Validity analysis of respiratory events of polysomnography using a plethysmography chest and abdominal belt.

PURPOSE: Respiratory inductive plethysmography (RIP) is recommended as an alternative respiratory sensor for the identification of each apnea and hypopnea event in polysomnography. Using this sensor, the cumulative RIP results from the chest and abdomen (RIP sum) and time-derived results of the RIP sum (RIP flow) are calculated to track respiratory flow. However, the effectiveness of this sensor and the calculated respiratory results is still unclear, and validation studies for the scoring of respiratory events in polysomnography are rare. METHODS: Two hundred subjects were selected according to the severity of obstructive sleep apnea. A sleep specialist re-evaluated the respiratory events based on RIP flow data in a single-blind study. Statistical analysis was conducted with paired respiratory events scored in each of the RIP flow and polysomnography datasets. RESULTS: All respiratory events scored from the RIP flow were strongly correlated with those identified with standard sensors of polysomnography, regardless of disease severity. Most of the respiratory parameters from RIP flow trended toward underestimation. The RIP flow obtained from the alternative RIP sensor was appropriate for the diagnosis of obstructive sleep apnea based on a receiver operating characteristic curve. CONCLUSIONS: Scored respiratory events from RIP flow data effectively reflected the respiratory flow and statistically correlated with the results from standard polysomnography sensors. Therefore, analyzing RIP flow utilizing an RIP sensor is considered a reliable method for respiratory event scoring.

Modelling Dynamically Re-Sizeable Electrodes (DRE) for Targeted Transcutaneous Measurements in Impedance Plethysmography.

Impedance plethysmography of extremities typically involves band electrodes around limbs to monitor changes in blood volume. This often causes monitored blood variations to only generate minuscule impedance values relative to the measured baseline, attributed to the tissue surrounding the artery or vein of interest. Smaller, ECG type electrodes can provide a larger signal, however their output is very easily affected by the placement of the electrodes relative to the targeted vasculature. This paper presents a novel method to adjust the active surface of electrodes, introducing Dynamically Re-sizeable Electrodes (DRE), to only target the exact area of interest, forming localised electrodes, without having to manually re-position them. Elongated rectangular electrodes were partitioned into smaller electrode segments, interconnected through custom circuitry. For the development and assessment of the DRE system, work was carried out both experimentally in-vitro on gelatine phantoms using custom switching circuits and through finite element modelling (FEM) simulations in COMSOL. A scanning sequence made use of DRE in single segment variable tetra-pole (SSVT) mode proved capable to identify the transcutaneous location of the blood vessel of interest and the specific electrode segments located in its vicinity. Impedance measurements were then taken using these segments connected to form localised electrodes only placed over the targeted vessel. The resulting localised electrodes exhibited up to [Formula: see text] increased sensitivity to blood variations relative to larger electrodes.

Noninvasive Cuffless Blood Pressure Estimation Using Pulse Transit Time and Impedance Plethysmography.

OBJECTIVE: To demonstrate the feasibility of everaging impedance plethysmography (IPG) for detection of pulse transit time (PTT) and estimation of blood pressure (BP). METHODS: We first established the relationship between BP, PTT, and arterial impedance (i.e., the IPG observations). The IPG sensor was placed on the wrist while the photoplethysmography sensor was attached to the index finger to measure the PTT. With a cuff-based BP monitoring system placed on the upper arm as a reference, our proposed methodology was evaluated on 15 young, healthy human subjects leveraging handgrip exercises to manipulate BP/PTT and compared to several conventional PTT models to assess the efficacy of PTT/BP detections. RESULTS: The proposed model correlated with BP fairly well with group average correlation coefficients of [Formula: see text] for systolic BP (SBP) and [Formula: see text] for diastolic BP (DBP). In comparison with the other PTT methods, PTT-IPG-based BP estimation provided a lower root-mean-squared-error of [Formula: see text] and [Formula: see text] for SBP and DBP, respectively. CONCLUSION: We conclude that the measurement of arterial impedance via IPG methods is an adequate indicator to estimate BP. The proposed method appears to offer superiority compared to the conventional PTT estimation approaches. SIGNIFICANCE: Using impedance magnitude to estimate PTT offers promise to realize wearable and cuffless BP devices.

Measurement of Aortic Pulse Wave Velocity With a Connected Bathroom Scale.

