A Handheld and Textile-Enabled Bioimpedance System for Ubiquitous Body Composition Analysis. An Initial Functional Validation.

In recent years, many efforts have been made to promote a healthcare paradigm shift from the traditional reactive hospital-centered healthcare approach towards a proactive, patient-oriented, and self-managed approach that could improve service quality and help reduce costs while contributing to sustainability. Managing and caring for patients with chronic diseases accounts over 75% of healthcare costs in developed countries. One of the most resource demanding diseases is chronic kidney disease (CKD), which often leads to a gradual and irreparable loss of renal function, with up to 12% of the population showing signs of different stages of this disease. Peritoneal dialysis and home haemodialysis are life-saving home-based renal replacement treatments that, compared to conventional in-center hemodialysis, provide similar long-term patient survival, less restrictions of life-style, such as a more flexible diet, and better flexibility in terms of treatment options and locations. Bioimpedance has been largely used clinically for decades in nutrition for assessing body fluid distributions. Moreover, bioimpedance methods are used to assess the overhydratation state of CKD patients, allowing clinicians to estimate the amount of fluid that should be removed by ultrafiltration. In this work, the initial validation of a handheld bioimpedance system for the assessment of body fluid status that could be used to assist the patient in home-based CKD treatments is presented. The body fluid monitoring system comprises a custom-made handheld tetrapolar bioimpedance spectrometer and a textile-based electrode garment for total body fluid assessment. The system performance was evaluated against the same measurements acquired using a commercial bioimpedance spectrometer for medical use on several voluntary subjects. The analysis of the measurement results and the comparison of the fluid estimations indicated that both devices are equivalent from a measurement performance perspective, allowing for its use on ubiquitous e-healthcare dialysis solutions.

Assessment of Mental, Emotional and Physical Stress through Analysis of Physiological Signals Using Smartphones.

Determining the stress level of a subject in real time could be of special interest in certain professional activities to allow the monitoring of soldiers, pilots, emergency personnel and other professionals responsible for human lives. Assessment of current mental fitness for executing a task at hand might avoid unnecessary risks. To obtain this knowledge, two physiological measurements were recorded in this work using customized non-invasive wearable instrumentation that measures electrocardiogram (ECG) and thoracic electrical bioimpedance (TEB) signals. The relevant information from each measurement is extracted via evaluation of a reduced set of selected features. These features are primarily obtained from filtered and processed versions of the raw time measurements with calculations of certain statistical and descriptive parameters. Selection of the reduced set of features was performed using genetic algorithms, thus constraining the computational cost of the real-time implementation. Different classification approaches have been studied, but neural networks were chosen for this investigation because they represent a good tradeoff between the intelligence of the solution and computational complexity. Three different application scenarios were considered. In the first scenario, the proposed system is capable of distinguishing among different types of activity with a 21.2% probability error, for activities coded as neutral, emotional, mental and physical. In the second scenario, the proposed solution distinguishes among the three different emotional states of neutral, sadness and disgust, with a probability error of 4.8%. In the third scenario, the system is able to distinguish between low mental load and mental overload with a probability error of 32.3%. The computational cost was calculated, and the solution was implemented in commercially available Android-based smartphones. The results indicate that execution of such a monitoring solution is negligible compared to the nominal computational load of current smartphones.

Wearable biomedical measurement systems for assessment of mental stress of combatants in real time.

The Spanish Ministry of Defense, through its Future Combatant program, has sought to develop technology aids with the aim of extending combatants' operational capabilities. Within this framework the ATREC project funded by the "Coincidente" program aims at analyzing diverse biometrics to assess by real time monitoring the stress levels of combatants. This project combines multidisciplinary disciplines and fields, including wearable instrumentation, textile technology, signal processing, pattern recognition and psychological analysis of the obtained information. In this work the ATREC project is described, including the different execution phases, the wearable biomedical measurement systems, the experimental setup, the biomedical signal analysis and speech processing performed. The preliminary results obtained from the data analysis collected during the first phase of the project are presented, indicating the good classification performance exhibited when using features obtained from electrocardiographic recordings and electrical bioimpedance measurements from the thorax. These results suggest that cardiac and respiration activity offer better biomarkers for assessment of stress than speech, galvanic skin response or skin temperature when recorded with wearable biomedical measurement systems.

Sensorized garments and textrode-enabled measurement instrumentation for ambulatory assessment of the autonomic nervous system response in the ATREC project.

