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This volume presents the proceedings of ICIBEL 2017, organized by the Centre for Innovation in Medical Engineering (CIME) under Innovative Technology Research Cluster, University of Malaya. It was held in George Town, Penang, Malaysia, from 10-13 December 2017.

The ICIBEL 2017 conference promotes the latest research and developments related to the integration of the Engineering technology in medical fields and life sciences. This includes the latest innovations, research trends and concerns, challenges and adopted solution in the field of medical engineering and life sciences.

### Erratum to: Is There a Relationship Between Bone Mineral Density, Mammographic Breast Density and Serum Estrogen Concentration Level? Study on Malaysian Women

N. M. Zain, K. C. Kanaga, E. S. Latif, A. Shantini

### Pathological Hand Tremor Measurement—Challenges and Advances

There are various wireless and wearable tremor assessment technologies available currently. In order to produce a reliable tremor assessment system to be used in practice, there is a need to improve the system in terms of processing time and quantification parameters. The future system should include an algorithm to separate postural and rest tremor and tremor stability index for better assessment of tremor in neurological disorders.

Zaidi Mohd Ripin, Ping Yi Chan

### Non Invasive Cardiovascular Health Assessment in Post-adolescent Age Group Using Augmentation Index

This paper presents a non-invasive method of classifying a subject’s health into either one of two classes depending on the condition of the subjects’ cardiovascular health. Novelty of the work lies in segregating the subjects who had good cardiovascular health and the subjects who were at risk. In the proposed work, VPG signals and other general information such as weight, height, BP were collected from 38 individuals in the post-adolescent age group. Furthermore, a signal from a person who was known to have good cardio vascular health was collected. This signal became the reference that was used to compare with other signals. After the initial pre-processing, the PPG and APG were obtained from the VPG. Then a total of 7 features of the wave contour from the APG and PPG signals were extracted. Based on the Augmentation Index the signals were classified into two classes using SVM and ELM classifiers. Where one class represented healthy individuals and the other class represents the individuals at risk of CVD. The average values of the extracted features were used and the final accuracy obtained was also an average value. The accuracy obtained using ELM classifier with K-fold cross validation was 77%. Whereas the efficiency achieved using SVM was 94.59%. Hence the proposed method can be used to assess the vascular health analysing PPG signals in the post-adolescent age group.

Sai Karun, Suhan S. Nath, Kunal Bharathi, Manjunath Gaonkar, B. Niranjana Krupa

### Novel and Security Connections for Extending Mobile Audio Signal Delivery to Personal/Notebook Computer

This study proposes a direct wiring solution for connecting a mobile on the near side to a personal computer/notebook computer (PC/NB) for accessing audio signals from a distant mobile device to avoid any interferences and interrupts. Such signals can be communicated to the PC/NB. This supports achieving enriched resources of signal processing by both hardware and software in PC/NB. The results of a successful experiment are presented to validate the function of this wiring design. Briefly, it is ready for mobile communication with signal processing algorithms by connecting with the novel line without any additional processes in this study if the advanced algorithm is successfully tested in PC/NB. In conclusion, a straightly wiring audio connecting line for mobile based communication to the PC/NB makes a better signal transfers that can be applied in auscultation much easily.

Meng-Lun Hsueh, Huey-Dong Wu, Bing-Yuh Lu

### Sensitivity Improvement of Respiratory Movement Detection in Non-contact In-Bed Cardiopulmonary Measurements During Sleep

Unobtrusive measurement methods for electrocardiograms and respiratory movements (RMs) have the potential to become key home monitoring technologies. This study reports on an improvement in the RM signals obtained from subjects when a non-contact in-bed cardiopulmonary measurement system was used; our aim was to improve the detection sensitivity (p sens ) of RMs that reflected chest and abdominal motions (RMchest and RMabd, respectively). A suitable capacitance value for a virtual midpoint circuit (CVMC) in the system was determined for stabilization during prolonged measurements. The system was then modified by using a suitable CVMC value in conjunction with a modified electrode structure, a revised front-end voltage follower, and a readjusted passband for filtering. The performance of the modified system was evaluated via overnight experiments conducted using seven healthy volunteers. The results revealed that p sens for both the RMchest and RMabd signals of the modified system were better than those found for the conventional system tested; on average, p sens for RMchest and RMabd were 15.8 and 13.5%, respectively, greater than those found for the conventional system. Although the modified system still needs to be improved with regard to p sens for both RMchest and RMabd, it seems to be a promising development as far as daily cardiopulmonary monitoring during sleep is concerned.

Mayuko Takano, Akinori Ueno

### Model Iterative Airway Pressure Reconstruction During Mechanical Ventilation Asynchrony: Shapes and Sizes of Reconstruction

Model-based methods estimating patient-specific respiratory mechanics may help intensive care clinicians in setting optimal ventilation parameters. However, these methods rely heavily on the quality of measured airway pressure and flow profiles for reliable respiratory mechanics estimation. Thus, asynchronous and/or spontaneous breathing cycles that do not follow a typical passive airway profile affect the performance and reliability of model-based methods. In this study, a model iterative airway pressure reconstruction method is presented. It aims to reconstruct a measured airway pressure affected by asynchronous breathing iteratively, trying to match the profile of passive breaths with no asynchrony or spontaneous breathing effort. Thus, reducing the variability of identified respiratory mechanics over short time periods where changes would be due only to asynchrony or spontaneous artefacts. A total of 2000 breathing cycles from mechanically ventilated patients with known asynchronous breathing were analyzed. It was found that this method is capable of reconstructing an airway pressure free from asynchronous or spontaneous breathing effort. This work focuses on several cases, detailing how iterative pressure reconstruction method performs under different cases, as well as its limitation.

Chee Pin Tan, Yeong Shiong Chiew, J. Geoffrey Chase, Yeong Woei Chiew, Christopher Pretty, Thomas Desaive, Azrina Md Ralib, Mohd Basri Mat

### Smart Balance Board to Improve Balance and Reduce Fall Risk: Pilot Study

Falls in the elderly population is a significant public health concern, and there are up to 37.3 million people experiencing severe falls each year. Balance board is commonly used for balance training, however, the device is not widely used at home due to lack of interactive element and training guide. A new, effective, and widely applicable strategy to prevent falls is urgently needed due to the increasing number of falls in elderly worldwide. This work demonstrates the feasibility of FIBOD, as a smart balance board that is able to provide interactive balance training and objective assessment for balance. Two elderly subjects performed 24 sessions of training within four weeks. Results show that the training using FIBOD could improve balancing capability, reduce falling risk, and increase the motivation to do balancing training. This study shows the feasibility of FIBOD as a balancing training device to improve balance skill and reduce the occurrence of fall.

Kang Xiang Khor, Phei Ming Chern, Che Fai Yeong, Eileen Lee Ming Su, Muhammad Farhan Mustar, Najib Bin Abdullah, Kang Xian Khor, Hadafi Fitri Mohd Latip

### Pushing a Manual Wheelchair Requires More Muscular Force Than Pulling

One of the most challenging problems faced by regular manual wheelchair users is the increased physical demand while navigating it and the resulting shoulder, wrist and hand injuries. These problems call for a device that reduces injury risk factor owing to a prolonged wheelchair use while simultaneously increasing user independence and mobility. The study suggests a modified wheelchair design that operates by means of a pulling motion as opposed to pushing. This motion offers a more efficient solution to the problems of shoulder, elbow, wrist injuries and user fatigue, since a pulling motion requires the use of a stronger and more capable group of muscles relative to those involved in standard pushing mechanism.

