人体日常健康管理可穿戴设备研究进展

随着大众对便携地获得个体健康信息的需求不断扩大,可穿戴设备不仅被广泛应用于临床,还由于其智能化、微型化、便携化等特点,被逐渐应用到普通家庭日常健康管理中.本文通过PubMed及CNKI数据库对可穿戴设备的文献进行搜索,依据可穿戴设备实现的不同功能对其进行分类,简述了其应用的算法及具体分析方法,并对其在人体健康领域的发展趋势做出了展望.     

智能可穿戴设备在高原心脑疾病中的应用研究EI北大核心CSCD

可穿戴设备具有便携、实时、动态和连续等特点,在生理监测和疾病预防等领域发挥着越来越重要的作用。将可穿戴设备推广至高原人群可能对预防高原心脑疾病具有一定优势。本文从高原环境对不同人群和实验动物心脑系统的影响、不同种类可穿戴设备的特点及应用与可穿戴设备在高原环境中的局限与挑战三方面综合阐释智能可穿戴设备在高原心脑疾病的应用研究,突出其应用价值,为预防高原疾病,保证生命健康提供实用的参考信息。     

可穿戴设备：评估与监测人体生理状态的展望

本文旨在探讨当今医疗系统所面临的主要挑战,提出了一种新的医疗范式,即充分发掘可穿戴设备的潜能并和新的健康与疾病的理论体系相结合。当前生活形态相关的各类疾病已成为主要医疗支出,并随人口老龄化不断增加。可穿戴设备正逐渐成为以疾病预防和管理为重点的大规模医疗健康系统的关键技术。微型传感器、系统集成、物联网、人工智能、5G等技术的进步使得可穿戴设备能够实现与医疗设备相当的高质量检测。通过各种物理、化学和生物传感器,可穿戴设备以无创或微创的方式持续监测体征信号,包括心电图、脑电图、呼吸、血氧、血压、血糖、活动等。通过融合复杂系统观念和非线性动力学方法,我们发展出一套崭新的连续动态生理信号分析理论——动态生物复杂度,动态信号分析的结果可以为疾病预防、诊断、治疗和管理提供重要信息。此外,可穿戴设备还可以作为连接医生和患者的重要桥梁,通过跟踪、存储患者数据,并与医疗机构共享患者数据,实现对患者的远程或实时健康评估,为精准医疗和个性化治疗提供技术支持。可穿戴设备在医疗领域有着广泛的前景,将成为医疗系统转型的重要推动力。同时,也将推动我们对于健康和疾病的认识和理解更为深入和全面,带来革命性的医疗变革。     

癌症早期诊断用纳米磁性粒子

<正>为早期诊断癌症和其他疾病,便于提高疗效。近日,谷歌X实验室正在设计一种纳米级的磁性粒子,其宽度小于红细胞宽度的千分之一,可以自动寻找并附着到细胞、蛋白质或身体内部的其它分子上。当它进入人体循环后,再用一种磁性可穿戴式设备,来计算粒子分布,可进行癌症和疾病的早期诊断。开发能帮助纳米粒子绑定到特定细胞的导引剂,纳米粒子的用量与进入人体循环磁性穿戴设备等还需要深入研究。要真正地用于临床还有大量研究工作要做,特别是监管力度将会比传统诊断设备高得多。     

可穿戴医疗/健康技术——生物医学工程的机遇和挑战

正本期刊载了8篇与可穿戴式设备相关的研究论文,涉及康复、生理、病理信息监测等,内容丰富、学术性强、应用前景显著。可穿戴设备,这里指的是可以直接穿戴在身上的便携式医疗或健康电子设备,在软件支持下感知、记录、分析、调控/干预甚至治疗疾病或维护健康状态。可穿戴健康设备可实现长时间动态监测,提供全面的临床诊断数据或健康信息,有利于寻找病因或感知健康状态,实现防病和早期治疗、提升诊疗水平、持续跟踪患者情况,或实现健康状态     

