CN106333745B - Electric knife system based on biomedicine signals control - Google Patents
Electric knife system based on biomedicine signals control Download PDFInfo
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- CN106333745B CN106333745B CN201610919464.1A CN201610919464A CN106333745B CN 106333745 B CN106333745 B CN 106333745B CN 201610919464 A CN201610919464 A CN 201610919464A CN 106333745 B CN106333745 B CN 106333745B
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
- A61B5/346—Analysis of electrocardiograms
- A61B5/349—Detecting specific parameters of the electrocardiograph cycle
- A61B5/352—Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00696—Controlled or regulated parameters
- A61B2018/00702—Power or energy
- A61B2018/00708—Power or energy switching the power on or off
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00839—Bioelectrical parameters, e.g. ECG, EEG
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Abstract
Electric knife system provided by the invention based on biomedicine signals control, with electric knife system control loop, trigger circuit is identified including ecg signal acquiring module and R waves, ecg signal acquiring module includes passive linear network, driven-right-leg circuit and analog-digital converter again, and R waves identify that trigger circuit is equipped with phase timing program and electrocardiosignal startup electric knife between the identification of R waves and trigger, R R and controls program.The present invention synchronizes triggering by surface electrocardiogram R waves and starts electric knife system design principle, electric knife, which is only triggered by R waves, to be started, enter pacemaker ventricular refractory period (VRP) later, such as interfere, VRP will continuously be restarted and trigger pacemaker noise reversion (NR) function, pacemaker impulse granting is not inhibited, so as to avoid random start and use electric knife, inhibit ventricular pace pulse to discharge risk in the ventricle vigilance phase, there is the good effect for improving medicine intelligentized control method and safety.
Description
Technical field
The present invention relates to medical supply auxiliary device technical fields, particularly belong to the electric knife controlled based on biomedicine signals
System and its control method.
Background technology
For implanting artificial Permanent Cardiac Pacemakers, the patient of surgical operation is needed, because can using electric knife in art
Pacemaker can be interfered to work, the patient especially relied on pacemaker may cause pacemaker impulse to inhibit, cardiac arrest, therefore
Surgical operation is carried out using before electric knife, need to usually ask heart specialist to assess the pacemaker working condition of patient, journey
Control and necessary parameter adjustment.Following suggestion is made using electric knife to the patient of implantable pacemaker in internal authority guide:1.
Need to provide 12 months before this Programmable Pacemakers data, including pacemaker type, operating mode, pacemaker working condition and each
Kind parameter is assessed by heart specialist.2. it is more than pair navel operation suggest by electrode it is program-controlled be bipolar perception and pace-making, it is right
Dependent patient must it is preoperative it is program-controlled be DOO or VOO, otherwise electric knife system work may interfere with pacemaker work, severe patient danger
And patient vitals' safety.However the Pacemaker programmer of the doctor, technical staff and costliness with pacemaker Specialty knowledge are not
Basic hospital is spread to, needs electric knife that must then turn higher level hospital if any operation, therefore the patient to being badly in need of operation may also be
Delay treatment, even the surgical operation that can carry out in basic hospital goes out because local hospital is without corresponding Programmable Pacemakers condition
It also has to turn higher level hospital in security consideration, the guidance spirit in this and the counties national serious disease Bu Chu is not met, while increasing trouble
The financial burden of person and national medical insurance, wastes relatively limited medical resource.In addition, even if in conditional higher level hospital,
It is DOO or VOO that program-controlled pacing mode is needed before corrective surgery, and professional people is observed in entire surgical procedure, postoperative recovery from anesthesia
Again by pacemaker pattern recovery to preoperative operating mode time-consuming a few hours or even 10 more than hour, this needs cardiovascular special member
Section doctor loads heavy Pacemaker programmer back and forth for several times, and Internal Medicine-Cardiovascular Dept. Asia professional classification is very thin at present, is not institute
There is doctor that can be carried out to pacemaker program-controlled, the doctor for being only engaged in pacemaker implantation work has the skill of Programmable Pacemakers
Art, Chang Yinwei, which lacks these technicians, to be in time and the delay time at stop, and pacemaker is with unaware pattern work during this period
Make, it will constitute competition the rhythm of the heart, the haemodynamics of patient is influenced, or even induce arrhythmia cordis, as pacemaker impulse falls into electrocardio
The ventricle vulnerable period of 30ms, will there is the risk for causing malignant ventricular arrhythmia before figure T wave crests peak.
