Normal Reference Plots for the Bioelectrical Impedance Vector in Healthy Korean Adults

BACKGROUND: Accurate volume measurement is important in the management of patients with congestive heart failure or renal insufficiency. A bioimpedance analyser can estimate total body water in litres and has been widely used in clinical practice due to its non-invasiveness and ease of results interpretation. To change impedance data to volumetric data, bioimpedance analysers use equations derived from data from healthy subjects, which may not apply to patients with other conditions. Bioelectrical impedance vector analysis (BIVA) was developed to overcome the dependence on those equations by constructing vector plots using raw impedance data. BIVA requires normal reference plots for the proper interpretation of individual vectors. The aim of this study was to construct normal reference vector plots of bioelectrical impedance for Koreans. METHODS: Bioelectrical impedance measurements were collected from apparently healthy subjects screened according to a comprehensive physical examination and medical history performed by trained physicians. Reference vector contours were plotted on the RXc graph using the probability density function of the bivariate normal distribution. We further compared them with those of other ethnic groups. RESULTS: A total of 242 healthy subjects aged 22 to 83 were recruited (137 men and 105 women) between December 2015 and November 2016. The centers of the tolerance ellipses were 306.3 Ω/m and 34.9 Ω/m for men and 425.6 Ω/m and 39.7 Ω/m for women. The ellipses were wider for women than for men. The confidence ellipses for Koreans were located between those for Americans and Spaniards without overlap for both genders. CONCLUSION: This study presented gender-specific normal reference BIVA plots and corresponding tolerance and confidence ellipses on the RXc graph, which is important for the interpretation of BIA-reported volume status in patients with congestive heart failure or renal insufficiency. There were noticeable differences in reference ellipses with regard to gender and ethnic groups.

Incidencia del edema pulmonar no cardiogénico mediante estudio histopatológico periodo 2013 ­ 2016 / Incidence of noncardiogenic pulmonary edema by histopathological study period 2013 ­ 2016

El edema pulmonar no cardiogénico es una entidad fisiopatológica caracterizada por una lesión generalizada de los capilares pulmonares que provoca un aumento de su permeabilidad a los líquidos, proteínas y otros elementos formes de la sangre, ocasionando un constante flujo de líquidos desde la circulación pulmonar hacia el espacio intersticial y los alvéolos, resultando el edema pulmonar no cardiogénico. El objetivo de este estudio es considerar la incidencia de esta entidad en los casos de muertes súbitas, por medio del estudio histopatológico y caracterizar los factores predisponentes relacionados a esta patología. Todas las muestras fueron sometidas a procedimientos técnicos para estudio histopatológico para confirmar o descartar el diagnóstico macroscópico emitido en la necropsia. Para este estudio se analizaron 518 informes de estudio histopatológico correspondientes a los años 2013, 2014, 2015 y 2016, las cuales 119 correspondieron a edema pulmonar no cardiogénico, siendo el 22,97 % de estos 119 informes de estudio histopatológico se analizaron e interpretaron de acuerdo con los factores predisponentes teniendo como hallazgo importante 39,49 % al síndrome metabólico; 21,84 % a la intoxicación alcohólica; 14,28 % a la intoxicación medicamentosa, entre otros. De esto concluimos que es importante realizar el estudio histopatológico a los casos de muerte súbita sin diagnóstico, puesto que algunas pueden ser encasilladas en un síndrome metabólico o intoxicaciones que ameritan investigación para determinar la causa de muerte.

Non-cardiogenic pulmonary edema is a pathophysiological entity characterized by a generalized lesion of the pulmonary capillaries that causes an increase of its permeability to the fluids, proteins and other form elements of the blood, causing a constant flow of liquids from the pulmonary circulation towards the interstitial space and alveoli, resulting in non-cardiogenic pulmonary edema. The aim of this study is to consider the incidence of this entity in cases of sudden deaths, through the histopathological study and to characterize the predisposing factors related to this pathology. All samples were subjected to technical procedures for histopathological study to confirm or rule out the macroscopic diagnosis emitted at necropsy. For this study, 518 histopathological reports corresponding to the years 2013, 2014, 2015 and 2016 were analyzed, of which 119 corresponded to non-cardiogenic pulmonary edema, with 22.97% of these 119 histopathological reports being analyzed and interpreted according to to the predisposing factors having as important finding 39.49% to the metabolic syndrome; 21.84% to alcoholic intoxication; 14.28% to drug intoxication among others. From this we conclude that it is important to carry out the histopathological study to cases of sudden death without diagnosis since some may be pigeonholed in a metabolic syndrome or poisonings that warrant investigation to determine the cause of death.

