Methods and reproducibility of measurement of resistivity in the calf using regional bioimpedance analysis

The usefulness of regional bioimpedance analysis (RBIA) in determining the dry weight in dialysis patients is currently being investigated. The aim of this study was to evaluate the reproducibility of measurement of resistivity in the calf. METHODS: Twenty-five normal subjects and 10 patients undergoing regular hemodialysis were studied. Four electrodes inserted into a blood pressure cuff were placed on the calf. Bioimpedance was continuously measured over 3- to 5-min periods (Xitron Hydra). After a resting period of 1 min, cuff pressure was increased to above the systolic blood pressure (SBP) for a few seconds to expel excess ECF fluid and then deflated. The effect on recordings of moving the electrodes 2 cm higher and then 2 cm lower than the normal position was studied in 8 normal subjects. In a second study of reproducibility, post-dialysis measurements were made twice in 10 patients who maintained the same post-dialysis target weight throughout the study period. RESULTS: The mean resting resistivity rho(0) in normal subjects was 532.6 +/- 95 omega.cm rising to 583.9 +/- 99.7 omega.cm when cuff pressure was applied rho(p). The average values of rho(0) and rho(p) in patients post-dialysis were 489 +/- 74 and 537 +/- 77 respectively showing that there were no significant differences in rho(0) and rho(p) between normal subjects and patients post-dialysis. The mean values of change in resistivity when the electrodes were shifted between the lowest and highest positions on the calf were -3.66 +/- 4.45 and -1.44 +/- 3.82%, respectively. Repeat measurement of resistivity in patients post-dialysis varied by 2.04 +/- 2.29% while post-dialysis body weight varied by 0.17 +/- 0.47%. CONCLUSION: In this study, resistivity measurement by RBIA at the calf showed similar levels of fluid loading in patients post-dialysis as in normal subjects. This study also showed that change in electrode position resulted in a mean change in resistivity of <5% and repeated measurements showed a change in resistivity <3% while body weight changes were <0.2%. This technique appears to have an acceptable level of reproducibility for its application to the assessment of patient hydration.     

Visceral adipose tissue level,as estimated by the bioimpedance analysis method,is associated with impaired lung function

Aims/Introduction: It has been reported that metabolic syndrome is associated with impaired lung function, and abdominal obesity is regarded as the most important determinant of this association. We evaluated the association between a component of metabolic syndrome, indices of body composition, including the total adipose tissue content, lean bodyweight and visceral adipose tissue content, as assessed by bioimpedance analysis, and lung function. Materials and Methods: A total of 516 participants responded to our questionnaire to determine the smoking status and history of past diseases. Waist circumference, height, bodyweight, percent forced expiratory volume in 1 s (%FEV1) and percent forced vital capacity (%FVC) were measured. Fasting blood samples were obtained to determine the serum levels of high‐density lipoprotein and triglyceride, and also the blood glucose. The body composition, including the total adipose tissue content and lean bodyweight, was measured, and the visceral adipose tissue content was estimated as the visceral adipose tissue level, by the bioimpedance analysis method. Results: Waist circumference, estimated visceral adipose tissue level and blood pressure were significantly associated with the %FEV1, and the serum high‐density lipoprotein cholesterol was significantly associated with the %FVC in men, after adjustment for age, smoking history, and past histories of bronchial asthma and ischemic heart disease. However, this association was not detected in women. Conclusions: We found an association between the visceral adipose tissue level as estimated by the bioimpedance analysis method and lung function. ( J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00189.x, 2011)     

Gastrointestinal and hepatic complications of hematopoietic stem cell transplantation

Recognition and management of gastrointestinal and hepatic complications of hematopoietic stem cell transplantation has gained increasing importance as indications and techniques of transplantation have expanded in the last few years. The transplant recipient is at risk for several complications including conditioning chemotherapy related toxicities, infections, bleeding, sinusoidal obstruction syndrome, acute and chronic graft-versus-host disease (GVHD) as well as other long-term problems. The severity and the incidence of many complications have improved in the past several years as the intensity of conditioning regimens has diminished and better supportive care and GVHD prevention strategies have been implemented. Transplant clinicians, however, continue to be challenged with problems arising from human leukocyte antigen-mismatched and unrelated donor transplants, expanding transplant indications and age-limit. This review describes the most commonly seen transplant related complications, focusing on their pathogenesis, differential diagnosis and management.     