心房颤动临床诊断误区分析

目的：结合临床诊断资料,对房颤诊断中极易出现的误区进行分析;方法从我院2012年1月~2013年12月门诊接诊的房颤患者中选取64例,对其临床诊断情况进行总结性分析;结果26例患者诊断为风心病等房颤,2例患者为特发性房颤在初次诊断时,误诊为植物神经功能紊乱,后在房颤发作时再测,确诊为特发性房颤;36例患者为冠心病房颤,其中10例属于持续性房颤,另26例属于阵发性房颤;7例患者出现心绞痛,其中3例患者出现持续性房颤;结论在心房颤动的临床诊断中,一定要综合患者的临床表现以及心电图检测结果,同时注意分析患者病史,以免出现误诊,导致治疗最佳时间被耽误。     

可穿戴技术的发展

从可穿戴技术的发展现状出发,讨论可穿戴技术的内涵与外延,回顾可穿戴技术发展的技术渊源与发展历史;从通信技术、芯片技术、传感器、柔性原件等几个方面,阐述可穿戴设备的关键技术;分析可穿戴设备的交互模式,介绍可穿戴设备中常用的操作系统;综述可穿戴设备的常见应用场景,指出可穿戴技术的发展方向。通过对可穿戴技术研究和应用中各个方面的系统论述,为可穿戴技术的研究提供一个基础框架。     

数字化技术在临床诊断与治疗中的应用

数字化技术的应用提高了临床诊断的准确性与治疗的成功率,使医院管理更加高效、安全。本文基于数字化技术在临床诊疗方面的应用,对其在经验医学诊断、实验医学诊断、术前规划、术中导航及术后评估等方面进行了分析阐述。我们提出未来通过大数据、智能手机与可穿戴式传感器的配合使用,可以实时监测人们健康情况,为临床诊断与治疗提供经验数据。数字化技术在未来医疗中的应用将发挥更大作用。     

急诊B超在腹部闭合性损伤中的应用探讨

目的探讨对腹部闭合性损伤应用B超进行检查所得到的临床效果。方法选择2012年8月~2013年10月我院曾接收的腹部闭合性损伤患者70例，对其B超检查资料进行回顾性分析。结果通过对所有患者进行B超诊断，其结果显示有65例为腹部闭合性损伤，对比手术结果，其诊断准确率为92.9%，不符率仅为7.1%。结论以B超对腹部闭合性损伤进行临床诊断，可得到比较理想的临床效果，临床诊断准确率比较高，能够对腹部闭合性损伤进行及时准确诊断，从而为临床治疗提供理论依据，是临床上诊断腹部闭合性损伤的一种较有效方法，可在临床上进行广泛应用。     

心房颤动的心外膜标测表征方法初探

心房颤动（简称房颤）是临床上最常见的复杂心律失常。由于其电生理机制尚未完全阐明,临床上治疗效果仍不甚明显。我们采用复旦大学研制的64-176道心外膜标测系统,通过对心房外膜电活动的记录和分析,对房颤的最佳表征方法进行了初步研究。实验结果表明波动图和矢量图能反映房颤的不规则电活动。统计分析揭示一定时间内的激动频率和相关性统计中窦性心律和房颤出现较大的差异,间期变异范围二者也有区别。本组结果初步表明,可用波动图和矢量图对房颤进行动态观测,通过统计图可得知激动规律,这可为临床上房颤的精密诊断和治疗提供应用基础。     

Reduced prevalence of atrial fibrillation in black patients compared with white patients attending an urban hospital: an electrocardiographic study

Electrocardiographic differences occur between African-American and white persons. The cardiac rhythms of 2123 African-American and white hospital patients from 20 through 99 years of age were studied in a consecutive manner. The prevalence of atrial fibrillation increases dramatically with advancing age in both African-American and white patients. The prevalence of atrial fibrillation begins to increase at age 60 years and continues to increase through the 10th decade of life, although the rate of rise of the prevalence of atrial fibrillation is less in African-American patients compared with white patients. The cause of the reduced prevalence of atrial fibrillation in African-American patients remains unexplained. Atrial fibrillation occurs in 2.5% of African-American patients compared with 7.8% of white patients attending an urban hospital. There is little difference in the prevalence of atrial fibrillation between men and women. Atrial fibrillation occurs nearly seven times more often than does atrial flutter.     

Inflammation and atrial fibrillation: Is Chlamydia pneumoniae a candidate pathogen of atrial fibrillation?