Modificación del volumen de los compartimientos líquidos corporales en pacientes tratados con cirugía correctora por cardiopatía isquémica / Volume modification of body fluids compartments in patients treated with corrective surgery due to ischemic heart disease

Se realizó un estudio descriptivo, longitudinal y prospectivo de 36 pacientes del sexo masculino con cardiopatía isquémica, intervenidos mediante cirugía correctora sin circulación extracorpórea en el Centro Territorial de Cirugía Cardiovascular de Santiago de Cuba, durante el primer cuatrimestre de 2010, a fin de identificar las modificaciones del vector de impedancia ante cambios del volumen del agua corporal por estrés quirúrgico en comparación con una población de referencia, para lo cual se utilizó el método de bioimpedancia eléctrica a 50 kHz. En la serie se apreciaron diferencias significativas en el eje mayor de las elipses de tolerancia (asociado al estado de hidratación) y en el eje menor (asociado a cambios de estructura), y la distribución del agua fue significativamente diferente entre la población de referencia y los pacientes en los estados preoperatorio y posoperatorio. Pudo concluirse que el método del análisis vectorial por bioimpedancia resulta útil para detectar las modificaciones del volumen de agua corporal provocadas por el estrés quirúrgico

A descriptive, longitudinal and prospective study of 36 patients of the male sex with ischemic heart disease was carried out. They were surgically treated by means of corrective surgery without extracorporeal circulation in the Territorial Center of Cardiovascular Surgery in Santiago de Cuba, during the first quarter of 2010, in order to identify the modifications of the impedance vector because of volume changes in body water due to surgical stress in comparison with a reference population, for which the electric bioimpedance method was used at 50 kHz. In the series significant differences in the highest axis of the tolerance ellipses were seen (associated to the hydration state) and in the smallest axis (associated to structure changes), and the distribution of water was significantly different between the reference population and the patients in the preoperative and postoperative conditions. It was concluded that the method of the vectorial analysis through bioimpedance is useful to detect the volume modifications of the body water caused by surgical stress

Exposición a fluidos corporales en trabajadores de salud del Hospital Universitario de Caracas: primer reporte: años 1991-1999 Caracas República de Venezuela / Exposure to body fluids in health workers the Hospital Universitario de Caracas: first report: years 1991-1999 Caracas República de Venezuela

Estudio prospectivo diseñado con el fin de evaluar a los trabajadores de salud del Hospital Universitario de Caracas que notificaran exposición a fluidos corporales al Sistema de Vigilancia de Virus de Inmunodeficiencia Humana y Hepatitis Viral, desde los años 1991 hasta 1999. Las variables estudiadas fueron: fecha y sitio del accidente, categoría del personal, edad, género, fluido involucrado, tipo de exposición, instrumento utilizado, serología basal para Virus de Inmunodeficiencia Humana y hepatitis viral del paciente índice y del TS, tipo de profilaxis antirretroviral, efectos adversos y seroconversión al Virus de Inmunodeficiencia Humana. Se utilizó el método descriptivo serie de casos los cuales fueron analizados por Epi-info. Versión 5. Durante el período de estudio fueron evaluados 242 trabajadores de la salud con exposición a fluidos corporales, 65% accidentes fueron notificados los dos últimos años. Ciento sesenta y tres femeninos y 79 masculinos, edad promedio 43 años (rango de 21-65 años). Los trabajadores de la salud que notificaron exposición a fluidos corporales procedían principalmente de los servicios de medicina interna, emergencia y cirugía. El mayor número de los accidentes correspondió a los médicos, principalmente residentes de posgrado. Exposición de tipo parenteral fue observada en 197 casos (179 percutáneas, y 18 salpicaduras en mucosas). Exposición cutánea se observó en 14 y combinada (piel y mucosas) 23 casos. El instrumento utilizado en 179 exposiciones percutáneas fue aguja con lumen en 48%. El fluido corporal involucrado fue la sangre en el 73% de los casos. La fuente fue conocida en 65% de las exposiciones. La profilaxis antirretroviral posexposición fue indicada inicialmente en 52% de los TS. Los efectos adversos se presentaron en 40%, en 7 casos fue motivo de abandono de tratamiento. El seguimiento se realizó en el 80% de los casos. Un trabajador de salud presentó Virus de Inmunodeficiencia Humana ocupacional...