Hamza Toor, Saad Jawaid Khan, Hashir Iqbal, Maria Tahir, Bareera Amjad, Mafia Afzal, Muhammad Shafique, Juliana Usman

### Wearable Instrument Applications for Indonesian’s Worker Clothing

UU No I 1970 tells about the assurance for workers’ health conditions. Current years, there is no monitoring aids that can help supervisors to monitor the workers condition. A standard worker’s clothing can protect from harm situation but it cannot deliver the actual physical condition of workers. If there is something happen dealing with physical condition of the workers it will not only interfere the operation and production line but also lead deathly risk. Monitoring of labor conditions is easily done in a laboratory but doing it directly in the production floor still face many challenge. Therefore, it is necessary to develop a device to monitor physiological conditions that can be used on the site. Wearable instrumentation is a solution to face these problems. This research aims to develop a physiological detector based on wearable instrumentation that able to indicate physical conditions of workers in real time. From these results, it is known that the TMP 36 sensor has a fairly accurate measurement values for different only 0.1–0.2 °C from the actual temperature. This instrumentation system accuracy was verified by observing physiological condition of 30 subjects. Further we are going to attach the system to a worker’s clothing which was specifically designed for simple and comfort usage.

Melani Sukirman, Pringgo Widyo Laksono, Ilham Priadythama

### Soft Tactile Sensors for Rehabilitation Robotic Hand with 3D Printed Folds

The tactile sensing technology has now progressed to the new developments in the field of robotics. In order to keep up with the trends, in this paper we have developed a soft fabric based tactile sensor which is incorporated with a 3D printed robotic hand for rehabilitation uses. Various types of tactile sensors were made with differences in the conductive material used. Conductive thread and conductive fabric based sensors were fabricated with the piezoresistive principle. On comparison with the conventional types of rigid tactile sensors, these newly fabricated sensors are advantageous in many ways in terms of their uncomplicated design, high sensitivity, lightweight and flexible nature. The 3D printed robotic hand has its inspiration from origami and its potential application in the rehabilitation process for stroke patients is validated in this paper.

Kirthika Senthil Kumar, Hongliang Ren, Yun Hol Chan

### The Effect of Different Size of Slicing Spheres of Polyaxial Screw Head on Static Compression Mechanical Test

Background The pedicle screw fixation system is the gold standard treated method in clinical for the unstable disease. Generally, pedicle screw can be classified into two categories included monoaxial and polyaxial constructions. Although the polyaxial screws were common used owing to it can provide more degree of freedom on the screw-to-rod connection to facilitate rod seating. However, the complexity of structural design may reduce their mechanical strength. The size of slicing spheres of polyaxial screw head was found as the important issue to influence the mechanical strength of the pedicle screw system. Therefore, this study investigated the effects of different size of slicing spheres of polyaxial screw head on the vertebrectomy model under compression test. Material and Method The different size (60, 75 and 90% diameter) of slicing spheres of polyaxial screw head were assembled for destructive mechanical testing. All pedicle screw systems assemblies were tested in compression test according to FDA regulation testing method of ASTM F1717. The stiffness and ultimate load were determined for different slicing spheres of screws. Result and discussion The results of testing found that stiffness were 10.91 ± 2.03, 19.34 ± 1.21, and 23.39 ± 0.85 N/mm and ultimate loads were 185.43 ± 14.57, 264.44 ± 21.68, and 364.54 ± 10.43 N for 60, 75, and 90% diameter, respectively. Significant differences (p < 0.05) were found among these three groups. Conclusion The mechanical strength presented by stiffness and ultimate load increased as the size of slicing spheres of polyaxial screw head increased.

Po-Yi Liu, Yu-Tzu Wang, Hsien-Wen Wang, Shao-Fu Huang, Yang-Sung Lin, Po-Liang Lai, Chun-Li Lin

### FES Standing: The Effect of Arm Support on Stability and Fatigue During Sit-to-Stand Manoeuvres in SCI Individuals

Functional Electrical Stimulation (FES) has been widely used as part of physiotherapy for spinal cord injury (SCI) patients. The ability to do sit to stand (STS) manoeuvre is an important and practical indicator of functional independence in SCI individuals. One of the factors that contributes to STS movement is arm support. The objective of this study is to instrument an arm support with pressure sensors, and to analyse the impact of using standing frame during FES-assisted STS movement to the SCI patients’ stability and rate of fatigue throughout multiple STS movements. FlexiForce sensors were used to analyse the force exerted on the frame’s handle. Experiments on STS activity with two SCI subjects were completed in two consecutive days (with and without assistance of FES) in a motion analysis laboratory. The instrumented standing frame (SF) was calibrated via a series of hanging test with ten healthy subjects with different body weights to provide an insight on the weight distribution along the SF. This test demonstrates the instrumented standing frame’s ability to measure the force exerted on the frame with minimum accuracy of 85% to total body weight. Both SCI subjects showed shorter time taken to complete a STS cycle without the assistance of FES. They showed early stage of fatigue with assistance of FES thus longer time taken recorded in performing STS activity. SCI subjects’ centre of force slightly inclined to the right side of the standing frame in both sessions without and with FES to compensate several conditions of lower limb joint contractures.

Musfirah Abd Aziz, Nur Azah Hamzaid

### A Low Cost Street Crossing Electronic Aid for the Deaf and Blind

This paper describes the design and implementation of a low cost electronic device to aid the visually impaired and deaf-blind to cross the road safely using an Arduino controlled transmitter and receiver. The prototype consists of two parts; the transmitter is placed on the green traffic light and the receiver which is held by the user. The transmitter sends the traffic light signal status and information on wait duration by broadcasting them out to the receiver using XBee. The visually impaired or deaf-blind person holding the receiver will be notified once he/she is within 10 meters from the traffic light, and guides the person to cross the road via sound and vibration. The prototype is able to function successfully, with few limitations and recommendations highlighted for future improvements.

Nur Hasnifa Hasan Baseri, Ee Yeng Ng, Alireza Safdari, Mahmoud Moghavvemi, Noraisyah Mohamed Shah

### Fastest Gait Parameters Estimation Precision Comparison Utilizing High-Sensitivity and Low-Sensitivity Inertial Sensor

The measurement system of stride length, toe’s height and toe’s angle at each step during fastest gait using inertial sensor is proposed. During fastest gait, acceleration and angular velocity of the toe exceed the measuring range of high-sensitivity inertial sensor. To estimate parameters of a gait, inertial sensor system that is composed of two triaxial accelerometer and two triaxial gyroscope with different measuring range each is developed. Sensor is attached to the right toe to observe the motion of fastest gait quantitatively. Subjects were asked to walk at their fastest speed while the inertial sensor measures the acceleration and angular velocity of the toe. To evaluate the effect of the proposed method, toe’s trajectory are calculated using the high-sensitivity data only, low-sensitivity data only, and interpolation of both high-sensitivity and low-sensitivity data. Results are compared with reference obtained by optical motion capture system. As a result of the motion measurement of the toe during fastest gait, the precision of the estimation system is improved by applying the proposed method.

