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Do you have     
- are you monitoring   
- are you taking
prescription drugs?
- are you aware of drug
side effects on ANS?
- self-improvement tips
Read more......
Feeling dizzy      
- are you low in blood
pressure or heart rate?
- are you taking
prescription drugs?
- You may experience
Baroreflex failure
Read more......
Irregular heartbeats?
- often noticing abnormal
heartbeats (missing,
uneven, or super-fast)?
- Yo might have cardiac
- Most sudden death
events are preceded by
irregular heartbeats
Read more......
Mitral Valve Prolapse?
- Mitral valve is the
bicuspid valve between left
atrium and ventricle
- If mitral valve is not
closed properly (called
mitral valve prolapse
MVP), the blood may
backflow during pumping
- there is a strong
connection between panic
attackes and MVP
- How to detect it?
Read more......
Am I having   
- autonomic nervous
system works to fine tune
body conditions depending
on physiological needs
- ANS consists of two
branches: sympathetic and
- do you have balanced
- what are the symptoms of
Read more......
2009-07-04:The investigation of heart rate variability in uremic patients with
respect to metabolic syndrome, diabetes mellitus and high-sensitivity C-reactive
protein level

Shuan-Kuang Jung /China Medical University /Graduate Institute of Integrated Medicine; Taiwan

A decrease in heart rate variability (HRV) is known to be an independent predictor of mortality
after myocardial infarction. Metabolic syndrome (MetS), diabetes mellitus(DM) and high-sensitivity
C-reactive protein(hs-CRP) level are known to play important roles in cardiovascular morbidity and
mortality. Therefore we investigated the heart rate variability (HRV) in uremic patients with respect
to metabolic syndrome (MetS)( Asia definition of NCEP-ATP III and IDF), diabetes mellitus(DM)
and high-sensitivity C-reactive protein(hs-CRP) level to find out their correlation with cardiovascular
risk in these patients.
Materials and methods:
A cross-sectional cohort study involving 23 patients on maintenance hemodialysis at the Dialysis
Unit of The Taipei City Hospital, Yangming Branch. Patients with the following conditions were
excluded: <40 years old, >75 years old, hemodialysis history <3 months; presence of cardiac
arrhythmia, weak pulses, psychosis, infection or malignance. Each participant took a 20-min rest
before the HRV evaluation with ANSWatch ® . The test which last 7 minutes was taken 30 minutes
prior to hemodialysis session (pre-dialysis period) and 30 minutes following dialysis session (post-
dialysis period). Data in ANSWatch® was downloaded to a notebook computer immediately
following the test for review and storage. The blood sample was taken in the same day before
Uremic patients with metabolic syndrome(NCEP-ATPIII), DM and hs-CRP > 3 have lower HRV
when compared to uremic patients without those conditions( 14.88±7.94(n=17)v.s.24.5±4.76(n=6);
13.27±7.48(n=11)v.s.21.17±7.48(n=12);14.54±8.1(n=13)v.s.21.1±7.48(n=10) ) in the pre-dialysis
period( all P value < 0.05). We separate the metabolic syndrome(NCEP-ATPIII)to 3 group: The
number of risk factors and HRV was found to have negative correlation. Risk factors≦2, risk
factors=3 and risk factors≧4 (24.5±4.76(n=6)v.s.17.11±9.45(n=9) v.s.12.38±5.34(n=8)) in the
pre-dialysis period and (21±4.38 (n=6) v.s. 17.44±6.21 (n=9) v.s. 11.5±5.24 (n=8)) in the post-
dialysis period. Patients with risk factors of metabolic syndrome ≧4 has the lowest HRV.
Uremic patients with metabolic syndrome(NCEP-ATPIII), DM and hs-CRP > 3 have lower HRV
which indicating impairment of autonomic nervous function, especially found in the pre-dialysis
period. In the metabolic syndrome(NCEP-ATPIII)group, the increase in the risk factors of
metabolic syndrome was correlated with the decrease of HRV, indicating the impairment of
autonomic nervous function, especially found in the pre-dialysis period. Patients with risk factors of
metabolic syndrome≧4 have the highest risk of cardiovascular disease because they have the
lowest HRV.

2010:A Study on Changes in Heart Rate Variability and Other Physiological
Parameters Induced by Indoor Simulated Driving

Liang, Wen- Chieh /National Tsing Hua University /Dept. of Industrial Engineering and Engineering
Management; Taiwan
The objective of the study was to monitor changes in physiological parameters (SYS, DIA, HR,
HRV, LF(AU), LF(NU), HF(AU), HF(NU), LF/HF, VLF(AU), TRP and TLP, a total of 12
parameters), subjective fatigue feeling (by questionnaire), and blood pressure waveforms before
and after an indoor simulated driving task for 90 to 120 minutes and conducted in the three time
zones (morning, afternoon, and evening), with or without an exercise break.
The results show that the time zone and the exercise break each had a significant effect on the
changes of the whole set of the twelve physiological parameters based upon one-way MANOVA.
Further, from two-way MANOVA (time zone and driving task), the driving task (90 or 120 mins)
had very significant effect on the changes of the twelve physiological parameters. Moreover, from
paired-t test (before vs. after driving), HRV, VLF(AU) and HF(AU) showed an increase while HR,
TLP and TRP showed a decrease after driving, regardless of time zone or exercise break.  In
contrast, LF(NU), HF(NU) and LF/HF had opposite changes between the afternoon and the
evening session and between with-exercise-break and without-exercise-break.  Systolic pressure
and radial artery waveform were better maintained in the state of homeostasis in the morning
session than the afternoon or evening sessions, thanks to the activation of sympathetic nervous
system. Exercise break had the similar effect.
Driving task is a demanding activity both mentally and physically. Autonomic nervous system (ANS)
activation may overcome some fatigue symptoms, but the recovery is nonetheless incomplete.
Exercise break was shown to be an effective remedy, especially when accompanied by the ANS
actions. Based upon the results of the study, the normalized parasympathetic index HF(NU), the
normalized sympathetic index LF(NU) and the sympatho-vagal balance index LF/HF are three
promising parameters that could be further developed for the monitoring of driver fatigue.

2009-10-28 Real-Time Heart Rate Variability Analysis and Physical Activity
Detection System

Ching-Wei Tsai /National Yang-Ming University /Institute of Biomedical Engineering; Taiwan
The aim of this thesis is the improvement of ambulatory ECG. We combine the development of the
hardware and firmware activity detection, HRV analyzing and myocardial ischemia detection. We
hope this system can assist us to detect the heart diseases prognostic symptom. We developed a
microcontroller-based system , included three parts: 1. Using accelerometer to identify the activity
level and posture of the user. 2. Using low power a microcontroller, we developed a real-time
activity-considering heart rate variability spectral analysis mechanism for ischemia heart disease
detection. 3. For long-term measurement, the bio-information is stored in flash memory for long-
term tracing or further research. This research demonstrated that the improved ambulatory ECG
system is able to fulfill the real-time processing and long-term monitoring (more than 24 hours)
requirements. Five healthy male subjects, mean age 24, were collected to analyze the
relationships between posture and HRV using our system. As the posture is changing from one to
another, LF and HF power is higher in lying than in sitting and dynamic activity. LF and HF power
is higher in sitting than in dynamic activity in some subjects. The LF power to HF power ratio form
dynamic activity, sitting to lying posture is decreasing. Seven cases selected form European ST-T
database were analyzed to observe the relationship between myocardial ischemia and HRV.