Advances in textile materials, technology and miniaturization of electronics for measurement instrumentation has boosted the development of wearable measurement systems. In several projects sensorized garments and non-invasive instrumentation have been integrated to assess on emotional, cognitive responses as well as physical arousal and status of mental stress through the study of the autonomous nervous system. Assessing the mental state of workers under stressful conditions is critical to identify which workers are in the proper state of mind and which are not ready to undertake a mission, which might consequently risk their own life and the lives of others. The project Assessment in Real Time of the Stress in Combatants (ATREC) aims to enable real time assessment of mental stress of the Spanish Armed Forces during military activities using a wearable measurement system containing sensorized garments and textile-enabled non-invasive instrumentation. This work describes the multiparametric sensorized garments and measurement instrumentation implemented in the first phase of the project required to evaluate physiological indicators and recording candidates that can be useful for detection of mental stress. For such purpose different sensorized garments have been constructed: a textrode chest-strap system with six repositionable textrodes, a sensorized glove and an upper-arm strap. The implemented textile-enabled instrumentation contains one skin galvanometer, two temperature sensors for skin and environmental temperature and an impedance pneumographer containing a 1-channel ECG amplifier to record cardiogenic biopotentials. With such combinations of garments and non-invasive measurement devices, a multiparametric wearable measurement system has been implemented able to record the following physiological parameters: heart and respiration rate, skin galvanic response, environmental and peripheral temperature. To ensure the proper functioning of the implemented garments and devices the full series of 12 sets have been functionally tested recording cardiogenic biopotential, thoracic impedance, galvanic skin response and temperature values. The experimental results indicate that the implemented wearable measurement systems operate according to the specifications and are ready to be used for mental stress experiments, which will be executed in the coming phases of the project with dozens of healthy volunteers.

Nodal marginal zone lymphoma: gene expression and miRNA profiling identify diagnostic markers and potential therapeutic targets.

Nodal marginal zone lymphoma (NMZL) is a small B-cell neoplasm whose molecular pathogenesis is still essentially unknown and whose differentiation from other small B-cell lymphomas is hampered by the lack of specific markers. We have analyzed gene expression, miRNA profile, and copy number data from 15 NMZL cases. For comparison, 16 follicular lymphomas (FLs), 9 extranodal marginal zone lymphomas, and 8 reactive lymph nodes and B-cell subtypes were included. The results were validated by quantitative RT-PCR in an independent series, including 61 paraffin-embedded NMZLs. NMZL signature showed an enriched expression of gene sets identifying interleukins, integrins, CD40, PI3K, NF-κB, and TGF-ß, and included genes expressed by normal marginal zone cells and memory B cells. The most highly overexpressed genes were SYK, TACI, CD74, CD82, and CDC42EP5. Genes linked to G(2)/M and germinal center were down-regulated. Comparison of the gene expression profiles of NMZL and FL showed enriched expression of CHIT1, TGFB1, and TACI in NMZL, and BCL6, LMO2, and CD10 in FL. NMZL displayed increased expression of miR-221, miR-223, and let-7f, whereas FL strongly expressed miR-494. Our study identifies new candidate diagnostic molecules for NMZL and reveals survival pathways activated in NMZL.

An analog front-end enables electrical impedance spectroscopy system on-chip for biomedical applications.

The increasing number of applications of electrical bioimpedance measurements in biomedical practice, together with continuous advances in textile technology, has encouraged several researchers to make the first attempts to develop portable, even wearable, electrical bioimpedance measurement systems. The main target of these systems is personal and home monitoring. Analog Devices has made available AD5933, a new system-on-chip fully integrated electrical impedance spectrometer, which might allow the implementation of minimum-size instrumentation for electrical bioimpedance measurements. However, AD5933 as such is not suitable for most applications of electrical bioimpedance. In this work, we present a relatively simple analog front-end that adapts AD5933 to a four-electrode strategy, allowing its use in biomedical applications for the first time. The resulting impedance measurements exhibit a very good performance in aspects like load dynamic range and accuracy. This type of minimum-size, system-on-chip-based bioimpedance measurement system would lead researchers to develop and implement light and wearable electrical bioimpedance systems for home and personal health monitoring applications, a new and huge niche for medical technology development.

Human recombinant erythropoietin does not promote cancer growth in presence of functional receptors expressed in cancer cells.

Human recombinant erythropoietin (hrEPO) therapy might be associated with tumor progression and death. This effect has been suggested to be secondary to rhEPO binding to its receptor (EPOR) expressed on cancer cells. However, there are several concerns about EPOR functionality when expressed on cancer cells. In this paper we have provided evidence that EPOR expressed in cancer cells could be implicated in proliferation events because a transfection of EPOR siRNA to EPOR-expressing bladder cancer cells resulted in a marked reduction in cell growth. However, these cell lines do not grow in the presence of hrEPO. Furthermore, bladder cancer patients that expressed EPOR in tumor samples had a reduced survival in absence of rhEPO treatment. Therefore, EPOR is implicated in bladder cancer growth but this effect appears to be independent from rhEPO supplementation. Reports which suggest that rhEPO promotes cancer growth due to the expression of EPOR in cancer cells must be observed with caution since in the presence of functional EPOR rhEPO does not promote growth.