Amir Mukhriz Azman, Hirofumi Kuga, Koichi Sagawa, Chikara Nagai

### Changes of the Head Control Ability in Patients with Cervical Spondylotic Myelopathy

This study aims to compare the head control ability in terms of the cervicocephalic kinesthetic sensibility between the elderly with and without cervical spondylotic myelopathy (CSM). Thirty CSM patients and thirty healthy elderly were recruited to perform the maximal neck extension as well as the maximal cervical range of motion (ROM) and head reposition tasks in neck flexion, extension, right and left rotation. Three measurements of the reposition accuracy were analyzed, including the constant error (CE), variable error (VE) and root mean square error (RMSE) of the reposition movements. Independent t test was used to investigate the difference of all measurements between the groups. CSM group showed less maximal neck strength and smaller cervical ROM compared with the healthy group with significant difference in cervical extension (p < 0.001) and right rotation (p < 0.05). During the reposition task, the CE of all movements showed significant difference between groups. The CSM group trended to show greater VE in all directions. The RMSE were greater in CSM group with significant difference in cervical extension and right rotation (p < 0.05). This study demonstrated that the CSM patients suffer from poor head control compared with that in the age-matched elderly. Those findings could help to facilitate the rehabilitation program targeting on the treatment of cervical problem in CSM patients.

Chih-Hsiu Cheng, Wei-Li Hsu, Andy Chien, Jaw-Lin Wang, Dar-Ming Lai, Shwu-Fen Wang, You-Syuan Yu

### Investigation of the “Pendulum Effect” During Gait Locomotion Under the Novel Body Weight Support System and Counter Weight System

In recent years, body weight support (BWS) systems have been applied and have played an important role in most of the gait training systems. Conventional BWS systems commonly use the rope–pulley mechanism such that the “pendulum effect” generated during gait training would cause discomfort to the subject. Our hypothesis was that the center of mass (COM) parameters in the lateral and vertical directions of the subject during walking under a weight support system would be modified. Moreover, the novel BWS system that was developed would reduce the “pendulum effect” during walking and exhibit an enhanced behavior in comparison with the counter weight system. Our findings revealed that the step width and the COM amplitude in the mediolateral and vertical directions in the cases using the new BWS and counter weight systems were significantly smaller than those for the normal walking case. The COM amplitudes obtained when using the new BWS were closer to the normal walking case and higher than the counter weight system.

Tran van Thuc, Shin-ichiroh Yamamoto

### Balance Ability Affects Dual-Task Strategy in Children with Attention Deficit Hyperactivity Disorder

Wen-Lan Wu, Jia-Hroung Wu, Ying-Yi Chen, Chia-Hsin Chen, Chih-Chung Wang, Jing-Min Liang

### Effects of Haptic Sensory Input of a Fluttering Cloth on Static and Dynamic Postural Control

This study investigated the effect of haptic sensory input provided by a fluttering cloth (FC) on postural control. Twenty-one healthy men were randomly assigned to a static or dynamic balance task group. Participants in the static task group performed a single-leg stance for 30s, while those in the dynamic task group performed a functional reach test under three different conditions, with their eyes closed. In the first condition, participants wore only half- or short-tights (HT) during each task. In the second and third conditions, they wore HT and a cloth wrapped snugly around the waist, or HT and an FC wrapped around the waist extending to the lower leg, respectively. Both balance test results were significantly improved in the FC-condition than in the HT-condition. The effect size of improvement was large in the dynamic task, but small in the static task. Therefore, the effect of clothing on balance control was more pronounced in the dynamic than in the static task. These results suggest that postural control might be enhanced by a garment’s shape or material.

Kazushige Oshita, Sumio Yano

### Design and Development of Low Cost Hand Exoskeleton for Rehabilitation

The proposed project is a low cost hand exoskeleton that is design and developed for rehabilitation while the safety rules and regulation kept in mind. The aim of the project is to rehabilitate the stroke patients who is suffers from stroke on the one side of the body. This system to rehabilitate the patient to gain mobility in the fingers where a sound hand is used to control the unsound hand. The sound hand is consists of flex sensors attached to the leather glove on MCP, PIP and IP joints while the unsound hand consists of servo motors. The microcontroller used is Arduino Nano and the software used is Arduino interfaced with MATLAB for the GUI. The communication is wireless with the help of Bluetooth. The testing results were taken to be 92.75% efficient.

Vickneswari Durairajah, Suresh Gobee, Waleed Rauf, Kok Sin Ngie, John Hong Aun Lim

### Design and Development of Upper Limb Soft Exoskeleton for Rehabilitation

Current physiotherapy sessions are expensive or not available readily for patients and elderly. The main aim of this project is to design and develop a wearable exoskeleton which could be made practical to rehearse wrist rehabilitation exercises. In the ever advancing robotics field, pneumatic muscles are a cost reliable alternative actuator for locomotion and manipulation for a master-slave biophysical system. Implementing the flex sensors as primary sensory tool on the sound limb to detect angular deflection of the wrist to assist radial deviation, ulnar deviation, extension and flexion motions, while the pneumatic muscles operate the unsound limb. The overall system efficiency was measured based on testing done with several human subjects, all using specifically fabricated pneumatic muscles of variable total length but a fixed active length of 14 cm. the active length of the pneumatic muscle is the key feature of any pneumatic muscle as this feature determines the contraction length that translates to the angular wrist movement. Furthermore, the system was able to be monitored aptly using a GUI programmed using LabVIEW and interfaced to Arduino. The testing results were taken to be 55.72% overall efficient.

Suresh Gobee, Vickneswari Durairajah, G. Mugilan

### Association of Rainfall and the Occurrence of Pathogenic Leptospira spp. in Recreational Stream Water, Hulu Langat, Selangor

Leptospirosis is a human disease caused mainly by Leptospira interrogans. Global Leptospirosis burden is significant especially in a tropical climate country like Malaysia. However, inadequate detection in environments and recreational areas has affected the awareness of the disease among the public community. In this study, the presence of pathogenic Leptospira spp. in recreational stream water samples from Sg. Tekala, Hulu Langat was described. A total of 126 water samples were collected randomly in bi-weekly time frame from February to July 2016 and tested for pathogenic Leptospira spp. using a PCR assay targeting the lipL32 gene. To assess the link between the presence of Leptospira spp. and rainfall, data on daily rainfall during six months of sampling have also been recorded from Malaysian Meteorological Department. The pathogenic Leptospira spp. were detected in 27/126 (21.4%) of samples. Statistical evaluation using Spearman’s Correlation Test on the association of Leptospira detected samples and rainfall data has shown a significant negative relationship, where a probability of pathogenic Leptospira spp. to be detected in water was higher at the time of low rainfall. This was the first report on the association of rainfall and the occurrence of pathogenic Leptospira spp. in recreational water. The connotation between the rainfall and presence of pathogenic Leptospira spp. in recreational water suggested the needs to develop a systematic approach for Leptospira spp. monitoring especially during dry season.