The defect of electric knife system at present:For the patient that the patient of implantable pacemaker, especially pacemaker rely on, one there is no
A electric knife system can use under conditions of not adjusting pacemaker parameter and pattern.This is because current electric knife system is
It by patient's random start and uses, if the ventricle vigilance phase in pacemaker Time Intervals, starts or will using electric knife
Inhibit ventricular pace pulse release, the patient relied on pacemaker, it would be possible to lead to cardiac arrest threat to life.
Invention content
The purpose of the present invention is to be to provide a kind of electric knife system and its control method controlled based on biomedicine signals,
To achieve the purpose that the patient that pacemaker relies on need not be carried out, pacing mode is program-controlled can to use electric knife system.
A kind of electric knife system based on biomedicine signals control provided by the present invention, there is electric knife system to control back
Road, including ecg signal acquiring module and R waves identify that trigger circuit, the ecg signal acquiring module include passive linear again
Network, driven-right-leg circuit and analog-digital converter, the R waves identify that trigger circuit is equipped with the identification of R waves and trigger, R-
Phase timing program between R, which is characterized in that electric knife system further includes electric knife standby module, and the electric knife standby module is equipped with
Electric knife-pen manual switch, ecg signal acquiring module, electric knife standby module, R waves identification trigger circuit are connected by conducting wire, are accessed
Electric knife system control loop, V11, V12 input interface of passive linear network by conducting wire respectively on the inside of human body right upper extremity
Electrode slice, the connection of left upper extremity medial electrode piece, the input interface of driven-right-leg circuit pass through in conducting wire and the right ankle-joint of human body
Lateral electrode piece connects, and the output end of driven-right-leg circuit is connected to passive linear network Voc input interfaces, passive linear network
Output port output is converted into digital signal after anti-electric knife interferes processed electrocardiosignal to be handled by analog-digital converter, defeated
R waves identification trigger circuit is given, the electric knife system control loop electrode plate at patient back connects R waves by loop electrode conducting wire to be known
The electric knife circuit port that other trigger circuit outer is stretched out, meanwhile, surgical procedure contact to be cut or the electricity of the tissue location of coagulation
The electric knife system outlet port that writing of indictments, appeals, etc. active electrode is stretched out by the active conducting wire of electric knife and electric knife stand-by circuit outer in succession,
In, the R waves identify that trigger circuit is equipped with electrocardiosignal and starts electric knife control program.
Further, this system is additionally provided with pacemaker operating mode selection key, competitive cardiac rhythm warning light, the pacemaker
Operating mode selection key is matched with the switching of electric knife system control loop, the competitive cardiac rhythm warning light and competitive cardiac rhythm
Control key matches.
Further, the competitive cardiac rhythm control key is the selective button of collection action and the two-way switching resetted.