Atrial fibrillation is the most common arrhythmia, however, the mechanism of atrial fibrillation is not well explained. It has been considered that inflammation plays a role in atrial fibrillation, recently. Patients undergoing coronary artery bypass graft are at high risk for developing postoperative atrial fibrillation. The peak levels of C-reactive protein (CRP) were paralleled to the incidence of postoperative atrial fibrillation. In general population, CRP was also higher in patients with atrial fibrillation than in control people. Persistent atrial fibrillation patients had a higher CRP level than paroxysmal atrial fibrillation patients. CRP was not only associated with the presence of atrial fibrillation but may also predict patients at increased risk for future development of atrial fibrillation. Why inflammation markers in atrial fibrillation are high is a puzzling problem. We hypothesized that Chlamydia pneumoniae infection is a possible cause of atrial fibrillation by initiating inflammation response. It was demonstrated that infection of endothelial cells with C. pneumoniae elicited the production of Monocyte Chemoattractant Protein-1, interleukin-1, interleukin-8, interleukin-18, tumor necrosis factor, interferon and soluble intercellular adhesion molecule. Most of these cytokines play a crucial role in inflammation response that associate with the initiating and maintenance of atrial fibrillation. There are so many pathogens that can trigger inflammation. Some evidences showed that C. pneumoniae was the most likely pathogen of atrial fibrillation. In epidemic study, the incidence of atrial fibrillation increased from younger to elder and atrial fibrillation was more common in men than in women. C. pneumoniae has the same epidemic trend as the incidence of atrial fibrillation. Hypertension, myocardial infarction and reduced lung function are predictors of atrial fibrillation. C. pneumoniae infection is high in the patients with the above diseases. C. pneumoniae was found in endomyocardial biopsy samples, which supported C. pneumoniae was the candidate pathogen, too. Chlamydia infection can cause myocardial interstitial fibrosis and inflammation cells infiltration. The pathology characters of C. pneumoniae infection are similar to that found in atrial fibrillation. Seroepidemic study should be carried out to evaluate if there is relationship between C. pneumoniae and atrial fibrillation. If the hypothesis is confirmed, macrocyclic lactone antibiotics may be used to eliminate the pathogen. It will be a new target point to treat atrial fibrillation.     

Can we improve outcomes in AF patients by early therapy?

Atrial fibrillation affects at least 1% of the population and causes marked society-wide morbidity and mortality. Current management of atrial fibrillation including antithrombotic therapy and management of concomitant conditions in all patients, rate control therapy in most patients, and rhythm control therapy in patients with severe atrial fibrillation-related symptoms can alleviate atrial fibrillation-related symptoms but can neither effectively prevent recurrent atrial fibrillation nor suppress atrial fibrillation-related complications. Hence, there is a need for better therapy of atrial fibrillation.     

CaMKⅡ在氧化应激中对心房重构的影响

<正>心房颤动(atrial fibrillation,AF)简称房颤,是临床上最常见的快速性心律失常之一,心房结构重构和电重构是房颤发生发展的症结所在。虽然房颤时心房发生重构的机制尚不清楚,但氧化应激对于引起心房肌细胞内Ca2+负载、调控离子通道从而缩短心房有效不应期(atrial effective refractory period,AERP)和动作电位时程(action potential duration,     

The fibrosis and atrial fibrillation: is the transforming growth factor-beta 1 a candidate etiology of atrial fibrillation

Atrial fibrillation (AF) is the most commonly occurring arrhythmia in clinical practice, however, the mechanism of atrial fibrillation is not well explained. It has been considered that myocardial fibrosis plays a role in atrial fibrillation. Within the heart, this fibrosis is thought to be mediated by transforming growth factor-beta 1 (TGF-beta 1), a potent stimulator of collagen-producing cardiac fibroblasts. Recent studies indicate that atrial fibrillation is associated with elevated serum concentrations of TGF-beta 1 and C-terminal propeptide of procollagen type I (a marker of collagen type I synthesis). TGF-beta 1 was not only associated with the presence of atrial fibrillation but may also predict patients at increased risk for future development of atrial fibrillation. Why TGF-beta 1 in atrial fibrillation is high is a puzzling problem. We hypothesized that TGF-beta 1 is a possible cause of atrial fibrillation by initiating fibrosis response. Atrial interstitial fibrosis has been seen in patients with CHF and in animal models of pacing-induced heart failure. It was demonstrated that TGF-beta 1 levels were increased in the atria after the development of congestive heart failure in dogs. In a similar study, mice with increased expression of TGF-beta 1 were prone to atrial fibrillation development as a result of raised levels of atrial fibrosis. If the hypothesis is confirmed, administration of TGF-beta 1 monoclonal antibodies may be used to eliminate the etiology. It will be a new target point to treat atrial fibrillation.     

