Clinical application of acupuncture-moxibustion for the treatment of spirit based on approximate entropy of electrooculogram signal / 中国针灸

According to the theory of acupuncture-moxibustion for the treatment of spirit, starting from the relationship between eye movement and spirit, the application of electrooculogram (EOG) signal acquisition and analysis technology for the clinical treatment of spirit by acupuncture-moxibustion is discussed. Based on the nonlinear dynamic characteristics of EOG signals, it is proposed to apply the approximate entropy algorithm to extract the EOG signal characteristics in autism spectrum disorder children under different behavior states, which could realize the preliminary exploration of the correlation between EOG signals and cognitive activities. This could provide a possibility to objectively reflect the patient' s current mental state, and could be used as a potential method to grasp spirit in clinical acupuncture- moxibustion treatment. Furthermore, considering the characteristics of acupoint stimulation on the body surface, the EOG signal acquisition and analysis technology could further be combined with biofeedback technology, and a new idea for clinical acupuncture-moxibustion to treat spirit guided by biofeedback of EOG is proposed.

Transcutaneous electrical acupoint stimulation based on electro-oculogram signal regulation for children with mental retardation: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of transcutaneous electrical acupoint stimulation (TEAS) at Changqiang (GV 1) based on the modulation of electro-oculogram (EOG) signal for children with mental retardation, and explore the evaluation effect of the goal attainment scale (GAS) in children with mental retardation.@*METHODS@#Sixty children with mental retardation were randomly divided into a treatment group and a control group, with 30 cases in each one. The children in the control group were treated with conventional rehabilitation, 5 times a week. On the basis of the control group, TEAS at Changqiang (GV 1) under the modulation of EOG signal was adopted in the treatment group. When the similarity between the collected EOG signal and the template was within the range of EOG threshold, one electric stimulation was triggered at Changqiang (GV 1) for 20 s (continuous wave, 70-100 Hz in frequency, 0.1-0.2 ms in pulse width), lasting 30 min in each treatment, the intervention was given twice a week. One course of treatment was composed of 4 weeks, and 3 courses were required in total in the two groups. The infant-junior high school student's social living ability scale (S-M) and GAS were scored and compared before and after treatment in the two groups.@*RESULTS@#After treatment, the scores of self-living ability in the treatment group and communication ability in the control group were higher than those before treatment (P<0.01, P<0.05). The scores of collective activity and motor ability in the treatment group were higher than those in the control group (P<0.05). After treatment, GAS scores were higher than before treatment in both groups (P<0.001), and the score in the treatment group was higher than the control group (P<0.05).@*CONCLUSION@#TEAS under the modulation of EOG signal is conductive to improving the collective, motor and self-living abilities of the children with mental retardation and promoting children's individual goals. Compared with the standard score of S-M, the T value of GAS can better reflect the subtle progress of individual.

Automatic removal algorithm of electrooculographic artifacts in non-invasive brain-computer interface based on independent component analysis / 生物医学工程学杂志

The non-invasive brain-computer interface (BCI) has gradually become a hot spot of current research, and it has been applied in many fields such as mental disorder detection and physiological monitoring. However, the electroencephalography (EEG) signals required by the non-invasive BCI can be easily contaminated by electrooculographic (EOG) artifacts, which seriously affects the analysis of EEG signals. Therefore, this paper proposed an improved independent component analysis method combined with a frequency filter, which automatically recognizes artifact components based on the correlation coefficient and kurtosis dual threshold. In this method, the frequency difference between EOG and EEG was used to remove the EOG information in the artifact component through frequency filter, so as to retain more EEG information. The experimental results on the public datasets and our laboratory data showed that the method in this paper could effectively improve the effect of EOG artifact removal and improve the loss of EEG information, which is helpful for the promotion of non-invasive BCI.

