Non-invasive hERG channel screening based on electrical impedance tomography and extracellular voltage activation (EIT-EVA)

hERG channel screening has been achieved based on electrical impedance tomography and extracellular voltage activation (EIT-EVA) to improve the non-invasive aspect of drug discovery. EIT-EVA screens hERG channels by considering the change in extracellular ion concentration which modifies the extracellular resistance in cell suspension. The rate of ion passing in cell suspension is calculated from the extracellular resistance Rex, which is obtained from the EIT measurement at a frequency of 500 kHz. In the experiment, non-invasive screening is applied by a novel integrated EIT-EVA printed circuit board (PCB) sensor to human embryonic kidney (HEK) 293 cells transfected with the human ether-a-go-go-related gene (hERG) ion channel, while the E-4031 antiarrhythmic drug is used for hERG channel inhibition. The extracellular resistance Rex of the HEK 293 cells suspension is measured by EIT as the hERG channels are activated by EVA over time. The Rex is reconstructed into extracellular conductivity distribution change Δσ to reflect the extracellular K+ ion concentration change Δc resulting from the activated hERG channel. Δc is increased rapidly during the hERG channel non-inhibition state while Δc is increased slower with increasing drug concentration cd. In order to evaluate the EIT-EVA system, the inhibitory ratio index (IR) was calculated based on the rate of Δc over time. Half-maximal inhibitory concentration (IC50) of 2.7 nM is obtained from the cd and IR dose-response relationship. The IR from EIT-EVA is compared with the results from the patch-clamp method, which gives R2 of 0.85. In conclusion, EIT-EVA is successfully applied to non-invasive hERG channel screening.

Great Toe Tip Reconstruction after Severe COVID-19 Using Hemi-pulp V-Y Advancement Flap: A Case Report

"COVID toe," one of the extrapulmonary disorders of coronavirus disease 2019 (COVID-19), may result in toe necrosis. In this case, we successfully reconstructed a severe COVID-19-induced defect in the great toe by using an innervated hemi-pulp V-Y advancement flap. A 48-year-old woman was diagnosed with fulminant myocarditis due to COVID-19 and received intensive care. Even after the acute phase, a skin defect measuring 10 mm × 7 mm was noted, exposing the underlying bone on her right great toe tip. Because of ulceration, she was unable to start walking training. To continue rehabilitation, we reconstructed it with the innerved hemi-pulp V-Y advancement flap. The pain improved quickly, and rehabilitation was resumed. During the 6-month follow-up period, no cosmetic or functional complications were observed. Plantar pressure measurements demonstrated favorable loading on the great toe, and it was a favorable outcome in walking function. This flap is a valuable option as one of the innervated flaps for toe-end necrosis with preserved blood flow, which helps in implementing prompt gait rehabilitation.

Drug selection pressure and fitness cost for artemether-resistant Plasmodium berghei ANKA parasites in vivo

BACKGROUND

The clinical use of artemisinin-based combination therapies is threatened by increasing failure rates due to the emergence and spread of multiple drug resistance genes in most human Plasmodium strains. The aim of this study was to generate artemether-resistant (AMR) parasites from Plasmodium berghei ANKA (AMS), and determine their fitness cost.

METHODS

Artemether resistance was generated by increasing drug pressure doses gradually for 9 months. Effective doses (ED50 and ED90) were determined using the 4-day suppressive test, and the indices of resistance (I) at 50% and 90% (I50 and I90) were determined using the ratio of either ED50 or ED90 of AMR to AMS, respectively. The stability of the AMR parasites was evaluated by: five drug-free passages (5DFPs), 3 months of cryopreservation (CP), and drug-free serial passages (DFSPs) for 4 months. Analysis of variance was used to compare differences in growth rates between AMR and AMS with 95% confidence intervals.

RESULTS

ED50 and ED90 of AMS were 0.61 and 3.43 mg/kg/day respectively. I50 and I90 after 20 cycles of artemether selection pressure were 19.67 and 21.45, respectively; 5DFP values were 39.16 and 15.27, respectively; 3-month CP values were 29.36 and 10.79, respectively; and DFSP values were 31.34 and 12.29, respectively. The mean parasitaemia value of AMR (24.70% ± 3.60) relative to AMS (37.66% ± 3.68) at Day 7 post infection after DFSPs revealed a fitness cost of 34.41%.

CONCLUSION

A moderately stable AMRP. berghei line was generated. Known and unknown mutations may be involved in modulating artemether resistance, and therefore molecular investigations are recommended.

