式RIP系统发生呼吸事件的特征性变化,提出了背心式RIP系统判别呼吸事件的规则.依据该规则,所有经背心式RIP系统诊断为SAHS患者的结果与PSG的诊断结果完全一致,背心式RIP系统检测呼吸事件的敏感性为97.8%,特异性为95.8%,实验结果表明背心式RIP系统能够可靠地检测出睡眠呼吸事件.由于其低生理、心理负荷特性,不需要佩带口鼻气流传感器,可用于家庭环境下、自然睡眠过程的睡眠呼吸紊乱性疾病的诊断.     

Smart Vest: wearable multi-parameter remote physiological monitoring system

The wearable physiological monitoring system is a washable shirt, which uses an array of sensors connected to a central processing unit with firmware for continuously monitoring physiological signals. The data collected can be correlated to produce an overall picture of the wearer's health. In this paper, we discuss the wearable physiological monitoring system called ‘Smart Vest’. The Smart Vest consists of a comfortable to wear vest with sensors integrated for monitoring physiological parameters, wearable data acquisition and processing hardware and remote monitoring station. The wearable data acquisition system is designed using microcontroller and interfaced with wireless communication and global positioning system (GPS) modules. The physiological signals monitored are electrocardiogram (ECG), photoplethysmogram (PPG), body temperature, blood pressure, galvanic skin response (GSR) and heart rate. The acquired physiological signals are sampled at 250 samples/s, digitized at 12-bit resolution and transmitted wireless to a remote physiological monitoring station along with the geo-location of the wearer. The paper describes a prototype Smart Vest system used for remote monitoring of physiological parameters and the clinical validation of the data are also presented.     

Feasibility of warable artificial kidney using presently commercially availble hollow-fiber membrane

On the assumption that continuous treatment is effective in preventing β₂-microglobulin deposition in a patient without kidney function, a wearable artificial kidney device was theoretically designed on the basis of using presently commercially available hollow-fiber membrane for hemodialysis. The device was assumed to be connected between an arteriole and a large vein. The device, with an optimal dimension consisting of the membrane with an appropriate filtration permeability, was capable of carrying out continuous hemofiltration using the blood pressure of the patient only and of preventing β₂-microglobulin deposition. If dialysate was fed into the device for an appropriate time every day, concentrations of urea nitrogen and creatinine were also maintained at a lower level than that of conventional intermittent hemodialysis. Because the dimension and technical data of the device giving these results are comparable to those of commercially available hemodialyzers, we should reconsider whether the wearable artificial kidney can be put into clinical use.     

Discordant phenotype of two overlapping deletions involving the PAX3 gene in chromosome 2q35

Waardenburg syndrome (WS), the most common form of Inheritedcongenltal deafness, is a pleiotropic, autosomal dominant conditionwith variable penetrance and expresslvity. WS is clinicallyand genetically heterogeneous. The basis for the phenotypicvariability observed among and between WS families is unknown.However, mutations within the paired-box gene, PAX3, have beenassociated with a subset of WS patients. In this report we usecytogenetic and molecular genetic techniques to study a patientwith WS type 3, a form of WS consisting of typical WS type 1features plus mental retardation, microcephaly, and severe skeletalanomalies. Our results show that the WS3 patient has a de novopaternally derived deletion, del (2)(q35q36), that spans thegenetic loci PAX3 and COL4A3. A molecular analysis of a chromosome2 deletional mapping panel maps the PAX3 locus to 2q35 and suggeststhe locus order: centromere-(INHA, DES)-PAX3-COL4A3-(ALPI, CHRND)-telomere.Our analyses also show that a patient with a cleft palate andlip pits, but lacking diagnostic WS features, has a deletion,del (2)(q33q35), Involving the PAX3 locus. This result suggeststhat not all PAX3 mutations are associated with a WS phenotypeand that additional regional loci may modify or regulate thePAX3 locus and/or the development of a WS phenotype.     