Choroidal Neovascularization in a Patient with Best Disease

PURPOSE: To report a case of choroidal neovascularization in a Best disease patient treated with intravitreal bevacizumab injection and followed up with optical coherence tomography angiography (OCTA). CASE SUMMARY: A 20-year-old female visited our clinic with decreased visual acuity of the left eye for 6 months. On optical coherence tomography (OCT), subretinal fluid and hyperreflective subretinal clumps were observed in the macula of the right eye. Subretinal hemorrhage and subretinal fluid were observed in the left eye. Choroidal neovascularization in the left eye was observed using OCTA, fluorescein angiography, and indocyanine green angiography. A full-field electroretinogram was normal in both eyes, but an electrooculogram revealed that the Arden ratio was 1.564 in the right eye and 1.081 in the left eye. Intravitreal bevacizumab injection was performed in the left eye. At 6 months after the intravitreal injection, the best-corrected visual acuity of the left eye had recovered to 20/20. OCT revealed that subretinal fluid reduced and choroidal neovascularization was stable. After 12 months, visual acuity of the left eye was maintained at 20/20, but OCTA revealed that choroidal neovascularization had increased. CONCLUSIONS: Choroidal neovascularization associated with Best disease can improve by intravitreal bevacizumab injection, and the changes in choroidal neovascularization can be followed using OCTA.

Phenotypic expression variability in Best Disease: a purpose of a series of cases / Variabilidade de expressão Fenotípica na Doença de Best: a propósito de uma série de casos

Abstract The objective of the following work is to document the phenotypic expression variability in Best Disease in first-degree relatives. The information was collected by assessing medical notes, interviewing the patient and obtaining photographic record of the diagnostic methods to which the patient was submitted. Data was analyzed along with a thorough review of the literature. A series of cases were reported in which the patient presenting the phenotypic characteristics of the disease has first degree relatives without ophthalmic findings during examination, but present an abnormal pattern on the electro-oculogram (EOG). Our article reveals the importance of electrophysiological exams in the diagnosis of Best vitelliform macular dystrophy, including the prevention of its clinical manifestation (autosomal dominant), providing concrete subsidies for genetic counseling.

Resumo O objetivo do presente trabalho é a documentação da variabilidade de expressão fenotípica da Doença de Best em parentes de primeiro grau. As informações foram obtidas por meio de revisão do prontuário, entrevista com o paciente e registro fotográfico dos métodos diagnósticos aos quais os pacientes foram submetidos. Dados foram analisados junto a uma extensa revisão da literatura. Relatamos uma série de casos, no qual o paciente que apresenta as alterações fenotípicas da doença tem familiares de primeiro grau sem alterações ao exame oftalmológico, porém os mesmos apresentam padrão anormal de eletro-oculograma (EOG). O nosso artigo revela a importância dos exames eletrofisiológicos no diagnóstico da distrofia macular viteliforme de Best, inclusive no que se refere à prevenção de sua manifestação clínica (autossômica dominante), fornecendo subsídios concretos para o aconselhamento genético.

Characteristics of Elderly-Onset (≥65 years) Headache Diagnosed Using the International Classification of Headache Disorders, Third Edition Beta Version

BACKGROUND AND PURPOSE: New-onset headache in elderly patients is generally suggestive of a high probability of secondary headache, and the subtypes of primary headache diagnoses are still unclear in the elderly. This study investigated the characteristics of headache with an older age at onset (≥65 years) and compared the characteristics between younger and older age groups. METHODS: We prospectively collected demographic and clinical data of 1,627 patients who first visited 11 tertiary hospitals in Korea due to headache between August 2014 and February 2015. Headache subtype was categorized according to the International Classification of Headache Disorders, Third Edition Beta Version. RESULTS: In total, 152 patients (9.3%, 106 women and 46 men) experienced headache that began from 65 years of age [elderly-onset group (EOG)], while the remaining 1,475 patients who first experienced headache before the age of 65 years were classified as the younger-age-at-onset group (YOG). Among the primary headache types, tension-type headache (55.6% vs. 28.8%) and other primary headache disorders (OPH, 31.0% vs. 17.3%) were more common in the EOG than in the YOG, while migraine was less frequent (13.5% vs. 52.2%) (p=0.001) in the EOG. Among OPH, primary stabbing headache (87.2%) was more frequent in the EOG than in the YOG (p=0.032). The pain was significantly less severe (p=0.026) and the frequency of medication overuse headache was higher in EOG than in YOG (23.5% vs. 7.6%, p=0.040). CONCLUSIONS: Tension-type headache and OPH headaches, primarily stabbing headache, were more common in EOG patients than in YOG patients. The pain intensity, distribution of headache diagnoses, and frequency of medication overuse differed according to the age at headache onset.