Metal Particle Detection by Integration of a Generative Adversarial Network and Electrical Impedance Tomography (GAN-EIT) for a Wet-Type Gravity Vibration Separator

The minor copper (Cu) particles among major aluminum (Al) particles have been detected by means of an integration of a generative adversarial network and electrical impedance tomography (GAN-EIT) for a wet-type gravity vibration separator (WGS). This study solves the problem of blurred EIT reconstructed images by proposing a GAN-EIT integration system for Cu detection in WGS. GAN-EIT produces two types of images of various Cu positions among major Al particles, which are (1) the photo-based GAN-EIT images, where blurred EIT reconstructed images are enhanced by GAN based on a full set of photo images, and (2) the simulation-based GAN-EIT images. The proposed metal particle detection by GAN-EIT is applied in experiments under static conditions to investigate the performance of the metal detection method under single-layer conditions with the variation of the position of Cu particles. As a quantitative result, the images of detected Cu by GAN-EIT ψ̿GAN in different positions have higher accuracy as compared to σ*EIT. In the region of interest (ROI) covered by the developed linear sensor, GAN-EIT successfully reduces the Cu detection error of conventional EIT by 40% while maintaining a minimum signal-to-noise ratio (SNR) of 60 [dB]. In conclusion, GAN-EIT is capable of improving the detailed features of the reconstructed images to visualize the detected Cu effectively.

A noise-controlling method by hybrid current-stimulation and voltage-measurement for electrical impedance tomography (HCSVM-EIT)

Image reconstruction in electrical impedance tomography (EIT) is a typical ill-posed inverse problem, from which the stability of conductivity reconstruction affects the reliability of physiological parameters evaluation. In order to improve the stability, the effect of boundary voltage noise on conductivity reconstruction should be controlled. A noise-controlling method based on hybrid current-stimulation and voltage-measurement for EIT (HCSVM-EIT) is proposed for stable conductivity reconstruction. In HCSVM-EIT, the boundary voltage is measured by one current-stimulation and voltage-measurement pattern (high-SNRpattern) with a higher signal-to-noise ratio (SNR); the sensitivity matrix is calculated by another current-stimulation and voltage-measurement pattern (low-condpattern) with a lower condition number; the boundary voltage is then transformed from thehigh-SNRpattern into thelow-condpattern by multiplying by an optimized transformation matrix for image reconstruction. The stability of conductivity reconstruction is improved by combining the advantages of thehigh-SNRpattern for boundary voltage measurement and thelow-condpattern for sensitivity matrix calculation. The simulation results show that the HCSVM-EIT increases the correlation coefficient (CC) of conductivity reconstruction. The experiment results show that theCCof conductivity reconstruction of the human lower limb is increased from 0.3424 to 0.5580 by 62.97% compared to the quasi-adjacent pattern, and from 0.4942 to 0.5580 by 12.91% compared to the adjacent pattern. In conclusion, the stable conductivity reconstruction with higherCCin HCSVM-EIT improves the reliability of physiological parameters evaluation for disease detection.

A European-Japanese study on peach allergy: IgE to Pru p 7 associates with severity

BACKGROUND

Pru p 3 and Pru p 7 have been implicated as risk factors for severe peach allergy. This study aimed to establish sensitization patterns to five peach components across Europe and in Japan, to explore their relation to pollen and foods and to predict symptom severity.

METHODS

In twelve European (EuroPrevall project) and one Japanese outpatient clinic, a standardized clinical evaluation was conducted in 1231 patients who reported symptoms to peach and/or were sensitized to peach. Specific IgE against Pru p 1, 2, 3, 4 and 7 and against Cup s 7 was measured in 474 of them. Univariable and multivariable Lasso regression was applied to identify combinations of parameters predicting severity.

RESULTS

Sensitization to Pru p 3 dominated in Southern Europe but was also quite common in Northern and Central Europe. Sensitization to Pru p 7 was low and variable in the European centers but very dominant in Japan. Severity could be predicted by a model combining age of onset of peach allergy, probable mugwort, Parietaria pollen and latex allergy, and sensitization to Japanese cedar pollen, Pru p 4 and Pru p 7 which resulted in an AUC of 0.73 (95% CI 0.73-0.74). Pru p 3 tended to be a risk factor in South Europe only.

CONCLUSIONS

Pru p 7 was confirmed as a significant risk factor for severe peach allergy in Europe and Japan. Combining outcomes from clinical and demographic background with serology resulted in a model that could better predict severity than CRD alone.