Prospective study designed to assess the health workers at the Hospital Universitario de Caracas to notify body fluid exposure to Human Immunodeficiency Virus Surveillance System and Viral Hepatitis, from the years 1991-1999. The variables studied were: date and place of the accident, staff category, age, gender, fluid involved, type of exposure, instrument used, and baseline serology for Human Immunodeficiency Virus and Viral Hepatitis of health workers and index patient, type of prophylaxis antiretroviral, side effects and Human Immunodeficiency Virus seroconversion. Descriptive method was used series of cases which were analyzed by Epi-info. Version 5. During the study period were evaluated health workers 242 with body fluid exposure, 65% accidents were reported the past two years. 163 female and 79 male, mean age 43 years (range 21-65 years). Health workers who reported exposure to body fluids were mainly of Internal Medicine, Emergency and Surgery. The greatest numbers of injuries were doctors, mainly postgraduate residents. Parenteral exposure rate was observed in 197 cases (179 percutaneous, splash to mucous membranes 18). Dermal exposure was observed in 14 and combined (skin and mucosa) 23 cases. The instrument used in 179 percutaneous exposures was needle lumen in 48%. The body fluid blood was involved in 73% of cases. The source was known in 65% of exposures. Antiretroviral prophylaxis post exposure was initially indicated in 52% of the TS. Adverse events occurred in 40 %, in 7 cases was cause for withdrawals. The monitoring was performed in 80%. A case of Human Immunodeficiency Virus occupational in which it ruled out other risk factors

Manejo odontológico del paciente con enfermedad renal crónica terminal: revisión bibliográfica / Dental management of patients with chronic renal disease: a review

La enfermedad renal avanzada es la incapacidad de los riñones para excretar los productos de desecho del organismo, concentrar la orina y conservar los electrolitos, que trae como consecuencia manifestaciones sistémicas que provocan patologías bucales entre otras entidades. El objetivo de esta investigación es realizar una revisión bibliográfica destacando las manifestaciones bucales más importantes, el manejo y cuidados que debe tener el odontólogo al momento de atender a un paciente que presente este trastorno

Advanced renal disease is the inability of the kidneys to excrete waste products from the body, concentrate urine and conserve electrolytes, which results in systemic manifestations that cause oral pathologies among others. The objective of this research is to review literature highlighting the most important oral manifestations, management and care that should the dentist have when treating a patient with this disorder

Influence of recombinant human growth hormone on body fluid compartments and water-sodium retention in severe burn patients / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the influence of recombinant human growth hormone (rhGH) on body fluid compartments and water-sodium retention in severe burn patients.</p><p><b>METHODS</b>Thirty adult patients with severe burn were divided into treatment (T) and control (C) groups by block randomized design. Patients in both groups were subcutaneously injected with same amount of rhGH (12 IU/d) or isotonic saline during 7 - 21 post burn day (PBD). The total body water (TBW), intracellular water (ICW), extracellular water (ECW) were measured by bioelectrical impedance analysis (BIA) on 7, 14, 21 PBD. The 24 h urinary output of Na+ was determined by ion selective electrode method (ISE).</p><p><b>RESULTS</b>There were no significant difference in levels of TBW, ICW, ECW and 24 h urinary output of Na+ between two groups on 7, 14, 21 PBD (P > 0.05). No difference in results was found between groups at different time points (P > 0.05). After the data were analyzed, the level of TBW (36 +/- 6 L), ICW (21 +/- 4 L) on 21 PBD were evidently lower than those on 7 PBD (38 +/- 6 L, 23 +/- 7 L, P < 0.01).</p><p><b>CONCLUSION</b>The level of ICW and TBW in severe burn patients decreased along with the time. Proper dosage of rhGH has no significant effect on body fluid compartments and water-sodium retention.</p>

Manejo de accidente laboral exposición a fluidos corporales / Handling of the labor accident with exhibition to corporal fluids

The flowed cut-sharp accidents with of high biological risk constitute a problem of ealth o the personnel wo has an important psycological impact. To know the risk I infect and its suitableaning is fundamental in a Hospital of high complexity.

Los accidentes corto-punzantes con fluidos de alto riesgo biológico constituyen un problema de salud del personal que tiene un importante impacto psicológico. Conocer los riesgos de contagio y su manejo adecuado es fundamental en un hospital de alta calidad.