Three Cases of Outer Retinal Tubulation in Bietti's Crystalline Dystrophy

PURPOSE: To report the prevalence and the characteristics of outer retinal tubulation (ORT) in Bietti's crystalline dystrophy in 6 eyes of 3 patients. CASE SUMMARY: Three patients with Bietti's crystalline dystrophy were examined using color fundus photography, fundus autofluorescence picture, spectral domain optical coherence tomography (SD-OCT), fluorescein angiography, electroretinogram and electrooculogram. ORT was detected in 3 of 3 (100%) Bietti's crystalline dystrophy patients. SD-OCT B-scan revealed hyperreflective material inside the hyporeflective internal space with hyperreflective border. ORT was observed under the fovea or outside the fovea and on the outer nuclear layer in the retina. ORTs were no greater than 70 x 140 microm in size when measured using SD-OCT B-scan image. CONCLUSIONS: ORT was observed frequently in patients with Bietti's crystalline dystrophy. These findings can potentially predict the extensive photoreceptor abnormalities in retinal pigment epithelial atrophy.

Result of Visual Evoked Potential, Electroretinography and Electrooculography in Normal Subjects Using MonPack 3 System

PURPOSE: We present the results of visual evoked potential (VEP), electroretinography (ERG), and electrooculography (EOG) in normal subjects using the Mon-pack 3 system (Metrovision). METHODS: VEP, ERG, and EOG were obtained in 92 normal eyes. The measurements followed the International Society for Clinical Electrophysiology of Vision (ISCEV) standardization protocol. In VEP, the standard electrode was placed on the forehead and the active electrode was attached on the occiput. In ERG, a 20-minute dark adaptation was performed after mydriasis, and an ERG-jet electrode was used. EOG was measured by attaching an electrode to each medial canthal skin. Each latent period and electric potential was measured with average, standard deviation, median, and 95% confidencenterval (95% CI). RESULTS: The mean P100 latency in pattern VEP was 104.36 ms, and P100 latency in flash VEP was 116.71 ms. For the maximal ERG response, the implicit times of a and b waves were 22.65 ms and 44.58 ms, respectively and the amplitude of a and b waves were 274.09 microv and 489.52 microv, respectively. For the ERG cone response, the implicit time of a and b waves were 18.21 ms and 33.40 ms, respectively, and the amplitude of a and b waves were 35.87 microv and 104.42 microv, respectively. The mean ERG oscillitatory potential was 285.53 microv. The average EOG Arden ratio was 2.54. CONCLUSIONS: VEP, ERG, and EOG results from normal subjects using the Mon-pack 3 system can be applied to the diagnosis of retina and optic nerve disease and basic research.

Characteristics and distribution of ERP by different field stimulation / 法医学杂志

OBJECTIVE@#To study the variation of latency and amplitude of the event related potential (ERP) and its distribution in human scalp when the normal subjects were stimulated with different visual fields.@*METHODS@#The ERP recorded in scalp with the stimulation of 10 degrees visual field and 60 degrees visual field respectively in 20 healthy volunteers with normal visual function.@*RESULTS@#Two different visual field stimulation may evoke the different exogenous components P1 (70-125 ms), N1 (90-170 ms), P2 (140-220 ms) and endogenous components N2 (190-280 ms) and P3 (290-430 ms). The latencies of all the components evoked by 10 degrees visual field were shorter than that of the 60 degrees visual field while the amplitudes of N1 and N2 were lower and appeared over the extensive encephalic region; and the amplitudes of the P1, P2 and P3 were higher and appeared in occipitotemporal, prefrontal and occipital region, respectively.@*CONCLUSION@#Two different visual field stimulation may evoke all the ERP components with significant differences in the latency, amplitude and distribution. The differences may reflect the different visual information integration and processing in human brain during the different visual field stimulation.