Free and bound sodium identification by skin dielectric properties separation algorithm of bioelectrical impedance spectroscopy (spa-BIS) in human skin model

Free and bound sodium in human skin models have been identified by two proposals: skin's phantom fabrication and skin's dielectric properties separation algorithm of bioelectrical impedance spectroscopy (spa-BIS). Thespa-BIS consist of conductivity-permittivity separation, contact impedance compensation, and a correlation score algorithm based on the vessel with a bipolar electrode. The skin phantom fabrication comprises a recipe combination with temperature-controlled protocol and sodium molarity calculation. In experiments, the human skin models are created to mimic the electrical properties of skin under1MHzwith several different sodium molarities. Based on five types of human skin models with five samples of each group, the free sodium type conductivity and concentration resultsR2=0.9903-following a linear trendline of concentration change in skin tissues theorems with the fRequency range from1kHzto1MHz,while the bound sodium type resultsR2=0.9061-.Thespa-BIS compensate7-16Ωof vessel contact impedance. The dielectric properties of each type have been extracted with less than 10% of the average standard deviation, which is considered an accurate identification method of dermis dielectric properties. The algorithm successfully identifies sodium type: free sodium has a negative, and bound sodium has a positive correlation score trend. As an additional discussion, the different time-dependent effects, the different water content, and different agar content analyses have been provided in this study. As a robust analysis method, thespa-BIS has a prominent performance to replace a²³Na-MRI in terms of free and bound sodium identification.

Physiological-induced conductive response evaluation in specific muscle compartments under hybrid of electrical muscle stimulation and voluntary resistance training by electrical impedance tomography

Objective: The physiological-induced conductive response has been visualised for evaluation in specific muscle compartments under hybrid (hybridEMS) of electrical muscle stimulation (EMS) and voluntary resistance training (VRT) by electrical impedance tomography (EIT). Methods: In the experiments, tendency of conductivity distribution images σ over time was clearly detected for three specific muscle compartments, which are called AM 1 compartment composed of biceps brachii muscle, AM 2 compartment composed of triceps brachii muscle, and AM 3 compartment composed of brachialis muscle, under three training modalities. Results: From the experimental results, the tendency of physiological-induced conductive response are increased in all three training modalities with increasing training time. Correspondingly, the spatial-mean conductivity <σ>AM1,AM2,AM3 increased with the conductance value G and extracellular water ratio β of right arm by bio-impedance analysis (BIA) method. In addition, hybridEMS has the greatest effect on physiological-induced conductive response in AM 1, AM 2, and AM 3. Under hybridEMS, the spatial-mean conductivity increased from <σ pre > AM1 = 0.154 to <σ 23mins > AM1 = 0.810 in AM 1 muscle compartment (n = 8, p < 0.001); <σ pre > AM2 = 0.040 to <σ 23mins > AM2 = 0.254 in AM 2 muscle compartment (n = 8, p < 0.05); <σ pre > AM3 = 0.078 to <σ 23mins > AM3 = 0.497 in AM 3 muscle compartment (n = 8, p < 0.05). Conclusion: The paired-samples t-test results of <σ>AM1,AM2,AM3 under all three training modalities suggest hybridEMS has the most efficient elicitation on physiological induced conductive response compared to VRT and EMS. The effect of EMS on deep muscle compartment (AM 3) is slower compared to VRT and hybridEMS, with a significant difference after 15 min of training.

Sodium Concentration Imaging in Dermis Layer by Square-wave Open Electrical Impedance Tomography (SW-oEIT) with Spatial Voltage Thresholding (SVT)

In this study, sodium concentration in the dermis layer is imaged by the square wave open electrical impedance tomography (SW-oEIT) with spatial voltage thresholding (SVT). The SW-oEIT with SVT consists of three steps which are 1) voltage measurement, 2) spatial voltage thresholding, and 3) sodium concentration imaging. In the 1st step, the root mean square voltage v ̃ is calculated based on the measured voltage v under the square wave current I through the planar electrodes on the skin domain Ω. In the 2nd step, the m-th measured voltage v is converted to a compensated voltage v^* based on the voltage electrodes distance d^v and threshold distance d^Γ in order to highlight the region of interest of the dermis layer Ω^d. In the 3rd step, sodium concentration is imaged by the Gauss-Newton reconstruction method. The SW-oEIT with SVT was applied to multi-layer skin simulation and ex-vivo experiments under various dermis sodium concentrations c in the range of 5-50 mM. As an image evaluation result, the spatial mean conductivity distribution 〈σ^* 〉 in Ω^d is successfully determined as increasing c on both simulations and experiments. The relationship between 〈σ^* 〉 and c was evaluated by the determination coefficient R2 and the normalized sensitivity 〈S〉. The optimized d^Γ with the highest evaluation values of R^2= 0.84 and 〈S〉= 0.83 is under the condition of d^Γ = 2 mm. Based on the signal evaluation, the SW-oEIT with SVT has a 15.32 % higher correlation coefficient CC compared to the conventional oEIT based on sinewave injection.