ECG characterization of paroxysmal atrial fibrillation: parameter extraction and automatic diagnosis algorithm

Paroxysmal atrial fibrillation (PAF) is one of the most common heart arrhythmias. It is very difficult to detect unless an explicit Atrial Fibrillation episode occurs during the exploration. The present paper describes a number of low level parameters extracted from ECG traces where no Atrial Fibrillation process is present. The ability of this parameter set to characterize PAF patients is studied and discussed. Based on these parameters a modular automatic classification algorithm for PAF diagnosis is developed and evaluated.     

Incidence and predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular block and dual chamber pacemaker implantation

Aim

To evaluate predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular (AV) block, normal left ventricular systolic function, and implanted dual chamber (DDD) pacemaker.

Methods

Hundred and eighty six patients with complete AV block were admitted over one year to the Sisters of Mercy University Hospital. The study recruited patients older than 70 years, with no history of atrial fibrillation, heart failure, or reduced left ventricular systolic function. All the patients were implanted with the same pacemaker. Out of 103 patients who were eligible for the study, 81 (78%) were evaluated. Follow-up time ranged from 12 to 33 months (average±standard deviation 23 ± 5 months). Primary end-point was asymptomatic atrial fibrillation occurrence recorded by the pacemaker. Atrial fibrillation occurrence was defined as atrial high rate episodes (AHRE) lasting >5 minutes. Binary logistic regression was used to identify the predictors of development of asymptomatic atrial fibrillation.

Results

The 81 patients were stratified into two groups depending on the presence of AHRE lasting >5 minutes (group 1 had AHRE>5 minutes and group 2 AHRE<5 minutes). AHRE lasting >5 minutes were detected in 49 (60%) patients after 3 months and in 53 (65%) patients after 18 moths. After 3 months, only hypertension (odds ratio [OR], 17.63; P = 0.020) was identified as a predictor of asymptomatic atrial fibrillation. After 18 months, hypertension (OR, 14.0; P = 0.036), P wave duration >100 ms in 12 lead ECG (OR, 16.5; P = 0.001), and intracardial atrial electrogram signal amplitude >4 mV (OR, 4.27; P = 0.045) were identified as predictors of atrial fibrillation.

Conclusion

In our study population, hypertension was the most robust and constant predictor of asymptomatic atrial fibrillation after 3 months, while P wave duration >100 ms in 12-lead ECG and intracardial atrial signal amplitude were predictors after 18 months.Atrial fibrillation is the most common cardiac arrhythmia, which is associated with high morbidity and mortality, primarily due to cerebrovascular thromboembolic accidents and heart failure (1). Atrial fibrillation can be either symptomatic or asymptomatic. The incidence and prevalence of asymptomatic atrial fibrillation in the general population and in patients who have a dual chamber permanent pacemaker (PPM) is unknown. Previous studies have shown that 90% of the patients with an implanted dual chamber PPM and previously documented atrial fibrillation are asymptomatic since they lack irregular ventricular rate (2).It is well known that age is an important risk factor for the development of atrial fibrillation (3,4). It is also known that the majority of elderly people with atrial fibrillation die of stroke or heart failure (5).Given the assumption that asymptomatic atrial fibrillation can contribute to those events, the question is whether we can stratify patients according to their risk of asymptomatic atrial fibrillation by using simple accessible methods. The first estimates of the asymptomatic atrial fibrillation incidence were published in 1994 and reported a ratio of asymptomatic to symptomatic atrial fibrillation of about 12:1 (3,6). Studies investigating patients with stroke or transient ischemic attack found atrial fibrillation in about 15%-28% of patients, depending on the monitoring method used, and excluding those with previously known atrial fibrillation (7,8).The Atrial Fibrillation Follow-up Investigation of Rhythm Management study, which compared the rate vs rhythm control in participants with atrial fibrillation older than 65 years, showed a trend toward higher mortality in the rhythm control arm. Stroke as significant contributor to mortality in this group was explained by warfarin withdrawal and asymptomatic atrial fibrillation occurrence (9).Comparative advantage of patients with implanted pacemaker is that they are under rhythm monitoring permanently, thus leading to detection of asymptomatic atrial fibrillation (10). In this study, we proposed that analyzing 12-lead ECG, natriuretic peptide values, and pacemaker recordings can help to identify patients who are at higher risk of developing asymptomatic atrial fibrillation and complications of this arrhythmia. The aim of this study is to evaluate the predictors of asymptomatic atrial fibrillation in patients with complete atrioventricular (AV) block and implanted PPM.     