2008-07 Around discussion movement to research human body nervous system
response behavior

Shih-Ming Yang /Ta Hwa Institute of Technology /Institute of Mechatronic Engineering; Taiwan

This paper proposed variations of heart rate and HRV under the condition before and after human
exercise. Ten healthy students are chosen as the objects of this study. They are subject to mid-
strength and high-strength exercise during five minutes on the treadmill. ANSWatch monitor is used
to record the heart rate and HRV signal. FFT software is developed as a post-treatment tool.
Results are shown that : 1. Blood pressure, heart rate and LF/HF are increasing after exercise.
However, RR-intervals, HRV and HF are decreasing. 2. Recovery time of blood pressure, HF and
LF do not be affected by the strength of exercise. 3. Recovery time of HRV, HR, and RR-intervals
are affected by the strength of exercise. One can conclude that human physiology signal are
affected by the strength of exercise. Keywork:Autonomic Nervous System、Heart rate、Blood
pressure、Power Spectrum Density。

2010-01 The Development of a Smart Tele-cardiac Surveillance System

Lee Meng-Hsiu /National Chung Cheng /Dept. of Communications Engineering; Taiwan

In recent years the statistic made by the Department of Health on the top ten leading causes of
death shows that the cardiovascular diseases are the major cause With the coming of the aging
society countries all over the world actively develop the health monitor services of home- and
community-care The clinician can get the information of patients through Internet regularly monitor
the physiological parameters and provide remote health care We often use Bluetooth to transmit
the ECG signal in the past Bluetooth is a wireless standard for the Wireless Personal Area
Network (WPAN) Bluetooth has limited addressing capability; a Piconet of Bluetooth contains eight
devices at most For the above reasons this study uses ZigBee a wireless standard based on
IEEE 802 15 4 which is a WPAN with low power consumption and high addressing capability This
study also combines the concept of telehealthcare The Smart Tele-cardiac Surveillance has been
implemented with remote monitoring and managing capability The Smart Tele-cardiac Surveillance
can diagnose cardiac diseases base on the user’s ECG signal compute the HRV of the user’s
signal and eventually translate every record into personal health report The medical staff can
monitor the user’s ECG signal through Internet and remind users to do something when necessary
by sending them MSGs and emails Through the implementation of this study the cardiac patient
can obtain a long-term healthcare service without going to the hospital This study would promote
the quality of people's life by making telehealthcare more practical

2007: The Exploration of the Relationships among Yin-Deficient symptoms and
Autonomic Nerve Functions and their Influence on Survival Rate in Yin-Deficient
Cancer Patients.

Shu-Chuan Lin /China Medical University /School of Nursing Institute of Nursing; Taiwan
Yin-deficiency (YD) is common seen in cancer patients under late stage. So far, it is not known
whether the Yin-deficient symptoms (YDS) are related to ANS functions which include heart rate
variability, basal metabolic rate and blood pressure. The aims of this study were to evaluate the
distribution of YDS, to analyze its’ relationships with ANS functions, and to investigate whether
YDS and ANS functions can predict the survival time in cancer patients with YD.
A cross sectional and follow-up study was conducted on cancer patients in a teaching hospital in
middle Taiwan. Forty-three patients were involved after signature of informed consent. We used a
structure questionnaire to evaluate the severities of YDS, and measured ANS function with an
analysis system, namely Lab VIEWTM. We also measured blood pressure with a monitor, namely
ANS Watch, and further calculated basal metabolic rate with a special formula. We coded the
collected questionnaire material and performed Statistics with SPSS12.0 coverall software. Data
were analyzed by descriptions analysis, ANOVA, Pearson’s correlation coefficients, t-test, multiple
regression and Kaplan Meier methods.
The results revealed that, the most 3 frequent and severe symptoms/signs in cancer patients with
YD were poor sleep with annoyance (90.7%) , less or non-coated tongue with or without redness
(86.0%), and dry mouth (69.8%). LF power had a significantly negative correlation with the
summated degree of poor sleep with annoyance had but significantly positive correlations with
both dizziness and rapid- small pulse. Heart rate had a significantly negative correlation with
blurring vision but a significantly positive correlation with hot over palm and sole. LF/HF ratio had a
significantly positive correlation with tinnitus and hearing decrease. On the other hand, BMR had
the significantly positive correlations with both the summated degree of hot over palm and sole
and night sweating but a significantly negative correlation with tinnitus and hearing decrease. The
analysis on the survival rates of subjects for 4 months revealed that, 5 parameters including
increased heart rate, decreased LF power and VLF power, less or non- coated tongue without
redness and increased basal metabolic rate can predict the survival rate.
Our study results also suggest that, the evaluation of Yin-deficient symptoms/signs can help
medical doctors and nurses to early detect YD and imbalance of ANS in cancer patients and to
make proper nursing management as soon as possible. This will increase the quality of nursing
care and promote the therapeutic effect.

2009: Effect of Exercise with Different Intensity on Oxygen Saturation and
Autonomic Nervous Systems at Rest and Exercise

Yeh-Ming LI /Kun Shan University /Department of Electrical Engineering; Taiwan

Modern people lack of exercise because of either heavy business or hard study. Though in
exercising, it must not being too vigorous to hurt body, even more to cause sudden death.
Unfortunately, many people don't notice their healthy condition while on the vigorous exercise, and
regrets happen over they can bear. Even the famous athlete also has the condition of occurrence
abrupt death. Demonstrated material over the years, although the movement sudden death with
other mobile disease like bone fracture, the muscle, the ligament damage and so on compares,
the formation rate is not high, but because the movement sudden death occurs mostly in young
and in the health crowd, therefore is deep for people's impression, shocks in a big way. Knowing
from the IOC medical treatment committee, in Lausanne Switzerland on December 10, 2004,
relevant the prevention because of the cardiovascular disease- exercise to die abruptly the
relevant document of the meeting is taught expert's group of leadership by Erik J. Meijboom to
point out, more than 90% of the athletes non- wound abrupt death has something to do with having
already existed of heart pathological changes. This research will build up a set of self-made blood
oxygen density to account and match with ANSWatch to measurement in different exercise in front
and back blood oxygen density, heartbeat rate, HRV and HF% and LF% etc. physiology data, and
record these data, in the power frequency chart the HF begged by "HF/TP × 100"%see as the
index sign that evaluates a parasympathetic nerve activity. And with the LF begged by "LF/TP ×
100"%see as index sign of evaluating the sympathetic nerves activity. This experiment carries on
three kinds of different exercise strengths(walk, run, climb fast stairs) to start experiment, by with
understand dissimilarity exercise strength's influence for the heart independent nerve and the blood
oxygen density, and the record, these three kinds of physiology data of exercise strengths, does
comparison and initial study.

2009: Aromatherapy on Regulation of Autonomic Nervous System for lementary
School Teachers

Shen Zhiwei /Asia University /Dept. of Photonics and Communication Engineering;Taiwan
Aromatherapy is widely used for relaxation. This research is to focus on autonomic nervous
system (ANS) variation due to aromatherapy. The subjects were 54 teachers within three
elementary schools (asthma, hypertension, hypotension and heart attack disease patients are
excluded). Atomization Bergamot oil was used for 10 minutes. Biosignals, such as SYS, DIA, HR,
HRV, LF%, HF%, LF/HF were collected before and after aromatherapy with the aid of
ANSWatch® monitor. BAI-II (Beck Anxiety Inventory) survey was also used as indicators.
Result demonstrates that there were decreasing for SYS, DIA , HR and LF% and LF/HF; while
there were increasing for HRV and HF% after using Aromatherapy (p<0.05). Further investigation
with groups by position, age and sex variable also showed that there was significant difference
with aroma treatment. The only insignificant outcome group was subjects with light anxious degree
and substitute teachers.
This study is the first article to investigate aromatherapy performance for elementary faculty in
Taiwan. The outcome shows that aromatherapy is effective to enhance parasympathetic activation
and to reduce blood pressure. Aromatherapy may be good choice for relaxation in high working
pressure workers, such as elementary school faculty.
2009: Heart rate and pulse transit time analysis of leg crossing on meditation practitioner.
Sih-Huei Chen /Asia University /Dept. of Photonics and Communication Engineering; Taiwan
Meditation common in many developing countries and developed countries, the Republic of China
is also commonly associated with the research report, it means using sit-ins, to observe the
practice in the long meditation of the 15 students did not receive meditation training with 14
students in the sitting cross-legged sitting position with legs straight, the acquisition of heart rate
variability and pulse transmit time and the two parameters was found in the cross-legged posture
control pulse transmit time on average there are significant differences, and Zen No fixed group;
the results and assumptions control group meditation practice in a long time, change in position,
the curved legs crossing over in the blood flow on unimpeded. While the movement experiment,
using to fling hand and kicking, this action can be cast in a small space stretching, observation of
pulse transmit time parameter is the value after exercise on reducing the trend; swing experiments
of many parameters have values reduce the trend after exercise, kicking foot experiment data
pulse transmit time averages have numerical decrease after exercise, but not obvious. Therefore,
we can find parameters of pulse transmit time in the leg crossing posture on heart rate variability
parameters than do more of the information available, and in the movement, speed up blood
circulation in the body of assumptions, not significantly different, but still can see a trend. Pulse
transmit time and the physiological parameters measured in only one non-invasive sensors, heart
rate variability than pure parameters can describe a number of related phenomena.