A Case of Hydroxychloroquine Retinopathy

PURPOSE: Hydroxychloroquine has been used as the antimalarial agent and drug of the treatment for autoimmune disease such as rheumatoid arthritis. Hydroxychloroquine retinopathy can cause serious visual disturbance although the incidence is low. This report is to describe a case of Hydroxycholoroquine retinopathy on 73 year old female. CASE SUMMARY: A 73 year old female patient presented our clinic with complaints of visual disturbance for several months. She had taking 400 mg/day (8.8 mg/kg of lean body weight/day) of hydroxychloroquine for 2 years. The best corrected visual acuity was 20/30 in both eyes. Bull's eye maculopathy was observed on her fundus examination and Humphrey Automated Visual Field 24-2 showed central scotoma in both eyes. Parafoveal thinning of photoreceptor layers, loss of the inner and outer segment junction and external limiting membrane was observed on spectral domain Optical Coherence Tomography. Window defect was visible at the parafoveal area on fluorescein angiography. Electroretinogram revealed subtle dysfunction of cone cell and multifocal ERG trace array showed decreased amplitudes at the parafoveal area. Electrooculogram showed decreased Arden ratio. CONCLUSIONS: We strongly advise that all patients taking Hydorxycholoroquine therapy have a regular examination to find hydroxychloroquine retinopathy in early stage especially in the patients having high risk factors.

Eletronistagmografia versus videonistagmografia: [revisão] / Electronystagmography versus videonystagmography: [review]

Electronystagmography (ENG) and videonystagmography (VNG) are eye movement recording methods used for the evaluation of balance disorders. AIM: To compare literature information on the similarities, differences, advantages e disadvantages between ENG and VNG. MATERIALS AND METHODS: review of the scientific literature. RESULTS: ENG and VNG are very helpful methods for evaluating balance disorders, due to their capacity to recognize signs of peripheral or central vestibular dysfunction and to pinpoint the side of the lesion. Major advantages of VNG are related to calibration, temporospatial resolution, and recording of horizontal, vertical and torsional eye movements. CONCLUSION: VNG is a new technology that presents advantages in the evaluation of eye movements; however, despite its disadvantages, ENG is still considered a valuable test in the clinical setting

A eletronistagmografia (ENG) e a videonistagmografia (VNG) são métodos de registro dos movimentos oculares, empregados na avaliação dos distúrbios do equilíbrio corporal. OBJETIVO: Comparar as informações da literatura sobre as semelhanças, diferenças, vantagens e desvantagens da ENG e da VNG. MATERIAL E MÉTODO: Estudo de revisão da literatura científica pertinente. RESULTADOS: A ENG e a VNG são sistemas muito úteis no diagnóstico dos distúrbios do equilíbrio corporal, diante da sua capacidade de identificar sinais de disfunção vestibular periférica ou central e determinar o lado da lesão. As principais vantagens da VNG estão relacionadas com calibração, resolução têmporo-espacial e gravação dos movimentos oculares horizontais, verticais e torsionais. CONCLUSÃO: A VNG é uma nova tecnologia que apresenta vantagens na avaliação dos movimentos oculares, mas a ENG, apesar de suas desvantagens, é ainda considerada um procedimento de valor na rotina clínica

Relationship Between Visual Acuity and Foveation Window in Infantile Nystagmus by Analyzing Nystagmus Waveforms

PURPOSE: To report herein on Nystagmus Acuity Estimator Function (NAEF) based on the foveation time, obtained by analyzing waveforms of infantile nystagmus patients and comparing the results with the patients' actual visual acuity. METHODS: Electro-oculographic data of 27 patients with infantile nystagmus were reviewed. Data of patients only with jerk type nystagmus and reliable visual acuity were analyzed. The foveation time was measured, and NAEF was calculated and compared with the patients' actual best corrected visual acuity. RESULTS: A correlation analysis of the patients' best corrected visual acuity with NAEF was performed, and the retrieved coefficient was 0.4266. The p-value calculated using the Pearson correlation coefficient was 0.0282, implying that high NAEF correlates positively with visual acuity. CONCLUSIONS: Estimated visual acuity, calculated based on the waveforms, positively correlates with the patients' actual visual acuity with statistical significance. However, since the foveation time can be measured only in the patients with jerk-type nystagmus waveforms, further study should be performed on the measurement of the foveation time with other waveforms. Furthermore, the present study shows that such analysis is possible with electrooculogram settings in most general hospitals.

