94 Bioimpedance Spectroscopy Is a Valid and Reliable Measure of Edema in Hand Burn Injury

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S61-S62
Author(s):  
Dale O Edwick ◽  
Dana A Hince ◽  
Jeremy M Rawlins ◽  
Fiona M Wood ◽  
Dale W Edgar

Abstract Introduction The assessment of swelling following burn injury is complicated by the presence of wounds and dressings, particularly as the patient cohort experience significant pain, impaired movement, and may require medications that result in modified behavior. Further, traditional measures of volume, such as water displacement volumetry (WDV) or circumferential limb measures may pose increased infection risk and pain due to contact with open wounds. Clinically, edema is most often assessed by noting loss of skin creases, palpation of areas of visible swelling, and loss of function, as there remains a lack of sensitive objective measures for edema in patients with hand burn injury. Bioimpedance spectroscopy (BIS) is a measure of body composition that has been demonstrated by our group to be reliable for measuring whole body and limb edema during resuscitation, and to be sensitive to local edema changes within healing wounds. The aim of this study was to determine the reliability and validity of BIS as a measure of edema following hand burn injury. Methods One hundred patients presenting with hand burn injury were recruited to this trial. Repeated volume measures of the hand were recorded using a novel application of BIS, and repeated using WDV. The results were analysed using multi-level mixed effects regressions. The use of BIS electrodes on the dorsum of the middle finger at the DIP and MCPJ levels, and dorsum of the wrist and forearm have been previously described for measuring lymphedema. Results Paired repeated measures were obtained for 195 hands. Alternate electrode positions on the palm of the middle finger and hand, and volar wrist and forearm, and a combination of palmar hand / dorsal forearm were assessed. There was no evidence of a significant difference between these electrode configurations and the previously described dorsal hand / forearm configuration (position x distance interaction, p=0.608–0.802). Dorsal hand / volar forearm configuration was significantly different (position x distance interaction, p=0.006) from the standard electrode position described. Comparison with WDV demonstrated a strong correlation (r=0.79; limits of agreement 198-460mL; bias 329mL). Reliability of BIS was determined by ICC: 0.9978–0.9999 (CI 0.9967–0.9999). Conclusions Compared to WDV, BIS is a valid and reliable measure of edema following acute hand burn injury. This study also confirmed the interchangeability of multiple BIS electrode positions. Applicability of Research to Practice BIS offers a real time measure of fluid (change) within the extracellular space, and therefore edema in patients with hand burn injury, while minimizing the risk of infection and increased pain in burns patients. The interchangeability of electrode positions provides clinicians with a number of flexible options to accommodate locations of hand burn wounds, thus allowing between patient comparisons.

2020 ◽  
Vol 41 (4) ◽  
pp. 780-787 ◽  
Author(s):  
Dale O Edwick ◽  
Dana A Hince ◽  
Jeremy M Rawlins ◽  
Fiona M Wood ◽  
Dale W Edgar

Abstract The assessment of swelling following burn injury is complicated by the presence of wounds and dressings and due to patients experiencing significant pain and impaired movement. There remains a lack of sensitive objective measures for edema in patients presenting with hand burn injury. Bioimpedance spectroscopy (BIS) is a measure of body composition that has been demonstrated by our group to be reliable for measuring whole body and limb edema during resuscitation and to be sensitive to edema changes within healing wounds. The aim of this study was to determine the reliability and validity of BIS as a measure of edema following hand burn injury specifically. One hundred patients presenting with burn injury including a portion of a hand were recruited to this trial. Repeated measures of the hand were recorded using a novel application of BIS and in parallel with water displacement volumetry (WDV). The results were analyzed using mixed-effects regressions. Paired repeated measures were obtained for 195 hands, using four electrode configurations. BIS demonstrated high reliability in measuring hand BIS—Intraclass Correlation Coefficient 0.995 to 0.999 (95% CI 0.992–1.000) and sensitivity—Minimum Detectable Difference 0.74 to 3.86 Ω (0.09–0.48 Ω/cm). A strong correlation was shown with WDV, Pearson’s r = −0.831 to −0.798 (P < .001). BIS is a sensitive and reliable measure of edema following acute hand burn injury.