2009: Heart Rate Variability and Hilbert-Huang Transform based Obstructive
Sleep Apnea ECG Analysis

Chien-Hung Lin /Asia University /Dept. of Photonics and Communication Engineering; Taiwan
Nowadays, the people have the pressure more and more, causes under the condition which many
people spiritually frequently tie tight to live. Especially, sleeps every night under not good sleep
quality, People spirit badly and want to doze off in daytime. Gradually the concentrated force
drops, the judgment goes bad and memory decrease. And also has the possibility to initiate the
cardiovascular aspect bad situation. In recent years, sleep disorder gradually national attention,
Obstructive sleep apnea syndrome (obstructive sleep apnea, OSA) most often occurring.
As a result of research sleep's domain bright gradually, therefore the sleep center is also popular.
But equipment actually expensive scarce, so that must arrive at the patient who the sleep center
makes the treatment to be fully occupied, but must line up the seeing a doctor. In order to solve
this situation, many R&D center then research development simple home measuring instrument.
The patient may carry on the examination in the familiar place; the solution has the inaccurate
situation in the new environment. In addition hardware's development has facilitated dexterously
gradually, on the software awaits improvements. Therefore the research discussion calculation
technology with the characteristic selection, whether there is the more accurate judgment OSA
symptom. The new calculating method analysis mode discusses by Hilbert-Huang Transform
(Hilbert-Huang Transform, HHT).

2008   Research on variation of blood vessel diameter before and after arm-
flinging exercise

Yi-Han Chang /Asia University /Dept. of Photonics and Communication Engineering; Taiwan
Arm-flinging exercise is a heritage passed down from Chinese
ancestors. From the perspective of Chinese medicine, arm flinging helps
the circulation or ?qi? and ?blood?. The microcirculation of human body
is made up of the heart and blood vessels as a mean for hemodynamics
and transportation, and it is a very important stage in blood circulation,
including arterioles, capillaries, capillary veins, and lymphatic capillaries.
This system, through which bodily fluids flow, is called the
microcirculation. It directly participates in the circulation of body fluids,
exchanging cellular and tissue matters, communicating with tissue organs
throughout the body. This study aims to use image processing to convert
color images into grayscale, acquiring threshold limit value using Otsu?s
method. After obtaining threshold limit value, the grayscale images are
converted into black and white images to calculate blood vessel diameter
before and after arm-flinging exercise. Finally, using independent sample
T test and ANOVA method as means of statistical calculation, variation of
blood vessel diameter over time can be obtained through the experiment

2006 Developing an Uncomfortable Index Estimation of Contrast Medium
Injection Patients for Pulse to Heart Rate Response

Su You Chuan /Asia University /Dept. of Photonics and Communication Engineering; Taiwan
CT scan provide valuable medical image information and
intravenous iodinated contrast medium injection can enhance the image
contrast quality. Some patients, who may suffer palpitation, emesis, and
other stress phenomena, even induce death after intravenous iodinated
contrast medium injection. In this paper, we develop a real-time risk
indicator based on patients’ heart rate variation. The heart rate was
extracted from Photoplethysmography by adaptive template matching and
moving average algorithms. Preliminary data indicate that there is
significant heart rate to be increased after iodinated contrast medium
injection. Statistical differences between patients with different risk index
were observed in linear and nonlinear HRV parameters. A new risk
indicator based on cumulated heart rate deviation is also developed that is
proven to be effective as early warning indicator less than short time after
intravenous iodinated contrast medium injection.

2007: The Development of Clinical Pulse Diagnosis System

Chang Yu-Su /Asia University /Dept. of Photonics and Communication Engineering; Taiwan
Due to the rapid progress in technology and computer popularization, the scientific data is more
important in medical treatment. We developed a pulse diagnosis and information system of
Chinese Medicine. Unifying a set of simple fast and methods, using DAQ Card to pick up the
physiological signal, and using some signal processing skills, we then achieved the scientific effect
for Chinese medicine.
By detecting the pulses of Chun, Guan and Chy, the doctor can view the pulse in the screen. The
system has the function of real-time displaying the pulses, ECG and Heart Rate Variability (HRV)
analysis. In addition, the database can improve the clinical application. Then, the doctor can
acquire and analyze the pulse signals more conveniently.

2007: Research of the Relationship between Pulse-Contracting Effect and Heart
Rate Variability

NAT Yang /Asia University /Dept. of Photonics and Communication Engineering; Taiwan
In recent years, the progress of technology and the popularization of computer, make the scientific
process of Chinese medicine become the important topic. Therefore, the treatment of Chinese
medicine pays more attention to the display of the scientific data.
  Therefore, this research probes into the relation of the Pulse- Contracting effect and the
Heart Rate Variability with the scientific method, examine the relation of the pulse and
electrocardiogram with pulse diagnosis apparatus, by the amount of 30 persons who is examined,
including 20 healthy persons who are examined (group N), and 10 healthy persons of them have
no Pulse-Shrink effect (N1 group) ,the other 10 healthy persons of them have the Pulses-Shrink
effect (group N2). Besides, this research examine the 10 disease persons whose mean age are
31.7 ± 6.1 years old have Pulse-Shrink effect (group P).
  This result of study shows, the health persons may have the Pulse-Shrink effect. In analyzing
N2 group HRV, the average 1.25±0.33 of LF/HF in N2 group is higher than the average 0.95±0.25
of LF/HF in N1 group, and reaches the obvious difference (p =0.029<0.05) . Besides, in analyzing
the HRV of P group, the average of LF/HF(= 2.66±0.4) is higher than N group(including N1 group
and N2 group) , and reach the obvious difference(p=2.93e-08<0.05 and p=2.76e-07<0.05).
Show that the disease persons who have the Pulses-Shrink effect tend to stronger activation of
sympathetic nerve and weaker activation of parasympathetic nerve.
  This result of study also shows, there are the Pulse-Shrink effect in group P and group N2,
but the average of LF/HF in group P is much larger than that of group N2. . Show that group P
tends to stronger activation of sympathetic nerve and weaker activation of parasympathetic nerve.
   This research result of pulse pictures, let Chinese medicine while carrying on the pulse
diagnosis, can also combine Western medicine of heartbeat variation analysis with
electrocardiogram, and thus the reference indicator will be exactly combined for Chinese and
Western medical treatment via the scientific data analysis.

2010: Investigation of Physiological Responses Related to VR-induced Motion-

Chen, Yu-Chieh /National Chiao Tung University /Institute of Electrical Control Engineering; Taiwan
This study investigates subjects’ physiological responses related to motion-sickness using a virtual-
reality-based driving simulator on a motion platform with six degrees of freedom, which provides
both visual and vestibular stimulations to induce motion-sickness in a manner that is close to that in
daily life. The degree of motion-sickness was simultaneously and continuously reported by the
subjects using an onsite joystick, providing non-stop behavioral references to the recorded
biomedical signals. This study assesses the temporal relationship between heart rate variability
(HRV) and the level of motion sickness (MS). Compared to the baseline (low MS) session, the low-
frequency (LF, 0.04–0.15Hz) and the ratio of low- to high- frequency (LF/HF) components of
HRVs increased significantly, while the HF (0.15–0.4Hz) component decreased when the self-
report MS level increased. This finding is consistent with a perception-driven autonomic response
of the cardiovascular system. Moreover, adaptive neural fuzzy inference system (ANFIS) was
used to assess and model the relation between the HRV indices and MS severity. The results of
this study showed that a combination of LF and HF indices and their ratio was strongly correlated
with changes of the subjective ratings of MS, suggesting that MS may affect the combination of
the sympathovagal interactions. Subjects’ brain dynamics associated with motion sickness were
measured using a 32-channel EEG system. The acquired EEG signals were parsed by
independent component analysis (ICA) into maximally independent processes. The decomposition
enables the brain dynamics that are induced by the motion of the platform and motion-sickness to
be disassociated. Five MS-related brain processes with equivalent dipoles located in the left
motor, the parietal, the right motor, the occipital and the occipital midline areas were consistently
identified across the subjects. The parietal and motor components exhibited significant alpha
power suppression in response to vestibular stimuli, while the occipital components exhibited MS-
related power augmentation in mainly theta and delta bands; the occipital midline components
exhibited a broadband power increase. Further, time series cross-correlation analysis was
employed to evaluate relationships between the spectral changes associated with different brain
processes and the degree of motion-sickness. According to our results, it is suggested both visual
and vestibular stimulations should be used to induce motion-sickness in brain dynamic studies.

