The Effect of Lifting-and-Thrusting Laser Acupuncture on Electrodermal Activity of Acupoints, Pulse Characteristics, and Brainwave.

Acupuncture has been shown as an effective traditional Chinese medicine treatment method, especially for pain relief. Recently, laser acupuncture is becoming increasingly popular, thanks to its noninvasive and painless nature and effectiveness in treating diseases, proven by many studies (for example, some previous studies showed that low-power laser stimulation is able to increase the power of alpha rhythms and theta waves). In our prior work, we developed a novel laser acupuncture model that emulates lifting-and-thrusting operation commonly used in traditional needle acupuncture and showed its benefit in improving cardiac output and peripheral circulation. By extending our previous studies, in this work, we perform extensive experiments to understand the effect of such a system on electrodermal activity (EDA) of acupoints, pulse characteristics, and brainwave, to further verify its efficacy. In particular, we found that laser stimulation could cause significant changes in EDA of acupoints, pulse amplitude, pulse-rate-variability (PRV), and acupoint conductance, as a function of laser power and stimulation time. In addition, laser acupuncture with the lifting-and-thrusting operation has more significant effect on increasing the power of alpha and theta frequency bands as compared to laser acupuncture without the lifting-and-thrusting operation. Finally, given sufficient stimulation time (e.g., > 20 min), the performance of a low-powered laser acupuncture with the lifting-and-thrusting operation could be comparable to that of traditional needle acupuncture.

Reflex Auriculo-Cardiac (RAC) Induced by Auricular Laser and Needle Acupuncture: New Case Results Using a Smartphone.

The reflex auriculo-cardiac (RAC), dynamic pulse reaction (Nogier reflex), or vascular autonomic signal was proposed by Nogier. It refers to the pulse changes that can occur in the radial artery immediately after auricular acupuncture is performed. RAC is helpful for the clinical practice of auricular acupuncture, but there is a lack of objective verification methods. Photoplethysmography (PPG) has been used to objectively calculate radial artery blood flow. This study used PPG via a smartphone to measure RAC induced by auricular acupuncture. Thirty subjects without major diseases were recruited to receive traditional needle and laser acupuncture. The Shen Men ear point and control points were stimulated for 20 s. PPG was continuously measured during the acupuncture. The PPG data were tested for differences with a paired t-test. The results showed that there were no statistical differences in the frequency and amplitude of PPG obtained before and after acupuncture, either with a traditional needle or laser acupuncture. However, interestingly, it was found that one patient with insomnia, one patient with viral respiratory symptoms, and two menstruating females exhibited changes in PPG within five seconds of needle placement. We hypothesized that RAC might be induced by auricular acupuncture and could be quantified by PPG, even among subjects suffering from mild diseases; however, auricular acupuncture might not induce a measurable RAC in totally healthy subjects.

Laser Acupuncture and Dynamic Pulse Reaction Quantified by Smartphone:Two Experimental Examples.

The dynamic pulse reaction (Nogier reflex), Reflex-Auriculo-Cardiac (RAC), or vascular autonomic signal is a physiologic phenomenon that is not fully accepted and widely understood in contemporary medical practice. In order to provide appropriate scientific evidence for better understanding, qualitative and-above all-quantitative research in this area is necessary. In this short report, 2 recordings of dynamic pulse reactions based on an analysis performed on a modified smartphone are demonstrated during laser acupuncture experiments using stimulation at ear acupuncture points.

An Initial Study on Multi-Point Laser Acupuncture Based on 2-D Galvo Mirror.

Currently, the majority of commercially available laser acupuncture instruments are still hand-held and only support single-point stimulation. Simultaneous multi-point stimulation improves the therapeutic efficacy of laser acupuncture by stimulating multiple acupoints at the same time. A "2-dimensional (2-D) galvo mirror" was utilized as a positioning laser acupuncture device for multi-acupoints stimulation. Due to its ability to perform 2-D fast scanning, a single laser beam was reflected by the mirror and stimulated multiple acupuncture points simultaneously. This introduction to the new system, presents its architecture, and shows some initial results. This initial stage of development was focused on the acupoints of the human forearm. This proposed system is the first low-cost, noncontact laser acupuncture system that enables continuous multi-acupoint stimulation with a single laser beam. Notably, it is technically feasible to develop this technique into a whole-body laser acupuncture stimulation system.