2021 ◽  
Author(s):  
Hannah L. Cornman ◽  
Jan Stenum ◽  
Ryan T. Roemmich

ABSTRACTAssessment of repetitive movements (e.g., finger tapping) is a hallmark of motor examinations in several neurologic populations. These assessments are traditionally performed by a human rater via visual inspection; however, advances in computer vision offer potential for remote, quantitative assessment using simple video recordings. Here, we evaluated a pose estimation approach for measurement of human movement frequency from smartphone videos. Ten healthy young participants provided videos of themselves performing five repetitive movement tasks (finger tapping, hand open/close, hand pronation/supination, toe tapping, leg agility) at four target frequencies (1-4 Hz). We assessed the ability of a workflow that incorporated OpenPose (a freely available whole-body pose estimation algorithm) to estimate movement frequencies by comparing against manual frame-by-frame (i.e., ground-truth) measurements for all tasks and target frequencies using repeated measures ANOVA, Pearson’s correlations, and intraclass correlations. Our workflow produced largely accurate estimates of movement frequencies; only the hand open/close task showed a significant difference in the frequencies estimated by pose estimation and manual measurement (while statistically significant, these differences were small in magnitude). All other tasks and frequencies showed no significant differences between pose estimation and manual measurement. Pose estimation-based detections of individual events (e.g., finger taps, hand closures) showed strong correlations with manual detections for all tasks and frequencies. In summary, our pose estimation-based workflow accurately tracked repetitive movements in healthy adults across a range of tasks and movement frequencies. Future work will test this approach as a fast, low-cost, accessible approach to quantitative assessment of repetitive movements in clinical populations.


2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S30-S30
Author(s):  
Carly M Knuth ◽  
Chris Auger ◽  
Abdikarim Abdullahi ◽  
Marc G Jeschke

Abstract Introduction A severe burn elicits a systemic hypermetabolic response that substantially alters the function of multiple organs and contributes to increased morbidity and mortality. A consequence of hypermetabolism is the activation of UCP1-mediated browning of white adipose tissue (WAT), which may further facilitate the hypermetabolic response. In this study, we aimed to provide comprehensive characterization of the acute and long term pathophysiological responses to burns to determine the persistence of adipose tissue browning and its potential contribution to the hypermetabolic response. Methods Mice were subjected to either a 30% total body surface area (TBSA) scald burn or were denoted sham. Body weight and food intake were monitored throughout the duration of the study. Cohorts were sacrificed at 6hrs, 1, 3, 5, 7, 14, 30 and 60d post-burn and adipose tissue depots were harvested. Mitochondrial respiration, protein expression, and morphology in adipose tissues were assessed. Results Despite consuming considerably more food, the burn group lost significantly more weight throughout the duration of the study. We also detected increases in free fatty acids and interleukin-6, markers of whole-body lipolysis and inflammation, respectively. At the tissue level, eWAT mass significantly decreased over time, suggesting that this depot provides substrate to fuel the hypermetabolic response. This was further supported by a decrease in adipocyte area and an increase in lipolytic markers which remains significant up until 60d post-burn relative to sham. There were no significant difference in iWAT mass, however we detected significant increases in the protein content of UCP1, the master regulator of adipose tissue browning, as early as day 3 which persisted until day 60. This was corroborated by the presence of UCP1+ adipocytes. Conclusions Consistent with previous human studies, a burn injury elicits a dynamic response that cannot be simply characterized by a single timepoint. The alterations that occur in adipose tissue are depot-specific, time-dependent, and this notion likely extends to other metabolic tissues. Further, we demonstrate that in our 30% TBSA burn murine model, the effects of the hypermetabolic response persist for up to 60 days following initial injury. Applicability of Research to Practice Our data indicate the hypermetabolic response persists for up to 60 days, the equivalent of approximately 7 years in humans. This underscores the severity of adipose tissue browning and potentially provides an explanation as to how the hypermetabolic response persists even after the wound has healed. Moreover, providing a comprehensive map of the time-dependent changes in a murine model gives clinicians a better indication of the metabolic effects in a burn patient and will contribute to the development of effective, targeted treatments.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261450
Author(s):  
Hannah L. Cornman ◽  
Jan Stenum ◽  
Ryan T. Roemmich

