Medical & Biological Engineering & Computing

, Volume 55, Issue 2, pp 257–270 | Cite as

Bilateral photoplethysmography for arterial steal detection in arteriovenous fistula using a fractional-order decision-making quantizer

Original Article
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Abstract

As inflow and outflow stenoses worsen, both flow resistance and pressure increase in the stenotic vascular access. During dialysis, when blood flow decreases, it may retrograde from the peripheral artery through the palmar arch to the arterial anastomosis site. Arterial steal syndrome (ASS) causes distal hypoperfusion, resulting in hand ischemia or extremity pain and edema. Hence, this study proposes the bilateral photoplethysmography (PPG) for ASS detection in arteriovenous fistulas. The decision-making quantizer utilizes the fractional-order feature extraction method and a non-cooperative game (NCG) framework to evaluate the ASS risk level. Bilateral asynchronous PPG signals have significant differences in the rise time and amplitude in relation to the degree of stenosis. The fractional-order self-synchronization error formulation is a feature extraction method used to quantify bilateral differences in blood flow changes between the dexter and sinister PPG signals. The NCG model as a method of decision-making is then employed to evaluate the ASS risk level. Using an acoustic Doppler measurement, the resistive (Res) index is also used to evaluate the vascular access stenosis at the arterial anastomosis site. In contrast with alternative methods including the high-sensitivity C-reactive protein level or Res index, our experimental results indicate that the proposed decision-making quantizer is more efficient in preventing ASS during hemodialysis treatment.

Keywords

Arterial steal syndrome (ASS) Photoplethysmography (PPG) Non-cooperative game (NCG) Fractional-order self-synchronization error formulation 
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Notes

Acknowledgments

This work is supported in part by the Ministry of Science and Technology, Taiwan, under contract number: MOST 103-2221-E-244-001, duration: August 1 2014–July 31 2015. The Institutional Review Board (IRB) of the Kaohsiung Veterans General Hospital, Tainan Branch, under contract number: VGHKS13-CT12-11.