2009: Early Intervention for Very Low Birth Weight Preterm Infants: Effects on
Interactive Behavior and Heart Rate Variability in Feeding

Lin, Yu-Chih /National Taiwan University /School of Physical Therapy; Taiwan
Purpose: This study was aimed to examine the effectiveness of early intervention for very low birth
weight (VLBW, birth weight &lt;1,500 g) preterm infants in mother-infant feeding interaction at 4
and 6 months corrected age. Methods: This study enrolled 62 term infants and 179 VLBW infants
that the latter were randomly assigned into usual care program (UCP), clinic-based intervention
program (CBIP) and home-based intervention (HBIP) group. Mother-infant dyads feeding activity
were examined using the Assessment of Mother Infant Sensitivity- Chinese version (AMIS-C).
Infants’ heart rate variability (HRV) was assessed using an electrocardiography at 4 and 6 months
corrected age. Results: For interactive behavior, the CBIP group showed significantly higher
maternal scores on the AMIS-C than the HBIP at 4 and 6 months corrected age (p = 0.004);
whereas, the infant, dyadic and total scores of all groups were comparable. As for the
physiological response, all groups showed similar HRV at baseline and during feeding at 6 months
corrected age. Furthermore, a higher AMIS-C dyadic and total score on at 4 months were
associated with a smaller change in some HRV indices from baseline to feeding at 6 months in all
groups (all r=-0.16, p&lt;0.05). A higher AMIS-C maternal and total score on at 6 months was
each associated with a smaller change in some HRV indices from baseline to feeding at 6 months
(r=-0.20 to -0.16, all p&lt;0.05). Conclusion: VLBW preterm dyads showed comparable interactive
behavior and infant’s heart rate variable than term dyads during feeding at 4 and 6 months
corrected age. Early intervention delivered at clinic visit was more beneficial than that delivered at
home in altering maternal feeding behavior during the follow-up period.


Wang,Jeng-Pang / National Taiwan University /Graduate Institute of Electrical Engineering; Taiwan
In this thesis we propose an immune –inflammatory model of human longevity and risks. This
thesis will theorize that inflammation as a common pathway and major risk leading to most
diseases ( cancer, atherosclerosis, aging-related diseases).and leading to most morbidity and
mortality. Anti-inflammatory measures are going to slow or prevent diseases from major health
risk, inflammation. And the thesis will also theorize immune phenotype change by available cell
proliferation technology would extend current limitation of human are many non-
chemical approaches in disease prevention and treatments. Of these, electrical bio-feedback is an
efficient non-invasive non-chemical approach against inflammation. The nature of non-invasiveness
and the efficiency of this approach strengthens the basis for using electrical bio-feedback anti-
inflammatory reflex in disease prevention for everyone in daily life. Here, the result showed that
HRV-HR is a promising parameter for checking inflammation. Other non-chemical approach are
also emphasized in disease prevention and treatment: Eliminate of food antigen, food toxins;
Unload mental stress; Eradicate occult infection. And maintain an efficient innate immunity.his
thesis also showed that changing immune phenotype is available by cell proliferation technology.
The case study on cancer innate immune therapy proves that it is possible and reasonable to use
our own innate immunity to treat cancer. Autologous natural killer( NK ) cell transfusions eradicate
cancer in pilot study. Terminal hepatocellular carcinoma with portal vein thrombosis totally
disappeared with NK cell transfusion as sole treatment. NK cell transfusion prolongs survival in all
cases. NK cell transfusion lengthens symptom-free intervals and progression free intervals. It is
freely used in any combination therapy. The life quality of patient is much superior to otherwise
treated patients. The phenotype change toward NK cell dominance is not only useful in treating
cancer is is also useful in prevention against atherosclerosis.The phenotype of NK cell, CD 56 dim
played an important role in Coronary Heart Disease. This type of patients has less NK cells. NK is
the immune phenotype of healthy longevity. Those with higher NK has favorable endocrine profile,
more muscle, more life activity, and less morbidity. Moreover, NK treats and prevents cancer,
atherosclerosis, treats variety of infection and brings inflammation back to homeostasis. Abundant
NK precursor cells are easily available in the peripheral blood. NK treats and prevents cancer. NK
prevents atherosclerosis. NK cell treats variety of infection and brings inflammation back to
homeostasis. NK prevalent is the phenotype of healthy ageing. There is easily available abundant
NK precursor cells in the peripheral blood , that make change into NK phenotype type present and
practical by current proliferation or promotion technology. Thus, we conclude that by having your
life immune-friendly way, by lowering the inflammation to prevent diseases, by selecting effective
and immune-harmless treatment against diseases, and by promoting or changing into NK prevalent
immune phenotype, would be the key for the human being to live beyond the current limitation of
human longevity.

2009: Fetal ECG Extraction using ICA of Multi-Channel Maternal ECG

Hsu Chao-Yang / National Taiwan University /Graduate Institute of Electrical Engineering; Taiwan
Electrocardiography (ECG or EKG) is the important and general non-invasive method for heart
diagnosis. The recording of the electrical activity from cutaneous electrodes provides observation
of abnormal heart function. Likewise, the recording of the electrical activity from cutaneous
electrodes of the pregnant woman can use for observation of fetal heart function, called fetal ECG
(FECG). As same as standard ECG, the fetal ECG also represents other biomedical information,
such as the observation of fetal autonomic nervous system (ANS) by successive changes of fetal
hart rate variability (HRV). Different from this, the observation of fetal ECG has difficulty in
practice. Because fetus is stored inside maternal body, there are two natural identical signal
sources exist simultaneously, such as maternal and fetal heart in recording signal from skin
electrodes. Especially the signal strength of maternal ECG is much large then fetal ECG is
increase the difficulty of signal processing. Furthermore, compare with weak fetal ECG, it is very
evident that the interference generated by other physiologic phenomenon or measuring noise
influence the signal of fetal ECG. The research of this thesis focuses on the signal obtainment of
fetal ECG. The objective of this thesis is to propose new algorithm architecture for proper fetal
ECG extraction without thoracic electrode, based on few abdominal electrodes only. The
processing result can be used for further analysis of fetal medical information. The proposed
algorithm integrates several processing by various perspectives, including frequency domain, time
domain, spatial domain and statistic domain. The first band-pass filter preliminary removes other
interference and noise based on signal composite differences of frequency component. Next, the
maternal ECG is represented as a summation of sequential PQRST complexes. The maternal
ECG reconstructed by positioning template of PQRST complex on each fiducial point in time.
Based on this approach, the output of band-pass filter is subtracted to the estimated maternal
ECG for maternal ECG elimination. Due to time-dependent of real heart beat, even neighboring
PQRST complex is hardly identical. Therefore the direct subtraction method does not remove
maternal ECG entirely. Afterward, the further elimination of residual maternal ECG and other
noises achieves by using a kind of independent component analysis (ICA) method, call projection
pursuit (PP). It extracts fetal ECG based on statistical characterization of source signal. The
experimental signals download from “Non-Invasive Fetal Electrocardiogram Database” of
“PhysioBank”, a publish database in internet. Those signals had measured by Ph.D. Marocelino
Martinez Sober and Jorge Granado Marco in the University of Valencia, Spain. The experimental
results demonstrate proposed algorithm achieves fetal ECG extraction from four recording of
abdominal electrodes only. Meanwhile, the discussion of how several design parameters, such as
the cut-off frequency of band-pass filter, the length and position of template of maternal PQRST
complex, the processing window of projection pursuit impact the fetal ECG extraction is described
in this thesis. In conclusion, corresponding experimental results prove the template based maternal
ECG subtraction method and ICA based projection pursuit method can be integrated together by
following a proper sequence and adjustment, the proposed algorithm succeeds fetal ECG
extraction effectively and accurately.