An Initial Study on Automated Acupoint Positioning for Laser Acupuncture.

Acupuncture plays an important role in traditional Chinese medicine (TCM) and is one kind of an inexpensive and effective treatment. However, some people might be reluctant to receive acupuncture treatment due to fear of pain. Laser acupuncture, thanks to its painless and infection-free advantages, has recently become an alternative choice to traditional acupuncture. The accuracy of acupuncture point positioning has a decisive influence on the quality of laser acupuncture. In this study, built on top of our prior work, we proposed a low-cost automated acupoint positioning system for laser acupuncture. By integrating several machine learning algorithms and computer vision techniques, we design and implement a robot-assisted laser acupuncture system on top of a smartphone. Our contributions include the following: (a) development of an effective acupoint estimation algorithm with a localization error less than 5 mm; (b) implementation of a smartphone-controlled automated laser acupuncture system with lift-thrust function, as a point-of-care device, that can be used by patients to relieve their symptoms at home.

Slow Breathing Exercise with Multimodal Virtual Reality: A Feasibility Study.

Many studies have shown that slow breathing training is beneficial for human health. However, several factors might discourage beginners from continuing their training. For example, a long training period is generally required for benefit realization, and there is no real-time feedback to trainees to adjust their breathing control strategy. To raise the user's interest in breathing exercise training, a virtual reality system with multimodal biofeedback is proposed in this work. In our system, a realistic human model of the trainee is provided in virtual reality (VR). At the same time, abdominal movements are sensed, and the breathing rate can be visualized. Being aware of the breathing rate, the trainee can regulate his or her breathing to achieve a slower breathing rate. An additional source of tactile feedback is combined with visual feedback to provide a more immersive experience for the trainees. Finally, the user's satisfaction with the proposed system is reported through questionnaires. Most of the users find it enjoyable to use such a system for mediation training.

Evaluating traditional Chinese medicine diagnostic instruments for functional dyspepsia: systematic review on measurement properties.

BACKGROUND: Pattern diagnosis-guided treatments in Traditional Chinese Medicine (TCM) has been recognised by the eleventh revision of the International Classification of Diseases (ICD-11). Accurate pattern diagnosis requires reliable and valid diagnostic instruments that guide the collection of TCM clinical data without bias. This study synthesised the existing TCM diagnostic instruments for functional dyspepsia (FD) and appraised their quality regarding their development process and measurement properties. METHODS: Seven electronic databases were searched for validation studies on TCM diagnostic instruments for FD. Synthesis and appraisal of the included studies were performed following the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Initiative guidelines adapted for TCM diagnostic instruments. Risk of bias assessment was conducted using the COSMIN Risk of Bias Checklist. RESULTS: Five studies were included, with five unique TCM diagnostic instruments for FD identified. All five diagnostic instruments were of inadequate quality in terms of their development process, implying a shortcoming in their relevance, comprehensibility, and comprehensiveness. Only the criterion validity of Stomach Qi Deficiency Pattern Assessment Scale was of sufficient quality and had no risk of bias in its validation. CONCLUSION: The quality of TCM diagnostic instruments for FD warrants urgent improvements. None of them was considered reliable or valid for guiding TCM pattern diagnosis. To support the evidence base of the standardization of TCM patterns in ICD-11, TCM diagnostic instruments should be developed and validated rigorously under the COSMIN guidelines. Amendments should be made on the guidelines to accommodate the features and uniqueness of TCM diagnostic process.

Traditional Chinese Medicine Pulse Diagnosis on a Smartphone Using Skin Impedance at Acupoints: A Feasibility Study.

In traditional Chinese medicine (TCM), pulse diagnosis is one of the most important methods for diagnosis. A pulse can be felt by applying firm fingertip pressure to the skin where the arteries travel. The pulse diagnosis has become an important tool not only for TCM practitioners but also for several areas of Western medicine. Many pulse measuring devices have been proposed to obtain objective pulse conditions. In the past, pulse diagnosis instruments were single-point sensing methods, which missed a lot of information. Later, multi-point sensing instruments were developed that resolved this issue but were much higher in cost and lacked mobility. In this article, based on the concept of sensor fusion, we describe a portable low-cost system for TCM pulse-type estimation using a smartphone connected to two sensors, including one photoplethysmography (PPG) sensor and one galvanic skin response (GSR) sensor. As a proof of concept, we collected five-minute PPG pulse information and skin impedance on 24 acupoints from 80 subjects. Based on these collected data, we implemented a fully connected neural network (FCN), which was able to provide high prediction accuracy (>90%) for patients with a TCM wiry pulse.

