Electrical impedance myography for the early detection of muscle ischemia secondary to compartment syndrome: a study in a rat model

Acute Compartment Syndrome (ACS) is one of the most devastating orthopedic conditions, affecting any of the body's many compartments, which, if sufficiently severe, may result in disability and amputation. Currently, intra-compartmental pressure measurements serve as the gold standard for diagnosing ACS. Diagnosing limbs at risk for ACS before irreversible damage to muscle and nerve is critical. Standard approaches for diagnosing impending compartment syndrome include clinical evaluation of the limb, such as assessment for "tightness" of the overlying skin, reduced pulses distally, and degree of pain, none of which are specific or sensitive. We have proposed a novel method to detect ACS via electrical impedance myography (EIM), where a weak, high-frequency alternating current is passed between one pair of electrodes through a region of tissue, and the resulting surface voltages are measured via a second pair. We evaluated the ability of EIM to detect early muscle ischemia in an established murine model of compression-induced muscle injury, where we collected resistance, reactance, and their dimensionless product, defined as Relative Injury Index (RII) during the study. Our model generated reproducible hypoxia, confirmed by Hypoxyprobe™ staining of endothelial regions within the muscle. Under conditions of ischemia, we demonstrated a reproducible, stable, and significant escalation in resistance, reactance, and RII values, compared to uninjured control limbs. These data make a reasonable argument for additional investigations into using EIM for the early recognition of muscle hypoperfusion and ischemia. However, these findings must be considered preliminary steps, requiring further pre-clinical and clinical validation.

An Impedance Readout IC with Ratio-Based Measurement Techniques for Electrical Impedance Spectroscopy

This paper presents an error-tolerant and power-efficient impedance measurement scheme for bioimpedance acquisition. The proposed architecture measures the magnitude and the real part of the target complex impedance, unlike other impedance measurement architectures measuring either the real/imaginary components or the magnitude and phase. The phase information of the target impedance is obtained by using the ratio between the magnitude and the real components. This can allow for avoiding direct phase measurements, which require fast, power-hungry circuit blocks. A reference resistor is connected in series with the target impedance to compensate for the errors caused by the delay in the sinusoidal signal generator and the amplifier at the front. Moreover, an additional magnitude measurement path is connected to the reference resistor to cancel out the nonlinearity of the proposed system and enhance the settling speed of the low-pass filter by a ratio-based detection. Thanks to this ratio-based detection, the accuracy is enhanced by 30%, and the settling time is improved by 87.7% compared to the conventional single-path detection. The proposed integrated circuit consumes only 513 μW for a wide frequency range of 10 Hz to 1 MHz, with the maximum magnitude and phase errors of 0.3% and 2.1°, respectively.

A Polar-Demodulation-Based Impedance-Measurement IC Using Frequency-Shift Technique With Low Power Consumption and Wide Frequency Range

In this paper, we present a new impedance measurement integrated circuit (IC) for achieving a wideband coverage up to 10 MHz and low power consumption. A frequency-shift technique is applied to down-shift the input frequency, which ranges from 100 kHz to 10 MHz, into an intermediate frequency of 10 kHz, while the frequency-shifting is bypassed when the input frequency falls in the range from 100 Hz to 100 kHz. It results in 100 times relaxation of the requirement on the instrumentation amplifier (IA) bandwidth and the comparator delay, greatly reducing overall power consumption. The proposed IC employs the polar demodulation structure with a reference resistor that provides reference timing information avoiding any synchronization issue with the transmitter. In order to compensate for the comparator delay and nonlinearity of the IA, the reference magnitude measurement path is added, making only the mismatch of the circuit affects the accuracy. This allows for employing the auto-zeroing technique that can remove the offset but increase the absolute delay by using an additional capacitor to the comparator. The chip fabricated in a 0.18- μm CMOS technology consumes the power of 756 μW while covering the measurement frequency range from 100 Hz to 10 MHz and exhibiting the maximum magnitude and phase errors of 1.1 % and 1.9 ^°, respectively.