Transmission and non-transmission portable ECG in home care medicine

Portable electrocardiography is advantageous in that patients can record ECG by themselves at any time and place. Portable ECG can be classified into two kinds of devices, transmission type and non-transmission type. By using transmission-type portable ECG, patients can obtain an ECG diagnosis from the center by transmitting the recorded ECG. Transmission-type portable ECG is extremely useful for patients needing emergency treatment for such as an attack of ischemic heart disease or arrhythmic event. On the other hand, a patient has to go to a specialist to obtain an ECG diagnosis with the non-transmission-type portable ECG device after recording the ECG alone. As this model is slightly cheaper, and is easy to use, the non-transmission-type portable ECG is good in non-emergency use for early diagnosis and prevention of cardiac disease. Portable ECG is useful for ECG monitoring over time without seeing the patient, not only for symptomatic analysis of the patient. For example, silent myocardial ischemia and arrhythmic events developing during exercise will become clear in periodical portable ECG recording. In particularly, portable ECG is useful for noncontinual ECG monitoring of patients with Brugada syndrome and those administered with antiarrhythmic drugs. Portable ECG increases the opportunity to discover cardiac disease from the aspect of preventive medicine. When patients use a portable ECG during exercise, they can understand whether the exercise is suitable for their heart. Portable ECG is a useful measurement in preventive medicine as described above, not only for the home care of patients.     

Early diagnosis of frailty: Technological and non-intrusive devices for clinical detection

This work analyses different concepts for frailty diagnosis based on affordable standard technology such as smartphones or wearable devices. The goal is to provide ideas that go beyond classical diagnostic tools such as magnetic resonance imaging or tomography, thus changing the paradigm; enabling the detection of frailty without expensive facilities, in an ecological way for both patients and medical staff and even with continuous monitoring. Fried's five-point phenotype model of frailty along with a model based on trials and several classical physical tests were used for device classification. This work provides a starting point for future researchers who will have to try to bridge the gap separating elderly people from technology and medical tests in order to provide feasible, accurate and affordable tools for frailty monitoring for a wide range of users.     

The Treatment of Acute Schizophrenic Patients in Private Practice

There are more schizophrenic patients outside hospitals than in them. Acute schizophrenics are a varied group of patients who very frequently may be best treated in outpatient office practice. They need a therapist who is strong enough to be a protective object and an auxiliary ego and who will deal with the unconscious meaning of the hallucinatory and delusional experiences. Relatives may provide support and housing for patients who would otherwise be hospitalised. Relatives can tolerate a psychotic individual surprisingly well if they see this as a response to an emergency situation which will be necessary for only a month or two at most. The availability of the therapist to the patient by telephone also permits the patient to deal with experiences and situations that would otherwise overwhelm him and require hospitalisation, or end in suicide. How to deal with patients without medication or how optimally to use medication, if that is the therapist's or the patient's preference, is discussed. In the light of current evidence it is clear that prolonged and continuous medication is not neurologically in the patient's best interest.     

Elevated ambulatory blood pressure in 20 subjects with Williams syndrome

Previous studies report conflicting frequencies of hypertension in cohorts of patients with Williams syndrome (WS). We studied blood pressure (BP) in WS using 24-hour ambulatory BP monitoring. This technique reliably measures day- and nighttime BP in a subject's natural environment and provides better prognostic information on long-term risks of hypertension than casual BP determinations. Twenty WS subjects evaluated through a multidisciplinary WS clinic and 35 age and gender-matched controls were studied. We found that WS subjects had significantly higher ambulatory BP than controls. After controlling for age, sex, and weight, the diagnosis of WS added approximately 10 mmHg to mean daytime and nighttime BPs. Hypertension, as defined by elevated mean daytime BP, was present in 40% of WS subjects versus 14% of controls (P < 0.05); among the children studied this difference was even more dramatic with 46% of WS children versus 6% of control children classified as hypertensive (P = 0.01). We also demonstrated normal diurnal BP variation but no evidence of a "white coat" effect or increased BP variability. Interestingly, parental reporting of a history of infantile hypercalcemia was strongly associated with the presence of hypertension (P = 0.008). Our data demonstrate that both children and adults with WS have higher mean BP and higher frequency of hypertension than healthy controls. Thus, elevated BP readings in the office setting should not be dismissed but require more thorough assessment.     