Supraventricular tachyarrhythmias in acute myocardial infarction

Onset of atrial tachycardia, flutter or fibrillation occurred in 11% of 274 consecutive patients with acute myocardial infarction (AMI). Atrial tachycardia started about 24 hours and atrial flutter/fibrillation about 72 hours after onset of AMI symptoms. Left heart failure, diagnosed as pulmonary rales or frank pulmonary edema, was not more common in these patients before onset of tachyarrhythmias than among the rest of the patients. On the other hand, a notching of the P wave in lead CR-was significantly more common in the patients with atrial fibrillation (67%). In most of these cases the terminal P force in lead CR1 was not negative as in so-called left atrial enlargement. These findings suggest that atrial conduction disturbances might be a basis of atrial fibrillation in AMI.     

Comorbidity associated with atrial fibrillation: a general practice-based study.

BACKGROND: Atrial fibrillation is an important risk factor for ischaemic stroke. Anticoagulation treatment with warfarin can substantially reduce the risk of stroke in people with atrial fibrillation but concerns about their side-effects have limited their use in clinical practice. However there has been little population-based research on the comorbidity associated with atrial fibrillation and on the prevalence of potential contraindications to anticoagulantion treatment among these patients. AIM: To determine the prevalence of known risk factors for ischaemic stroke and possible contraindications to anticoagulant treatment among patients with atrial fibrillation. METHOD: One-year prospective cohort study in 60 general practices in England and Wales with a total population of 502,493 people. Age and sex specific prevalence rates and relative risks of risk factors for ischaemic stroke and possible contraindications to antithrombotic treatment were calculated. RESULTS: The number of patients who had a diagnosis of atrial fibrillation during the year was 1,414 (0.3%) patients. The prevalence of other nsk factors for ischaemic stroke in patients with atrial fibrillation increased with age in men, from 48% (relative risk [RR] = 3.78, 95% confidence interval [95% CI] = 3.23-4.41) at 45 to 64 years to 64% (RR = 2.21, 95% CI = 2.00-2.44) at 75years and over A similar increase of 50% (RR = 4.36, 95% CI = 3.54-5.38) to 60% (RR = 2.07, 95% CI = 1.91-2.23) was seen in women. The percentage of men with atrial fibrillation with at least one contraindication to antithrombotic treatment was 5% at 45 to 64 years and 14% at 75 years and over. Among women with atrial fibrillation, 7% had a contraindication at 45 to 64 years and 16% at 75 years and over. The all-ages relative risk of a contraindication was 1.17 (95% CI = 0.92-1.48) in men and 1.53 (95% CI = 1.28-1.83) in women. Forty per cent (575) of patients with atrial fibrillation had at least one risk factor for ischaemic stroke and no contraindications to antithrombotic treatment. CONCLUSION: Atrial fibrillation is associated with a substantial increase in the prevalence of risk factors for ischaemic stroke. By contrast, potential contraindications for antithrombotic treatment are more evenly distributed among patients with and without atrial fibrillation. Around 40% of patients with atrial fibrillation in primary care are at high risk of stroke and have no contraindicationsfor antithrombotic treatment.     

非瓣膜病心房纤颤与抗血栓栓塞相关性研究

通过观察136例非瓣膜病心房纤颤(NVAF)以及76例非房颤性心脏病患者并随访825±365天.研究非瓣膜病心房纤颤与抗血栓栓塞的相关性。结果:NVAF中,慢性房颤组123例中.26例脑栓塞(21.2％),其中14例死亡(11.3％),阵发性房颤组13例中2例脑栓塞(15.3％)死亡1例(7.6％),非房颤心脏病组76例中3例脑栓塞(3.9％),1例死亡(1.7％)。NVAF与非房颤心脏病脑栓塞之比是20.5％:3.9％(P<0.001)。死亡率之比是11.0％:1.3％(P<0.01)。因此NVAF与血栓栓塞事件紧密相关,积极采取抗凝是治疗NVAF一个重要的措施。