Assessment of repetitive movements (e.g., finger tapping) is a hallmark of motor examinations in several neurologic populations. These assessments are traditionally performed by a human rater via visual inspection; however, advances in computer vision offer potential for remote, quantitative assessment using simple video recordings. Here, we evaluated a pose estimation approach for measurement of human movement frequency from smartphone videos. Ten healthy young participants provided videos of themselves performing five repetitive movement tasks (finger tapping, hand open/close, hand pronation/supination, toe tapping, leg agility) at four target frequencies (1–4 Hz). We assessed the ability of a workflow that incorporated OpenPose (a freely available whole-body pose estimation algorithm) to estimate movement frequencies by comparing against manual frame-by-frame (i.e., ground-truth) measurements for all tasks and target frequencies using repeated measures ANOVA, Pearson’s correlations, and intraclass correlations. Our workflow produced largely accurate estimates of movement frequencies; only the hand open/close task showed a significant difference in the frequencies estimated by pose estimation and manual measurement (while statistically significant, these differences were small in magnitude). All other tasks and frequencies showed no significant differences between pose estimation and manual measurement. Pose estimation-based detections of individual events (e.g., finger taps, hand closures) showed strong correlations (all r>0.99) with manual detections for all tasks and frequencies. In summary, our pose estimation-based workflow accurately tracked repetitive movements in healthy adults across a range of tasks and movement frequencies. Future work will test this approach as a fast, quantitative, video-based approach to assessment of repetitive movements in clinical populations.


2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S49-S50
Author(s):  
Ashley M Welsh ◽  
William S Dewey ◽  
James C Casey ◽  
Kyle B Cunningham

Abstract Introduction Hands are the most common area of the body to sustain a burn injury. Maintaining motion and function throughout the healing process of a burn injury is one of the most important goals of the rehabilitation process. After a deep burn to the dorsal aspect of the hand requiring skin grafting, the adjacent metacarpophalangeal (MCP) joints are at risk for developing a burn scar contracture (BSC), limiting the joints’ ability to fully flex towards a fist position. Post-operative positioning protocols state that patient’s hand should be temporarily immobilized for graft protection. A resting hand splint is used to maintain the wrist in approximately 20–30 degrees of extension, MCP joints at approximately 50–70 degrees of flexion and the interphalangeal joints in full extension. The purpose of this study was to assess the benefit of splinting as a treatment intervention to prevent MCP joint extension contractures following dorsal hand skin grafting. Methods This was a retrospective review of prospectively collected observational data from the “Burn Patient Acuity Demographics, Scar Contractures and Rehabilitation Treatment Time Related to Patient Outcomes” (ACT) study. Patients were included with grafted dorsal hand burns occurring within 1 of the 4 established cutaneous functional units (CFU) along the dorsal aspect of the second through fifth metacarpals. Since most subjects had more than one dorsal hand CFU involved, the number of CFUs were analyzed as opposed to the number of subjects. Isolated MCP joint flexion measurements were utilized to determine incidence of contracture. Included causes of contracture were scar tissue or other soft tissue limitations. Data were then analyzed by two groups: contracted and non-contracted. Results A total of 221 dorsal hand CFUs were included in this study; 119 contracted and 102 non-contracted. There was no statistical significant difference between the average splint wear time between the 2 groups. The average percent of affected CFUs grafted within the contracted group was 92.4% compared to 76.8% in the non-contracted group. In burns to the dorsal hand with less than 99% of the CFU grafted, splinting was effective in preventing 60% of MCP joint extension contractures. When greater than 99% of affected CFU was grafted, splinting was effective in prevention only 36% of contractures. Conclusions Splinting can be an effective intervention option in preventing MCP extension contractures when less than 75% of the affected CFU has been grafted; however, its effectiveness decreases as the percentage of CFU involvement increases to greater than or equal to 99%. Applicability of Research to Practice Determine most effective post-operative rehabilitations plan following dorsal hand skin grafts.