BACKGROUND: Measurement of arterial stiffness should be more available. Our aim was to show that aortic pulse wave velocity can be reliably measured with a bathroom scale combining the principles of ballistocardiography (BCG) and impedance plethysmography on a single foot. METHOD: The calibration of the bathroom scale was conducted on a group of 106 individuals. The aortic pulse wave velocity was measured with the SphygmoCor in the supine position. Three consecutive measurements were then performed on the Withings scale in the standing position. This aorta-leg pulse transit time (alPTT) was then converted into a velocity with the additional input of the height of the person. Agreement between the SphygmoCor and the bathroom scale so calibrated is assessed on a separate group of 86 individuals, following the same protocol. RESULTS: The bias is 0.25 m·s-1 and the SE 1.39 m·s-1. This agreement with Sphygmocor is "acceptable" according to the ARTERY classification. The alPTT correlated well with cfPTT with (Spearman) R = 0.73 in pooled population (cal 0.79, val 0.66). The aorta-leg pulse wave velocity correlated with carotid-femoral pulse wave velocity with R = 0.76 (cal 0.80, val 0.70). CONCLUSION: Estimation of the aortic pulse wave velocity is feasible with a bathroom scale. Further investigations are needed to improve the repeatability of measurements and to test their accuracy in different populations and conditions.

A Novel Method for Continuous, Noninvasive, Cuff-Less Measurement of Blood Pressure: Evaluation in Patients With Nonalcoholic Fatty Liver Disease.

OBJECTIVE: One promising approach for a continuous, noninvasive, cuff-less ambulatory blood pressure (BP) monitor is to measure the pulse wave velocity or the inversely proportional pulse transit time (PTT), based on electrical and optical physiological measurements in the chest area. A device termed IsenseU-BP+ has been developed for measuring continuous BP, as well as other physiological data. The objective of this paper is to present results from the first clinical evaluation with a wide range of patients. The study was set up to verify whether IsenseU-BP+ can be used to measure raw signals with sufficient quality to derive PTT.  Methods: The test protocol, run 23 times on 18 different patients with nonalcoholic fatty liver disease, includes both supine measurement at rest as well as measurements during indoor cycling. Changes in PTT were compared with the BP changes measured using validated reference sensors.  Results: IsenseU-BP+ measured signals with good quality during rest on 17 of 18 patients despite the high diversity in age, body shape, and body mass index. Evaluation during cycling was difficult due to a lack of good reference measurements. CONCLUSION: IsenseU-BP+ measures PTT with high quality during supine rest and exercise and could therefore be suitable for deriving noninvasive continuous BP, although evaluation during exercise was limited due to inaccurate reference BP measurements. SIGNIFICANCE: Continuous, noninvasive measurement of BP would be highly beneficial in a number of clinical settings. Systems currently considered as the gold standard for the investigation of hypertension carry considerable limitations, which could be overcome by the method proposed here.

Wearable Vector Electrical Bioimpedance System to Assess Knee Joint Health.

OBJECTIVE: We designed and validated a portable electrical bioimpedance (EBI) system to quantify knee joint health. METHODS: Five separate experiments were performed to demonstrate the: 1) ability of the EBI system to assess knee injury and recovery; 2) interday variability of knee EBI measurements; 3) sensitivity of the system to small changes in interstitial fluid volume; 4) reducing the error of EBI measurements using acceleration signals; and 5) use of the system with dry electrodes integrated to a wearable knee wrap. RESULTS: 1) The absolute difference in resistance ( R) and reactance (X) from the left to the right knee was able to distinguish injured and healthy knees (p < 0.05); the absolute difference in R decreased significantly (p < 0.05) in injured subjects following rehabilitation. 2) The average interday variability (standard deviation) of the absolute difference in knee R was 2.5 Ω and for X was 1.2 Ω. 3) Local heating/cooling resulted in a significant decrease/increase in knee R (p < 0.01). 4) The proposed subject position detection algorithm achieved 97.4% leave-one subject out cross-validated accuracy and 98.2% precision in detecting when the subject is in the correct position to take measurements. 5) Linear regression between the knee R and X measured using the wet electrodes and the designed wearable knee wrap were highly correlated ( R2 = 0.8 and 0.9, respectively). CONCLUSION: This study demonstrates the use of wearable EBI measurements in monitoring knee joint health. SIGNIFICANCE: The proposed wearable system has the potential for assessing knee joint health outside the clinic/lab and help guide rehabilitation.