Gastric functional monitoring by gastric electrical impedance tomography (gEIT) suit with dual-step fuzzy clustering

Gastric Function has been successfully estimated by gastric electrical impedance tomography (gEIT) Suit with dual-step fuzzy clustering. The gEIT Suit which are made of elastic cloth with dual-planar electrodes and compact data acquisition (DAQ) system measures gastric impedance Z to visualize the gastric conductivity distribution σ. The dual-step fuzzy clustering extracts the clustered gastric conductivity distribution ^kσ, which accurately estimates the gastric function. The gEIT Suit with dual-step fuzzy clustering are applied to eight healthy persons during liquid meal consumption to estimate the gastric function under gastric accommodation phase of 200, 400 and 600 mL based on the gastric emptying phase. As the results, the gEIT Suit successfully estimate the gastric function. By the measured impedance Z, the subjects have a mean temporal impedance [Formula: see text]= - 9.27 [Ohm] and p-value of that [Formula: see text] p(Z) = 0.0013[-]as the t-test result. In the case of gastric conductivity distribution σ, the subjects have a value of spatial mean conductivity distribution ⟨σ⟩ = 0.23[-] and p-value of that ⟨σ⟩ p(σ) = 0.0140[-]. Lastly, in the case gastric volume V, subjects have a gastric volume V = 12.44 [%] and p-value p(V) = 0.0664[-].

Skin layer classification by feedforward neural network in bioelectrical impedance spectroscopy

Conductivity change in skin layers has been classified by source indicator ok (k=1: Stratum corneum, k=2: Epidermis, k=3: Dermis, k=4: Fat, and k=5: Stratum corneum + Epidermis) trained from feedforward neural network (FNN) in bioelectrical impedance spectroscopy (BIS). In BIS studies, treating the skin as a bulk, limits the differentiation of conductivity changes in individual skin layers, however skin layer classification using FNN shows promise in accurately categorizing skin layers, which is essential for predicting source indicators ok and initiating skin dielectric characteristics diagnosis. The ok is trained by three main conceptual points which are (i) implementing FNN for predicting k in conductivity change, (ii) profiling four impedance inputs αξ consisting of magnitude input α|z|, phase angle input αθ, resistance input αR, and reactance input αx for filtering nonessential input, and (iii) selecting low and high frequency pair ( f r l h ) by distribution of relaxation time (DRT) for eliminating parasitic noise effect. The training data set of FNN is generated to obtain the αξ ∈ R10×17×10 by 10,200 cases by simulation under configuration and measurement parameters. The trained skin layer classification is validated through experiments with porcine skin under various sodium chloride (NaCl) solutions CNaCl = {15, 20, 25, 30, 35}[mM] in the dermis layer. FNN successfully classified conductivity change in the dermis layer from experiment with accuracy of 90.6% for the bipolar set-up at f 6 l h = 10   & 100   [ kHz] and with the same accuracy for the tetrapolar at f 8 l h = 35   & 100   [ kHz] . The measurement noise and systematic error in the experimental results are minimized by the proposed method using the feature extraction based on αξ at f r l h .

Study of transmembrane ion transport under tonicity imbalance using a combination of low frequency-electrical impedance spectroscopy (LF-EIS) and improved ion transport model

Transmembrane ion transport under tonicity imbalance has been investigated using a combination of low frequency-electrical impedance spectroscopy (LF-EIS) and improved ion transport model, by considering the cell diameterd[m] and the initial intracellular ion concentrationc_in[mM] as a function of tonicity expressed by sucrose concentrationc_s[mM]. The transmembrane ion transport is influenced by extracellular tonicity conditions, leading to a facilitation/inhibition of ion passage through the cell membrane. The transmembrane transport coefficientP[m s^-1], which represents the ability of transmembrane ion transport, is calculated by the extracellular ion concentrations obtained by improved ion transport model and LF-EIS measurement.Pis calculated as 4.11 × 10^-6and 3.44 × 10^-6m s^-1atc_sof 10 and 30 mM representing hypotonic condition, 2.44 × 10^-6m s^-1atc_sof 50 mM representing isotonic condition, and 3.68 × 10^-6, 5.16 × 10^-6, 9.51 × 10^-6, and 14.89 × 10^-6m s^-1atc_sof 75, 100, 125 and 150 mM representing hypertonic condition. The LF-EIS results indicate that the transmembrane ion transport is promoted under hypertonic and hypotonic conditions compared to isotonic condition. To verify the LF-EIS results, fluorescence intensityF[-] of extracellular potassium ions is observed to obtain the temporal distribution of average potassium ion concentration within the region of 3.6μm from cell membrane interfacec_ROI[mM]. The slopes of ∆c_ROI/c_ROI1to timetare 0.0003, 0.0002, and 0.0006 under hypotonic, isotonic, and hypertonic conditions, wherec_ROI1denotes initialc_ROI, which shows the same tendency with LF-EIS result that is verified by the potassium ion fluorescence observation.