K. Dzulaikha, M. Y. Nurul Yuziana, J. J. Maizatulriah, A. W. Marfiah

### Optimal EEG Channel Selection for Vascular Dementia Identification Using Improved Binary Gravitation Search Algorithm

The aim of the present study was to select optimal channels that may help in detecting the abnormalities in the electroencephalogram (EEG) of vascular dementia (VaD) patients. Spectral entropy $$(SpecEn)$$, approximation entropy $$(ApEn)$$ and permutation entropy $$(PerEn)$$ have been extracted from the EEG background activity of 5 VaD, 15 patients with stroke-related mild cognitive impairment (MCI) and 15 healthy control subjects during a working memory (WM) task. EEG artifacts were removed using automatic independent component analysis and wavelet denoising technique (AICA-WT). In order to reduce the computational time, improved binary gravitation search algorithm (IBGSA) channel selection was used to find the most effective EEG channels for VaD patients’ detection. Eight channels were found suitable to extract EEG markers that help to detect dementia in the early stages. Moreover, k-nearest neighbors (kNN) was used after the IBGSA technique. The IBGSA technique increased the kNN classification accuracy from 86.67 to 90.52%. These results suggest that IBGSA consistently improves the discrimination of VaD, MCI patients and control normal subjects and it could be a useful feature selection to help the identification of patients with VaD and MCI.

Noor Kamal Al-Qazzaz, Sawal Hamid Bin Mohd Ali, Siti Anom Ahmad, Javier Escudero

### Fabrication of Low-Resistance Carbon MEMS/NEMS as Material for Biosensing

This paper presents the fabrication of low-resistance carbon MEMS/NEMS as material for biosensing. The carbon source is the negative photoresist SU8 epoxy. At room temperature the SU8 is in liquid form, making it easier to mix with nanoparticles. The SU8 epoxy is mixed with single-walled-Carbon-Nanotubes (swCNTs) and stirred for 48 h. The experimental variable was the weight percentage (wt%) of swCNTs in the SU8 epoxy. The controlled variables were the layer thickness and experimental environment such as the room’s humidity and furnace model. The silicon wafer was used as substrate because it can withstand high temperatures during the pyrolysis step. The spin coater was used for coating the mixture onto the substrates uniformly. The spinning process was repeated for sample design 2 and 3 to obtain the double layer characteristic. Samples were exposed to ultra-violet (UV) radiation for 40 s. This process is called photolithography. The samples were heated on the hotplate before (pre-bake) and after (post-bake) the photolithography step for solvent evaporation. SU8 developer solution and acetone were used to remove the un-exposed SU8 for pattern developer. Finally, the samples were carbonized at 900 °C maximum in an oxygen free environment (purified Nitrogen gas (N 2 ) gas 99.9995%). The experimental result showed that the lowest possible resistance value was 25 Ω for the sample design 2 and 3 at 0.01 wt% swCNTs.

M. F. Zulkeflee, F. Ibrahim, M. Madou

### Evaluation of Depth Perturbation Method for Localizing Fluorophore Inside a Pork Chuck Meat Sample

Depth perturbation method for improvement of a mesoscopic epifluorescence tomography (MEFT) we previously developed was evaluated in an experimental system using biological samples. We conducted ex vivo experiments using pork chuck meat to verify the depth perturbation concept in a relatively realistic environment. Fluorescence images were acquired with/without a thin optical phantom (perturbator with known optical scattering property) onto the phantom. Fluorescence intensity variation resulting from the depth perturbation was used for estimating three dimensional location of fluorophores. Estimated fluorophore central depths (placed at depth from 3–9 mm) are consistent with the expected values. Absolute estimation errors of the center position of fluorophores placed inside the phantom were 0.3–0.5 mm (on average). Slight optical heterogeneity did not bring great estimating errors.

Ichiro Sakuma, Tuo Zhou, Keiichi Nakagawa, Etsuko Kobayashi

### An Effect of Magnetic Beads to Boesenbergia rotunda Antioxidant Activity Using Photoprotective Microfluidic CD

Microfluidics compact disc (CD) system has offer many advantages to biological and chemical analysis. It simplifies the procedures and miniaturize the sample and reagent volume. Beads has been used in the microfluidics CD technology in order to enhance the mixing of the reagents or sample. However, the effect of the beads need to be monitor to ensure the effectiveness, biocompatibility and corrosion protection of the beads. This paper has presented the advantage of photoprotective microfluidic CD for Boesenbergia rotunda antioxidant activity and the effect of magnetic bead in enhancing the reaction time of the mixing. The results have shown that, with the magnetic beads usage, the uniformity time of the liquid mixing in the reaction chamber are faster than the non-beads reaction chamber. However, in terms of the stability, the beads have been found to give an interference to the Boesenbergia rotunda 2,2-diphenyl-1-picrylhydrazyl (DPPH) antioxidant activity. To solve this issues, we would recommend an inert coating of the beads to prevent a chemical reaction between the beads and the free radical’s reagents. The proposed method has minimized human handling in the DPPH plant antioxidant activity by using microfluidics CD with imitation of the real test environment in the conventional method (photoprotective). Consequently, the laborious repetitive routine in the laboratories, which is one of the factor in pre-analytical error has been reduced. This system would be a great advantage to the future laboratories techniques, as it can be applied as a point of care testing and be used in the small laboratories.

Nurhaslina Abd Rahman, Fatimah Ibrahim, M. Mahdi Ainehvand, Rohana Yusof, Marc Madou

### Assessment of Local Heating Effect on the Cutaneous Microcirculatory Vasodilatation

The skin provides a conveniently accessible site to assess the peripheral microvascular function which may be used as an early index of allover cardiovascular system. In the study, the laser Doppler flowmetry (LDF) was applied to investigate the vasodilatation of microcirculation on the foot bottom during a local heating protocol in 21 healthy participants. The temperature was heated up to 44 °C in one minute and maintained such temperature through the 30-min heating period. Both a 10-min record of LDF signals during the baseline and a 30-min record during the heating period were registered and then analyzed using the wavelet transform. For the 21 participants, the amplitudes of the initial peak [208 ± 64 perfusion unit (PU)] and the plateau (279 ± 80 PU) of the LDF signals were significantly higher during the local heating period than the baseline (85 ± 25 PU). Meanwhile, the composite vasodilatation indexes for the initial peak and the plateau were 154 ± 65 and 239 ± 93%, respectively. Also found was a significant decline in the spectral power density percentage associated with the endothelial nitric oxide-dependent metabolic activity band during the heating period, as compared with the baseline. Those findings may help to assess the skin microcirculation dysfunction in patients with diabetes or hypertension in future clinical applications.