Predicting optimal wet granulation parameters for extrusion-spheronisation of pharmaceutical pellets using a mixer torque rheometer.

Mixer torque rheometry (MTR) was evaluated as a pre-production (pre-formulation and optimization) tool for predicting ideal liquid-to-solid ratios (L/S) for extrusion-spheronisation of a wide range of APIs using 10g formulations. APIs of low, medium and high solubility were formulated at low and high loadings (15 and 40% w/w, respectively) with PVP as binder (5%) and MCC as the major excipient. L/S corresponding to the maximum torque produced during wet massing in the MTR, L/S(maxT), was 0.8 for the low solubility APIs, which decreased to 0.6 for some of the more soluble APIs, especially at high loadings. Formulations extruded-spheronised at L/SmaxT) produced pellets of acceptable size (between 900 and 1400um) for all formulations, but mostly of unacceptable shape (dumb-bells of aspect ratio 1.2). Increasing L/S by 25% successfully produced spherical or near-spherical (aspect ratio 1.1) pellets for all formulations except one of the highly soluble APIs (piracetam) at high loading. Overall, MTR was demonstrated to be a useful pre-formulation and optimization tool in extrusion-spheronisation.

Estimation of Penetrated Bone Layers During Craniotomy via Bioimpedance Measurement.

OBJECTIVE: Craniotomy is the removal of a bone flap from the skull and is a first step in many neurosurgical interventions. During craniotomy, an efficient cut of the bone without injuring adjoining soft tissues is very critical. The aim of this study is to investigate the feasibility of estimating the currently penetrated cranial bone layer by means of bioimpedance measurement. METHODS: A finite-element model was developed and a simulation study conducted. Simulations were performed at different positions along an elliptical cutting path and at three different operation areas. Finally, the validity of the simulation was demonstrated by an ex vivo experiment based on use of a bovine shoulder blade bone and a commercially available impedance meter. RESULTS: The curve of the absolute impedance and phase exhibits characteristic changes at the transition from one bone layer to the next, which can be used to determine the bone layer last penetrated by the cutting tool. The bipolar electrode configuration is superior to the monopolar measurement. A horizontal electrode arrangement at the tip of the cutting tool produces the best results. CONCLUSION: This study successfully demonstrates the feasibility to detect the transition between cranial bone layers during craniotomy by bioimpedance measurements using electrodes located on the cutting tool. SIGNIFICANCE: Based on the results of this study, bioimpedance measurement seems to be a promising option for intra operative ad hoc information about the bone layer currently penetrated and could contribute to patient safety during neurosurgery.

Efficient Simultaneous Reconstruction of Time-Varying Images and Electrode Contact Impedances in Electrical Impedance Tomography.

OBJECTIVE: In electrical impedance tomography (EIT), we apply patterns of currents on a set of electrodes at the external boundary of an object, measure the resulting potentials at the electrodes, and, given the aggregate dataset, reconstruct the complex conductivity and permittivity within the object. It is possible to maximize sensitivity to internal conductivity changes by simultaneously applying currents and measuring potentials on all electrodes but this approach also maximizes sensitivity to changes in impedance at the interface. METHODS: We have, therefore, developed algorithms to assess contact impedance changes at the interface as well as to efficiently and simultaneously reconstruct internal conductivity/permittivity changes within the body. We use simple linear algebraic manipulations, the generalized singular value decomposition, and a dual-mesh finite-element-based framework to reconstruct images in real time. We are also able to efficiently compute the linearized reconstruction for a wide range of regularization parameters and to compute both the generalized cross-validation parameter as well as the L-curve, objective approaches to determining the optimal regularization parameter, in a similarly efficient manner. RESULTS: Results are shown using data from a normal subject and from a clinical intensive care unit patient, both acquired with the GE GENESIS prototype EIT system, demonstrating significantly reduced boundary artifacts due to electrode drift and motion artifact.

Evaluating Risk Factors for Pediatric Post-extubation Upper Airway Obstruction Using a Physiology-based Tool.