2014 ◽  
Vol 116 (11) ◽  
pp. 1382-1389 ◽  
Author(s):  
Samer R. Abbas ◽  
Fansan Zhu ◽  
George A. Kaysen ◽  
Peter Kotanko ◽  
Nathan W. Levin

This study explored divergence (error) between ultrafiltration volumes (UFV) and intradialytic changes in extracellular volume (ΔECV) in hemodialysis (HD) patients measured by whole body (wBIS) and sum of segmental bioimpedance spectroscopy (sBIS). The primary aim of the study was to evaluate the effect of different ultrafiltration rates (UFR) on error of estimation of ΔECV by changes in their distribution in body segments (arm, trunk, and leg). Forty-four HD patients (26 men, age 63.5 ± 14.3 yr) were studied twice in the same week following high and low UFR treatments. ΔECV and distributions (segmental ΔECV/∑segmental ΔECV, %) in arm, trunk, and leg were measured. ΔECV by wBIS underestimated UFV (0.58 ± 0.43 in high vs. 0.36 ± 0.5 liters at low UFR; P < 0.001, respectively); however, using sBIS no significant difference between UFV and ΔECV was present. Divergence using wBIS but not sBIS correlated positively with UFR. ΔECV distribution in trunk and leg at high UFR (44.1 ± 8.3, 47.2 ± 8.5, %) differed significantly ( P < 0.01) from low UFR (36 ± 15.7, 53.8 ± 14.7) respectively, but in arm did not differ between UFR. Primary sources of whole body resistance are arms and legs. Due to different cross-sectional areas between trunk and limbs, wBIS is insensitive to detection of changes in trunk volume. At higher UFR, plasma water was rapidly and largely removed from the trunk but with only a small change in whole body resistance. As a result, accuracy of estimation of ECV by wBIS is further decreased by high UFR, while sBIS remains accurate using separate measurements of segmental volumes.


2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9519-9519
Author(s):  
T. Van den Wyngaert ◽  
M. T. Huizing ◽  
E. Fossion ◽  
J. B. Vermorken

9519 Background: Bisphosphonates (BP) have been associated with the occurrence of osteonecrosis of the jaw (ONJ), possibly by causing an excessive inhibition of local bone turnover. However, little in vivo evidence currently exists to support this theory. Methods: Whole-body scintigrams acquired after administration of 99mTc labeled medronate of 120 patients were studied. Patients with skeletal metastases from a solid tumor (n=40) were individually matched with cancer patients without BP exposure (n=40) and controls with neither a malignancy nor BP use (n=40). Controls were matched for age, gender, malignancy, steroid and hormonal therapy use, where appropriate. Patients with established ONJ or intense focal abnormalities in the studied regions were excluded. Mandibular bone turnover (MBT) was quantified relative to the femurs by defining regions-of-interest on the scintigrams with correction for background activity. The study had a power of 90% to detect a 10% reduction in MBT after BP use. Results were analyzed using a repeated-measures ANOVA with a two-sided significance level of p<0.05. Results: The patients with BP exposure (34 female, 6 male) had a median age of 62 years (range 25–80) and received a median number of 11 zoledronic acid administrations (range 1–48). Malignancies included: breast (n=30), prostate (n=4), colon (n=2) and bladder cancer (n=2); and neuroendocrine carcinoma (n=2). The mean MBT was significantly lower in BP using cancer patients (2.59) compared with matched controls from oncological patients without BP use 3.01 (difference 0.42; 95% CI 0.13 - 0.72; p=0.006), or patients without cancer or BP exposure 3.09 (difference 0.50; 95% CI 0.21 - 0.78; p=0.001). In contrast, there was no significant difference in MBT between non-BP users (difference 0.08; 95% CI -0.31 - 0.46; p=0.7). Likewise, no correlation between MBT and the number of BP administrations could be demonstrated (r2=0.01; p=0.4), suggesting a stochastic rather than a deterministic effect. Conclusions: This in vivo data suggests that BP cause a higher inhibition of bone turnover in the mandible relative to the femur, which strengthens the hypothesis that the inhibition of bone turnover may be important in the pathophysiology of ONJ. [Table: see text]


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Emilie Gregers ◽  
Louise Linde ◽  
Sivagowry Moerk ◽  
Jo B Andreasen ◽  
morten smerup ◽  
...  