Assessing Ischemic Injury in Human Intestine Ex Vivo with Electrical Impedance Spectroscopy

Electrical impedance spectroscopy is a well-established tool for monitoring changes in the electrical properties of tissue. Most tissue and organ types have been investigated in various studies. As for the small intestine, there are several published studies conducted on pig and rat models. This study investigates the changes in passive electrical properties of the complete wall of the human intestine non-invasively during ischemia. We aim to use the passive electrical properties to assess intestinal viability. The bioimpedance measurements were performed using a two-electrode set-up with a Solartron 1260 Impedance/gain-phase analyser. The small intestinal samples were resected from patients who underwent pancreaticoduodenectomy. Impedance measurements were conducted following resection by placing the electrodes on the surface of the intestine. A voltage was applied across the intestinal sample and the measured electrical impedance was obtained in the ZPlot software. Impedance data were further fitted into a Cole model to obtain the Cole parameters. The P_y value was calculated from the extracted Cole parameters and used to assess the cell membrane integrity, thus evaluate the intestinal viability. Eight small intestinal segments from different patients were used in this study and impedance measurements were performed once an hour for a ten-hour period. One hour after resection, the impedance decreased, then increased the next two hours, before decreasing until the end of the experiment. For all the intestinal segments, the P_y values first increased and reached a plateau which lasted for 1 - 2 hours, before it decreased irreversibly. The time interval where P_y value reached the maximum is consistent with reported viable/non-viable limits from histological analysis.

A Harmonic Error Cancellation Method for Accurate Clock-Based Electrochemical Impedance Spectroscopy

Electrochemical impedance spectroscopy (EIS) is a widely used method to characterize the biological materials. In traditional methods for EIS, a sinusoidal current is used to excite the material under test and the measured voltage across that material is demodulated by a linear multiplication with quadrature sinusoidal signals. From the resulting demodulated output, the impedance (magnitude and phase) can be calculated. Although this sine-wave-based impedance measurement method can produce accurate impedance measurements, it requires bulky components and suffers from poor power efficiency due to sinusoidal waveform generation and linear multiplication. Alternatively, a method using square-wave signal, which is simply a clock, for both excitation and demodulation can be much more area and power efficient, but inherently suffers from substantial errors in the result due to significant harmonics in square waves. In this paper, we propose a technique to cancel out the errors caused by such harmonics of the square-wave-based excitation and demodulation. The proposed technique, based on the fact that the magnitude ratio of all the harmonics of a square wave are known, cancels out harmonic errors by subtracting or adding the square-wave-based measured results at higher harmonic frequencies as a simple post-processing calculation. Simulations on specific and also generic impedance models demonstrate the applicability of this technique to various impedance models. Experimental results using a discrete circuit model show that this technique can provide a precise measurement of the impedance with 1% magnitude error and 0.5° phase error considering just five terms. In addition, measurements with a biological tissue show an average magnitude and phase error of 0.7% and [Formula: see text], respectively, using the proposed error cancellation. Because this method replaces sinusoidal signal generation and linear multiplication with clock generation and simple switching, it has great potential to be integrated in a wearable and implantable health monitoring device at low area and power consumption.

Hearts during ischemia with or without HTK-protection analysed by dielectric spectroscopy

OBJECTIVE

We investigated canine hearts during ischemia after aortic cross clamping (UI, n  =  20) and after HTK-cardioplegia (HTK, n  =  24) at 35 °C, 25 °C, 15 °C, and 5 °C with the aim to compare tissue changes caused by the activity of anaerobic metabolism(AAM), cell membrane destruction(CD), and gap junction uncoupling(GJU).

APPROACH

We measured continuously the complex dielectric spectrum(DS), ATP- and lactate content, extracellular pH, and rigor contracture. To identify changes in DS caused by AAM, CD, and GJU we performed additional experiments on the gap junction-free skeletal muscle. We used heart model simulations to calculate the effect of temperature.

MAIN RESULTS

AAM affected the DS at 10 MHz and we found a strong correlation between DS and the proton concentration with a maximum of DS at 10 mmol g^-1 dry weight in ATP-concentration. The time of GJU was detected by a characteristic increase in DS and CD by a characteristic decrease at 13 kHz. In comparison to UI, GJU, AAM and CD were delayed by HTK and by hypothermia, indicating a minimization of energy consumption and an improved preservation of tissue structure.