RATIONALE: Subglottic edema is the most common cause of pediatric extubation failure, but few studies have confirmed risk factors or prevention strategies. This may be due to subjective assessment of stridor or inability to differentiate supraglottic from subglottic disease. OBJECTIVES: Objective 1 was to assess the utility of calibrated respiratory inductance plethysmography (RIP) and esophageal manometry to identify clinically significant post-extubation upper airway obstruction (UAO) and differentiate subglottic from supraglottic UAO. Objective 2 was to identify risk factors for subglottic UAO, stratified by cuffed versus uncuffed endotracheal tubes (ETTs). METHODS: We conducted a single-center prospective study of children receiving mechanical ventilation. UAO was defined by inspiratory flow limitation (measured by RIP and esophageal manometry) and classified as subglottic or supraglottic based on airway maneuver response. Clinicians performed simultaneous blinded clinical UAO assessment at the bedside. MEASUREMENTS AND MAIN RESULTS: A total of 409 children were included, 98 of whom had post-extubation UAO and 49 (12%) of whom were subglottic. The reintubation rate was 34 (8.3%) of 409, with 14 (41%) of these 34 attributable to subglottic UAO. Five minutes after extubation, RIP and esophageal manometry better identified patients who subsequently received UAO treatment than clinical UAO assessment (P < 0.006). Risk factors independently associated with subglottic UAO included low cuff leak volume or high preextubation leak pressure, poor sedation, and preexisting UAO (P < 0.04) for cuffed ETTs; and age (range, 1 mo to 5 yr) for uncuffed ETTs (P < 0.04). For uncuffed ETTs, the presence or absence of preextubation leak was not associated with subglottic UAO. CONCLUSIONS: RIP and esophageal manometry can objectively identify subglottic UAO after extubation. Using this technique, preextubation leak pressures or cuff leak volumes predict subglottic UAO in children, but only if the ETT is cuffed.

Detection of intraneural needle-placement with multiple frequency bioimpedance monitoring: a novel method.

Electrical impedance measurements have been used to detect intraneural needle placement, but there is still a lack of precision with this method. The purpose of the study was to develop a method for the discrimination of nerve tissue from other tissue types based on multiple frequency impedance measurements. Impedance measurements with 25 different frequencies between 1.26 and 398 kHz were obtained in eight pigs while placing the tip of a stimulation needle within the sciatic nerve and in other tissues. Various impedance variables and measurement frequencies were tested for tissue discrimination. Best tissue discrimination was obtained by using three different impedance parameters with optimal measurement frequencies: Modulus (126 kHz), Phase angle (40 kHz) and the Delta of the phase angle (between 126 and 158 kHz). These variables were combined in a Compound variable C. The area under the curve in a receiver operating characteristic was consecutively increased for the Modulus (78 %), Phase angle (86 %), Delta of the phase angle (94 %), and the Compound variable C (97 %), indicating highest specificity and sensitivity for C. An algorithm based on C was implemented in a real-time feasibility test and used in an additional test animal to demonstrate our new method. Discrimination between nerve tissue and other tissue types was improved by combining several impedance variables at multiple measurement frequencies.

An orbital shear platform for real-time, in vitro endothelium characterization.

Electrical impedance techniques have been used to characterize endothelium morphology, permeability, and motility in vitro. However, these impedance platforms have been limited to either static endothelium studies and/or induced laminar fluid flow at a constant, single shear stress value. In this work, we present a microfabricated impedance sensor for real-time, in vitro characterization of human umbilical vein endothelial cells (HUVECs) undergoing oscillatory hydrodynamic shear. Oscillatory shear was applied with an orbital shaker and the electrical impedance was measured by a microfabricated impedance chip with discrete electrodes positioned at radial locations of 0, 2.5, 5.0, 7.5, 10.0, and 12.5 mm from the center of the chip. Depending on their radial position within the circular orbital platform, HUVECs were exposed to shear values ranging between 0.6 and 6.71 dyne/cm(2) (according to numerical simulations) for 22 h. Impedance spectra were fit to an equivalent circuit model and the trans-endothelial resistance and monolayer's capacitance were extracted. Results demonstrated that, compared to measurements acquired before the onset of shear, cells at the center of the platform that experienced low steady shear stress (∼2.2 dyne/cm(2) ) had an average change in trans-endothelial resistance of 6.99 ± 4.06% and 1.78 ± 2.40% change in cell capacitance after 22 hours of shear exposure; cells near the periphery of the well (r = 12.5 mm) experienced transient shears (2.5-6.7 dyne/cm(2) ) and exhibited a greater change in trans-endothelial resistance (24.2 ± 10.8%) and cell capacitance (4.57 ± 5.39%). This study, demonstrates that the orbital shear platform provides a simple system that can capture and quantify the real-time cellular morphology as a result of induced shear stress. The orbital shear platform presented in this work, compared to traditional laminar platforms, subjects cells to more physiologically relevant oscillatory shear as well as exposes the sample to several shear values simultaneously. Biotechnol. Bioeng. 2016;113: 1336-1344. © 2015 Wiley Periodicals, Inc.