Introduction: In refractory out-of-hospital cardiac arrest (OHCA), prolonged whole-body ischemia with global tissue injury proceeds even after achievement of reperfusion with extracorporeal cardiopulmonary resuscitation (eCPR). Hypothesis: Biomarkers reflecting ischemia and inflammation may be used for prognostication of refractory OHCA managed with eCPR. Methods: This nationwide retrospective study included patients (≥18 years) with refractory OHCA managed with eCPR in Denmark (2011 to 2020). Biomarker levels at admission, at 24 hours (lactate, leukocytes, and platelets), and repeated measures of lactate after eCPR initiation were analyzed. Lactate clearance was calculated as (admission lactate - post eCPR lactate) / admission lactate x100%. Results: Two hundred eighteen patients (80% male; age 52±12yrs) were included. Primary cause of OHCA was acute myocardial infarction (63%), 69% had shockable primary rhythm and 86% witnessed OHCA with a median low-flow time of 105 minutes (Q1-Q3: 86-124 min.). Fifty-three (24%) survived to hospital discharge. Survivors had a significantly lower lactate level at admission (13.1 vs. 15.4 mmol/l, p=0.004) and after 24 hours (2.8 vs. 5.0, p=0.001), and a significantly higher admission platelet level (181 vs. 153 x10 9 /l, p=0.03). No difference in admission levels of leukocytes nor leukocytes and platelets after 24 hours were found between survivors and non-survivors. Lactate clearance was available for 68% and 79% of patients alive after 8 and 24 hours, respectively. All survivors had a lactate level less than admission lactate at 8 hours (lactate clearance >0%) and had cleared >25% of admission lactate at 24 hours after eCPR initiation. There was a significant difference in survival between quartiles of lactate clearance at 8 hours after eCPR initiation (Figure 1). Conclusion: In conclusion, early lactate clearance after eCPR initiation was associated with survival to discharge in refractory OHCA-patients.


2018 ◽  
Vol 26 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Alex S. Ribeiro ◽  
Matheus A. Nascimento ◽  
Brad J. Schoenfeld ◽  
João Pedro Nunes ◽  
Andreo F. Aguiar ◽  
...  

The main purpose of this study was to compare the effects of resistance training (RT) performed two versus three times per week on phase angle (a cellular health indicator) in older women. A total of 39 women (69.1 ± 5.5 years) were randomly assigned to perform a RT program two (G2X) or three (G3X) days per week for 12 weeks. The RT was a whole-body program (eight exercises, one set, 10–15 repetitions). Phase angle, resistance, reactance, and total body water were assessed by bioimpedance spectroscopy. Intracellular water, reactance, and phase angle increased significantly in G2X (2.1%, 3.0%, and 5.6%, respectively) and G3X (5.0%, 6.9%, and 10.3%, respectively) from pretraining to posttraining, with no significant difference between groups. Bioimpedance resistance decreased similarly in both groups (G2X = −1.7% vs. G3X = −3.2%). We conclude that a single set RT program with a frequency of 2 days per week may be sufficient to promote an improvement in cellular health in older women.


2020 ◽  
Author(s):  
Lucas S. Ryan ◽  
Jeni Gerberich ◽  
Uroob Haris ◽  
ralph mason ◽  
Alexander Lippert

<p>Regulation of physiological pH is integral for proper whole-body and cellular function, and disruptions in pH homeostasis can be both a cause and effect of disease. In light of this, many methods have been developed to monitor pH in cells and animals. In this study, we report a chemiluminescence resonance energy transfer (CRET) probe Ratio-pHCL-1, comprised of an acrylamide 1,2-dioxetane chemiluminescent scaffold with an appended pH-sensitive carbofluorescein fluorophore. The probe provides an accurate measurement of pH between 6.8-8.4, making it viable tool for measuring pH in biological systems. Further, its ratiometric output is independent of confounding variables. Quantification of pH can be accomplished both using common fluorimetry and advanced optical imaging methods. Using an IVIS Spectrum, pH can be quantified through tissue with Ratio-pHCL-1, which has been shown in vitro and precisely calibrated in sacrificed mouse models. Initial studies showed that intraperitoneal injections of Ratio-pHCL-1 into sacrificed mice produce a photon flux of more than 10^10 photons per second, and showed a significant difference in ratio of emission intensities between pH 6.0, 7.0, and 8.0.</p> <b></b><i></i><u></u><sub></sub><sup></sup><br>


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