2009: Propofol improves autonomic dysfunction and survival time in conscious
septic rat model

Li-Ming Hsu /Kaohsiung Medical University /Graduate Institute of Medicine; Taiwan
Although several clinical trails have been performed, there is not much improvement in septic
mortality in recent years. The major cause of septic mortality is septic shock, which also accounts
for 10% of mortality in intensive care unit (ICU). In ICU, propofol is often used for sedation. In
addition to the effects of anesthesia and sedation, propofol also has anti-inflammation and free
radicles scavenger effects in vitro study. The present study aimed to understand whether propofol
has any benefit in treatment of sepsis. This is an in vivo study. We adapted awake CLP-induced
sepsis rat model without any anesthesia agent. In the study, there were records of sepsis survival
time and the change status of blood pressure. In addition, HRV LF/HF ratio (heart ate variability,
low frequency/high frequency), a method of non-invasive recording of ANS (autonomic nervous
system) was also used. The rat brain stem i-NOS was detected by western blot to explain the
mechanism. The results show that cardiovascular sudden collapse happened after the onset of
septic shock, and the modulation function of ANS decreased after the late stage of sepsis.
Propofol would protect the dysfunction of ANS modulation by reducing the i-NOS production in rat
brain stem during sepsis. With above mechanisms, propofol would improve the condition of
cardiovascular sudden collapse after septic shock and prolong the survival time of sepsis. The
study showed the basic evidence, that propofol would protect the function of ANS modulation in
septic rat model. The results would provide another choice in treating sepsis patients. Key words:
sepsis, septic shock, HRV, propofol

2009: Design and Implementation of Front-End Readout Chip for Electrocardiac
Signal Acquisition Systems

Chang-Yi You /Chung Yuan Christian University /Dept. of Electrical Engineering ;Taiwan

The future medical treatment will use active method to monitor personal health. Nowadays, many
kinds of portable health-care instruments, which like blood-glucose, blood-pressure and heart-rate
monitors or clinical thermometer, are popular used in human life. The future medicine will connect
community hospitals, information service and personalize multi-function monitor device to reach
home-care target.
This research is focus on electrocardiac signal integrated readout circuit design. In the beginning,
there proposes an improving constant Gm compensation circuitry to conform with high common-
mode rejection ratio characteristic of readout circuit which is implemented by discrete
components. For integrated readout circuit design, the fully differential structure is used to resist
the nature noise and the differential output instrumentation amplifier composed of current
conveyors with chopping stabilize technique is in order to cancel self dc offset. The lowpass filter
is designed by forth-order fully differential switched-capacitor configuration. In addition, this work
also propose a high stable, low frequency oscillator, that is using IPTAT current to compensate
the temperature and process effect, to provide the clock signal for readout circuitry. Finally, the
monitor system is verified by LabView platform and FPGA developed board to analyze and display
ECG signal.
The integrated readout circuit is simulated and implemented by using TSMC 0.35um 2P4M
process with 1.21mm2 chip size. The readout chip is operated in ±1.65V supply voltage and
10KHz clock frequency. The circuitry lowpass cutoff frequency is design at 51Hz and with
50~70dB gain in passband. The steady state power consumption is around 375uW.

2009: Implementation of Programmable Biosignal Digital Processor with

Shih-Yu Lee / Chung Yuan Christian University /Dept. of Electrical Engineering ;Taiwan
The Objective of this research is to develop a biomedical signal processing System on Chip (SoC)
platform which is based on Field Programmable Gate Array. The SoC (FPGA) will be integrating
and controling the peripherals device such as LCD, USB, Flash Memory, and SRAM Memory. It is
a RISC architecture Microcontroller (MCU) which is based on the Microprocessor without
Interlocked Pipeline Stages (MIPS) techonology. The SoC will be used to extract the power
spectral from acquired bio-signal with a dedicated co-processor of Fast Fourier Transform (FFT).
The design of FPGA programmable system chip was specifically dedicated to the analysis
requirement of the frequency and time domain analysis for Bio-medical signal processing. The
instruction sets were divided into two types. One is regular MCU instruction which function wass to
controlling the operation flow, to move data and to perform arithmetic and logic operation. The
other is the special instruction set which was to set-up parallel computing flag that will be
performing the signal processing in real-time, governing the data storage, and displaying the
presentation of the data and the result. In this thesis, the processes of Heart Rate Variability
(HRV) analysis in real-time will be an example to present the result of this SoC desing. In this Soc
platform, main frequency and MIPS instruction frequency uses 50MHz and 10MHz, respectively.
The sampling rate for acquiring electrocardiogram is 303Hz, and HRV is re-sampled in 5Hz for
analyzing. The results of FFT power spectra of real-time ECG processing was compared to the
result that processed using the MatLab. The correlation of the frequency spectrum was 0.9926.
This showed that the designed SoC platform is capable for processing bio-signal in real-time.

2009: Analysis natural heart rate variability using photoplethysmography

Chao-Feng Chang /Chung Yuan Christian University /Dept. of Electrical Engineering ;Taiwan

This innovation is related to measuring the heart rate under unawareness of subject to extract the
true nature heart rate variability. The Heart Rate Variability (HRV) is an important index that could
be used for long term monitor of cardiac function. The low variability of heart rate indicates that
the cardiac rhythm could not be regulated by autonomic nerve system. It is not a healthy condition
for regular daily activities. This innovation has devised a portable photo-plethysmo-graphy (PPG)
through an ear plug appliance.
The PPG signal was acquired and analyzed using a simple microcontroller with a MP3 data
decoder. In this way, the user of MP3 player could has option of monitoring and recording his or
her heart rate and heart rate variability regularly and unaware. The prototype system was also
including functions of data display with color LCD, data storage with CF card, data communication
with USB. An off-line PC window program was also provided for reviewing the recorded PPG and
analyzed HRV.
The system was used to assess the psychophysic effect of heart beat monitoring over four
circumstances. That were the situation of monitoring the ECG without listening to music, assessing
the PPG without listening to music, listening to music with monitoring the ECG, and listening to
music with the assessment of PPG. Four types of HRV parameters were analysed among named
four circumstances using Student’s T-TEST. It were to examine the impact of heart beat
monitoring methods on users. While examining the HRV frequency spectrum against each testing
situation, the parasympathetic tone was found activated much earlier using PPG to assessing
heart beat than the using ECG. This result demonstrated that the subjects’s heat rate and their
natural heart rate variability could be monitored unconsciously using PPG while listening to music.

2009: Study of Chan-Meditation Mechanisms for Stress Manipulation

Wu, Shr-Da /National Chiao Tung University /Institute of Electrical Control Engineering; Taiwan

This dissertation is aimed to investigate the mechanisms of Chan meditation for stress
manipulation. The study involving both the psychological and physiological factors was conducted
for two groups of subjects who with and without Chan-meditation experience. In the psychological-
factor study, a survey study was conducted by evaluating the negative emotional states of college
students with and without Chan-meditation practice in their daily lives. The DASS questionnaire
was used to measure the negative emotional states (depression, anxiety and stress/tension). The
results showed that, compared with non-practitioners, much lower percentage of college students
with routine Chan-meditation practice had negative-emotion problems. Other factors including
experience, duration and frequency of Chan meditation are also investigated and reported in the
dissertation. One significant finding suggests that meditation experience (>0.5year) is essential for
effective management of depression and anxiety. In the physiological-factor study, we focused on
the behaviors of heart rate variability (HRV) and cardiorespiratory phase synchronization (CRPS),
based on the designed experimental protocols. HRV has being extensively employed in
understanding the function of autonomic nervous system both in clinics and researches. We
analyzed the HRV both in time and frequency domains. The major effects of meditation on HRV
were the decrease of LF/HF ratio and LF norm as well as the increase of HF norm, which
suggested the benefit of a sympathovagal balance toward parasympathetic activity. Moreover, we
observed regular oscillating rhythms of the heart rate when the LF/HF ratio was small under Chan
meditation. CRPS was applied to the study of cardiorespiratory interactions most recently. It may
establish an effectual co-action between cardiac and respiratory systems for better preservation
of bodily energy. This dissertation presents the approach of synchrogram analysis for studying the
CRPS. In the synchrogram scheme, we first evaluated phase synchronization between cardiac
and respiratory systems by analyzing electrocardiogram (ECG) and respiration signals. In
addition, three synchronization parameters (lasting length, number of epochs, and total length)
were defined to examine the efficacy of Chan meditation in the cardiorespiratory phase
synchronization. Statistical analysis reveals that the number of synchronous epochs and the total
synchronization length significantly increase during Chan meditation. Furthermore, a predominance
of 4:1 and 5:1 rhythm-ratio synchronizations was observed during Chan meditation.