A kind of control method of electric knife system based on biomedicine signals control provided by the present invention, feature exist
In including the following steps:
Step 1:Electrode slice on the inside of left upper extremity, on the inside of right upper extremity and on the inside of right lower extremity ankle-joint passes through the body surface heart respectively
Electrical signal collection conducting wire accesses in the corresponding interface of electric knife system control loop, the electric knife system control loop electricity at patient back
Pole plate connects R waves by loop electrode conducting wire and identifies the electric knife circuit port stretched out trigger circuit outer, meanwhile, surgical procedure connects
Touching will cut or the electric knife-pen active electrode of the tissue location of coagulation is stretched by the active conducting wire of electric knife and electric knife stand-by circuit outer
The electric knife system outlet port gone out is in succession.It waits after the completion of connecting, opens the working power of electric knife system;
Step 2:Pacemaker operating mode selection key is pressed, electric knife system is selected to trigger mode state for R waves, is connected
Electric knife system control loop;
Step 3:The manual switch of electric knife-pen is opened, electric knife enters standby mode;
Step 4:Electric knife head contact to be cut or the tissue of coagulation, connects R waves and identifies trigger circuit, runs phase meter between R-R
Shi Chengxu starts electric knife into electrocardiosignal and controls program, and specific control flow is as follows:
S101:R wave recognizers identify ventricular pacemaking or the R waves of itself;
S102:When recognizing R waves, synchronous triggering starts electric knife;
S103:R -- R interval measures, and measures triggering and starts two R -- R interval values after electric knife:1. such as difference≤50ms, carry
After showing that electric knife does not interfere or trigger noise reversion (NR), paced rate is faster than itself heart rate, into S104;2. such as difference >
50ms, and R -- R interval≤1.2S prompt triggering noise reversion (NR), and competitive cardiac rhythm occurs, and competitive cardiac rhythm warning light flickers, such as
Allow competitive cardiac rhythm, then electrocardiosignal starts electric knife control program and allows to continue to discharge, and maintains triggering noise reversion (NR);If not
Allow competitive cardiac rhythm, then after pressing competitive cardiac rhythm control key, into S105;3. as R -- R interval differs > 50ms, and R -- R interval
As protectiveness program when > 1.2S, electrocardiosignal starts electric knife control program control pause electric discharge, and electric knife pause uses;
S104:Electrocardiosignal, which starts electric knife control program, to be allowed to continue to discharge;
S105:Electrocardiosignal start electric knife control program control pause electric discharge, electric knife pause use, reenter S101 and
S102 enters S106 later;
S106:The pause electric discharge in 300ms after R waves triggering electric knife starts, does not inhibit the heart because discharging in ventricular refractory period
Room pacemaker impulse does not trigger noise reversion (NR) yet, competitive cardiac rhythm does not occur, the rhythm of the heart is neat at this time, and competitive cardiac rhythm warning light stops
Only flicker.After S105 electric knifes suspend use, when electric knife head is contacted again tissue, triggering electric knife in each R waves starts 300ms
When, electrocardiosignal starts electric knife control program and temporarily disconnects electric knife system control loop, suspends electric knife, in cycles;
Further, after entering S106 competitive cardiac rhythm warning lights and stopping flicker, as patient needs keeping electric knife to work
Continuity, and allow the of short duration presence of competitive cardiac rhythm after assessing, competitive cardiac rhythm control key can be pressed again, by not allowing competitive cardiac rhythm
State reset then enters corresponding program S104 to competitive cardiac rhythm state is allowed, i.e., starts electricity by electrocardiosignal after the triggering of R waves
Knife control program allows to continue to discharge, and lasting triggering maintains noise reversion (NR).
A kind of electric knife system and its control method based on biomedicine signals control provided by the present invention, pass through body surface
ECG R wave synchronizes the design principle that triggering starts electric knife system, is only triggered by R waves, is not answered into pacemaker ventricle later
Phase (VRP), when electric knife is persistently used in VRP, the i.e. electric knife interference signal of interference, which can such as occur, to be perceived by ventricular lead, it will even
It is continuous to restart VRP, until when basic pacing interval end, noise reversion (NR) function of pacemaker is triggered, does not inhibit pacemaker impulse to send out
It puts, at this time such as rate response function (R) opening, is then paced with the frequency of sensor driving, such as R closings or without R functions, then with low
Frequency pace-making is limited, even if suspending electric knife during this, VRP is restarted and does not reach basic pacing interval end, pacemaker impulse will not be inhibited
Granting, to completely avoid random start and use electric knife, be likely to be at the ventricle vigilance phase and inhibit ventricular pace pulse
The risk of release has the good effect for improving medicine intelligentized control method and safety.
