Volume Status in Patients on Peritoneal Dialysis: The Role of Apelin and Bio-Impedance Spectroscopy

One of the main factors determining the survival of peritoneal dialysis (PD) patients is volume status. We aimed to investigate hydration status of PD patients by bio-impedance spectroscopy (BIS) and echocardiography and to study the relation of them with apelin, which has effects related with volume status like vasodilation, positive inotropism, and inhibition of ADH release and RAS antagonism. Chronic PD patients without active cardiac disease or clinically prominent hypervolemia were included. Besides the demographic, clinical, and laboratory data, BIS and echocardiographic findings together with apelin levels were recorded. The study included 21 patients. Of them, eight patients were euvolemic, one patient was hypovolemic, and others have some degree of overhydration (1.1–6.8 L) with BIS, although all were euvolemic clinically. Mean apelin level was 1.49 ± 0.49 ng/mL. Apelin level was positively correlated with ejection fraction and negatively with total body water (TBW), intracellular and extracellular water, lean tissue mass, and left atrium diameter. On linear regression model, TBW was the major determinant of apelin. Although apelin is expected to increase in hypervolemic patients, the negative correlation with body water in this study may be related with yet unknown role of apelin in dialyzed patients. They may have important roles in volume status in future.     

Three case studies indicating the effectiveness of manual lymph drainage on patients with primary and secondary lymphedema using objective measuring tools

The superficial lymphatic system is divided into areas called lymphatic territories which are separated by watersheds. When the lymphatic system fails to remove its load either due to surgery, radiotherapy or some congenital malformation of it then the fluid (and the proteins and wastes contained within it) accumulates in that territory. Anastomotic connections exist across the watersheds and while they can work unaided, manual lymph drainage (MLD) can significantly help drainage across them into unaffected lymphatic territories. MLD also can help the movement of extracellular fluids into the lymph vessels and then along them. The purpose of the study is to examine the effectiveness of a manual technique in moving fluids and softening hardened tissues using three non-invasive examination tools. We examined the movement of fluids from the affected limbs of three lymphedema patients who underwent a standardized 45-min treatment using the Dr Vodder method of M L D. We chose a typical cross section of patients with either a primary leg, secondary leg or secondary arm lymphedema. The arm lymphedema patient was also measured for return of edema over a 30-min period after the conclusion of treatment and underwent a follow-up control measurement, 2 months later without treatment. The tools used were tonometry, multi-frequency bioelectrical impedance and perometry. All three evaluation tools indicated a movement of fluid to different and unblocked lymphatic territories as well as a softening of tissues in some of the affected limbs. Fluid movements were also detected in the contralateral, apparently normal limbs, even though they were not treated. MLD thus is an effective means of fluid clearance when it has accumulated as a consequence of a failure of the lymphatic system. It seems likely that MLD has a systemic effect on the lymphatic system and that it can improve flow from otherwise normal tissues. It is hypothesized that a series of treatments (as is the norm) would result in even more significant improvements.     

基于串口的胃阻抗信号采集处理

基于生物阻抗的胃动力信息提取是我们正在研究的一个重要项目。采用串口以及串口控件实现了信号采集，采用小波分析等现代信号处理方法，实现胃蠕动信号的提取和动态谱分析。由此方法研制的胃动力检测系统可在消化道生理、病理生理、药理及临床应用上发挥重要作用。     