2008: Effects of Nickel on Autonomic Regulation: Role of Oxidative Stress and

Hsueh, Tzu-Wei /National Taiwan University /Institute of Occupational Medicine and Industrial
Hygiene; Taiwan

The components of ambient particle may induce not only pulmonary injury but also cardiovascular
diseases. Epidemiology studies have observed that oxidative stress and inflammation may be
associated with the alterations of heart rate variability, especially in some susceptible persons. But
the mechanism of these associations is unclear. Spontaneously hypertensive rats (SHR) were
compared with Wistar Kyoto (WKY) rats after nickel sulfate exposure. We investigated the
difference of HRV change between SHR and WKY. Additionally, in order to establish the role of
oxidative stress and inflammatory effect on HRV, we used N-acetylcysteine (NAC) and Celecoxib
to modify the anti-oxidative and anti-inflammatory capability of SHR. This study was based on a
self-control study design. We used telemetry transmitters and collected 72 hours ECG data after
NiSO4 exposure. The parameters of HRV such as ANN, LnSDNN, and LnRMSSD were calculated
from the ECG data. After NiSO4 exposure, we found that SHR had greater ANN change than
WKY (p&lt;0.05). After four doses of NAC and Celecoxib treatment, the alterations of ANN on
SHR were reduced to the levels caused by WKY. In summary, nickel-induced HRV change may be
caused by oxidative stress and inflammation. Further toxicological studies are needed to establish
the mechanism of oxidative stress and inflammation affect on HRV.

2008: The Effects of Home-Based Exercise Program on Heart Rate Variability
and Functional Capacity Among Postmenopausal Women With Coronary Artery

Shih-Ting Tu /Taipei Medical University /Graduate Institute of Nursing; Taiwan

Heart rate variability(HRV)was commonly used to monitor the autonomic regulation and was an
important indicator of cardiovascular autoregulation. Decreased HRV was noted in coronary artery
disease(CAD). The purpose of this study is to investigate the effects of home-based exercise
program on functional capacity and HRV in postmenopausal women with CAD.
Methods and Subjects: Thirty-two postmenopausal women with CAD were recruited from one
medical center, and assigned to an exercise group(n=16, averaged age 64.19 ± 5.86 years) or a
control group(n=16, averaged age 66.69 ± 5.26 years). The home-based exercise program was 3
times per week for 8 weeks. All the subjects were asked to keep their daily activity, dietary
intake, and medication during the study period. Functional capacity(6-minute walking test) and
HRV were measured before and after a 8-week study period for each subjects. Differences in
demographic data between groups were evaluated by using χ2 and t-test. Relations between
functional capacity and HRV were assessed by Pearson correlation. Paired t-test, Independent t-
test, and two-ways ANOVA were used for comparison between and within the two groups.
Results: No significant difference in baseline demographic, functional capacity, and HRV was
observed between two groups. No correlations were found between functional capacity and HRV
either at baseline or after training in the exercise group. Age and 6-minute walking test had
negative relation(γ=-.518, p =.002). The increase of functional capacity of the exercise group was
significantly and markedly greater than the control group(41.86 vs. 9.18 m)(p =.001). After 8
weeks home-based exercise training, the exercise group had significant increase in HRV indexes:
TP(ms2), HF(ms2), LF(ms2), and HF(nu)(p< .05), but the LF(nu) and LF/HF ratio remained
unchanged. In addition, all HRV variables remained unchanged in the control group.
Conclusion: Eight weeks home-based exercise program can significantly improve functional
capacity, HRV, and vagal activity in postmenopausal women with CAD.

2008: Ensemble Back-propagation Neural Network Applied to brain death index
prediction for the patients with severe head injury

Kai-Yuan Cheng /Yuan Ze University /Dept. of Mechanical Engineering; Taiwan                        

The concept of organ donation has already been accepted by people gradually in recent years so
the judicial brain death determination process becomes very important. Clinically, patients with
irreversible apnoeic coma (IAC) will be considered legally as brain death based on a judicial
process, but this process can only be applied to people who had already signed the letter of
consent to donate organs. Besides, the judicial process is also very lengthy. This study tried to
find out an easier way to diagnose the prognosis of the patients with severe head injury, and offer
the medical staffs other information to determine brain death.
  Medical doctors depend on their experience to diagnose patients’ prognosis by observing the
variation of different physiological signals. We tried to find out this relationship between the
signals’ variation and doctors’ determination process. Heart rate variability (HRV) is the most
common noninvasive physiological signal. It’s also a rich signal which contains a lot of information
of human body, and probably the most investigated and readily assessable measure of autonomic
nerves’ function. Therefore, we designed a two-stage experiment to achieve our purpose. For the
first stage, the model is an expert system designed to mimic the determining process of medical
doctors. We chose ten most important physiological signals to be the analyzing data in the first
stage. But in the second stage, we only focused on analyzing the heart rate signal. The technique
of artificial neural networks (ANN) and empirical mode decomposition (EMD) has been applied to
construct the prediction model of brain death index (BDI). The multi-layer perception (MLP) and
ensemble neural networks are chosen to be the network type of BDI model. This model can
provide medical staffs a reference index to evaluate the status of IAC and brain death patients.

2008: Construction and elementary function estimate of circulation physiology
parameter measurement analysis system

Wen Chi Lin / Yuan Ze University / Department of Electrical Engineering; Taiwan
The physiological relevant theory of circulation has been developed for many years. Hence, it is
very important measure with the scientific method and offers experimental data to researchers.
The emphases of this research is to build one physiological parameter circulatory measurement
system and to provide researchers some basic data so that they can develop or prove relevant
research of the circulation theory through this system. For example, the R wave could be
intercepted in order to understand the HRV change of the heart rate variation via detection of ECG
signal, and the timing of heart rate change via frequency domain analyze of wavelet. Regarding
system expansion in the future, the rotational speed of the motor could be adjusted through
different heart rate and different shaking waves could be produced by motor driving water bed to
prove the influences on the human body by stimulating the acupuncture point in different frequency.
There are three parts in system conception of the main circuit and system software. First, the
analogy circuit is used for human ECG signal detection. The system uses the instrument amplifier
to amplify ECG voltage signal and uses the filter to cut out the frequency we want, Second, the
analogy and digital communication circuit. After filter and amplify signal, we need to transfer the
signal from analogy to digital into the computer by RS232 interface of MCU. The software system
uses Labview to analyze and detect the heart rate of ECG and HRV to produce domain graph by
wavelet transform frequency. Finally the heart rate is analyzed with system. Third is D/A circuit.
D/A circuit drives the motor to produce different rotational speed. Regarding the system proof, the
human body shall be surveyed actually for the accurate measurement of heart rate against the
system via standard ECG wave and variation of HRV in the human body analyzed by the signal of
heating acupuncture point.

2008: Hilbert-Huang Transform Analysis Applied to the Patients’ Blood flow
variability and Heart rate variability during surgery

Pei-Fung Shi /Yuan Ze University /Dept. of Mechanical Engineering; Taiwan
There’s no specific definition of depth of anesthesia (DOA). It is obtained from patient’s basic
physiological signal and the anesthetist’s experience for many years in order to offer proper
medicine i.e. give the patient the best and safe anesthesia process. In the past, a lot of studies
indicated that heart rate variability (HRV) is a recognized parameter for assessing autonomous
nervous system activity. Therefore, HRV can be an indication of DOA. However, heartbeat can be
affected by anesthesia drugs, breathing rate and electric influence by operating electric knife.
These reasons may bring anesthetist wrong information.
The purpose of this research is to use engineering analysis to analyze blood flow variability (BFV)
and HRV during anesthesia. When HRV can’t present the patient’s states in some situations, BFV
can replace HRV. We help anesthetists to know the patient’s truly states and characteristics, and
increase the security of the anesthesia process.
This research collects the physiological signals from 20 patients who have accepted ears, nose,
throat (ENT) surgery and 10 patients who have accepted the abdominal surgery. Then we use
Hilbert-Huang Transform (HHT) to analyze the data and find out the changes of BFV and HRV.
Finally, the results have been shown as follows:
1. After injecting Atropine, BFV is less affected than HRV.
2. When the doctor use electric knife to stop bleeding, blood flow signal is less influenced by
electricity than ECG.