Effects of the New Lift-Thrust Operation in Laser Acupuncture Investigated by Thermal Imaging.

Acupuncture manipulation is one of the key factors affecting the performance of acupuncture in Traditional Chinese Medicine. Lift-thrust and twirl-twist are two of the most commonly used manipulation methods for needle acupuncture. We previously have developed a novel laser acupuncture model that emulates lift-thrust operation. In this study, we intend to show the effectiveness of such a model by applying it on the Neiguan acupoint (PC6). Stimulation was reported to be beneficial for improving cardiac output and peripheral circulation. Therefore, we hypothesized that the stimulation of laser acupuncture may increase the temperature of the subjects' fingertip due to increased peripheral blood flow. A thermal imager was used to measure the temperature change of subjects' fingertips. Through regression analysis, it has been shown that while PC6 is stimulated, laser acupuncture with lift-thrust operation caused a more rapid, stable, and lasting temperature rise of fingertip than that without lift-thrust operation. On the contrary, we observe no significant temperature change when a sham point nearby PC6 (a point which is not traditionally defined as the acupoint) was stimulated. Our results suggest the emulation of manipulation methods such as the lift-thrust operation could be a potential direction for the future development of laser acupuncture.

Robot-Controlled Acupuncture-An Innovative Step towards Modernization of the Ancient Traditional Medical Treatment Method.

Background: For several years now, research teams worldwide have been conducting high-tech research on the development of acupuncture robots. In this article, the design of such an acupuncture robot is presented. Methods: Robot-controlled acupuncture (RCA) equipment consists of three components: (a) Acupuncture point localization, (b) acupuncture point stimulation through a robotic arm, and (c) automated detection of a deqi event for the efficacy of acupuncture point stimulation. Results: This system is under development at the Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan. Acupuncture point localization and acupuncture point stimulation through a robotic arm works well; however, automated detection of a deqi sensation is still under development. Conclusions: RCA has become a reality and is no longer a distant vision.

Automated tongue diagnosis on the smartphone and its applications.

Tongue features are important objective basis for clinical diagnosis and treatment in both western medicine and Chinese medicine. The need for continuous monitoring of health conditions inspires us to develop an automatic tongue diagnosis system based on built-in sensors of smartphones. However, tongue images taken by smartphone are quite different in color due to various lighting conditions, and it consequently affects the diagnosis especially when we use the appearance of tongue fur to infer health conditions. In this paper, we captured paired tongue images with and without flash, and the color difference between the paired images is used to estimate the lighting condition based on the Support Vector Machine (SVM). The color correction matrices for three kinds of common lights (i.e., fluorescent, halogen and incandescent) are pre-trained by using a ColorChecker-based method, and the corresponding pre-trained matrix for the estimated lighting is then applied to eliminate the effect of color distortion. We further use tongue fur detection as an example to discuss the effect of different model parameters and ColorCheckers for training the tongue color correction matrix under different lighting conditions. Finally, in order to demonstrate the potential use of our proposed system, we recruited 246 patients over a period of 2.5 years from a local hospital in Taiwan and examined the correlations between the captured tongue features and alanine aminotransferase (ALT)/aspartate aminotransferase (AST), which are important bio-markers for liver diseases. We found that some tongue features have strong correlation with AST or ALT, which suggests the possible use of these tongue features captured on a smartphone to provide an early warning of liver diseases.

Toward Hypertension Prediction Based on PPG-Derived HRV Signals: a Feasibility Study.

Heart rate variability (HRV) is often used to assess the risk of cardiovascular disease, and data on this can be obtained via electrocardiography (ECG). However, collecting heart rate data via photoplethysmography (PPG) is now a lot easier. We investigate the feasibility of using the PPG-based heart rate to estimate HRV and predict diseases. We obtain three months of PPG-based heart rate data from subjects with and without hypertension, and calculate the HRV based on various forms of time and frequency domain analysis. We then apply a data mining technique to this estimated HRV data, to see if it is possible to correctly identify patients with hypertension. We use six HRV parameters to predict hypertension, and find SDNN has the best predictive power. We show that early disease prediction is possible through collecting one's PPG-based heart rate information.