References

  1. 1.
    Allen J, Oates CP, Lees TA, Murray A (2005) Photoplethysmography detection of lower limb peripheral arterial occlusive disease: a comparison of pulse timing, amplitude and shape characteristics. Physiol Meas. 26:811–821CrossRefPubMedGoogle Scholar
  2. 2.
    Almeida D, Alvarez J, Barajas JG (2006) Robust synchronization of Sprott circuits using sliding mode control. Chaos Solitons Fractals 30(1):11–18CrossRefGoogle Scholar
  3. 3.
    Buchs A, Slovik Y, Rapoport M, Rosenfeld C, Khanokh B, Nitzan M (2005) Right-left correlation of the sympathetically induced fluctuations of photoplethysmographic signal in diabetic and non-diabetic subjects. Med Biol Eng Comput 43:252–257CrossRefPubMedGoogle Scholar
  4. 4.
    Cardenas AA, Amin S, Schwartz G, Dong R, Sasry S (2012) A game theory model for electricity theft detection and privacy-aware control in AMI systems. Allerton conference 2012, pp 1830–1837Google Scholar
  5. 5.
    Chen WL, Chen T, Lin CH, Chen PJ, Kan CD (2013) Phono-angiography with a fractional order chaotic system-a novel and simple algorithm in analyzing residual arteriovenous access stenosis. Med Biol Eng Comput 51(9):1011–1019CrossRefPubMedGoogle Scholar
  6. 6.
    Chen WL, Kan CD, Lin CH, Chen T (2014) A rule-based decision-making diagnosis system to evaluate arteriovenous shunt stenosis for hemodialysis treatment of patients using fuzzy Petri nets. IEEE J Biomed Health Inform 18(2):703–713CrossRefPubMedGoogle Scholar
  7. 7.
    Cheng S-M, Ng S-P, Yang F-S, Shih F-S (2003) Interventional treatment for complete occlusion of arteriovenous shunt: our experience in 39 Cases. Chin J Radiol 28:137–142Google Scholar
  8. 8.
    Cowan D, Stevens AL, Roberts VC (1988) Design of a continuous-wave Doppler ultrasonic flowmeter for perivascular application: part2 signal processing system. Med Biol Eng Comput 26(2):153–160CrossRefPubMedGoogle Scholar
  9. 9.
    Cracowski JL, Minson CT, Salvat-Melis M, Halliwill JR (2006) Methodological issues in the assessment of skin microvascular endothelial function in humans. Trends Pharmacol Sci 27(9):503–508CrossRefPubMedGoogle Scholar
  10. 10.
    Ennezat PV, Marechaux S, Six-Carpentier M, Pincon C, Sediri I, Delsart P, Gras M, Mounier-Vehier C, Gautier C, Montaigne D, Jude B, Asseman P, Le Jemtel TH (2011) Renal resistance index and its prognostic significance in patients with heart failure with preserved ejection fraction. Nephrol Dial Transplant 26:3908–3913CrossRefPubMedGoogle Scholar
  11. 11.
    Fish P. Physics and instrumentation of diagnostic medical Ultrasound. Wiley, New York. ISBN 0-471-92651-5Google Scholar
  12. 12.
    Garagic D, Cruz JB (2003) An approach to Fuzzy non-cooperative games. J Optim Theory Appl 118(3):475–491CrossRefGoogle Scholar
  13. 13.
    Karkar A (2011) Caring for patients with CRF: rewards and benefits. Int J Nephrol Article ID 639840, 1–6Google Scholar
  14. 14.
    Kashyap VS, Lakin RO, Feiten LE, Bishop PD, Sarac TP (2013) In vivo assessment of endothelial function in human lower extremity arteries. J Vasc Surg 58(5):1259–1266CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kuo CL (2007) Design of an adaptive Fuzzy sliding-mode controller for chaos synchronization. Int J Nonlinear Sci Numer Simul 8(4):631–636CrossRefGoogle Scholar
  16. 16.
    Kuo CL, Lin CH, Yau HT, Chen JL (2013) Using self-synchronization error dynamics formulation based controller for maximum photovoltaic power tracking in micro-grid systems. IEEE J Emerg Sel Topics Circuits Syst 3(3):459–467CrossRefGoogle Scholar
  17. 17.
    Kusche-Vihrog K, Urbanova K, Blanque A, Wilhelmi M, Schillers H, Kliche K, Pavenstadt H, Brand E, Oberleithner H (2011) C-reactive protein makes human endothelium stiff and tight. Hypertension 57(2):231–237CrossRefPubMedGoogle Scholar
  18. 18.
    Leon C, Asif A (2007) Arteriovenous access and hand pain: the distal hypoperfusion ischemic syndrome. Clin J Am Soc Nephrol 2(1):175–183CrossRefPubMedGoogle Scholar
  19. 19.
    Li HY, Wang J, Wu YX, Zhang L, Liu ZP, Filep JG, Potempa LA, Wu Y, Ji SR (2014) Topological localization of monomeric C-reactive protein determines pro-inflammatory endothelial cell responses. J Biol Chem 289(20):283–290CrossRefGoogle Scholar