You-Heng Su, Jia-Jung Wang, Yue-Ting Tsai, Wei-Kung Tseng

### Effects of Oral Glutathione Precursors’ Supplementation on Human Glutathione Level

Glutathione (GSH) is a tripeptide of cysteine, glutamate, and glycine. These amino acids made the synthesis of GSH possible and act as a major cellular antioxidant in the body. The production of GSH in the body depends on several factors; such as dietary intake and cysteine availability. With the turnover rate of endogenous GSH can be as high as 65% per day, more consumers has turned to GSH supplement to maintain or boost up their GSH level. GSH supplement available in the market usually contains GSH precursor/s that are said to be able to increase GSH level in the body. In this study, the oral GSH supplement used contains all three precursors of GSH; cystine replacing cysteine, glutamate, and glycine. Subjects were asked to consume the supplement according to the instructed dosage in order to measure the effects of oral GSH precursors’ supplement on human GSH level after the three-month study period ends. The results from this study suggest that the oral GSH precursors’ supplement increases GSH level across the test groups after the three-month study period.

Asdani Saifullah Dolbashid, Mas Sahidayana Mohktar, Wan Safwani Wan Kamarul Zaman, Nur Rasyidah Hasan Basri, Mohd Faiz Azmi, Sakunie Sawai, Mohd Yusof Hasif Ilyasa

### Review on the Usage of Swarm Intelligence in Gene Expression Data

This paper presents a review of the recent usage of swarm intelligence for optimizing feature selection in microarray data focusing on its application for cancer detection and classification. The feature selection technique is used in the analysis of microarray so that only useful data is trained for further analysis and prediction. The process of feature selection would affect the effectiveness of the classification. This is due to the enormous quantity of genes being expressed at the same time. An optimized feature selection would ensure a high accuracy of classification. Swarm intelligence has been effective in solving feature selection and classification problems. This paper also gives overview on the sources of microarray data which are used in the literature.

Nurhawani Ahmad Zamri, Bhuvaneswari Thangavel, Nor Azlina Ab Aziz, Nor Hidayati Abdul Aziz

### Support Vector Machine Classification of EEG Nonlinear Features for Primary Insomnia

Primary insomnia is a term used to describe a subtype of insomnia that constitutes the disorder itself and is not a consequent to any other psychiatric or sleep disorder. Hitherto, there is no clear objective markers from Polysomnography (PSG) signal to characterize insomnia. Although linear methods like spectral analysis of EEG frequency bands have been used to detect physiological arousal in patients with insomnia, these methods may not be sufficient enough to extract valuable information and detect abnormalities in the signals. The EEG signal itself originate from a complex neuronal activity in the brain, therefore the use of nonlinear measures may show some hidden information that could better explain the activation of this hyperarousal. The aim of the present study is to classify the primary insomnia patient from the healthy based on the supervised learning machine technique of SVM and the usage of nonlinear features of EEG signal. The classification result by using SVM achieved an overall of 83% of accuracy, 85 and 80% of sensitivity and specificity respectively.

Haslaile Abdullah, Chanakya Reddy Patti, Chamila Dissanyaka, Thomas Penzel, Dean Cvetkovic

### Prospects of Low-Cost Photometers for Colorimetric Serum Iron Concentration Determination

Iron is an essential element in the body that could cause harm to the body if there is deficiency or overload. Iron deficiency is a widespread nutritional disorder that affects the lives of a huge amount of people in the world and could lead to anemia if left untreated. Meanwhile, iron overload could lead to liver, heart problems or even death. Iron status is commonly diagnosed using sophisticated instruments, which are bulky and expensive. The need for a low-cost and portable iron body reader arises, as there are no such commercially available devices for this specific purpose. The serum iron concentration can be measured via colorimetric method using photometers. The colorimeter is commonly used to correlate the light absorbance and the concentration. This paper reviews the published works on developments of low-cost photometers. The possibility of developing a low-cost and portable colorimeter, specifically for measurement of serum iron was discussed.

Arthur Foo Yen Tan, Noor Azrina Talik, Boon Kar Yap, Prajindra Sankar Krishnan

### Decision Support for Parenteral Nutrition Supplementation in ICU Using Model-Based Glycemic Control Protocol

Nutrition therapy is part of the standard care given to all critically ill patients. In general, nutrition is administered as enteral nutrition (EN) and/or parenteral nutrition (PN). PN is given if the patients have contraindications to EN or as supplement if daily energy requirement cannot be achieved by EN alone. PN can be given as partial (dextrose solution only) or complete (include all macro- and micro-nutrients). The mode of nutrition therapy is influenced by several factors which include the need to maintain normoglycemia. A simulation is done to find the appropriate time to introduce PN while the patients are already on EN. In this context, a virtual study was conducted on 66 retrospectives critically ill patients’ data using clinically validated insulin-nutrition model and Stochastic TARgeted (STAR) protocol. The results suggested that this protocol benefited critically ill patients in two-fold. This approach is not only useful in controlling per-patient normoglycemic level, but also able to recognize the time for PN supplement when patients become hypoglycemic. This serves as a potential decision support in the intensive care environment when healthcare providers faced with the complexity of dynamics between good glycemic control and optimized nutrition therapy.

A. Abu-Samah, N. N. Razak, F. M. Suhaimi, U. K. Jamaluddin, A. M. Ralib, M. B. Mat-Nor, G. Chase

### Investigation of Glucose-Insulin Model Efficacy for Diabetes Patient in the ICU

This paper investigates the inter-relationship of blood glucose (BG) model fitting error percentage for both diabetic and non-diabetic patient’s status with ICING glucose-insulin model efficacy. Data were taken from 132 critically ill patients admitted in ICU of Hospital Tunku Ampuan Afzan (HTAA), Kuantan, Malaysia. The BG fitting error results are important to determine the efficacy and safety of chosen glucose-insulin model-based. Analysis results of per-patient and by-cohort were used to suggest whether diabetes is an influential factor for model BG fitting error efficacy. For diabetic per-patient and by-cohort, median model fit error are 0.29 and 0.31% respectively Meanwhile, for non-diabetic per-patient and by-cohort model fit error are 0.27 and 0.29% respectively. In conclusion, results demonstrated no significant difference between diabetic and non-diabetic patient in model fitting error. Thus, ICING model may be used to deliver real time model-based insulin therapy whether patient is diabetic or non-diabetic.

Athirah Abdul Razak, Asma Abu-Samah, Normy N. Razak, Nurhamim Ahamad, Fatanah M. Suhaimi , Ummu K. Jamaludin, Azrina Md Ralib, M. B. Mat-Nor

### Inflammatory Response of Bioscaffolds Decellularized by Sonication Treatment

Decellularization of sonication system efficiency is dictated by evaluation of host immune response on scaffolds. This aim of this study is to examine the inflammatory response after implantation of bioscaffolds decellularized by sonication treatment at 35 days post-surgery in rats. In this study, aortic tissues decellularized by sonication treatment in 0.1 and 2% of Sodium Dodecyl Sulfate (SDS) detergents. Samples were washed for 5 days in Phosphate Buffer Saline (PBS) following decellularization. Samples were implanted in on the lower right thoracic cavity of rats for 35 days. To examine the inflammatory response, the implanted samples were explanted and evaluated histologically by Hematoxylin Eosin (H-E) staining. From the histological analysis, bioscaffolds decellularized by sonication treatment in response to macrophages shows the minimal inflammatory response. Minimal inflammatory response elicits by bioscaffolds suggests the safety of bioscaffolds prepared by sonication treatment as biomedical implants.