Wireless multihop backhauls for rural areas: A preliminary study.

Rural areas have very low revenue potential. The major issue in providing low-cost broadband to rural areas is to provide reliable backhaul connections that spread over tens or even hundreds of miles, connecting villages to the nearest service provider. Along with aerial networks of Google and Facebook, there has been a considerable amount of research toward long-distance terrestrial WiFi links. As a comparison, WiFi routers are easier to be deployed and maintained by non-technical people from the local communities, whereas the aerial networks require professional support to operate. Moreover, they are still in the experimentation phase. However, the long distance WiFi links require high-gain directional antennas and very expensive tall towers for high data rates. On the other hand, multihop paths with stronger links may provide better data rates without the need of tall towers. In this paper, we evaluated the concept of using such multihop WiFi links for long backhaul connections. Our simulation results show that these networks can possibly be a cost-effective and practical solution for rural connectivity. These initial results can serve as a first step to understand the comprehensive feasibility of using multihop WiFi networks for backhaul connections in rural area.

Correction: Avoiding Biased-Feeding in the Scheduling of Collaborative Multipath TCP.

[This corrects the article DOI: 10.1371/journal.pone.0161213.].

Avoiding Biased-Feeding in the Scheduling of Collaborative Multipath TCP.

Smartphones have become the major communication and portable computing devices that access the Internet through Wi-Fi or mobile networks. Unfortunately, users without a mobile data subscription can only access the Internet at limited locations, such as hotspots. In this paper, we propose a collaborative bandwidth sharing protocol (CBSP) built on top of MultiPath TCP (MPTCP). CBSP enables users to buy bandwidth on demand from neighbors (called Helpers) and uses virtual interfaces to bind the subflows of MPTCP to avoid modifying the implementation of MPTCP. However, although MPTCP provides the required multi-homing functionality for bandwidth sharing, the current packet scheduling in collaborative MPTCP (e.g., Co-MPTCP) leads to the so-called biased-feeding problem. In this problem, the fastest link might always be selected to send packets whenever it has available cwnd, which results in other links not being fully utilized. In this work, we set out to design an algorithm, called Scheduled Window-based Transmission Control (SWTC), to improve the performance of packet scheduling in MPTCP, and we perform extensive simulations to evaluate its performance.

Gait Monitoring for Early Neurological Disorder Detection Using Sensors in a Smartphone: Validation and a Case Study of Parkinsonism.

BACKGROUND: Diagnosing brain disorders, such as Parkinson's disease (PD) or Alzheimer's disease, is often difficult, especially in the early stages. Moreover, it has been estimated that nearly 40% of people with PD may not be diagnosed. Traditionally, the diagnosis of neurological disorders, such as PD, often required a doctor to observe the patient over time to recognize signs of rigidity in movement. MATERIALS AND METHODS: The pedestrian dead reckoning (PDR) system is a self-contained technique that has been widely used for indoor localization. In this work we propose a PDR-based method to continuously monitor and record the patient's gait characteristics using a smartphone. Seventeen patients were studied over a period of 1 year. During the year it became apparent that 1 of the patients was actually developing PD. To the best of our knowledge, our work is the first attempt to use sensors in a smartphone to help identify patients in their early stages of neurological disease. RESULTS: On average, the accuracy of our step length estimation was about 98%. Using a binary classification method-namely, support vector machine-we carried out a case study and showed that it was feasible to identify changes in the walking patterns of a PD patient with an accuracy of 94%. CONCLUSIONS: Using 1 year of gait trace data obtained from the users' phones, our work provides a first step to experimentally show the possibility of applying smartphone sensor data to provide early warnings to potential PD patients to encourage them to seek medical assistance and thus help doctors diagnose this disease earlier.

Color Correction Parameter Estimation on the Smartphone and Its Application to Automatic Tongue Diagnosis.