Best Disease With Old-age Onset Misdiagnosed as Chronic Central Serous Chorioretinopathy: A Case Report

PURPOSE: To report a case of Best's disease with old-age-onset with unusual clinical features. CASE SUMMARY: A 68-year-old woman with a six-month history of using oral steroids complained of decreased vision in both eyes. Fundus examination revealed a circular area of macular elevation measuring approximately 1.5 disc diameter size in both eyes. Optical coherence tomography (OCT) showed serous retinal detachment, but pigment epithelial detachment was seen only on fluorescein angiography and indocyanine green angiography. The patient received a diagnosis of chronic central chorioretinopathy with choroidal neovascularization. Photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) injections were prescribed as treatment, but were ineffective. For a definitive diagnosis, we performed an electro-oculogram (EOG) and the result was abnormal with an Arden ratio below 1.5 in both eyes. A final diagnosis of Best's disease was established. Spectral domain OCT findings at the last visit showed a clearly visible RPE split and a low reflective space between the split RPE layers, as well as a high reflectivity corresponding to the subretinal material. CONCLUSIONS: We report a case of Best's disease with old-age onset with unusual clinical features and abnormal EOG findings. Spectral domain OCT was helpful in evaluating the disease. Treatment with PDT and IVB was not effective.

Removal of ocular artifact from EEG based on JADE / 生物医学工程学杂志

The method of Joint approximate diagonalization (JADE) is used to remove the ocular artifact from Electroencephalogram (EEG). As the JADE algorithm can be used to separate sub-gaussian and super-gaussian sources, it is possible to extract the signals that are statistically independent, and to identify the spatial map that is associated with the artifactual component. Thus the method can remove artifactual component. Satisfactory results illustrate the robust and practicability of the algorithm.

Methodological considerations related to sleep paradigm using event related potentials

In the last few decades, several works on event related potentials (ERPs hereafter) during sleep have been reported. In spite of numerous studies, clear methodological rules for this kind of study are often missing, making it difficult to valorize the scope of these results. We propose here a description of methodological aspects to be considered when evaluating ERPs during sleep. The use of Rechtschaffen and Kales rules versus automatic methods is assessed, plus the additional use of certain quantitative measures. Additionally, two topics are discussed which must be controlled in ERPs sleep studies: the First Night Effect, and sleep disturbances. Better control of experimental paradigms is relevant for the growth of the neuroscience of sleep.

The medial septum acts through the medial preoptic area for thermoregulation and works with it for sleep regulation.

The chronic changes in sleep-wakefulness (S-W), body temperature (Tb), locomotor activity (LMA) and thermal preference were studied in male Wistar rats after the destruction of neurons in both the medial preoptic area (mPOA) and the medial septum (MS) by intracerebral injection of N-methyl-D-aspartic acid. An increase in the Tb, and a preference for higher ambient temperature (Tamb) of 30 degrees C were observed after the combined lesion of the mPOA and the MS. Similar changes were reported to occur after the lesion that was restricted to the mPOA. But these alterations were in contrast to the decrease in Tb and preference for lower Tamb, observed after the MS lesion. The thermostat of the brain would have been reset at a higher level after the combined lesion, as there was an increase in Tb, along with a preference for a higher Tamb, and an increase in LMA. There was a reduction in the frequency and the duration of the slow wave sleep (SWS) episodes, and a reduction in the frequency of the paradoxical sleep (PS) episodes after the combined lesion. The destruction of the MS neurons was probably responsible for the reduction in the frequency of SWS, whereas the loss of mPOA neurons was responsible for the decrease in the duration of SWS and frequency of PS. It can be suggested that the MS exerts its influence on thermoregulation through the mPOA. However, the MS and the mPOA seem to play independent, but complementary roles in sleep promotion.