Métodos de evaluación de la composición corporal: una revisión actualizada de descripción, aplicación, ventajas y desventajas / Methods of assessment of body composition: an updated review of description, application, advantages and disadvantages

El estudio de la composición corporal es un tema de interés creciente que puede ser utilizado tanto para la investigación como para fines clínicos. Para los profesionales de las ciencias de la salud es importante conocer las características de los diferentes métodos de evaluación y análisis de la composición corporal, ya que cambios en esta guardan relación directa con la salud y el riesgo de enfermedades. Actualmente, los métodos de análisis de la composición corporal son divididos en tres grupos, donde están el directo, los indirectos y los doblemente indirectos. El método directo es la disección de cadáveres. Entre los indirectos encontramos la tomografía axial computarizada, la resonancia magnética nuclear (RMN), la absorciometría dual de rayos X y la plestimografía; y en lo referente a los métodos doblemente indirectos destacan la antropometría y la impedancia bioelectrica. Asi, este trabajo tiene como objetivo revisar los métodos mas utilizados para el análisis de la composición corporal, describiéndoles, analizando sus aplicaciones, ventajas y desventajas. Se llevo a cabo una búsqueda de artículos en las bases de datos PubMed, Web of Science, Scopus, SportDiscus y Google Academico. Las palabras usadas fueron, body composition, body mass, body fat, muscle mass, fat mass, measurement, assessment y evaluation, aisladas o combinadas, y sus respectivos sinónimos en castellano y portugués. Fueron encontrados 221 artículos, de los cuales fueron seleccionados 59 para esta revisión. Se concluye que los diferentes métodos para evaluar la composición corporal presentan ventajas y desventajas, que deben ser analizados cuando se elige el método a ser empleado, para intentar minimizar sus desventajas y potencializar sus ventajas (AU)

The study of body composition is a topic of growing interest that can be used both for research and for clinical purposes. For professionals of health sciences is important to know the characteristics of the different methods of evaluation and analysis of body composition because, it changes are directly related to health and disease risk. Currently, methods of analysis of body composition are divided into three groups, which are direct, indirect and double indirect. The direct method is the dissection of cadavers. Indirect find computed tomography, magnetic resonance imaging, dual X-ray absorptiometry and plethysmography and in terms of the doubly indirect methods include anthropometry and bioelectrical impedance. Thus, this paper is aimed to review the most used for analysis of body composition by describing, analyzing their applications, advantages and disadvantages methods. Was conducted a search of article in databases PubMed, Web of Science, Scopus, SportDiscus and Google Scholar. The words used were, body composition, body mass, body fat, muscle mass, fat mass, measurement, assessment and evaluation, isolated or combined and their alternatives in Castilian and Portuguese. Were selected articles that were in English, Castilian and portuguese. They were found 221 articles, of which 59 were selected for this review. It is concluded that the different methods for assessing body composition have advantages and disadvantages, which should be analyzed when choosing the method to be used to try to minimize the disadvantages and empower its advantages (AU)

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.

Static imaging of the electrical impedance tomography on cylinder physical phantom.

Static imaging of the electrical impedance tomography can obtain the absolute electrical conductivity distribution at one section of the subject. The test is performed on a cylinder physical phantom in which slim rectangle, hollow cylinder, small rectangle or three cylinders are selected to simulate complex conductivity perturbation objects. The measurement data is obtained by a data acquisition system with 32 compound electrodes. A group of static images of conductivity distribution in the cylinder phantom are reconstructed by the modified Newton-Raphson algorithm with two kinds of regularization methods. The results show correct position, size, conductivity difference, and similar shape of the perturbation objects in the images.

Biological impedance cross evaluation and imaging from composite measurements of magnetic and electrical methods.