Description of the drawings
Fig. 1 is the circuit diagram of ecg signal acquiring module in the prior art;
Fig. 2 is the fundamental diagram of the present invention;
Fig. 3 is the control flow chart of the present invention.
In figure:I is ecg signal acquiring module;
1, right upper extremity medial electrode piece;2, left upper extremity medial electrode piece;3, right ankle-joint medial electrode piece;4, electric knife-pen is made
Use electrode;5, electric knife system control loop electrode plate.
Specific implementation mode
Present invention is further described in detail with specific implementation mode below in conjunction with the accompanying drawings:
A kind of electric knife system based on biomedicine signals control provided by the present invention, there is electric knife system to control back
Road, including ecg signal acquiring module I, R waves identification trigger circuit and electric knife standby module, ecg signal acquiring module are wrapped again
Passive linear network, driven-right-leg circuit and analog-digital converter are included, R waves identify that trigger circuit is equipped with R waves and identifies and trigger journey
Sequence, R -- R interval timing program and electrocardiosignal start electric knife and control program, ecg signal acquiring module, electric knife standby module,
R waves identification trigger circuit is connected by conducting wire, accesses electric knife system control loop, passive linear network V11, V12 input interface
Connect respectively with human body right upper extremity medial electrode piece 1, left upper extremity medial electrode piece 2 by conducting wire, driven-right-leg circuit it is defeated
Incoming interface is connect by the right ankle-joint medial electrode piece of conducting wire and human body 3, and the output end of driven-right-leg circuit is connected to passive
The output port output of Linear Network Voc input interfaces, passive linear network interferes processed electrocardiosignal logical through anti-electric knife
It is converted into digital signal after crossing analog-digital converter processing, is conveyed to R waves identification trigger circuit, the electric knife system control at patient back
Loop electrode plate 5 connects R waves by loop electrode conducting wire and identifies the electric knife circuit port stretched out trigger circuit outer, meanwhile, hand
Art operation contact to be cut or the electric knife-pen active electrode 4 of the tissue location of coagulation waits for electromechanics by the active conducting wire of electric knife and electric knife
The electric knife system outlet port that road outer is stretched out is in succession, wherein passive linear network carries out anti-electricity to collected electrocardiosignal
Knife interference is handled, so that electric knife does not interfere R -- R interval timing and identification R waves after starting;Electric knife standby module is equipped with electric knife-pen
Manual switch.
In addition, this system is additionally provided with pacemaker operating mode selection key, competitive cardiac rhythm warning light, pacemaker work
Mode selecting key is matched with the switching of electric knife system control loop, is equivalent to the master switch of electric knife system control loop, to
It selects to start whether electric knife system works for R waves triggering pattern as needed.So that this system had both been applicable to not install pace-making
The patient of device, and can be used for the patient of pacemaker.Pacemaker operating mode selection key is not pressed, that is, is given tacit consent to electric knife work and adopted
With common-mode, that is, it is suitable for the corrective surgery of non-pacemaker;Pacemaker operating mode selection key is pressed, electric knife has been connected
System control loop is suitable for the hand for the patient that pacemaker relies on into the electric knife system controlled based on biomedicine signals
Art.
Further, the competitive cardiac rhythm warning light is matched with competitive cardiac rhythm control key.
Further, the competitive cardiac rhythm control key is the selective button of collection action and the two-way switching resetted.
When competitive cardiac rhythm warning light flickers, if patient does not allow competitive cardiac rhythm, competitive cardiac rhythm control key is pressed, temporarily disconnects electric knife system
Noise reversion (NR) function of system control loop, electric knife break-off, pacemaker terminates, and competitive cardiac rhythm stops, and competitive cardiac rhythm carries
Show lamp stop flicker, hereafter as patient need keep electric knife work continuity, and assess after allow the of short duration presence of competitive cardiac rhythm,
Competitive cardiac rhythm control key can be pressed again, by not allowing competitive cardiac rhythm state reset to competitive cardiac rhythm state is allowed, then enter phase
Program S104 is answered, i.e., starting electric knife control program by electrocardiosignal after the triggering of R waves allows to continue to discharge, and lasting triggering maintains
Noise inverts (NR).