Simultaneous electrical online estimation of changes in blood hematocrit and temperature in cardiopulmonary bypass

Two equations have been developed from multi-frequency measurements of blood impedance Z_b for a simultaneous electrical online estimation of changes in blood hematocrit ΔH [%] and temperatures ΔT [K] in cardiopulmonary bypass (CPB). Z_b of fixed blood volumes at varying H and T were measured by an impedance analyzer and changes in blood conductivity σ_b and relative permittivity ε_b computed. Correlation analysis were based on changes in σ_b with H or T at f = 1 MHz while H and T equations were developed by correlating changes in ε_b with H and T at dual frequencies of f = 1 MHz and f = 10 MHz which best capture blood plasma Z_p and red blood cell cytoplasm Z_cyt impedances respectively. Results show high correlations between σ_b and H (R² = 0.987) or σ_b and T (R² = 0.9959) indicating dependence of the electrical parameters of blood on its H and T. Based on computed ε_b, changes in blood hematocrit ΔH and temperature ΔT at a given time t are estimated as ΔH(t) = 1.7298Δε_b (f = 1 MHz) - 1.0669Δε_b (f = 10 MHz) and ΔT(t) = -2.186Δε_b (f = 1 MHz) + 2.13Δε_b (f = 10 MHz). When applied to a CPB during a canine mitral valve plasty, ΔH and ΔT had correlations of R² = 0.9992 and R² = 0.966 against H and T respectively as measured by conventional devices.

A High Accuracy Voltage Approximation Model Based on Object-oriented Sensitivity Matrix Estimation (OO-SME Model) in Electrical Impedance Tomography

The image reconstruction in electrical impedance tomography (EIT) has low accuracy due to the approximation error between the measured voltage change and the approximated voltage change, from which the object cannot be accurately reconstructed and quantitatively evaluated. A voltage approximation model based on object-oriented sensitivity matrix estimation (OO-SME model) is proposed to reconstruct the image with high accuracy. In the OO-SME model, a sensitivity matrix of the object-field is estimated, and the sensitivity matrix change from the background-field to the object-field is estimated to optimize the approximated voltage change, from which the approximation error is eliminated to improve the reconstruction accuracy. Against the existing linear and nonlinear models, the approximation error in the OO-SME model is eliminated, thus an image with higher accuracy is reconstructed. The simulation shows that the OO-SME model reconstructs a more accurate image than the existing models for quantitative evaluation. The relative accuracy (RA) of reconstructed conductivity is increased up to 83.98% on average. The experiment of lean meat mass evaluation shows that the RA of lean meat mass is increased from 7.70% with the linear model to 54.60% with the OO-SME model. It is concluded that the OO-SME model reconstructs a more accurate image to evaluate the object quantitatively than the existing models.

“Target Heart Rate” calculated aiming at zero overlap of mitral E and A waves is useful for prediction of long-term outcome for patients with heart failure and reduced ejection fraction

Background

Lower heart rate (HR) is associated with more favourable long-term outcome in patients with heart failure with reduced ejection fraction (HFrEF). However, an optimal threshold of HR remains unclear. Targeted HR (THR), defined by echocardiographic deceleration time (DCT) to eliminated overlap of E and A waves, may aid in risk stratification of HFrEF patients.

Purpose

In this study, we aimed to clarify the impact of on long-term clinical outcome in patients with HFrEF.

Methods

In the multicenter WET-HF registry, 4000 consecutive patients hospitalized for acute decompensated HF (ADHF) were registered between 2006 and 2017. Among them, the patients with EF ≥40% or a history of atrial fibrillation were excluded. THR was calculated based on their DCT value measured in compensated HF phase during the index admission. The following formula was applied; THR (bpm)=93 - 0.13 × deceleration time (DCT, msec). A total of 876 patients with HFrEF were included in the present analysis (age: 72 [60–81], male: 69%) and the patients were divided into the 2 groups of HR at discharge ≤ THR (L group) and &gt; THR (H group). The primary endpoint (PE) was defined as the composite of all-cause death and ADHF re-admission.