Because of the need for rapid detection and location of diseases in clinical applications, this work proposes a composite measurement of magnetic induction tomography (MIT) and electrical impedance tomography (EIT). This paper is composed of the following aspects: portable and integral hardware design, stable dual constant-current sources, the composite detection method, cross-plane data acquirement, 3-dimensional image reconstruction and so on. A qualitative evaluation of conductivity, resolution and relative position error were taken by combining the EIT and MIT methods via the experiment model. The sensitivities of both methods were analyzed to improve the imaging results. The reconstruction results reveal that the system is capable of obtaining better physiological measurements, which is very useful in clinical monitoring, quick medical diagnosing and preliminary screening of community health.

SAR and thermal response effects of a two-arm Archimedean spiral coil in a magnetic induction sensor on a human head.

This study investigates the radiation safety of a newly designed magnetic induction sensor. This novel magnetic induction sensor uses a two-arm Archimedean spiral coil (TAASC) as the exciter. A human head model with a real anatomical structure was used to calculate the specific absorption rate (SAR) and temperature change. Computer Simulation Technology (CST) was used to determine the values of the peak 10-g SAR under different operating parameters (current, frequency, horizontal distance between the excitation coil and the receiver coil, vertical distance between the top of the head model and the XOY plane, position of excitation coil, and volume of hemorrhage). Then, the highest response for the SAR and temperature rise was determined. The results showed that this new magnetic induction sensor is safe in the initial state; for safety reasons, the TAASC current should not exceed 4 A. The scalp tissue absorbed most of the electromagnetic energy. The TAASC's SAR/thermal performance was close to that of the circular coil.

A novel in vivo corneal trans-epithelial electrical resistance measurement device.

PURPOSE: To develop a device that is capable of easily measuring corneal transepithelial electrical resistance (TER) and changes in the corneal barrier function. METHODS: We had previously developed an in vivo method for measuring corneal TER using intraocular electrode. This method can be used to precisely measure the decline of the corneal barrier function after instillation of benzalkonium chloride (BAC). In order to lessen the invasiveness of that procedure, we further refined the method for measuring the corneal TER by developing electrodes that could be placed on the cornea and in the conjunctival sac instead of inserting them into the anterior chamber. TER was then calculated by subtracting the electrical resistance, which lacked the corneal epithelial input, from the whole electrical resistance that was measured between the electrodes. Slit lamp examination and scanning electron microscopy (SEM) were used to determine safety of the new device. Corneal TER changes after exposure to 0.02% BAC were determined using the new device as well as SEM and transmission electron microscopy (TEM). RESULTS: Slit lamp examination before and after exposure of rabbits' corneas to the sensor confirmed safety of the device. SEM examination revealed no difference of the corneal epithelium which exposed to the new device with normal corneas. SEM and TEM pictures revealed damaged microvilli and tight junctions after instillation of 0.02% BAC. TER change after treatment with 0.02%BAC was similar to those determined by the established anterior chamber method. CONCLUSION: We succeeded to develop a less invasive device for corneal TER measurement in vivo in animals. This new device may be applicable in the future for clinical use in humans.

Bioimpedance at the bedside: current applications, limitations, and opportunities.

The loss of muscle mass is a defining characteristic of malnutrition, and there is ongoing interest in the assessment of lean tissue at the bedside. Globally, bioimpedance techniques have been widely appreciated for their noninvasiveness, safety, ease of use, portability, and relatively low cost compared with other clinically available methods. In this brief update, we review the 3 primary types of commercially available bioimpedance devices (single- and multiple-frequency and spectroscopy) and differentiate the underlying theory and current applications of each. We also address limitations and potential opportunities for using these devices at the bedside for clinical assessment. Mixed reports in the validation literature for all bioimpedance approaches have raised questions about absolute accuracy to estimate whole body composition in clinical populations, particularly those with abnormal fluid status and/or body geometry in whom underlying method assumptions may be violated. Careful selection of equations can improve whole body estimates by single- and multiple-frequency techniques; however, not all devices will allow for this approach. Research is increasing on the use of bioimpedance variables including phase angle and impedance ratio as potential markers of nutrition status and/or clinical outcomes; consensus on reference cut-points for interpreting these markers has yet to be established. Novel developments in the bioimpedance spectroscopy approach are allowing for improved fluid management in individuals receiving dialysis; these developments have implications for the clinical management of other conditions associated with fluid overload and may also provide enhanced whole body estimates of lean tissue through new modeling procedures.