A kind of control method of electric knife system based on biomedicine signals control provided by the present invention, including walk as follows
Suddenly:
Step 1:Electrode slice on the inside of left upper extremity, on the inside of right upper extremity and on the inside of right lower extremity ankle-joint passes through the body surface heart respectively
Electrical signal collection conducting wire accesses in the corresponding interface of electric knife system control loop, the electric knife system control loop electricity at patient back
Pole plate 5 connects R waves by loop electrode conducting wire and identifies the electric knife circuit port stretched out trigger circuit outer, meanwhile, surgical procedure
Contact will be cut or the electric knife-pen active electrode 4 of the tissue location of coagulation passes through outside the active conducting wire of electric knife and electric knife stand-by circuit
In succession along the electric knife system outlet port stretched out.It waits after the completion of connecting, opens the working power of electric knife system;
Step 2:Pacemaker operating mode selection key is pressed, electric knife system is selected to trigger mode state for R waves, is connected
Electric knife system control loop;
Step 3:The manual switch of electric knife-pen is opened, electric knife enters standby mode;
Step 4:Electric knife head contact to be cut or the tissue of coagulation, connects R waves and identifies trigger circuit, runs phase meter between R-R
Shi Chengxu starts electric knife into electrocardiosignal and controls program, and specific control flow is as follows:
S101:R wave recognizers identify ventricular pacemaking or the R waves of itself;
S102:When recognizing R waves, synchronous triggering starts electric knife;
S103:R -- R interval measures, and measures triggering and starts two R -- R interval values after electric knife:1. such as difference≤50ms, carry
After showing that electric knife does not interfere or trigger noise reversion (NR), paced rate is faster than itself heart rate, into S104;2. such as difference >
50ms, and R -- R interval≤1.2S prompt triggering noise reversion (NR), and competitive cardiac rhythm occurs, and competitive cardiac rhythm warning light flickers, such as
Allow competitive cardiac rhythm, then electrocardiosignal starts electric knife control program and allows to continue to discharge, and maintains triggering noise reversion (NR);If not
Allow competitive cardiac rhythm, then after pressing competitive cardiac rhythm control key, into S105;3. as R -- R interval differs > 50ms, and R -- R interval
As protectiveness program when > 1.2S, electrocardiosignal starts electric knife control program control pause electric discharge, and electric knife pause uses;
S104:Electrocardiosignal, which starts electric knife control program, to be allowed to continue to discharge;
S105:Electrocardiosignal start electric knife control program control pause electric discharge, electric knife pause use, reenter S101 and
S102 enters S106 later;
S106:The pause electric discharge in 300ms after R waves triggering electric knife starts, does not inhibit the heart because discharging in ventricular refractory period
Room pacemaker impulse does not trigger noise reversion (NR) yet, competitive cardiac rhythm does not occur, the rhythm of the heart is neat at this time, and competitive cardiac rhythm warning light stops
Only flicker.After S105 electric knifes suspend use, when electric knife head is contacted again tissue, triggering electric knife in each R waves starts 300ms
When, electrocardiosignal starts electric knife control program and temporarily disconnects electric knife system control loop, suspends electric knife, in cycles;
Further, after entering S106 competitive cardiac rhythm warning lights and stopping flicker, as patient needs keeping electric knife to work
Continuity, and allow the of short duration presence of competitive cardiac rhythm after assessing, competitive cardiac rhythm control key can be pressed again, by not allowing competitive cardiac rhythm
State reset then enters corresponding program S104 to competitive cardiac rhythm state is allowed, i.e., starts electricity by electrocardiosignal after the triggering of R waves
Knife control program allows to continue to discharge, and lasting triggering maintains noise reversion (NR).