Results

Compared to the H group, the L group showed higher prevalence of males (74% vs. 66%, P=0.025) with higher body mass index (BMI, 23.2 vs. 22.2, P=0.016), hemoglobin (Hb, 12.9 vs. 12.4, P=0.031), albumin (Alb, 3.7 vs. 3.6, P=0.039) and larger left atrial diameter (LAD, 44 mm vs. 41 mm, P=0.002) and tricuspid regurgitation pressure gradient (TRPG, 29 mmHg vs. 27 mmHg, P=0.012). Age, estimated glomerular filtration rate (eGFR), LVEF (29% vs. 30%, P=NS) and E/e' (17.7 vs. 16.8, P=NS) were similar for both groups. At discharge, HR was lower in L group (66 [60–71] bpm vs. 80 [74–86] bpm, P&lt;0.001), albeit there were no significant differences in b-blocker prescription (90% vs. 85%, P=0.069) or its dose (3.75 [1.25–7.25] mg vs. 2.5 [1.25–5] mg, P=0.11).

In the survival analysis, the L group showed a significantly lower rate of PE (P=0.03), whereas there was no significant difference in the incidence of PE between the patients with HR at discharge ≥70 bpm and &lt;70 bpm (P=NS).

Multivariate Cox hazard analysis showed that HR at discharge ≤ THR was an independent predictor of PE (hazard ratio 0.67 [0.46–0.97], P=0.037), even after adjusting for confounding factors including age, sex, BMI, Hb, Alb, and b-blocker prescription, whereas HR at discharge &lt;70 bpm was not (hazard ratio 0.94 [0.65–1.33], P=0.71).

Conclusion

THR was associated with long-term outcomes in patients with HFrEF after acute decompensation, suggesting that it may aid in tailored treatment for HR reduction in these patients.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Electrical-tomographic imaging of physiological-induced conductive response in calf muscle compartments during voltage intensity change of electrical muscle stimulation (vic-EMS)

Objectives. The electrical-tomographic imaging has been achieved for exploring differential tendency of physiological-induced conductive response in calf muscle compartments during voltage intensity change of electrical muscle stimulation (vic-EMS).Approach. In the experiments, the differential tendency of conductivity distribution imagesσduringvic-EMS were clearly imaged as three responsive muscle compartments, which are calledM₁compartment composed of gastrocnemius muscle,M₂compartment composed of tibialis anterior, extensor digitorum longus, and peroneus longus muscles, andM₃compartment composed of soleus muscle.Main results. The differential tendency of spatial-mean conductivity 〈σ〉_M1is the same as the differential tendency of venous blood flow velocityv_bland blood lactate concentrationC_blduringvic-EMS by the increased tendency of spatial-mean conductivity difference Δ〈σ〉_M1, venous blood flow velocity difference Δv_bland blood lactate concentration difference ΔC_bl. The 〈σ〉_M1is increased with the increase of voltage intensity from 〈σ^pre〉_M1 = 0.142 [-] to 〈σ^l14 〉 _M1 = 0.442 [-] (pre: pre-training,l14: voltage level duringvic-EMSl = 14) by Δ〈σ^l14-pre〉_M1 = 204.2% (n = 16,p < 0.01). Correspondingly, thev_blandC_blare increased with the increase of voltage intensity by Δv_bl^l14-pre= 1480.5% (n = 16,p < 0.01) and ΔC_bl^l14-pre= 230.1% (n = 16,p < 0.01) respectively.Significance: The reason for the differential tendency of increase in <σ>_M1suggests an increase in muscle extracellular volumes duringvic-EMS due to the co-effect of venous blood flow velocity and blood lactate metabolism. Based on the conductivity second-order difference images∂2σM1φ∂φ2φand spatial-mean conductivity second-order difference∂2σM1φ∂φ2φ,optimum voltage intensityφ_OVIis discussed among sixteen volunteer subjects, which increased with a thicker subcutaneous fat layer.