Dermatofibroma lineal (en placa) / Dermatofibroma (plate-like)

El dermatofibroma (DF) es una lesión de usual observación en la práctica dermatológica. Afecta preferentemente al sexo femenino y por lo general se localiza en las extremidades inferiores. El DF se manifiesta típicamente como una pápula de crecimiento lento, firme y solitaria, y menos frecuente como una plaqueta o nódulo. Presenta un número de variantes clínicas, incluyendo manifestaciones gigantes, atróficas y polipoides. Presentamos el caso de una mujer que padece un DF lineal (en placa), variante clínica de infrecuente observación.

Dermatofibroma (DF) is a frequent cutaneous condition of probable inflammatory origin, seen frequently in women, and commonly involves the lower extremities. DF typically appears as a slow-growing, firm, solitary papule, more rarely a plaque or nodule, and has diverse clinical variants, including giant, atrophic, and polypoid presentations. We report the case of a woman with an unusual clinical presentation of linear DF.

Involvement of CCL27-CCR10 interactions in drug-induced cutaneous reactions.

BACKGROUND: Drug-induced skin reactions, including toxic epidermal necrolysis and Stevens-Johnson syndrome, are severe bullous cutaneous diseases of uncertain etiology, although cytotoxic T cells seem to be involved. Cutaneous T cell-attracting chemokine (CTACK/CCL27) is selectively expressed in skin and attracts CCR10-expressing cells. Exclusive CTACK expression by keratinocytes suggests its involvement in inflammatory skin diseases. OBJECTIVE: We addressed whether CTACK/CCL27 production by the epidermis and CCR10+ lymphocytes are involved in toxic epidermal necrolysis and Stevens-Johnson syndrome. METHODS: We measured CTACK expression by epidermal cells in 2 patients with drug-induced bullous skin reactions and compared it to lesional skin from several drug-induced exanthemas. In parallel we measured CCR10 mRNA in peripheral blood mononuclear cells from the patients during the course of the disease and in lymphocytes infiltrating the skin. RESULTS: CTACK expression levels in skin biopsies from the 2 patients with drug-induced bullous reactions were higher than those found in healthy subjects or in other drug-induced exanthemas. CCR10 mRNA levels were also elevated in peripheral blood lymphocytes and in lesional skin during the acute phase of the disease. Moreover, resolution was associated with a return to baseline of both CTACK and CCR10 receptor expression. CONCLUSION: CTACK-CCR10 interactions may be involved in the selective recruitment to the skin of cytotoxic lymphocytes in toxic epidermal necrolysis and Stevens-Johnson syndrome, as well as in less severe drug-induced cutaneous diseases.

Fine-needle aspiration cytology of extranodal natural killer/T-cell lymphoma.

Extranodal NK/T-cell lymphoma, nasal type, is a predominantly extranodal lymphoma characterized histologically by prominent necrosis, angiocentric growth, and vascular destruction. Only one report describing its fine-needle aspiration (FNA) cytologic features is available and shows highly unusual findings for a lymphoma. The present case concerns a 58-yr-old patient that presented with a soft tissue mass of the thigh in addition to an ulcerative lesion of the palate and nodular hepatic and splenic lesions. FNA cytology of the thigh tumor was interpreted as a malignant mesenchymal lesion (sarcoma). The subsequent pathologic study revealed an NK/T-cell lymphoma. Our findings are very similar to those previously reported. They were highly unusual for a lymphoma and consisted of polymorphic, round to spindle neoplastic cells distributed in irregular aggregates, and single cells. No significant number of lymphoglandular bodies were present.

Radiation therapy and combination of cladribine, cyclophosphamide, and prednisone as treatment of Bing-Neel syndrome: Case report and review of the literature.

Waldenström's macroglobulinemia is a low-grade lymphoma that produces monoclonal IgM. Central nervous system symptoms are frequent in Waldenström's macroglobulinemia, mostly associated with blood hyperviscosity. Nevertheless, central nervous system infiltration by malignant cells (Bing-Neel syndrome) has rarely been reported. We describe the case of a 72-year-old man with Waldenstrom's macroglobulinemia and central nervous system infiltration by malignant cells with tumor formation. All similar cases reported in the literature are reviewed and the different therapeutic approaches discussed.