Aqilah Hazwani, Munirah Sha’ban, Azran Azhim

### Model-Based Insulin-Nutrition Administration for Glycemic Control in Malaysian Critical Care: First Pilot Trial

Stress-induced hyperglycemia is prevalent in critical care, even in patients with no history of diabetes. Control of blood glucose level with tight insulin therapy has been shown to reduce incidences of hyperglycemia leading to reduced mortality and improved clinical outcomes. STAR is a tablet-based glucose control protocol with a specialized user interface into which insulin and nutrition information can be entered and predicted. This research describes the first clinical pilot trial of STAR approach in International Islamic University Hospital, Kuantan, Malaysia. The clinically specified target for blood glucose level is between 4.4 and 8.0 mmol/L. Seven episodes (of 359 h) were recruited based on the need for glucose control. Overall, 43.93% of measurement are in the range of 4.4–8.0 mmol/L band. The blood glucose median is 8.30 [6.32–10.00] mmol/L with only 1 patient having below than 2.22 mmol/L which is the guaranteed minimum risk level. This pilot study shows that STAR protocol is a patient specific approach that provides a good glycemic control in critically ill patients. Nevertheless, its implementation in Malaysian intensive care environments requires modifications and improvements in certain areas.

A. Abu-Samah, N. H. Ahamad, N. N. Razak, F. M. Suhaimi, U. K. Jamaluddin, A. M. Ralib, M. B. Mat-Nor, C. G. Pretty, J. L. Dickson, G. Chase

### Multi-channel Fabric Based Pressure Mapping Data Acquisition System

A smart fabric based multichannel pressure mapping Data Acquisition System (DAS) was specially designed to read and visualize real time pressure data from an array of piezoresistive fabric pressure sensor. This DAS is important to enable rapid monitoring of pressure distribution for biomedical engineering applications. A customized pressure mapping circuit using off-the-shelf components has been designed and fabricated. In addition, a pressure mapping algorithm which runs on Arduino platform and MATLAB was developed to continuously read and visualize pressure profile from the fabric pressure sensor. To ensure low component count and simple hardware, the concept of multiplexing has been employed in the hardware architecture and the firmware was written to support this architecture. This approach allows the system to perform even with single processor and single ADC. The reliability of the system was tested with array of fabric pressure sensor using a special portable load cell (Advance Force Gauge by MECMESIN). Pressure profile for each sensor unit matches the sensor resistive load characteristic, repeatability and accuracy of a commercial data acquisition system. The system is suitable for reading slow changing analog signal. If one desired to measure fast changing signal, the same architecture can still be used but specifications of the components must be higher. In conclusion, a smart multichannel pressure mapping Data Acquisition System (DAS) was designed, fabricated and tested. The unit capable of acquiring and visualizing pressure data from the developed sensor array. The speed of the system can be increased by using higher speed components while maintaining the same architecture.

Normazlianita M. Alias, Zakiran Abd Razak, Mohd Yazed Ahmad, Nur Azah Hamzaid

### Development of Computer Aids ASPECTS System for Acute Ischemic Stroke Patient: A Preliminary Study

In recent years, stroke ranked within the top ten leading causes of death and the incidence is still rising. As a result of clinical interpretation of Alberta Stroke Program Early CT Score (ASPECTS), the relevant personnel to define stroke area and score range are not consistent and cause difficulty to make treatment decision. This study was to develop a computer-aided scoring system for ischemic stroke patient to help doctors effectively determine the severity of ischemic stroke. Image processing technology was used to develop the system. First, an adaptive median filter was used to filter noise in computed tomography (CT) image, and then bi-level and regional growth methods were used to obtain effective image information. After texture parameters selection through t-test and support vector machine (SVM), regions of interesting (ROI) were automatically selected. Finally, the ischemic severity were obtained based on calculated ASPECTS score (by compared the left and right sides of the brain image). The CT images of 80 sets (40 training sets and 40 test sets) were used to evaluate the system by comparing with corresponding DWI-MRI. The results showed that the area under the ROC curve of the training sets and the test sets were 0.952 and 0.938, respectively, when four parameters (autocorrelation, variance, maximum probability, and homogeneity) were chosen. Accuracy was 0.90, sensitivity was 0.76, specificity was 1, and Kappa value was 0.52 for test data respectively, and the performance was superior to the physician group.

Jenn-Lung Su, Lung Chan, S. Y. Huang

### Testing the Effect of H-field Using Biological Phantom

The purpose of this paper is to propose a method to test the biological phantom after an exposure of the electromagnetic field (H-field). The phantom is believed to be influenced by the H-field created by wireless power transfer procedure. In the investigation, the phantom has been exposed for about 150 min. Two parameters were measured from the phantoms which are the impedance and the temperature before and after the exposure of the H-field. From the outcome, we can identify whether there are any changes detected in the assigned frequency. Both parameters change when exposed in the H-field but there are no significant changes after a duration of time exposed in the H-field zone indicates this range of frequency is safe to be used upon the biological phantom. This biological phantom comprises of the cucumber, saline and corn oil. In this test, it is utilizing 20% of corn oil and 80% of saline inside the cucumber as to show the arrangement of fat in typical human body. Since the changes is very low, this WPT setup is safe for testing the biological tissues. Nevertheless, as the complexity of the biological tissues, there are still many aspects to be considered and highlighted as this study play an important role to be referred for the next study about the effect of H-field towards the biological phantom.

N. Z. Syahir, Mas S. Mohktar, Sami F. Khalil, M. R. Basar, M. Y. Ahmad

### Design Performance of Taylor Spatial Frame in Comparison with Other Orthopaedic Fixation Plate

Treatment options for limb deformities were delevoped through time and Taylor Spatial Frame was indicated as a Stewart Platform based external fixation system that superior in terms of correction and ease of use. New external fixator (i.e. Ross’s external fixator) was created as solution from Taylor Spatial Frame’s problems. Several changes on Taylor Spatial Frame design were made to create Ross’ external fixator. However, Ross’ frame may have stability issue as consequence from Taylor’s design changes. Comparation of these frames is needed to develop limb deformities treatment. This paper is focused on the design performance of external fixator’s rings based on Stewart Platform. Taylor Spatial Frame’s and Ross Frame’s ring are compared and evaluated in design form. Both ring models are presented using Autodesk Inventor 2016. Numerical Modelling (i.e. Finite Element Analysis) used for compare both rings design performance. The comparation results will be useful for further research in ring fixation product development.

Ilham Priadythama, Lobes Herdiman, Durkes Herlina Apriani, I Dewa Nyoman Suci Anindya Murdiyantara

### The Effects of Oral Glutathione Supplementation on Human Volunteers: An Observation on Metabolic Syndrome Status

Oral glutathione supplementation helps in improving metabolic syndrome status of human volunteers. Glutathione is a cluster of amino acid containing one molecule of L-glutamic acid, L-cysteine, and glycine each. It act as a master antioxidant that combat free radicals in cells and help in detoxification of chemical from our body. This study aim to observe the effects of glutathione on metabolic syndrome symptoms after 12 weeks of supplementation. Reflection of the effects were carried on fasting glucose, blood pressure, cholesterols, waist to hip ratio, body fat percentage and basic measurement such as body mass index and blood pressure. Volunteers were divided into two groups; Group 1: One dosage of 5 g supplement, Group 2: Two dosage of 5 g supplement. A total of 23 volunteers’ have been recruited for the study. Based on the metabolic syndrome diagnosis we studied, out of 23, six subjects were found to have metabolic syndrome. After 12 week of supplementation, based on the parameter studied, there seems to be an improvement in the level of HDL cholesterol, body mass index (BMI), and waist to hip ratio for both group volunteers.