2008: The influence of electroacupuncture on EKG and temperature under
diabetic and normal rat

Hung-Chiang Cheng /China Medical University /Graduate Institute of Acupuncture Science; Taiwan
Acupuncture had been used to treat diseases for several thousand years, and there were a
variety of theories to explain the mechanisms of acupuncture, including gate control theory, double
gate control theory, neuro-physiological effect, neuro-chemical effect、neuro-endocrinological
effect and humeral mechanism, but its mechanisms are still unknown. The different functions and
different actions of acupuncture were noted when acupuncture was used to treat the diseases.
this study is the continuation of acupuncture’s effect on the diabetes mellitus (DM).
The DM is ranked among the top ten of leading causes for death through out the world. The
control and prevention of DM is getting more important due to its complications and disability
which made huge economic loss and the cost effect of health. The cause of the illness mostly due
to the high levels of plasma glucose, make the peripheral tissue dehydration, then let the blood too
sticky and reduce blood flow in blood vessels. The high levels of plasma cholesterol and other
lipids attach on the wall of blood vessels then decreased the vessels elastic, which change the
vessel fragile and the permeability of blood vessels, thus difficult to control blood pressure.
Further, the acupuncture affect the autonomic nervous even heart beat. In this study, we would
like to investigate EA stimulation on STZ and normal rat to explore the physiological changes of
electrocardiogram (EKG) and body temperature.
Male healthy Wistar and STZ induced diabetic rats were used in this study. Under anesthesia by
pentobarbital (40 mg/Kg, i.p.), we will proceed two major experiments, the one is under saline and
the other is under intravenous-glucose-tolerance-test (IVGTT) background, Then the rats will
divided into experimental group (EG) treating 15 Hz electroacupuncture (EA) on bilateral zusanli
acupoint for 60 min and control group (CG) not treating EA for the same time. We will compare
the effect of electrocardiogram (EKG) and body temperature between different animal models and
different treatments (EG and CG) by time in 90-min observation.
As the results showed, STZ and wistar rats’ physiological indicators (heart rate, body
temperature, RR interval) had significant differences. The STZ rats’ heart rate was slower than
wistar rats’, and their body temperature was also lower than wistar rats. The short-period of EA
can elevate STZ rats’ heart rate closer to the wistar rats’. During the IVGTT, these phenomenon
was not significant, it’s may be the load of the glucose under IVGTT that stimulate the
parasympathetic activity. The role of acupuncture’s effects on sympathetic and parasympathetic
nerve may use the heart rate variability (HRV) for further analysis.
2008: Effects on Heart Rate Variability of Auricular Acupressure in Hypertension Adults
Shin-yi Ou /China Medical University /School of Nursing Institute of Nursing; Taiwan

2008:  The difference of heart rate variability between match acupoints of the
same meridian and match acupoints of adjacent meridian in heart meridian :
Shenmen pairs to Tongli and Shenmen pairs to Neiguan

Yi-Fang Yang /China Medical University /Graduate Institute of Integrated Medicine; Taiwan

Match-acupoint is choosing two or more points with similar physical actions or synergistic effects
clinically, used to enhance the therapeutic effects. Shenmen (HT7) is the Yuan-Source point of
Heart-Meridian; its actions are slowing down the heart rate and calming the mind. Tongli (HT 5) is
the Luo-Connecting point of Heart-Meridian with the effect of quieting the spirit and stabilizing the
mind. The HT7 and HT5 are located in the same meridian with the similar actions, thus HT7 pairing
to HT5 could complement each other. Neiguan (PC6) is the Luo-Connecting point of Pericardium-
Meridian and also the main point for visceral diseases. Heart-Meridian is adjacent to Pericardium-
Meridian, HT7 pairing to PC6 is considered to bring the synergistic effects. Heart rate variability
(HRV) is a simple, noninvasive, quantified, appliance to analyze autonomic nervous activities in the
clinical studies. The aim of the study is to investigate the difference of HRV between match
acupoints of the same meridian and the adjacent meridian in heart meridian. We design a cross-
over clinical trial, a total of 20 healthy volunteers were studied. All of the volunteers received 4
experimental tests, including sham acupuncture (SA) with paste slices at bilateral HT7 points only,
3 verum acupuncture (VA) tests- acupuncture at bilateral HT7, HT7+HT5, and HT7+PC6. HRV
analyzer was used before (HRV recordings of baseline), during (HRV recordings of acupuncture
period) the application of acupuncture, and after the needles were taken out (HRV recording of
post-acupuncture period). Frequency-domain analysis of the stationary R-R intervals was also
performed. The results indicated that the LF and Variance of HRV at 20-min recordings of post-
acupuncture period were lower in the HT7 and HT7+HT5 tests than that in the SA test, whereas
no similar changes was noted in the HT7+PC6 test.
In conclusion, acupuncture at HT7 and HT7+HT5 may reduce sympathetic nerve activity, and
increase parasympathetic nerve activity relatively. These results are good agreement that both
HT7 and HT5 have sedative effect and may be used to treat anxiety and palpitation in Traditional
Chinese Medicine theory. With regard to HT7+PC6 that could not enhancing the action of HT7,
and even resulting in no effect on the LF and Variance components of HRV, therefore the further
study is needed.

2008: The effect of epilepsy on function of autonomic nervous system in human

Tomor Harnod  /Tzu Chi University /Institute of Medical Science; Taiwan
Impairment of cardiovascular regulation in the autonomic nervous system has been reported in
humans and animal models of epilepsy. This dysregulation has been positively correlated with long-
term morbidity and mortality in epileptic patients. In epileptic patients, the risk of sudden
unexpected death (SUDEP) is about 40 times higher than healthy people. Previous studies of heart
rate variability (HRV) in epilepsy patients provided evidences that the risk of SUDEP probably
comes from a higher interictal sympathetic activity coupled with an ictal surge in sympathetic
activity. Most studies of HRV in epilepsy patients are limited in standard temporal lobe epilepsy
(TLE). We designed these studies in pediatric and adult patients with epilepsy other than TLE to
understand their respective changes of sympathetic and parasympathetic regulations.
Patients diagnosed as non-TLE using electroencephalography were enrolled. By their seizure
frequency, refractory or non-refractory epilepsy was defined. Their seizure types were variable
but generalized seizures were recorded in most subjects. The patients having arrhythmia, diabetic
neuropathy and adverse effects with their medications were excluded from this study.
Lead I electrocardiograms, for 300 seconds in each recording, were carried out at the times of
enrollment and follow-up. These were taken during the interictal period of awaken patients in
daytime while they lied in head up 30-45 degree posture quietly. Frequency-domain analysis of
HRV was performed using fast Fourier transformation of the heart beat contour. Each power
spectrum was subsequently converted to R-R interval (RR) and standard frequency-domain
measures, including high frequency power (HF; 0.15-0.45 Hz), low frequency power (LF; 0.04-
0.15 Hz), and LF/(HF + LF) expressed in normalized units (LF%). The HF component is
considered to represent cardiac vagal (parasympathetic) regulation. The fraction LF% is
considered to mirror sympathetic regulation.
Frequency-domain analysis of HRV showed that seizure control in patients with generalized
seizures was accompanied by significant increase in parasympathetic regulation and significant
decrease in sympathetic regulation. Our study confirmed that seizure control might modulate the
autonomic function. In further analysis, the indicator of parasympathetic regulation, HF, showed to
be a better prognostic tool than the sympathetic indicator, LF%, when assessing seizure control
among patients with generalized seizures.
In epileptic adults with generalized seizures, they had shorter interictal heart rate intervals and
faster heart rates, which might be due to higher sympathetic and lower parasympathetic regulation
of autonomic cardiac activity. This results are similar to that have been reported in patients with
TLE. Epileptic children with refractory generalized epilepsy had lower HRV during the interictal
period, which we postulated resulting from parasympathetic or vagal reduction.
Patients with frontal lobe epilepsy had shorter interictal heart rate intervals and faster heart rates,
which we postulated might be due to lower parasympathetic or vagal regulation of autonomic
cardiac activity.
These results suggest 1) that the mechanism of decreased HRV in children with epilepsy is
probably different than in adults with epilepsy and 2) the mechanism of decreased HRV in patients
with FLE is probably different from that in patients with TLE.