基于体外阻抗测量的恶性胶质瘤介电特性

目的研究脑胶质瘤生物电阻抗特性,探索出恶性胶质瘤组织与正常脑组织的特征性电参数,为区分恶性胶质瘤与正常脑组织提供依据。方法基于四电极法阻抗测量设计了一种体外阻抗测量传感器,利用普林斯顿阻抗分析仪Versa STAT3对10例裸鼠脑胶质瘤和脑组织进行阻抗测量,并对20Hz~250 k Hz范围内阻抗频谱特性曲线进行定量分析;结合生物阻抗谱理论,建立体外脑胶质瘤等效电路模型,并利用ZSimp Win对等效阻抗电路进行拟合仿真,以探讨脑胶质瘤在阻抗电路中的特性。结果胶质瘤的阻抗模值在20 Hz~250 k Hz范围内随频率的增大而减小,幅值曲线在200 Hz和50 k Hz附近各存在一个斜坡,这两个斜坡的斜度都小于对应的正常鼠脑组织的斜度。10组裸鼠体外实验中,胶质瘤和脑组织的虚部-实部图中有两个时间环节,可以用两个时间常数的等效电路代替,并且电路元件中的参数R1对于胶质瘤和脑组织差异明显。结论体外鼠脑胶质瘤与正常脑组织可以用阻抗特性曲线的斜坡值进行定量区别。此外,等效电路电参数中的R1也可以作为一个区分胶质瘤和脑组织的指标,这为临床检测和区分胶质瘤组织开拓了新的研究思路。     

一种新型的阻抗式呼吸检测系统

介绍了一种新型的阻抗式呼吸检测方法的设计与实现。系统采用生物阻抗法．在空间上通过增加电极．将多路呼吸信号进行空域叠加滤波．以提高信号的信噪比．并通过传统的软硬件滤波进一步增强抗干扰能力。样机系统基于MSP430单片机．实现了便携式低功耗设计。对样机的人体实验表明,其抗心动、血流和运动等干扰的性能较好,系统运行稳定。     

The utility of novel non-invasive technologies for remote hemodynamic monitoring in chronic heart failure

Monitoring a patient’s hemodynamic status may be a revolutionary way to aid a ‘health maintenance’ strategy in which the physician strives to therapeutically keep the patient in an ideal hemodynamic range. Currently, home telemonitoring employs a ‘crisis-prevention’ approach. This strategy is still based on easily acquired measures such as heart rate, weight and blood pressure – measurements that are useful to help implement guideline-directed therapy but provide little information about impending decompensation or the risk of hospitalisation. Current systems provide limited information to personalize and adapt medication therapy for heart failure. Several innovative technologies that can remotely monitor estimates of cardiovascular hemodynamics, such as cardiac index, systemic vascular resistance, augmentation index and added heart sounds may enable earlier detection of heart failure decompensation. This editorial presents an overview of the innovative technologies that are available for non-invasive hemodynamic monitoring and maybe adapted for home telemonitoring for chronic heart failure.     

基于DDS芯片的多频阻抗激励源的设计

目的：设计一个采用直接数字合成技术的电流模式多频阻抗激励源。方法：作者设计了基于DDS芯片AD9850的波形发生单元和基于AD844的电压电流转换单元的阻抗激励源系统。并对其各项性能进行了测试。结果：激励源的频率分辨率高，频率设置方便，VI电压电流转换性能较好，信号质量较高。结论：基于AD9850芯片的激励源适用于阻抗测量的实验系统和扫频模式的多频阻抗系统。     

Efficacy and safety of haemodialysis treatment with the Hemocontrol biofeedback system: a prospective medium-term study.