SIGNIFICANCE

The novel findings were that in UI at 5 °C GJU occurred earlier and AAM remained constant, indicating a less effective preservation in UI by deep hypothermia in contrast to HTK.

Guidelines to electrode positioning for human and animal electrical impedance myography research

The positioning of electrodes in electrical impedance myography (EIM) is critical for accurately assessing disease progression and effectiveness of treatment. In human and animal trials for neuromuscular disorders, inconsistent electrode positioning adds errors to the muscle impedance. Despite its importance, how the reproducibility of resistance and reactance, the two parameters that define EIM, are affected by changes in electrode positioning remains unknown. In this paper, we present a novel approach founded on biophysical principles to study the reproducibility of resistance and reactance to electrode misplacements. The analytical framework presented allows the user to quantify a priori the effect on the muscle resistance and reactance using only one parameter: the uncertainty placing the electrodes. We also provide quantitative data on the precision needed to position the electrodes and the minimum muscle length needed to achieve a pre-specified EIM reproducibility. The results reported here are confirmed with finite element model simulations and measurements on five healthy subjects. Ultimately, our data can serve as normative values to enhance the reliability of EIM as a biomarker and facilitate comparability of future human and animal studies.

Age-related differences of intraischemic gap junction uncoupling in hearts during ischemia

OBJECTIVE

Myocardial ischemia leads to energetic, morphologic, metabolic, and functional alterations. To evaluate differences in ischemia tolerance between neonatal and adult hearts, we investigated gap junction uncoupling (GJU) and its correlation to myocardial intracellular edema formation during normothermic ischemia.

METHODS

Hearts of landrace piglets (neonates, 7.4 ± 1.9 days of age, body weight 2.9 ± 0.5 kg, n = 5 and adults, 84 ± 9 days of age, body weight 30.5 ± 3.9 kg, n = 5) were investigated. After we harvested the hearts, the bioelectrical impedance spectra were measured continuously during normothermic global ischemia (35°C). Spectra of the dielectric permittivity, ε'(frequency), and conductivity, σ(frequency), were calculated from the impedance measurements, and GJU was identified in the sigmoidal time course of ε' (13 kHz). The extracellular volume was estimated by the ratio σ (100Hz)/σ (1MHz). Dielectric data were correlated with electron-microscopical images.

RESULTS

Intraischemic GJU was observed in neonates after 54 ± 9 minutes of ischemia and thus significantly earlier than in adults (90 ± 7 minutes, P < .05). A more than 20% increase of intercalated water was found in tissue samples of neonates after 20 ± 2 minutes, in contrast to adults after 137 ± 8 minutes (P < .05).

CONCLUSIONS

Intraischemic formation of edema and earlier GJU indicate faster intraischemic changes in neonates compared with adults. Intraischemic GJU and determination of intracellular water shifts are an experimental approach to establish the period of life-threatening damage. Because both parameters are linked and occur significantly earlier in neonates, they distinctly demonstrate the lower ischemia tolerance of neonatal hearts as both events interact.

Evaluation of Electrical Impedance as a Biomarker of Myostatin Inhibition in Wild Type and Muscular Dystrophy Mice

Objectives

Non-invasive and effort independent biomarkers are needed to better assess the effects of drug therapy on healthy muscle and that affected by muscular dystrophy (mdx). Here we evaluated the use of multi-frequency electrical impedance for this purpose with comparison to force and histological parameters.

Methods

Eight wild-type (wt) and 10 mdx mice were treated weekly with RAP-031 activin type IIB receptor at a dose of 10 mg kg⁻¹ twice weekly for 16 weeks; the investigators were blinded to treatment and disease status. At the completion of treatment, impedance measurements, in situ force measurements, and histology analyses were performed.