Nur Rasyidah Hasan Basri, Mas Sahidayana Mohktar, Wan Safwani Wan Kamarul Zaman, Hasif Ilyasa Mohd Yusof

### Robotic Upper Limb Rehabilitation Using Armeo®Spring for Chronic Stroke Patients at University Malaya Medical Centre (UMMC)

This is a retrospective study of patients with chronic partial arm paresis post stroke who attended neurorehabilitation at University Malaya Medical Centre, Malaysia. In this study we aimed to analyze the clinical and practical outcome of robotic-assisted upper limb rehabilitation. Specifically, we analyzed the impact of therapy on motor and function of chronic stroke arm paresis through structured therapy protocol. We extended our analysis towards user acceptance in robotic-assisted rehabilitation. We applied our Armeo®Spring Therapy Protocol on stroke patients with unilateral partial upper limb paresis of more than six months duration. The outcome measures were muscle strength, spasticity and hand dexterity. Thirty three patients who fulfilled the criteria of treatment protocol attended outpatient therapy session. Fourteen patients completed the treatment protocol in which ten participants were stroke patients. This study reported statistically significant improvement in multiple joint range of motions following therapy. Although there was non progressing arm spasticity, and improved paretic hand dexterity, both latter outcomes were not statistically significant at the end of therapy.

N. Hamzah, N. I. Giban, M. Mazlan

### Development of Near-Infrared Diffuse Correlation Spectroscopy for Noninvasive Monitoring of Cerebral Blood Flow

Cerebral blood flow (CBF) is a critical physiological process because it controls the oxygen supply, metabolic consumption, and byproduct clearance in the brain. However, a non-invasive method for long-term CBF monitoring is lacking. In recent years, NIR light has been used to monitor brain activities and cerebral blood flow based on DCS technique because it is able to penetrates human skull. The aim of this study was to develop a near infrared (NIR) Diffuse correlation spectroscopy (DCS) system for CBF monitoring. NIR laser at wavelength of 785 nm with properties of continuous wave and long coherence length (>10 m) was emitted into tissue. Single photons scattered by the red blood cells (RBCs) inside the cerebrovascular, were picked up. The auto-correlation function of the optical signal was calculated by the correlator downstream optical-detector. The developed NIR-DCS was first tested on a phantom in which the particle vibration was changed to simulate the changes in blood flow. Then the system was further tested on rats suffered with hypercapnia, normoxia and hyperoxia to measure the changes in CBF. The rats were connected to the ventilator through two plastic tubes—one for inhalation, the other for exhalation. The content of the exhaled gas was analyzed, and the real-time partial pressure of CO2 and the current end tidal CO2 (EtCO2) are measured. The results showed that hyperoxia increased blood flow due to changes in vascular wall tension. The outcome from this study supported DCS as a novel noninvasive method to measure CBF.

I-Tseng Huang, Kuan-Chen Wu, Jia-Jin Chen

### Positively Charged Silver Nanoparticles as Labels for Paper-Based Colorimetric Detection of Heparin

A novel paper-based colorimetric sensor has been developed for ultrasensitive detection of heparin based on aggregation of positively charged silver nanoparticles. The electrostatic interaction between negatively charged heparin and positively charged silver nanoparticles (AgNPs) resulted in a shift in the surface plasmon resonance (SPR) wavelength leading to a color change from yellow to colorless. The proposed assay can selectively detect heparin with an ultra-low detection limit of 1.898 ng mL−1 in solution and 8.68 µg mL−1 on paper. In future, the assay can be further employed for detection of heparin in human blood serum samples.

Sanjay Kumar, Pulak Bhushan, Shantanu Bhattacharya

### Single Image Super-Resolution for MRI Using a Coarse-to-Fine Network

Single Image Super-Resolution (SISR) which aims to recover a high resolution (HR) image from a low-resolution (LR) image has a wide range of medical applications. In this paper, we present a novel Super-Resolution Coarse-to-Fine Network (SRCFN) that recovers the finer texture details strongly and enables precise high-frequency detail to address this challenging task. First, we apply some residuals units to achieve a coarse Super-Resolution result. Second, we add a fine module using the idea of segmentation networks to combine more high-frequency detail into the coarse results for final Super-Resolution results. In addition, we use a combined loss function of Mean square error loss and SSIM loss. Our proposed method applied to medical MRI outperforms previous methods of accuracy (PSNR and SSIM) and visual improvements.

Jia Liu, Fang Chen, Huabei Shi, Hongen Liao

### High-Quality 3D Autostereoscopic Medical Display Method with Optical Enhancement and Image Compensation

With the growing demand for intuitive and accurate medical image visualization, autostereoscopic 3D display becomes a new developing trend in image guided diagnosis and therapy. However, the limited resolution and inadequate accuracy of current autostereoscopic techniques are two common problems that restrict the application of 3D medical display. This research introduces an image enhancement and optical compensation method based high quality autostereoscopic medical display system. An image enhancement module is designed to improve the spatial resolution and viewing angle of the same time. The accuracy degradation caused by optical aberration is compensated by the proposed raytracing rendering. Experiments demonstrated the feasibility in the improvement of 3D image quality and accuracy. Anatomic details of volunteer data were well shown by the proposed method. With further improvements in real-time image rendering, the proposed methods will have wide applicability in improving the display performance in the field of AR guidance system, microscope and head-mounted display systems.

Xinran Zhang, Tianqi Huang, Hongen Liao

### Application of Sinogram-Based Moving Window Subtraction Technique in OSEM Algorithm to Reduce Ring Artifacts for Cone-Beam Micro-CT Image Quality Assessment

Severe ring artifacts in cone-beam micro-CT degrade image quality and usually cause error recognition during image-based-observer study or computed-aid-diagnosis (CAD). It causes wrong values, such as size of the tumor. The aim of this study was to derive a moving window subtraction method before the iterative reconstruction step to reduce ring artifacts. To access acceptable image quality data, we used a uniform water cylinder phantom and followed the performance measurement guide, ISO-15708 and EN 16016, to evaluate the imaging performance. Results show there are 1.23 times improvement in SNR and 5% improvement in uniformity. Most importantly, we can reduce the error estimate of the object size from 6 pixels to less than 2 pixels. Our proposed method can efficiently reduce the error rate caused by ring artifacts for automatic size estimation applications.