  20. 20.
    Li CM, Du YC, Wu JX, Lin CH, Ho YR, Lin YJ, Chen T (2014) Synchronizing chaotification with support vector machine and wolf pack search algorithm for estimation of peripheral vascular occlusion in diabetes mellitus. Biomed Signal Process Control 9(2014):45–55CrossRefGoogle Scholar
  21. 21.
    Nash J (1951) Non-cooperative games. Ann Math 54(2):286–295CrossRefGoogle Scholar
  22. 22.
    Paffen E, deMaat MPM (2006) C-reactive protein in atherosclerosis: a causal factor? Cardiovasc Res 71(1):30–39CrossRefPubMedGoogle Scholar
  23. 23.
    Podlubny I (1999) Fractional differential equations, mathematics in science and engineering, vol 198. Academic Press, New York (Chapter 6 and 10) Google Scholar
  24. 24.
    Richardson PCA, Stevens AL, Cowan D, Calil S, Roberts VC (1987) Design of a continuous-wave Doppler ultrasonic flowmeter for perivascular application. Med Biol Eng Comput 25(6):661–666CrossRefPubMedGoogle Scholar
  25. 25.
    Ridker PM (2003) Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 107:363–369CrossRefPubMedGoogle Scholar
  26. 26.
    Ridker PM (2003) Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 107:363–369CrossRefPubMedGoogle Scholar
  27. 27.
    Snaedal S, Heimburger O, Qureshi AR, Danielsson A, Wikstrom B, Fellstrom B, Fehrman-Ekholm I, Carrero JJ, Alvestrand A, Stenvinkel P, Barany P (2009) Comorbidity and acute clinical events as determinants of C-reactive protein variation in hemodialysis patients: implications for patient survival. Am J Kidney Dis 53(6):1024–1033CrossRefPubMedGoogle Scholar
  28. 28.
    Soinio M, Marniemi J, Laakso M, Lehto S, Rönnemaa T (2006) High-sensitivity C-reactive protein and coronary heart disease mortality in patients with type 2 diabetes: a 7-year follow-up study. Diabetes Care 29(2):329–333CrossRefPubMedGoogle Scholar
  29. 29.
    Stalder AF, Frydrychowicz A, Russe MF, Korvink JG, Hennig J, Li K, Markl M (2011) Assessment of flow instabilities in the healthy aorta using flow-sensitive MRI. J Magn Reson Image 33:839–846CrossRefGoogle Scholar
  30. 30.
    Sung PH, Kan CD, Chen WL, Jang LS, Wang JF (2015) Hemo-dialysis vascular access stenosis detection using auditory spectro-temporal features of Phono-angiography. Med Biol Eng Comput 53(3):393–403CrossRefPubMedGoogle Scholar
  31. 31.
    Tordoir JHM, Dammers R, van der Sande FM (2004) Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg 27:1–5CrossRefPubMedGoogle Scholar
  32. 32.
    Usta M, Yurdakul S, Aral H, Turan E, Oner E, Inal BB, Oner FA, Gurel MS, Guvenen G (2011) Vascular endothelial function assessed by a noninvasive ultrasound method and serum asymmetric dimethylarginine concentrations in mild-to-moderate plaque-type psoriatic patients. Clin Biochem 44:1080–1084CrossRefPubMedGoogle Scholar
  33. 33.
    Wizemann V, Wabel P, Chamney P, Zaluska W, Moissl U, Rode C, Malecka-Masalska T, Marcelli D (2009) The mortality risk of overhydration in hemodialysis patients. Nephrol Dial Transplant 24(5):1574–1579CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Wu JX, Lin CH, Wu MJ, Li CM, Lim BY, Du YC (2015) Bilateral photoplethysmography analysis for arteriovenous fistula dysfunction screening with a fractional-order feature and cooperative game based embedded detector. IET Healthc Technol Lett 2(3):64–69CrossRefGoogle Scholar
  35. 35.
    Randox. C-reactive protein (CRP)-highly accurate testing for the detection of inflammation and infection. www.randox.com/brochures/PDF%20Brochure/LT118.pdf

Copyright information

© International Federation for Medical and Biological Engineering 2016

Authors and Affiliations

  1. 1.National Synchrotron Radiation Research CenterHsinchu Science ParkHsinchuTaiwan
  2. 2.Department of Internal MedicineKaohsiung Veterans General Hospital, Tainan BranchTainan CityTaiwan
  3. 3.Department of Electrical EngineeringKao-Yuan UniversityKaohsiung CityTaiwan
  4. 4.Department of Biomedical EngineeringNational Cheng Kung UniversityTainan CityTaiwan

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