Reliability of bioimpedance and indirect calorimetry to evaluate resting metabolic rate in Brazilian women with metabolic syndrome

Background and aimsPrecise evaluation of resting metabolic rate (RMR) is critical, especially for seniors in syndromes conditions. The study aimed to compare different methods and devices to evaluate the resting metabolic rate and assess them’ reliability in Brazilian women with metabolic syndrome.MethodsA single-center prospective study with forty elderly postmenopausal women was performed to verify the reliability of indirect calorimetry (IC) versus Bioimpedance (BIA) on RMR fluctuations for an interval length of six months.ResultsMeasurements showed a high correlation between devices at baseline [BIA vs IC, intraclass correlation coefficient (ICC) = 0.906 (0.822–0.950)]. Surprisingly, a high correlation was kept between BIA and IC after six months [BIA vs. IC, ICC = 0.909 (0.829–0.952)]. The results suggest that both BIA and IC are excellent strategies to measure RMR in elderly postmenopausal women and with metabolic syndrome.ConclusionsHowever, the BIA method presents greater convenience, optimizes patients’ time, and does not require prolonged fasting to obtain good reliable results compared to IC.     

Reducing the incidence of post-hepatectomy hepatic complications by preoperatively applying parameters predictive of liver function

Background/purpose

To prevent or reduce hepatic complications after hepatectomy, it is important to employ preoperative predictive parameters and to determine the indications for hepatectomy. In the present study, we evaluated risk parameters in patients who underwent hepatectomy between 1994 and 2003, and selected three parameters to modify the surgical indications. Using these indications before surgery in patients who underwent hepatectomy between 2004 and 2008, we compared the prevalences of postoperative complications in the the two groups of patients.

Methods

We examined 250 consecutive patients who underwent hepatectomy for liver disease [149 in 1994–2003 (termed the early period) and 101 in 2004 to 2008 (termed the later period)].

Results

In the early period, uncontrolled ascites was observed in 55 patients and hepatic failure was observed in 15 of the 149 patients. Multivariate analysis identified volume of the resected liver (≥50%), intraoperative blood loss (≥1500 ml), prothrombin activity (<70%), hyaluronic acid level (≥200 ng/ml), and LHL15 (hepatic uptake ratio of technetium-99m galactosyl human serum albumin (^99mTc-GSA) (<0.85) as risk factors; the latter three parameters were evaluated as predictors of outcome. From 2004, we used these three parameters, in addition to the indocyanine green retention rate at 15 min (ICGR15), as criteria for indications for hepatectomy. Despite the lower prevalence of normal liver in the later period, comparisons showed decreases in the rates of uncontrolled ascites (23 vs. 37%, P = 0.03), hepatic failure (4 vs. 10%, P = 0.12), and hepatic complications (25 vs. 44%, P = 0.003) in patients in the later period compared with these rates in the previous period.

Conclusions

The use of prothrombin activity, and levels of hyaluronic acid and LHL15, as parameters of functional liver reserve in the selection of candidates for surgery reduced the incidence of hepatic complications after hepatectomy.     

Assessment of body fat composition disturbances by bioimpedance analysis in HIV-infected adults

HIV-lipodystrophy syndrome is characterized by different patterns of body fat distribution (BFD) which are identified by clinical and body composition (BC) assessment, including bioimpedance analysis (BIA). Our aim was to compare BC in HIV-infected patients on combination antiretroviral therapy (cART) according to 4 distinct phenotypes of BFD (G1-no lipodystrophy, G2-isolated central fat accumulation, G3-lipoatrophy, G4-mixed forms of lipodystrophy) and assessed factors associated with them. Anthropometry and BIA were performed in 344 HIV-1 patients. G2 and G4 phenotype patients had significantly higher fat mass (FM) but no differences were observed in fat-free mass (FFM) and total body water among the 4 phenotypes. Significant negative associations were found between the presence of lipoatrophy and female gender, body mass index (BMI), waist (WC), hip (HC) and thigh circumferences, and total body FM estimated by BIA. After adjustment for gender, cART duration and BMI, G3 had significant lower WC [odds ratio (OR)=0.84; 0.78- 0.90] and HC (OR=0.88; 0.81-0.96) mean. Independently of gender, cART duration and BMI, G2 remained significantly associated with higher WC (OR=1.11; 1.05-1.18) and HC (OR=1.15; 1.07-1.23) mean, and with FM estimated by BIA [FM as %, OR=1.17 (1.09-1.26); and FM as kg, OR=1.15 (1.06- 1.25)]. There was a significant positive association between G4 and female gender (OR=1.66; 1.01-2.75), BMI (OR=1.10; 1.04-1.17) and WC (OR=1.15; 1.09-1.21). The similar FFM along the BFD spectrum describes the actual BC of these patients without sarcopenia. In a clinical setting, BIA is an easy and useful tool to evaluate fat mass and FFM and gives us a picture of BC that was not possible with anthropometry.     