Evolução clínica de pacientes com doença de Ménière / The outcome of patients with ménières disease

A doença de Ménière é vestibulopatia freqüente e manifesta-se após a 4ª década de vida. Diagnóstico é clínico e caracteriza-se por vertigem, perda auditiva neurossensorial, zumbido e plenitude aural. OBJETIVO: Estudar a evolução da doença de Ménière em função do tempo de evolução da vertigem, do zumbido, da plenitude aural, da perda auditiva, idade e acometimento unilateral ou bilateral. CASUíSTICA E MÉTODO: Estudo retrospectivo. Avaliados 39 pacientes com diagnóstico clínico definido de doença de Ménière, confirmado pela eletrococleografia, em centro de referência. Foram submetidos ao exame clínico, audiometria e eletrococleografia transtimpânica bilateral. Foram divididos em 2 grupos: doença de Ménière bilateral e doença de Ménière unilateral. RESULTADOS: Idade média de 42,9 com predominância feminina (72,5 por cento). Flutuação da audição ocorreu em 54,5 por cento e 65,7 por cento apresentavam crises vertiginosas freqüentes. Envolvimento bilateral foi observado em 33,3 por cento. A doença iniciou mais cedo (33,7 anos) no grupo bilateral que no grupo unilateral (p= 0,0013). Não houve diferença da duração da doença, zumbido, plenitude aural e perda auditiva entre os grupos. CONCLUSÃO: Pacientes com doença de Ménière bilateral apresentam sintomas mais precocemente que aqueles com doença unilateral, mas não diferem em relação ao tempo de evolução da doença e dos sintomas associados.

Ménière`s disease is a frequent vestibular disease that occurs predominantly in the fourth decade of life. Diagnosis is mostly medical and is based on findings of vertigo, sensorineural hearing loss, tinnitus and aural fullness. AIM: To study the clinical findings of Ménière`s disease: age, duration of vertigo, tinnitus, hearing loss and aural fullness, and unilateral or bilateral involvement. METHOD: a retrospective study included 39 patients with a diagnosis of Ménière`s disease confirmed by electrocochleography, who were seen at a neuro-otology referral centre. Patients underwent a clinical examination, audiometry and bilateral transtympanic electrocochleography. Patients were separated into 2 groups: bilateral Ménière`s disease and unilateral Ménière`s disease. RESULTS: The mean age was 42.9 years; 72.5 percent were female. Fluctuation of hearing loss occurred in 54.5 percent of cases, and 65.7 percent had frequent attacks of vertigo. Bilateral disease was observed in 33.3 percent. The onset of the disease was earlier in the bilateral group (33.7 years) compared to the unilateral group (p= 0.0013). Duration of disease, tinnitus, hearing loss and aural fullness were similar between groups. CONCLUSION: Patients with bilateral Ménière`s disease had symptoms earlier than patients with unilateral disease. There was no difference between the groups in duration of disease and associated symptoms.

An improved weighted median filter and its application in EOG processing / 生物医学工程学杂志

As a classic eye movement method, electrooculogram (EOG) has been extensively used in many applications. There are many different types of eye movements and artifact in the EOG signal. Noise attenuation and signal separation have received special attention in the EOG research. In this paper, we introduce a novel Linear-nonlinear combinational filter based on weighted FIR-median-hybrid (WFMH) with the characteristic of the EOG signal. The result of the simulation shows that this filter has the property of removing random noise more efficiently when preserving sharp edges. Finally, it is shown that the new filter is effective in separating saccadic and eye blink in the EOG signal.

Tamoxifen Induced Corneal Opacity in Breast Cancer Patient

Since 1970's, Tamoxifen has been used as an antiestrogen agent for adjuvant hormonal therapy, targeting hormone receptor positive breast cancer. Tamoxifen has adverse side effects such as menopausal hot flush, vaginal discharge, irregular menses, thromboembolism, and uterine endometrial carcinoma. Tamoxifen has structure and side effects similar to amphiphilic cationic agents like chlorpromazine, thorazine, amiodarone, and chloroquine. With long period use in high dose, tamoxifen can cause ocular side effects such as retinal crystalline deposition, macular edema, whorl-like corneal opacities, posterior subcapsular lens opacities, optic neuritis, and affected EOG. Recently several reports showed that ocular side effect could happen even in low dose standard treatment. We experienced a case of keratopathy of corneal opacity without disorder of retina, lens, and optic nerve in low dose tamoxifen therapy for breast cancer.