BACKGROUND: An automatic tongue diagnosis framework is proposed to analyze tongue images taken by smartphones. Different from conventional tongue diagnosis systems, our input tongue images are usually in low resolution and taken under unknown lighting conditions. Consequently, existing tongue diagnosis methods cannot be directly applied to give accurate results. MATERIALS AND METHODS: We use the SVM (support vector machine) to predict the lighting condition and the corresponding color correction matrix according to the color difference of images taken with and without flash. We also modify the state-of-the-art work of fur and fissure detection for tongue images by taking hue information into consideration and adding a denoising step. RESULTS: Our method is able to correct the color of tongue images under different lighting conditions (e.g. fluorescent, incandescent, and halogen illuminant) and provide a better accuracy in tongue features detection with less processing complexity than the prior work. CONCLUSIONS: In this work, we proposed an automatic tongue diagnosis framework which can be applied to smartphones. Unlike the prior work which can only work in a controlled environment, our system can adapt to different lighting conditions by employing a novel color correction parameter estimation scheme.

Implementation of a wireless sensor network for heart rate monitoring in a senior center.

OBJECTIVE: Wearable sensor systems are widely used to monitor vital sign in hospitals and in recent years have also been used at home. In this article we present a system that includes a ring probe, sensor, radio, and receiver, designed for use as a long-term heart rate monitoring system in a senior center. The primary contribution of this article is successfully implementing a cheap, large-scale wireless heart rate monitoring system that is stable and comfortable to use 24 h a day. MATERIALS AND METHODS: We developed new finger ring sensors for comfortable continuous wearing experience and used dynamic power adjustment on the ring so the sensor can detect pulses at different strength levels. RESULTS: Our system has been deployed in a senior center since May 2012, and 63 seniors have used this system in this period. During the 54-h system observation period, 10 alarms were set off. Eight of them were due to abnormal heart rate, and two of them were due to loose probes. The monitoring system runs stably with the senior center's existing WiFi network, and achieves 99.48% system availability. The managers and caregivers use our system as a reliable warning system for clinical deterioration. CONCLUSIONS: The results of the year-long deployment show that the wireless group heart rate monitoring system developed in this work is viable for use within a designated area.

Using off-the-shelf lossy compression for wireless home sleep staging.

BACKGROUND: Recently, there has been increasing interest in the development of wireless home sleep staging systems that allow the patient to be monitored remotely while remaining in the comfort of their home. However, transmitting large amount of Polysomnography (PSG) data over the Internet is an important issue needed to be considered. In this work, we aim to reduce the amount of PSG data which has to be transmitted or stored, while having as little impact as possible on the information in the signal relevant to classify sleep stages. NEW METHOD: We examine the effects of off-the-shelf lossy compression on an all-night PSG dataset from 20 healthy subjects, in the context of automated sleep staging. The popular compression method Set Partitioning in Hierarchical Trees (SPIHT) was used, and a range of compression levels was selected in order to compress the signals with various degrees of loss. In addition, a rule-based automatic sleep staging method was used to automatically classify the sleep stages. RESULTS: Considering the criteria of clinical usefulness, the experimental results show that the system can achieve more than 60% energy saving with a high accuracy (>84%) in classifying sleep stages by using a lossy compression algorithm like SPIHT. COMPARISON WITH EXISTING METHOD(S): As far as we know, our study is the first that focuses how much loss can be tolerated in compressing complex multi-channel PSG data for sleep analysis. CONCLUSIONS: We demonstrate the feasibility of using lossy SPIHT compression for wireless home sleep staging.

On calibrating the sensor errors of a PDR-based indoor localization system.

Many studies utilize the signal strength of short-range radio systems (such as WiFi, ultrasound and infrared) to build a radio map for indoor localization, by deploying a large number of beacon nodes within a building. The drawback of such an infrastructure-based approach is that the deployment and calibration of the system are costly and labor-intensive. Some prior studies proposed the use of Pedestrian Dead Reckoning (PDR) for indoor localization, which does not require the deployment of beacon nodes. In a PDR system, a small number of sensors are put on the pedestrian. These sensors (such as a G-sensor and gyroscope) are used to estimate the distance and direction that a user travels. The effectiveness of a PDR system lies in its success in accurately estimating the user's moving distance and direction. In this work, we propose a novel waist-mounted based PDR that can measure the user's step lengths with a high accuracy. We utilize vertical acceleration of the body to calculate the user's change in height during walking. Based on the Pythagorean Theorem, we can then estimate each step length using this data. Furthermore, we design a map matching algorithm to calibrate the direction errors from the gyro using building floor plans. The results of our experiment show that we can achieve about 98.26% accuracy in estimating the user's walking distance, with an overall location error of about 0.48 m.