Results

As compared to untreated animals, RAP-031 wt and mdx treated mice had greater body mass (18% and 17%, p < 0.001 respectively) and muscle mass (25% p < 0.05 and 22% p < 0.001, respectively). The Cole impedance parameters in treated wt mice, showed a 24% lower central frequency (p < 0.05) and 19% higher resistance ratio (p < 0.05); no significant differences were observed in the mdx mice. These differences were consistent with those seen in maximum isometric force, which was greater in the wt animals (p < 0.05 at > 70 Hz), but not in the mdx animals. In contrast, maximum force normalized by muscle mass was unchanged in the wt animals and lower in the mdx animals by 21% (p < 0.01). Similarly, myofiber size was only non-significantly higher in treated versus untreated animals (8% p = 0.44 and 12% p = 0.31 for wt and mdx animals, respectively).

Conclusions

Our findings demonstrate electrical impedance of muscle reproduce the functional and histological changes associated with myostatin pathway inhibition and do not reflect differences in muscle size or volume. This technique deserves further study in both animal and human therapeutic trials.

Wireless impedance measurements for monitoring peripheral vascular disease

Wireless microdevices powered by ultrasound energy have been fabricated to measure and telemeter tissue impedance spectrums for applications in peripheral vascular disease monitoring. The system is characterized by simplicity of the implant consisting of only two electrical components. Ex vivo testing shows the potential for constructing tissue impedance spectrum plots over the range from 10 Hz to 10 kHz by a device less than 1 mm in diameter and 1 cm long. The neurostimulator microdevice was powered by continuous waveform 650 kHz ultrasound with a swept-frequency amplitude modulation. The system was operated at safe ultrasound power levels on the order of 10-100 mW/cm(2). The device proved to be sensitive and able to measure tissue impedances over a broad range. Volume conducted signals carrying impedance information from the microdevice were remotely detected by surface biopotential electrodes.

Design of tri-level excitation signals for broadband bioimpedance spectroscopy

Bioimpedance spectroscopy (BIS) measurement methods have been evolving from the traditional frequency-sweep approach to the multi-frequency simultaneous measurement technique which can drastically reduce measuring time and will be increasingly attractive for time-varying biological applications. Multi-frequency mixed (MFM) signals with sparsely distributed spectra are desirable for broadband BIS measurement. This paper proposes a synthesis method to design a series of tri-level MFM signals which contain only three values (+1, 0, -1), and has majority energy distributed on its (2(n))th primary harmonics. Tri-level MFM signals have both high energy efficiency and a low crest factor. An impedance measurement experiment excited by an 8th-order tri-level MFM signal on a RC three-element equivalent model has been performed, and the results on 8 primary harmonic frequencies ranging from 8 to 1024 kHz show a high accuracy with the mean amplitude relative error of 0.41% and mean phase absolute error of 0.18°, which has validated the feasibility of the tri-level MFM signals for broadband BIS measurement.

Multi-frequency simultaneous measurement of bioimpedance spectroscopy based on a low crest factor multisine excitation

Bioimpedance spectroscopy (BIS) is becoming a powerful diagnostic tool for a wide variety of medical applications, and the multi-frequency simultaneous (MFS) measurement of BIS can greatly reduce measurement time and record the transient physiological status of a living body compared with traditional frequency-sweep measurement technology. This paper adopts the Van der Ouderaa's multisine, which has 31 equidistant and flat amplitude spectra and a low crest factor of 1.405 as the broadband excitation, and realizes the MFS measurement of BIS by means of spectral analysis using the fast Fourier transform algorithm. The approach to implement the multisine based on a field-programmable gate array and a digital to analog converter is described in detail, and impedance measurement experiments are performed on three resistance-capitance three-element phantoms. Experimental results show a commendable accuracy with a mean relative error of 0.55% for the impedance amplitudes, and a mean absolute error of 0.20° for the impedance phases on the 31 frequencies ranging linearly from 32 to 992 kHz. This paper validates the feasibility of the MFS technology for BIS measurement based on the multisine excitation.

Development of a stair-step multifrequency synchronized excitation signal for fast bioimpedance spectroscopy

Wideband excitation signal with finite prominent harmonic components is desirable for fast bioimpedance spectroscopy (BIS) measurements. This work introduces a simple method to synthesize and realize a type of periodical stair-step multifrequency synchronized (MFS) signal. The Fourier series analysis shows that the p-order MFS signal f(p, t) has constant 81.06% energy distributed equally on its p  2ⁿth primary harmonics. The synthesis principle is described firstly and then two examples of the 4-order and 5-order MFS signals, f(4, t) and f(5, t), are synthesized. The method to implement the MFS waveform based on a field-programmable gate array (FPGA) and a digital to analog converter (DAC) is also presented. Both the number and the frequencies of the expected primary harmonics can be adjusted as needed. An impedance measurement experiment on a RC three-element equivalent model is performed, and results show acceptable precision, which validates the feasibility of the MFS excitation.