2008: Autonomic Nervous System (ANS) Biomarker Investigation Based on
Electrocardiogram (ECG)

Ya-Ting Tsao /Tzu Chi University /Graduate Institute of Medical Informatics; Taiwan

Autonomic nervous system (ANS) is part of human’s nervous system which divided into the
sympathetic and the parasympathetic nervous systems. The sinoatrial (SA) and atrioventricular
(AV) nodes in the heart are also innervated by the sympathetic and parasympathetic. Besides,
other biomarkers such as respiration and blood pressure can influence by ANS activities. Many
experts investigated the relations between the heart and ANS. Most commonly, physicians
nowadays use the heart rate variability (HRV) to observe ANS more than others.
Instead of previous HRV methods for investigate ANS; the aim of this research is to find possible
additional ANS biomarkers also based on Electrocardiogram (ECG) for distinguishing the ANS
activities. Our first experiment is to repeat pervious HRV research by changing ANS related
poses, which are resting pose and 90° head-up tilt. And our second experiment plans to find out
the different between supine, standing, and sitting. According to our research, it is obtained that
the mean of PR interval and frequency analysis of T-wave alternans (TWA) are influenced by ANS
activities. Moreover, our research found significant on discovery of frequency-domain of PR
tachogram and makes a new definition on PRV spectrum. Although traditional TWA ratio has no
significant relation with ANS activities, the spectrum analysis of slopes of T waves is a potential
ANS biomarker. Hence, our experiment confirmed that both PR interval and frequency spectrum
analysis of slope of T waves is a potential indicator of ANS. The observations can contribute
knowledge on development of the pacemaker algorithm, doctor diagnosis, HRV analysis, and ANS
physiological modelling.

2008: The spectrum analysis of heart rate and arterial pressure variability in
mechanical ventilated patients during cemented total hip arthroplasty

Ting-Kuo Yao / Tzu Chi University /Graduate Institute of Integrative Physiology and Clinical
Sciences; Taiwan
Total hip arthroplasty is the common surgical procedure for treatment of the advanced hip
problems. The vital signs of the patients are changed during the cemented hip arthroplasty
procedure. These are known as the bone cement implantation syndrome ( SCIS ). The cause of
SCIS may be the dysfunction of cardiovascular or autonomic nerve system of the patient in
cemented hip arthroplasty, and resulted in the failure of compensation of hypotension and death.
The purpose of this study is to find the cause of SCIS and the prevention method.
We collected 10 patients entered this prospective clinical trial. These patients were underwent the
hip arthroplasty using a conventional cementing technique, whereas patients with cementless
femoral stem collected for control group. Blood pressure, heart rate, blood oxygen saturation and
ECG were recorded at 5 consecutive time points. These data are analysis by spectrum analysis
to find differences before and after cementing in the heart rate and arterial pressure variability.
Meanwhile, we also collected 8 patients underwent cementless hip arthroplasty as control group.
The artrial pressure drop after cementing compared to before cementing. The difference is
significant (p = 0.002) . The increased high frequency in APV after cementing was also found , and
the difference of the change ratio is significant compared to the control group(p = 0.028). One
patient with severe SCIS did not have elevated high frequency signal like other patients. There
were not significant differences in other parameters. The control group did not have the APV or
HRV change during operation period.
We found increase cardiac sympathetic activity after cementing. It may be related to drop blood
pressure after cementing. There is a case with severe SCIS who had not increase HF after
cementing. The reason needs further study.


Han-Luen Huang /China Medical University /Graduate Institute of Integrated Medicine; Taiwan

Traditional Chinese medicine dictates that the bilateral Tsun, Guan, Chi of radial pulse areas would
be the reflection of some specific internal organs. The left tsun pulse area is associated with
condition and activity of heart. It is interesting to understand whether the pulse characteristics at
the left Tsun pulse area are truly different from patients with heart disease and that of the normal
population. This study analyzes the radial sphygmography whether the heart failure symptoms are
associated with specific variables in the left radial sphygmography and heart rate variability.
Thirty patients with congestive heart failure (CHF) are selected from the out patient department
and ward of Internal Medicine, then categorized into four levels according to the severity of clinical
symptoms. The control group is comprised of niteen normal populations of a similar mixture of age
and gender, also selected from the out patient department and ward of Internal Medicine.
Patients with congestive heart failure were screened via our ward as Framingham Heart Study did,
and then categorized into four levels according to the severity of clinical symptoms. Both groups
received echocardiogram first then, ANSWatch Model TS 0411 was used to measure both the
heart rate variability and the waveform values of bilateral radial Tsun, Guan, Chi pulse areas .
Echocardiogram results indicate significant difference in left ventricular systolic function,left
ventricular diastolic function,left ventricular volumn,inferior vena cava diameter and right
ventricular systolic pressure. Heart rate variability analysis result found significant decrease in
heart rate variability,total power,low frequency,high frequency,very low frequency and
variance in congestive heart failure group. Radial sphygmography results indicate that there are
more different value in left Tsun pulse area between the control group and the experimental group.
Results of our study suggest that it is likely that the pulsation at the left Tsun pulse area is
associated with the conditions of the heart but further studies may be required to determine the
practical implication of this model.

2009: The study of work strain on nurses of shift work

Chia-Ming Yen /China Medical University /Graduate Institute of Integrated Medicine; Taiwan

The nursing is a kind of shift work , the operating time changes unceasingly. That not only
destroys the biological rule, but also disturbs the day-night rhythm. Diagnosis by feeling the pulse
is a kind of important method for Chinese medicine. It is also a kind of unique method for
diagnosis, prognosis, and judgment the condition of the patient. There is very widely use of HRV in
a lot of research. In actually, it is a kind of simply, non-invasive tool for the observation of the
activity of autonomic nerve. We will quantify the Empirical datum, which was collected from HRV
and the instrument that can be diagnosed the differential of pulse. To find out the correlation
between the change of autonomic nerve and the pulse in shift nurses. We also can afford the
measure improving the working conditions. Material and methods: 33 nurses were enrolled this
study. They were separated into 3 groups which depends on the care unit (OR, ICU, WARD) they
were belonged. The ANS watch was adopted for measuring HRV and pulse diagnosis at the day-
shift, before and after the 1st day of night-shift, before and after the 5th day of night-shift. Result:
There is no significant difference in pulse diagnosis in 3 groups. We find some parameters of HRV
were predominately related to age. And the parameters of HRV are independent of work unit,
work strains, the duration of night-shift, the time of measuring.

2008: Electroacupuncture on physiological function in patients with acute
hemorrhagic stroke: a pilot study

Chih-Chuan Yang /China Medical University /Graduate Institute of Integrated Medicine; Taiwan

Stroke is one of the leading three causes of death in the world and Taiwan. Around 13000
persons died every year in Taiwan. Not only is the high number of deaths in Taiwan, at the same
time it lead to physical and mental torture on patients and their families, as well as a heavy burden
on the economy. According to Huangdi Neijing and clinical literatures, acupuncture can improve the
functional outcomes and life quality after stroke. Acupuncture is also known to influence autonomic
nervous activity.
A prospective, randomized, controlled study was conducted. Patients were randomly assigned to
the electroacupuncture(EA) group and sham electroacupuncture group. All received conventional
medical treatment. EA or sham EA was applied additionally from 72 hours after patients' vital
signs had been stabilized. Zusanli (St 36) and shangjuxu(St37) were stimulated with EA or sham
EA(placebo stimulation). HRV, physical signs and TCD were recorded in all patients before and
after electroacupuncture. These data are compared between different groups. The results shows
that electroacupunctures on bilateral St36 and St37 did not significantly change the body
temperature, blood pressure, middle cerebral artery mean velocity and pulsatility index in acute
hemorrhagic stroke patients. After consecutive three-day electroacupunctures, HF, RMSSD and
PNN50 increase compared with the baseline. We propose that electroacupuncture can enhance
the parasympathetic activity in acute hemorrhagic stroke patients.
Graduate Work (M.S. or Ph.D. Thesis) that
employed or cited ANSWatch Wrist Monitor
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