In-vivoviscoelastic properties estimation in subcutaneous adipose tissue by integration of poroviscoelastic-mass transport model (pve-MTM) into wearable electrical impedance tomography (w-EIT)

In-vivoviscoelastic properties have been estimated in human subcutaneous adipose tissue (SAT) by integration of poroviscoelastic-mass transport model (pve-MTM) into wearable electrical impedance tomography (w-EIT) under the influence of external compressive pressure-P.Thepve-MTM predicts the ion concentration distributioncmod(t)by coupling the poroviscoelastic and mass transport model to describe the hydrodynamics, rheology, and transport phenomena inside SAT. Thew-EIT measures the time-difference conductivity distribution∆γ(t)in SAT resulted from the ion transport. Based on the integration, the two viscoelastic properties which are viscoelastic shear modulus of SATGvand relaxation time of SATτvare estimated by applying an iterative curve-fitting between the normalized average ion concentration distributioncˆmod(t)predicted frompve-MTM and the experimental normalized average ion concentration distributioncˆexp(t)derived fromw-EIT. Thein-vivoexperiments were conducted by applying external compressive pressure-Pon human calf boundary to induce interstitial fluid flow and ion movement in SAT. As a result, the value ofGvwas range from 4.9-6.3 kPa and the value ofτvwas range from 27.50-38.5 s with the value of average goodness-of-fit curve fittingR² > 0.76. These values ofGvandτvwere compared to the human and animal tissue from the literature in order to verify this method. The results frompve-MTM provide evidence thatGvandτvplay a role in the predicted value ofcˆmod.

Evaluation of the effectiveness of electrical muscle stimulation on human calf muscles via frequency difference electrical impedance tomography

Objectives. The human skeletal muscle responds immediately under electrical muscle stimulation (EMS), and there is an immediate physiological response in human skeletal muscle. Non-invasive quantitative analysis is at the heart of our understanding of the physiological significance of human muscle changes under EMS. Response muscle areas of human calf muscles under EMS have been detected by frequency difference electrical impedance tomography (fd-EIT).Approach. The experimental protocol consists of four parts: pre-training (pre), training (tra), post-training (post), and relaxation (relax) parts. The relaxation part has three relaxation conditions, which are massage relaxation (MR), cold pack relaxation (CR), and hot pack relaxation (HR).Main results. From the experimental results, conductivity distribution imagesσ^p(pmeans protocol = pre,tra,post,or relax) are clearly reconstructed byfd-EIT as response muscle areas, which are called theM₁response area (composed of gastrocnemius muscle) and theM₂response area (composed of the tibialis anterior muscle, extensor digitorum longus muscle, and peroneus longus muscle). A paired samplest-test was conducted to elucidate the statistical significance of spatial-mean conductivities 〈σ^p〉_M1and 〈σ^p〉_M2inM₁andM₂with reference to the conventional extracellular water ratioβ^pby bioelectrical impedance analysis. Significance. From thet-test results, 〈σ^p〉_M1and〈σ^p〉_M2have good correlation withβ^p. In the post-training part, 〈σ^post〉 andβ^postwere significantly higher than in the pre-training part (n = 24,p < 0.001). The relax-pre difference ratios of spatial-mean conductivity Δ〈σ^relax-pre〉 and the relax-pre difference ratios of extracellular water ratio Δβ^relax-prein both MR and CR were lower; on the contrary, the Δ〈σ^relax-pre〉 and Δβ^relax-prein HR were significantly higher than those in post-pre difference ratios of spatial-mean conductivity Δ〈σ^post-pre〉 (n = 8,p < 0.05). The reason for the changes in 〈σ^p〉_M1and 〈σ^p〉_M2are caused by the changes in muscle extracellular volumes. In conclusion,fd-EIT satisfactorily evaluates the effectiveness of human calf muscles under EMS.

Correlation between alterations in blood flow of malignant lymphomas after induction chemotherapies and clinical outcomes: a pilot study utilising contrast-enhanced ultrasonography for early interim evaluation of lymphoma treatment

AIM

To clarify the utility of contrast-enhanced ultrasonography (CEUS) for interim evaluation of response to chemotherapy in lymphoma treatment.

MATERIALS AND METHODS

CEUS was performed both before (day 0) and after the treatment (7 and/or 14 days), and a time-intensity curve was obtained. The patients were divided into two groups (complete remission [CR] group and non-CR group) according to the results of conventional response evaluation, and peak enhancement (PE), time to peak enhancement, perfusion index (PI), the total area under the curve during wash-in (AUC-in), and the total AUC were compared between the groups.

RESULTS

Among 27 patients with various types of lymphoma, the median change ratio of PE and PI at day 7 evaluation were significantly different between the CR group and the non-CR group (0.81 versus 1.39, p=0.017 for PE and 0.92 versus 2.09, p=0.010 for PI). The change ratio of PE < 1.09 (specificity: 86%; sensitivity, 88%) and PI < 1.65 (specificity: 86%; sensitivity: 94%) distinguished CR from non-CR. Patients who achieved a PE change ratio <1.09 or a PI change ratio <1.65 had significantly better estimated progression-free survival (p<0.001).