Claims (3)
1. based on the electric knife system of biomedicine signals control, there is electric knife system control loop, including ecg signal acquiring mould
Block and R waves identify trigger circuit, the ecg signal acquiring module again including passive linear network, driven-right-leg circuit and
Analog-digital converter, the R waves identify that trigger circuit is equipped with the identification of R waves and trigger, R -- R interval timing program, feature
It is, electric knife system further includes electric knife standby module, and the electric knife standby module is equipped with manual switch, ecg signal acquiring mould
Block, electric knife standby module, R waves identification trigger circuit are connected by conducting wire, access electric knife system control loop, passive linear network
V11, V12 input interface are connected with human body right upper extremity medial electrode piece (1), left upper extremity medial electrode piece (2) respectively by conducting wire
It connects, the input interface of driven-right-leg circuit is connect by conducting wire with the right ankle-joint medial electrode piece (3) of human body, right leg drive electricity
The output end on road is connected to passive linear network Voc input interfaces, and the output port output of passive linear network is dry through anti-electric knife
It disturbs after processed electrocardiosignal is handled by analog-digital converter and is converted into digital signal, be conveyed to R waves identification trigger circuit, suffer from
The electric knife system control loop electrode plate (5) at person back connects R waves by loop electrode conducting wire and identifies that trigger circuit outer is stretched out
Electric knife circuit port, meanwhile, surgical procedure contact will be cut or the electric knife-pen active electrode of the tissue location of coagulation (4) passes through
The electric knife system outlet port that the active conducting wire of electric knife is stretched out with electric knife stand-by circuit outer is in succession, wherein the R waves identification is touched
Power Generation Road is equipped with electrocardiosignal and starts electric knife control program.
2. the electric knife system according to claim 1 based on biomedicine signals control, which is characterized in that this system is also set
There are pacemaker operating mode selection key, competitive cardiac rhythm warning light, the pacemaker operating mode selection key and electric knife system control
The switching in circuit processed matches, and the competitive cardiac rhythm warning light is matched with competitive cardiac rhythm control key.
3. the electric knife system according to claim 2 based on biomedicine signals control, which is characterized in that the competition
Rhythm of the heart control key is the selective button of collection action and the two-way switching resetted.
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US4716897A (en) * | 1985-07-15 | 1988-01-05 | Olympus Optical Co., Ltd. | Electrosurgical apparatus |
CN1806751A (en) * | 2006-01-27 | 2006-07-26 | 天津大学 | Cardiac monitor module capable of resisting high frequency electric knife interference |
CN104027167A (en) * | 2014-07-02 | 2014-09-10 | 上海旭旦实业有限公司 | Electromagnetic radiation protector and electrotome with electromagnetic radiation protection function |
CN204049834U (en) * | 2014-07-02 | 2014-12-31 | 上海旭旦实业有限公司 | Electromagnetic radiation protector and there is the electric knife of electromagnetic radiation protection function |
CN206372121U (en) * | 2016-10-21 | 2017-08-04 | 昆明医科大学第一附属医院 | The electric knife device controlled based on biomedicine signals |
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Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
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US4716897A (en) * | 1985-07-15 | 1988-01-05 | Olympus Optical Co., Ltd. | Electrosurgical apparatus |
CN1806751A (en) * | 2006-01-27 | 2006-07-26 | 天津大学 | Cardiac monitor module capable of resisting high frequency electric knife interference |
CN104027167A (en) * | 2014-07-02 | 2014-09-10 | 上海旭旦实业有限公司 | Electromagnetic radiation protector and electrotome with electromagnetic radiation protection function |
CN204049834U (en) * | 2014-07-02 | 2014-12-31 | 上海旭旦实业有限公司 | Electromagnetic radiation protector and there is the electric knife of electromagnetic radiation protection function |
CN206372121U (en) * | 2016-10-21 | 2017-08-04 | 昆明医科大学第一附属医院 | The electric knife device controlled based on biomedicine signals |
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