Improved Cole parameter extraction based on the least absolute deviation method

The Cole function is widely used in bioimpedance spectroscopy (BIS) applications. Fitting the measured BIS data onto the model and then extracting the Cole parameters (R0, R∞, α and τ) is a common practice. Accurate extraction of the Cole parameters from the measured BIS data has great significance for evaluating the physiological or pathological status of biological tissue. The traditional least-squares (LS)-based curve fitting method for Cole parameter extraction is often sensitive to noise or outliers and becomes non-robust. This paper proposes an improved Cole parameter extraction based on the least absolute deviation (LAD) method. Comprehensive simulation experiments are carried out and the performances of the LAD method are compared with those of the LS method under the conditions of outliers, random noises and both disturbances. The proposed LAD method exhibits much better robustness under all circumstances, which demonstrates that the LAD method is deserving as an improved alternative to the LS method for Cole parameter extraction for its robustness to outliers and noises.

A new measuring and identification approach for time-varying bioimpedance using multisine electrical impedance spectroscopy

The bioimpedance measurement/identification of time-varying biological systems Z(ω, t) by means of electrical impedance spectroscopy (EIS) is still a challenge today. This paper presents a novel measurement and identification approach, the so-called parametric-in-time approach, valid for time-varying (bio-)impedance systems with a (quasi) periodic character. The technique is based on multisine EIS. Contrary to the widely used nonparametric-in-time strategy, the (bio-)impedance Z(ω, t) is assumed to be time-variant during the measurement interval. Therefore, time-varying spectral analysis tools are required. This new parametric-in-time measuring/identification technique has experimentally been validated through three independent sets of in situ measurements of in vivo myocardial impedance. We show that the time-varying myocardial impedance Z(ω, t) is dominantly periodically time varying (PTV), denoted as ZPTV(ω, t). From the temporal analysis of ZPTV(ω, t), we demonstrate that it is possible to decompose ZPTV(ω, t) into a(n) (in)finite sum of fundamental (bio-)impedance spectra, the so-called harmonic impedance spectra (HIS) Zk(ω)s with [Formula: see text]. This is similar to the well-known Fourier series of a periodic signal, but now understood at the level of a periodic system's frequency response. The HIS Zk(ω)s for [Formula: see text] actually summarize in the bi-frequency (ω, k) domain all the temporal in-cycle information about the periodic changes of Z(ω, t). For the particular case k = 0 (i.e. on the ω-axis), Z0(ω) reflects the mean in-cycle behavior of the time-varying bioimpedance. Finally, the HIS Zk(ω)s are directly identified from noisy current and voltage myocardium measurements at the multisine measurement frequencies (i.e. nonparametric-in-frequency).

Novel estimation of the electrical bioimpedance using the local polynomial method. Application to in vivo real-time myocardium tissue impedance characterization during the cardiac cycle

Classical measurements of myocardium tissue electrical impedance for characterizing the morphology of myocardium cells, as well as cell membranes integrity and intra/extra cellular spaces, are based on the frequency-sweep electrical impedance spectroscopy (EIS) technique. In contrast to the frequency-sweep EIS approach, measuring with broadband signals, i.e., multisine excitations, enables to collect, simultaneously, multiple myocardium tissue impedance data in a short measuring time. However, reducing the measuring time makes the measurements to be prone to the influence of the transients introduced by noise and the dynamic time-varying properties of tissue. This paper presents a novel approach for the impedance-frequency-response estimation based on the local polynomial method (LPM). The fast LPM version presented rejects the leakage error's influence on the impedance frequency response when measuring electrical bioimpedance in a short time. The theory is supported by a set of validation measurements. Novel preliminary experimental results obtained from real-time in vivo healthy myocardium tissue impedance characterization within the cardiac cycle using multisine excitation are reported.