David Shih-Chun Jin, Wen-Hsiang Chou, Jyh-Cheng Chen

### Is There a Relationship Between Bone Mineral Density, Mammographic Breast Density and Serum Estrogen Concentration Level? Study on Malaysian Women

Estrogen is known to affect both mammographic breast density and bone mineral density. Breast density is a well-known risk factor of breast cancer determined by the physiological hormonal changes. Studies shown inconclusive relationship of breast density and bone mineral density as breast cancer risk factors. This study aimed to determine the relationship of bone mineral density; mammographic breast density and serum estrogen concentration level in Malaysian women. A cross sectional study on 108 women aged above 40 years who underwent bone scan and mammography screening was conducted at the General Hospital Kuala Lumpur from 2016 to 2017. Subjects were chosen using convenient sampling technique. With women commenced cancer treatment and women who had mastectomy done being excluded from the study. An independent-t and chi-square statistical test were used to analyze the continuous and categorical data whilst binary logistic regression was used to determine the mentioned relationship. A total of 75.5% of the respondents had a normal bone mineral density in the hip and 76.9% in the spine. Abnormality in bone mineral density were recorded to be higher in postmenopausal women with the bone mineral density in spine (23.2%) region were slightly higher compared to the hip (18.5%). There was no statistical significant relationship between mammographic breast density and serum concentration level with bone mineral density in hip and spine.

N. M. Zain, K. C. Kanaga, E. S. Latif, A. Shantini

### Blood Glucose and Sepsis Score on Sepsis Patients Requiring Insulin Therapy

Early treatment of sepsis is crucial in improving the patient condition and reduces mortality. The lack of information and methods to diagnose sepsis at an early stage is a significant barrier to early treatment. Treatment is normally based on clinical judgment since blood cultures are negative in the majority of sepsis or septic shock cases as reported in several studies. Even with blood cultures result, a delay in diagnosis may happen while waiting for the results. Therefore, clinical guidelines are still required to provide guidance for the clinician caring for a patient with severe sepsis or septic shock. In this study, a validated glucose-insulin model is used to capture patient-specific insulin sensitivity profile. The validated model is incorporated with a sepsis system to create a glucose-insulin model that describe sepsis occurrence. The relationship between insulin sensitivity, blood glucose and sepsis score is investigated using a retrospective data of 8 patients admitted in the Tengku Ampuan Afzan Hospital, Kuantan. Results indicate that there was a significant relationship between blood glucose level and sepsis score (p < 0.001), and insulin sensitivity with a sepsis score (p < 0.001). Additionally, blood glucose level was higher in a severe sepsis group compared to the non-sepsis group. Whereas, insulin sensitivity is lower in a severe sepsis group. Insulin sensitivity profile can be incorporated with the sepsis system for monitoring sepsis patients requiring insulin therapy as seen in this study. Thus, the sepsis glucose-insulin model can potentially be used as an indicator or tools for sepsis diagnosis.

Fatanah Mohamad Suhaimi, Ummu Kulthum Jamaludin, Normy Norfiza Abdul Razak, Christopher G. Pretty, Azrina Md. Ralib, Mohd Basri Mat Nor, Fatimah Dzaharudin

### Contact Pattern of /b/ and /p/ in Malay Language Using Electropalatography

This article highlights the use of Electropalatography (EPG) to analyse the pattern of consonants /b/ and /p/ production. These plosive consonants occur when the upper and lower lips are brought together bringing the soft palate close to the posterior wall of the throat. This condition causes the air from the lung to be trapped in the mouth and voice channel. Once air is released, two phenomenon occurs. Firstly, if the air vibrates the vocal cord upon release, plosive consonant (/b/) is produced. Secondly, if the air do not vibrate the vocal cord, voiceless plosive consonant (/p/) is produced. This study aimed to observe the differences between the plosive production of /b/ and /p/ among three Malay adults aged from 24 to 52 years old. The subjects were required to wear the Reading EPG palate with 62 electrodes for monitoring their tongue-palate contact. Data were analysed using Articulate Assist 1.18 software. The results highlighted that the contact patterns for /b/ and /p/ productions were almost similar during the articulation. The contact patterns for the production of /p/ and /b/ occurred at the velar zone. However, significant difference was observed on the contact pattern of S1 due to higher upper arch depth.

Syatirah Mat Zin, Fatanah Mohamad Suhaimi, Siti Noor Fazliah Mohd Noor, Ahmad Fakrurrozi Mohamad, Nur Fatehah Md Shakur, Nurulakma Zali

### Knee Cartilage Ultrasound Image Segmentation Using Locally Statistical Level Set Method

Boundary delineation of a hypoechoic layers between the surrounding tissues and the bone structure is a necessary step in order to compute the knee cartilage thickness from ultrasound images. Speckle noise and intensity bias often complicates the segmentation task in the ultrasound images. This paper presents knee cartilage boundary segmentation using locally statistical level set method (LSLSM). Comparing to other methods in segmenting the cartilage, LSLSM produces a more satisfying outcome. Application of LSLSM on a set of 80 images illustrates a significant agreement with Cohen’s $$\kappa$$ coefficient equal to $$0.73$$ for the segmentation quality of the cartilage region rated by two raters. The quantitative evaluation measures of Dice coefficient and Hausdorff distance indicate the overall average values of $$0.91 \pm 0.01$$ and $$6.21 \pm 0.59$$ pixels, respectively. These good and consistent segmentation performances indicate that the segmented images can be applied for making the thickness computation in the ultrasound images.

Amir Faisal, Siew-Cheok Ng, Siew-Li Goh, Khin Wee Lai

### Adaptive Network Based Fuzzy Inference System (ANFIS) for an Active Transfemoral Prosthetic Leg by Using In-Socket Sensory System

Prosthetic leg is known as one of the solutions to help the amputee to regain back their ambulation ability. However, most of the current existing knee components still lacks in the ability to provide active body propulsion, which in turn. Thus, higher metabolic energy consumption is required by the amputee in doing locomotion movement. Hence, this study proposed the idea of developing both the mechanical structure as well as an ANFIS knowledge-based control system of the active actuated knee joint for transfemoral (TF) prosthetic leg. ANFIS was adopted using Matlab software to analyze human gait phase recognition necessary for cadence and torque control required by the knee joint mechanism while the actuated knee joint was developed using Inventor CAD software. Physical simulation of the controller presented a realistic simulation of the actuated of the knee joint in terms of knee mechanism. The fuzzy system could replicate human gait cycle by categorizing the cycle into seven gait phases.

Nur Hidayah Mohd Yusof, Yan Chai Hum, Nur Azah Hamzaid, Khin Wee Lai

### Vibroarthrography Difference Between Left and Right Knee for Osteoarthritis Detection

Osteoarthritis (OA) is the most common type of Arthritis; mostly occur on knees and hip joint. Although majority of elderly suffer from OA, all the existing diagnosis methods have major drawbacks. Past studies have discovered the relationship between knee alignment and weight distribution which are directly related to the OA in the elderly and can be diagnosed years before occurrence of the OA. In this study, specially made Vibroarthrography (VAG) data logging tool was used to collect the knee vibrations of 20 subjects, where 10 of the subjects were confirmed OA patients with grade 2 and higher severity. The test was completed by placing the sensor mounted on knee band of both left and right knees. The goal of this research is to compare the left and right knee of both healthy and OA subjects using Vibroarthrography method. Current results obtained shows significant difference between left and right knee VAG signals for both Healthy and OA knees

Farshad Golshan, Yan Chai Hum, Belinda Pingguan-Murphy, Khin Wee Lai