Assessment of Fluid Shifts of Body Compartments using Both Bioimpedance Analysis and Blood Volume Monitoring

Fluid shifts are commonplace in chronic hemodialysis patients during the intra- and interdialytic periods. In this study, we evaluated fluid shifts of body compartments using both bioimpedance spectroscopy and blood volume monitoring from the start to the end of hemodialysis. 24 stable hemodialysis patients were included on the study. Relative change of blood volume was progressively reduced from the start to the end of hemodialysis (1 hr, -7.22+/-3.23%; 2 hr, -9.78+/-4.69%; 3 hr, -12.88+/-5.65%; 4 hr, -15.41+/-6.54%, respectively). Mean % reduction of intracellular fluid was not significantly different to that of extracellular fluid at the end of hemodialysis (delta ICF, -6.58+/-5.34% vs. delta ECF, -7.07+/-5.12%). Mean % fluid reduction of arms, legs and trunk was -11.98+/-6.76%, -6.43+/-4.37% and -7.47+/-4.56%, respectively at the end of hemodialysis. There were 3 characteristic patterns in blood-volume change. Similar amounts of fluid were removed from the extracellular and intracellular compartments during hemodialysis, with the arms showing the greatest loss in terms of body segments. The pattern of blood volume change measured by blood volume monitoring may be useful for more accurate determination of dry-weight and for correcting volume status in hemodialysis patients.

Bioelectrical impedance spectroscopy for the assessment of body fluid volumes of term neonates

The assessment of fluid volume in neonates by a noninvasive, inexpensive, and fast method can contribute significantly to increase the quality of neonatal care. The objective of the present study was to calibrate an acquisition system and software to estimate the bioelectrical impedance parameters obtained by a method of bioelectrical impedance spectroscopy based on step response and to develop specific equations for the neonatal population to determine body fluid compartments. Bioelectric impedance measurements were performed by a laboratory homemade instrument. The volumes were estimated in a clinical study on 30 full-term neonates at four different times during the first month of life. During the first 24 hours of life the total body water, extracellular water and intracellular water were 2.09 ± 0.25, 1.20 ± 0.19, and 0.90 ± 0.25 liters, respectively. By the 48th hour they were 1.87 ± 0.27, 1.08 ± 0.17, and 0.79 ± 0.21 liters, respectively. On the 10th day they were 2.02 ± 0.25, 1.29 ± 0.21, and 0.72 ± 0.14 liters, respectively, and after 1 month they were 2.34 ± 0.27, 1.62 ± 0.20, and 0.72 ± 0.13 liters, respectively. The behavior of the estimated volume was correlated with neonatal body weight changes, leading to a better interpretation of such changes. In conclusion, this study indicates the feasibility of bioelectrical impedance spectroscopy as a method to help fluid administration in intensive care neonatal units, and also contribute to the development of new equations to estimate neonatal body fluid contents.

Application of Multi-frequency Bioelectrical Impedance Analysis for Body Water Evaluation in Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: It is necessary to measure total body water (TBW) in evaluation of the hemodialysis adequacy. Waston's equation has been used clinically. And it is important to measure adequate dry body weight to avoid fluid overloading after hemodialysis. But there was no objective method to measure dry body weight, it was estimated subjectively by clinicians (doctors and nurses). Multi-frequency bioelectrical impedance analysis (MFBIA) has emerged as a clinical tool of the measurement of total body water (TBW) and body fluid compartment (ICW, ECW). The purpose of this study is to investigate the correlation MFBIA-TBW and Watson equation, Then intracellular water (ICW)/extracellular water (ECW) ratio (I/E ratio) usefulness in the evaluation of dry body weight. METHODS: 20 HD patients treated 3 times/week and 21 sex and age adjusted normal control subjects were studied. We measuerd and compared MFBIA-TBW to Waston equation, estimate reproducibility MFBIA-TBW measurement. Then MFBIA-ECW, ICW and I/E ratio were measured and compared dialysis patients both pre- and post dialysis to control group. RESULTS: The correlation between Wastron-TBW and MFBIA-TBW for patients was 0.948 (p<0.001). The closeness of agreement between MFBIA-TBW and Waston-TBW is shown Bland-Altman plots. There was no difference in post-dialysis patient's ICW/ECW ratio compared to control group. CONCLUSION: MFBIA is useful tool for dialysis patients' TBW measurements. Also ICW/ECW ratio measurement by MFBIA may be used to estimate the adequate ultrafiltration.

Airway rapidly adapting receptors--sensors of pulmonary extra-vascular fluid volume.

The factors regulating transfer of fluid into the pulmonary extra-vascular space and the role of sensory receptors of the airways in detecting such fluid fluxes are reviewed and discussed. It is concluded that the rapidly adapting receptors (RARs) located in apposition to bronchial venules are highly sensitive to changes in the pulmonary extra-vascular space produced by mild elevations of left atrial pressure, plasmapheresis and pulmonary lymphatic obstruction and their activation causes respiratory stimulation, an increase in tracheal tone and cough. There is a reflex diuresis also following the stimulation of these receptors by pulmonary lymphatic obstruction. It is proposed that the RARs function as a sensory component of the pulmonary defence mechanisms which preserve the 'milieu interior'.