ERCP in the diagnosis and management of complications after surgery for hepatic echinococcosis

BACKGROUND: Surgery for liver hydatidosis can result in serious morbidity and mortality. The role and efficacy of ERCP in the management of these complications was reviewed. METHODS: Retrospective analysis of 79 patients with liver hydatidosis who underwent ERCP for postoperative complications. RESULTS: All patients with biliary fistulas (n = 50) were managed by endoscopic sphincterotomy, although 9 (18%) also required a biliary endoprosthesis. Surgical reintervention was avoided in 46 (92%) patients with subsequent surgery required in only in 4 (8%). The mean time to fistula closure was 13.3 days. Patients with daughter cysts in the bile ducts (n = 7) were also treated by endoscopic sphincterotomy and evacuation of obstructing cyst material. Seven patients with elevated liver enzymes or biliopancreatic symptoms but normal ERCP findings also underwent endoscopic sphincterotomy with normalization of biochemical tests. CONCLUSIONS: ERCP is valuable for detecting and treating postoperative biliary complications after surgery for hepatic echinococcal disease. In the majority of patients, endoscopic sphincterotomy allows healing of postoperative external biliary fistulas, and should be performed as early as possible. In some cases, a biliary prosthesis may be required. Endoscopic sphincterotomy also enables clearing of the bile ducts of hydatid remnants.     

Fibronectin and Kupffer cell function in fulminant hepatic failure

The relationship between plasma fibronectin,in vitro plasma opsonic activity, which measures the biological activity of fibronectin, andin vivo Kupffer cell function, as assessed by the systemic clearance of microaggregated [¹²⁵I]albumin, were determined simultaneously in 15 patients with fulminant hepatic failure and 12 normal subjects. Both the plasma fibronectin and plasma opsonic activity were significantly reduced in patients with fulminant hepatic failure, while the systemic clearance of microaggregated albumin was decreased. There was a significant correlation between plasma fibronectin and the plasma opsonic activity on admission, but no correlation could be detected between either parameter and the clearance of microaggregated albumin. A gelatin-derived plasma expander was shown to block the plasma opsonic activity bothin vitro andin vivo. The low plasma fibronectin and decreased clearance of microaggregated albumin in fulminant hepatic failure reflect different aspects of the overall impairment of Kupffer cell function.     

Child-Pugh分级联合ICG与肝瞬时弹性值评估肝部分切除术肝细胞癌患者肝储备功能

目的探讨以肝瞬时弹性值(Fibroscan)和吲哚氰绿试验(ICG measurement)补充Child-Pugh分级形成的肝储备功能新评分系统在评估原发性肝细胞癌患者肝储备功能中的可行性。方法选择2011年10月至2012年10月间本科室接受肝部分切除原发性肝细胞癌病例93例,分别于术前及术后1个月内以Child-Pugh分级与新评分系统评估肝储备功能,了解两种方法预测术后肝功能代偿情况的准确率。结果 Child-Pugh预测术后肝功能代偿良好准确率为62.22%,新分级预测术后肝功能代偿良好准确率为83.33%(P=0.033);Child-Pugh预测术后肝功能代偿轻度不良准确率为64.58%,新分级预测术后肝功能代偿轻度不良准确率为87.23%(P=0.009)。结论新分级系统较Child-Pugh评分能够更全面评价原发性肝细胞癌合并肝硬化患者围手术期肝储备功能。     

Ursodeoxycholic acid for the prevention of hepatic complications in allogeneic stem cell transplantation