BACKGROUND: Hypovolaemia has been implicated as a major causal factor of morbidity during haemodialysis (HD). A model biofeedback control system for intra-HD blood volume (BV) changes modelling has been developed (Hemocontrol), Hospal Italy) to prevent destabilizing hypovolaemia. It is based on an adaptive controller incorporated in a HD machine (Integra), Hospal Italy). The Hemocontrol biofeedback system (HBS) monitors BV contraction during HD with an optical device. HBS modulates BV contraction rates by adjusting the ultrafiltration rate (UFR) and the refilling rate by adjusting dialysate conductivity (DC) in order to obtain the desired pre-determined BV trajectories. METHODS: Nineteen hypotension-prone uraemic patients (seven males, 12 females; mean age 64.5+/-3.0 SEM years; on maintenance HD for 80.5+/-13.2 months) volunteered for the present prospective study that compared the efficacy and safety of bicarbonate HD treatment equipped with HBS, as a whole, with the gold-standard bicarbonate treatment equipped with a constant UFR and DC (BD). The study included three phases: Medium-term studies started with one period of 6 months of BD and always had a follow-up period of HBS treatment ranging from 14 to 30 months (mean 24.0+/-1.6); short-term studies started in September 1999, when all patients went back to BD treatment for a wash-out period of 4 weeks and a short-term study period of a further 3 weeks (phase A). Afterwards, they once again started HBS treatment for a wash-out period of 4 weeks and a short-term study period of a further 3 weeks (phase B). Every patient underwent acute studies during a single HD run, once during phase A and once in phase B. Resistance (R) and reactance (Xc) measurements were obtained utilizing a single-frequency (50 kHz) tetrapolar bioimpedance analysis (BIA). Extracellular fluid volume (ECV) was calculated from R, Xc, and height and body weight measurements using the conventional BIA regression equations. RESULTS: The overall occurrence of symptomatic hypotension and muscle cramps was significantly less in HBS treatment in both medium- and short-term studies. Self-evaluation of intra- and inter-HD symptoms (worst score=0, best score=10) revealed a statistically significant difference, as far as post-HD asthenia was concerned (6.2+/-0.2 in HBS treatment vs 4.3+/-0.1 in BD treatment, P<0.0001). No difference was observed between the two treatments when comparing pre- and post-HD lying blood pressure, heart rate, body weights and body weight changes in medium- and short-term studies. The residual BV%/ Delta ECV% ratio, expression of the vascular refilling, was significantly higher during HBS treatment in acute studies. CONCLUSIONS: HBS treatment is effective in lowering hypovolaemia-associated morbidity compared with BD treatment; this could be related to a greater ECV stability. Furthermore, HBS is a safe treatment in the medium-term because these results are not achieved through potentially harmful changes in blood pressure, body weight, and serum sodium concentration.     

方波激励的生物电阻抗谱自动测试系统

目的为解决多频率方波自动测量生物电阻抗谱的问题,本文设计了一个方波激励的生物电阻抗谱自动测试系统。方法将任意波形函数发生器、仪表放大器和采集卡以及PC组成电阻抗谱自动测试系统,利用PC中的Labview程序分别控制函数发生器和采集卡自动完成激励的产生和数据采集,并将采集到的数据自动保存在PC中,最后利用Matlab程序对数据进行快速傅里叶变换得到阻抗谱。首先对阻抗网络模型进行阻抗谱的仿真,将仿真得到的阻抗谱和理论计算得到的阻抗谱对比;再分别使用此系统和阻抗分析仪对阻抗网络模型进行阻抗测量,将测试得到的阻抗谱进行曲线拟合得到元件值,根据元件值比较测试误差。最后,使用方波激励和稳态正弦激励对酵母细胞悬浮液进行阻抗测量,根据酵母细胞悬浮液的阻抗谱计算介电谱,将得到的介电谱和参考文献中的介电谱作比较,并比较两种激励的测量时间。结果仿真得到的阻抗谱和理论计算得到的阻抗谱一致,验证了方波激励的可行性。测试系统对阻抗网络模型的测试结果和阻抗分析仪的相比误差小于10%,验证了测试系统的正确性。使用方波激励和稳态正弦激励测试酵母细胞悬浮液的阻抗谱,转换成介电谱后,发现其变化规律和参考文献所得结果相符。在100Hz^2MHz的测试范围内,方波激励的测量时间为0.9s,稳态正弦激励的测试时间为1.7s,方波激励的测试速度快。结论本文设计的方波激励的生物电阻抗谱自动测试系统具有自动测试生物阻抗谱的能力,由于使用方波激励,可以兼顾速度和信噪比的要求,实现了计算机控制,可根据实际情况调整激励信号的参数,具有很强的灵活性和可扩展性。