Volumen circulante medido por la depuración de agua libre, en niños operados del corazón / The circulatory volumen in children ongoing cardiac surgery

Se midió el volumen circulante en 10 niños que ingresaron a cirugía cardiaca, mediante la depuración de agua libre (CH2O). Se determinó la CH2O antes del hecho quirúrgico obteniendo una media de -0.5016 mL/min, y posterior a ésta, con una mediana de -0.14, (p< 0.05). Se valoró la función renal mediante la depuración de creatinina y la fracción excretada de sodio pre y postquirúrgico, sin encontrar variación entre ellos, fuera de la función renal normal. Se correlacionaron los valores de CH2O con la diferencia de peso y la densidad urinaria, antes y después de la cirugía cardiaca, así como la presión venosa central, estableciéndose una asociación para determinar que existió un aumento del volumen cirulante

Total body water measurements by deuterium dilution in adult Indian males and females.

Total Body Water (TBW) was measured in a group of 20 healthy adult Indian men and 10 women by the deuterated water dilution technique and their body composition was determined by applying a hydration factor of 0.7194 for fat free mass (FFM). The TBW in the male subjects whose mean body weight was 49.8 +/- 6.7 kg, was 60.6 +/- 3.2% of body weight (range 55.8%-65.4%), from which a FFM of 41.9 +/- 6.1 kg (range 31.8 kg-51.3 kg) was obtained. Total body water in the group of 10 female subjects whose mean body weight was 42.7 +/- 4.9 kg, was 57.0 +/- 4.5% of body weight (range 52.5%-64.2%) from which a FFM of 34.0 +/- 5.1 kg (range 28.4 kg-39.4 kg) was obtained.

Physiological studies in the South American camelid llama (Lama guanicoe f. d. glama). I. Body water spaces and water turnover

En ocho animales adultos de ambos sexos durante el invierno se determinaron mediante agua tritiada (THO) y 82Br. el agua corporal (AC) y extracelular (AEC) en forma simultánea. Se midieron el tiempo medio biológical del THO(T1/2THO) y el recambio diario de agua (RDA) y se calculó el agua intracelular (AIC). Los estudios con THO se repitieron en los mismos animales y en dos hembras en lactación durante la primavera y el verano. En la primavera también se estudaron dos animales lactantes. Los valores obtenidos en invierno fueron: AC 659 ñ 12ml/Kg; T1/2THO 9.2 ñ 1 día, RDA en 24h 50 ñ 3ml/Kg ó 116 ñ ml/Kg**.82 y 163 ml/AC**.82; AEC 215 ml/Kg ó 32.5 por ciento del AC. Los resultados registrados durante los estudios de primavera mostraron un incremento en los valores de RDA altamente significativo y en verano un aumento adicional en todos los animales, cuando los datos se expresan como porciento de los sólidos del cuerpo, ello fue más notable en las hembras en lactación. La porporción del AC fue también significativamente más alta en todos los animales en el verano. En los animales en lactación durante el verano el AC fue de 783 ñ 9ml/Kg y en los otros animales 718 ñ 18ml/Kg; los valores de T1/2 THO fueron 3.3 ñ 06 y 4.5 ñ 4 días, respectivamente. El RDA fue 396 ñ 9ml/Kg**.82 ó 484 ñ 8ml/l AC**.82 en los animales en lactación y 260ml/Kg**.82 ó 314 ñ 12ml/l AC**.82 en los otros animales. Los valores de RDA fueron más altos que los registrados en camellos dromedarios, pero más bajos que los reportados para diferentes tipos de bovinos, ovejas y cabras. Se postula que, aunque todos los camélos tienen un antecesor común y antecedentes evolutivos semejantes, las adaptaciones fisiológicas a condiciones desérticas diferentes, dio como resultado características particulares en el metabolismo del agua para cada especie

Organ fluid compartments in rats exposed to high altitude.

Rats were exposed to acute hypobaric hypoxia corresponding to an altitude of 6,100 m for 5 hours and 24 hours and were studied for organ fluid changes. Total water and extracellular water content of various organs, i.e. lung, liver, spleen, heart, kidney, muscle, brain testis and subcutaneous tissue were determined by the difference of dry and wet weights and using radiobromide-82 respectively. Lung and liver were found to be significantly hydrated with lower water contents in subcutaneous tissue, spleen and muscle on prolonged exposure. The data indicated a shift of fluids from extracellular to intracellular compartment.