The role of ursodeoxycholic acid (UDCA) in the prevention of hepatic complications after allogeneic stem cell transplantation was studied in a prospective randomized open-label multicenter trial. A total of 242 patients were allocated to receive (n = 123) or not to receive (n = 119) UDCA in the dose of 12 mg/kg/d orally from the day preceding the conditioning until day 90 after transplantation. In the UDCA-treated group a significantly smaller proportion of patients developed a serum bilirubin level exceeding 50 microM (18 of 123 versus 31 of 119, P =.04), and similarly a smaller proportion of patients exceeded the alanine aminotransferase level of 100 U/L. There was no difference in the incidence of veno-occlusive disease of the liver. Compared to the control group, in the UDCA-treated group there was a nonsignificant trend toward a lower overall incidence of acute graft-versus-host disease (GVHD) and a significantly lower incidence of grade III to IV acute GVHD (5 of 123 versus 17 of 119, P =.01), stage II to IV liver and intestinal GVHD, and stage III to IV skin GVHD. There was no difference in the incidence of chronic GVHD or in the relapse rate. Among the patients given UDCA, the survival at 1 year was significantly better, 71% versus 55% (P =.02), and the nonrelapse mortality rate was lower, 19% versus 34% (P =.01), than in the control group. There were significantly more deaths in GVHD in the control group. In conclusion, UDCA administration reduced hepatic problems and severe acute GVHD and improved survival. These results suggest a role for UDCA in the prevention of transplant-related complications in allogeneic transplantation.     

Treatment of complications of hepatic hydatid disease by ERCP

BACKGROUND: The aim of this study was to evaluate the effectiveness of endoscopic sphincterotomy for preoperative and postoperative complications of hepatic hydatid disease. METHODS: Nineteen patients underwent endoscopic treatment for complications of hepatic hydatid disease. Indications for ERCP in 5 patients treated before surgery (Group A) were obstructive jaundice in 1 and acute cholangitis in 4. In 14 patients treated after surgery (Group B), the indication was acute cholangitis in 6, obstructive jaundice 2, and persistent external drainage in 6 patients. OBSERVATIONS: In group A, ERCP detected hydatid vesicles within the bile duct. All patients underwent endoscopic sphincterotomy and clearance of the duct with no complications. The 6 patients in Group B with persistent external drainage had biliary fistulas that resolved after endoscopic treatment within 10 to 20 days. Among the 8 patients with postoperative obstructive jaundice or acute cholangitis, 7 had cyst remnants obstructing the bile duct and 1 had findings of sclerosing cholangitis. All underwent endoscopic sphincterotomy and clearance of the bile duct without complications. After treatment, all patients, with the exception of the one with sclerosing cholangitis, remained asymptomatic. CONCLUSION: Endoscopic sphincterotomy is a safe and effective treatment for biliary complications of hepatic hydatid disease.     

Serial body composition by bioimpedance analysis in a diabetic subject with rapid insulin-induced weight gain--a case report

Insulin treatment is well known to induce progressive body weight gain. However, rapid weight increase due to transient fluid accumulation is rare. Bioelectrical impedance analysis (BIA) is a convenient method for determining body composition and water content. We report an 18-year-old diabetic female with rapid insulin-induced weight gain due to excessive body water retention, found by serial BIA measurement. The patient was admitted to our hospital due to uncontrolled diabetes. She had an initial body weight of 55 kg and height of 165 cm. However, a weight gain of 6.5 kg was noted one week after starting insulin injections and further increased to 8 kg after the second week. Finally a net weight increase of 4 kg from fat and lean mass was attained after two months. The weekly BIA data showed that most of the initial weight gain came from water retention, peaking on day 14 and recovering afterwards. Rapid weight gain shortly after insulin therapy may be due to excessive but reversible water retention, detected by repeated BIA measurements.     

肠道微生态与肝性脑病的关系

肝性脑病(HE)是肝硬化患者常见的一种复杂的神经精神性并发症,具有高发病率、高复发率及高病死率的特点,也是住院和再住院风险增加的一个重要因素。目前对于HE的治疗尚无特效药物,近年来研究发现,肠道微生态变化与HE的发生、发展及预后相关,而且调整肠道菌群对HE有一定的预防性作用。旨在对近年来肠道微生态与HE之间关系的研究进行总结,希望为临床防治HE提供新的治疗思路。