Data quality of a wearable vital signs monitor in the pre-hospital and emergency departments for enhancing prediction of needs for life-saving interventions in trauma patients

Abstract

This study was designed to investigate the quality of data in the pre-hospital and emergency departments when using a wearable vital signs monitor and examine the efficacy of a combined model of standard vital signs and respective data quality indices (DQIs) for predicting the need for life-saving interventions (LSIs) in trauma patients. It was hypothesised that prediction of needs for LSIs in trauma patients is associated with data quality. Also, a model utilizing vital signs and DQIs to predict the needs for LSIs would be able to outperform models using vital signs alone. Data from 104 pre-hospital trauma patients transported by helicopter were analysed, including means and standard deviations of continuous vital signs, related DQIs and Glasgow coma scale (GCS) scores for LSI and non-LSI patient groups. DQIs involved percentages of valid measurements and mean deviation ratios. Various multivariate logistic regression models for predicting LSI needs were also obtained and compared through receiver-operating characteristic (ROC) curves. Demographics of patients were not statistically different between LSI and non-LSI patient groups. In addition, ROC curves demonstrated better prediction of LSI needs in patients using heart rate and DQIs (area under the curve [AUC] of 0.86) than using heart rate alone (AUC of 0.73). Likewise, ROC curves demonstrated better prediction using heart rate, total GCS score and DQIs (AUC of 0.99) than using heart rate and total GCS score (AUC of 0.92). AUCs were statistically different (p?<?0.05). This study showed that data quality could be used in addition to continuous vital signs for predicting the need for LSIs in trauma patients. Importantly, trauma systems should incorporate processes to regulate data quality of physiologic data in the pre-hospital and emergency departments. By doing so, data quality could be improved and lead to better prediction of needs for LSIs in trauma patients.     

一种可穿戴式心电图动态监护系统

介绍一种基于柔性电极可穿戴心电监护系统的软硬件设计方案,主要解决现阶段心电监护系统中存在的高成本、高耗能、心电图信号连续性差等问题。同时在电极设计上采用银纤维布料的方法,消除一次性AgCl/Ag湿电极在可穿戴心电系统中无法长期佩戴的弊端。经志愿者测试验证分析,系统有着较高的稳定性和实用性,对可穿戴心电监护体系的发展有实际应用推广价值。     

A comprehensive survey of wearable and wireless ECG monitoring systems for older adults

Wearable health monitoring is an emerging technology for continuous monitoring of vital signs including the electrocardiogram (ECG). This signal is widely adopted to diagnose and assess major health risks and chronic cardiac diseases. This paper focuses on reviewing wearable ECG monitoring systems in the form of wireless, mobile and remote technologies related to older adults. Furthermore, the efficiency, user acceptability, strategies and recommendations on improving current ECG monitoring systems with an overview of the design and modelling are presented. In this paper, over 120 ECG monitoring systems were reviewed and classified into smart wearable, wireless, mobile ECG monitoring systems with related signal processing algorithms. The results of the review suggest that most research in wearable ECG monitoring systems focus on the older adults and this technology has been adopted in aged care facilitates. Moreover, it is shown that how mobile telemedicine systems have evolved and how advances in wearable wireless textile-based systems could ensure better quality of healthcare delivery. The main drawbacks of deployed ECG monitoring systems including imposed limitations on patients, short battery life, lack of user acceptability and medical professional’s feedback, and lack of security and privacy of essential data have been also discussed.     

How do we monitor asthma control?

The present consensus on asthma management includes avoidance of triggers, education, regular follow-up, and an action plan that relies on symptoms and lung function measurements for the monitoring of disease severity. Inclusion of objective measurements for monitoring seems to be important because patients and physicians may not always recognize asthma symptoms or their severity. However, the additional value of monitoring peak flow and symptoms in guiding asthma therapy has not been well established. Furthermore, it can be questioned whether a treatment strategy which is solely based on optimizing symptoms and lung function leads to optimal control of asthma in each individual patient, since airway hyperresponsiveness (AHR) and airways inflammation may persist. The chronicity of such abnormalities may lead to airways remodelling, thereby worsening the long-term outcome of asthma. It has been shown that AHR provides prognostic information on asthma control, because it can serve as a valuable noninvasive surrogate marker of airways inflammation when added to the guides of asthma therapy. A limited increase in dose of inhaled steroids, instead of applying an increased dose indiscriminately, can be successfully tailored to the needs of the individual patient based on the degree of AHR. Such a strategy leads to both a better clinical outcome and a better histologic outcome. The present worldwide effort is to find alternative markers of airways inflammation in asthma that can be easily implemented in routine practice. In the near future, longitudinal studies will determine which parameter is potentially most useful in guiding asthma management.