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Atherosclerosis and resultant peripheral arterial disease (PAD) are common complications in patients with type 2 diabetes mellitus or end-stage renal disease and in elderly patients. The prevalence of PAD is higher in patients receiving haemodialysis therapy. For early assessment of arterial occlusion using bilateral photoplethysmography (PPG), such as changes in pulse transit time and pulse shape, bilateral timing differences could be used to identify the risk level of PAD. Hence, the authors propose a discrete fractional-order integrator to calculate the bilateral area under the systolic peak (AUSP). These indices indicated the differences in both rise-timing and amplitudes of PPG signals. The dexter and sinister AUSP ratios were preliminarily used to separate the normal condition from low/high risk of PAD. Then, transition probability-based decision-making model was employed to evaluate the risk levels. The joint probability could be specified as a critical threshold, < 0.81, to identify the true positive for screening low or high risk level of PAD, referring to the patients' health records. In contrast to the bilateral timing differences and traditional methods, the proposed model showed better efficiency in PAD assessments and provided a promising strategy to be implemented in an embedded system.

A wrist‐based photoplethysmography (PPG) tool offers a simple and non‐invasive approach for applications in vital sign monitoring and healthcare. However, in a telecare network, these physiological signals ensure the authorisation demands for the domain of medical applications. Hence, this study proposes an intelligent method for PPG signal encryption and decryption. This method combines chaotic map and radial basis function network (RBFN) into symmetric cryptography with an adaptive scheme. The sine‐power chaotic map is used as a key generator of 256 non‐ordered numbers (key space) to set the private cipher codes. Two RBFNs are used to train an encryptor and a decryptor with the authorised cipher codes. Its substitution‐based infosecurity scheme can change the numerical values of PPG raw data for each encrypted communication, and the decrypted PPG data are further applied for time‐ and frequency‐domain analyses in clinical applications, such as heart and respiration rate analysis and arterial stiffness and upper extremity vascular disease evaluations. Through experimental results, the security levels are validated using the number of pixel change rate (NPCR), unified averaged changed intensity (UACI), and correlation analysis. The average NPCR, UACI, and correlation coefficient (CC) are 96.57%, 35.43%, and 0.005, respectively, between the plain PPG and the encrypted PPG data against hacker attacks. The larger‐the‐better of NPCR and UACI indexes and the smaller‐the‐better of CC index are obtained to evaluate the efficiency of the proposed cryptography method. The encrypted PPG also guarantees physiological signals of good quality in clinical applications. In addition, the performance of RBFN‐based method is superior in adaptive learning capability than that of the traditional learning method in real‐time applications. The cover image is based on the Original Research Paper Intelligent physiological signal infosecurity: Case study in photoplethysmography (PPG) signal by Chia Hung‐Lin et al., https://doi.org/10.1049/sil2.12089. [ABSTRACT FROM AUTHOR]

Common upper limb peripheral artery diseases (PADs) are atherosclerosis, embolic diseases, and systemic diseases, which are often asymptomatic, and the narrowed arteries (stenosis) will gradually reduce blood flow in the right or left upper limbs. Upper extremity vascular disease (UEVD) and atherosclerosis are high-risk PADs for patients with Type 2 diabetes or with both diabetes and end-stage renal disease. For early UEVD detection, a fingertip-based, toe-based, or wrist-based photoplethysmography (PPG) tool is a simple and noninvasive measurement system for vital sign monitoring and healthcare applications. Based on time-domain PPG analysis, a Duffing–Holmes system with a master system and a slave system is used to extract self-synchronization dynamic errors, which can track the differences in PPG morphology (in amplitudes (systolic peak) and time delay (systolic peak to diastolic peak)) between healthy subjects and PAD patients. In the preliminary analysis, the self-synchronization dynamic errors can be used to evaluate risk levels based on the reflection index (RI), which includes normal condition, lower PAD, and higher PAD. Then, a one-dimensional convolutional neural network is established as a multilayer classifier for automatic UEVD screening. The experimental results indicated that the self-synchronization dynamic errors have a positive correlation with the RI (R2 = 0.6694). The K-fold cross-validation is used to verify the performance of the proposed classifier with recall (%), precision (%), accuracy (%), and F1 score. [ABSTRACT FROM AUTHOR]