CONCLUSION

The present study demonstrated that changes in tumour perfusion parameters evaluated with CEUS at 1 week after the treatment initiation were significantly different between lymphoma patients in CR group and non-CR group. Alterations in perfusion parameters evaluated via CEUS could impact the prognosis of lymphoma patients.

Quantitative Evaluation of Burn Injuries Based on Electrical Impedance Spectroscopy of Blood with a Seven-Parameter Equivalent Circuit

A quantitative and rapid burn injury detection method has been proposed based on the electrical impedance spectroscopy (EIS) of blood with a seven-parameter equivalent circuit. The degree of burn injury is estimated from the electrical impedance characteristics of blood with different volume proportions of red blood cells (RBCs) and heated red blood cells (HRBCs). A quantitative relationship between the volume portion H_HCT of HRBCs and the electrical impedance characteristics of blood has been demonstrated. A seven -parameter equivalent circuit is employed to quantify the relationship from the perspective of electricity. Additionally, the traditional Hanai equation has been modified to verify the experimental results. Results show that the imaginary part of impedance Z_Imt under the characteristic frequency (f_c) has a linear relationship with H_HCT which could be described by Z_Imt = −2.56H_HCT − 2.01 with a correlation coefficient of 0.96. Moreover, the relationship between the plasma resistance R_p and H_HCT is obtained as R_p = −7.2H_HCT + 3.91 with a correlation coefficient of 0.96 from the seven -parameter equivalent circuit. This study shows the feasibility of EIS in the quantitative detection of burn injury by the quantitative parameters Z_Imt and R_p, which might be meaningful for the follow-up clinical treatment for burn injury.

Effect of air pollution on acute heart failure hospitalization differ across specific heart failure populations

Introduction

Several report showed the association between ambient air pollution including particular matter under 2.5um (PM2.5) and increasing rate of hospitalization for heart failure. However, these report analyzed mainly cross-sectional, epidemiological data, thus the reports regarding association between vulnerability to PM2.5 and specific populations in acute heart failure (AHF) were scarce.

Purpose

1. To analyze the association between air pollution and rate of hospitalization for AHF

2. To analyze whether the vulnerability to air pollution differ between specific populations in AHF. Methods

A case-cross over analysis was conducted to 4980 consecutive patients registered for multicenter acute heart failure registry in 2017 in our city Japan. This registry enrolled patients transferred to cardiovascular care unit (80 institutions) via emergency medical services across our city area. Logistic regression analysis were conducted to estimate percentage changes in the rate of acute heart failure hospitalization associated with per 1μg/m3 PM2.5 concentration increase. We also conducted subgroup analysis for patients stratified by age, gender, comorbidities, left ventricular ejection fraction, and clinical scenario.

Results

An increase in 1 μg/m3 PM2.5 concentration corresponded to 2.9% (95% CI 1.2–4.6%) increase in AHF hospitalization. Patients with age younger than 75, without prior heart failure hospitalization, without history of hypertension, without anemia, and with reduced ejection fraction were more susceptible to increase in PM2.5 concentration (Figure).

Conclusions

Increase in PM2.5 concentration was associated with increased rate of AHF hospitalization. Effect of PM2.5 may differ across specific AHF subpopulations.

Figure 1

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Tokyo Metropolitan Government

Low-Frequency Impedance-Based Cell Discrimination Considering Ion Transport Model in Cell Suspension

Low-frequency impedance-based (LFI) cell discrimination as a novel non-destructive and non-invasive cell discrimination is proposed. LFI cell discrimination discriminates the cell type by considering an ion transport model in cell suspension. Ion transport model in cell suspension is constructed on the basis of Fick's laws of diffusion in the extracellular region under ion permeability P which represents the characteristics of cell type. P is achieved using the ion transport model equation through an iterative curve fitting to an ion concentration in extracellular region obtained from low-frequency impedance which is assumed to be linearly related to the ion concentration in extracellular region. In experiment, the electrical impedance spectra from the frequency of 200 kHz to 2.0 MHz are measured over time during producing ions from intracellular region to extracellular one in cell suspension using an impedance analyzer and an interdigitated array electrode system. As a target cell type, two different cell types based on Medical Research Council 5 (MRC-5), which are different in intracellular component are used. The curve fitting is performed for the low-frequency impedance at 200 kHz at which impedance reflects the ion concentration in extracellular region in order to obtain P of each cell type. As a result, each cell type has its own P. The proposed LFI cell discrimination successfully discriminates the cell type.