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Mayrovitz HN. Intra-day variations in volar forearm skin hydration. Skin Res Technol 2024; 30:e13849. [PMID: 38978227 PMCID: PMC11231035 DOI: 10.1111/srt.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Skin hydration (SKH) measurements are used for multiple purposes: to study skin physiology, to clinically investigate dermatological issues, and to assess localized skin water in pathologies like diabetes and lymphedema. Often the volar forearm is measured at various times of day (TOD). This report aims to characterize intra-day variations in volar forearm SKH to provide guidance on expected TOD dependence. MATERIALS AND METHODS Forty medical students (20 male) self-measured tissue dielectric constant (TDC) on their non-dominant forearm in triplicate as an index of local skin tissue water every 2 h starting at 0800 and ending at 2400 h. All were trained and pre-certified in the procedure and had whole-body fat (FAT%) and water (H2O%) measured. Day average TDC (TDCAVG) was determined as the average of all time points expressed as mean ± SD. RESULTS Males versus females had similar ages (25.1 ± 2.2 years vs. 25.1 ± 1.5 years), higher H2O% (56.6 ± 5.0 vs. 51.8 ± 5.7, p = 0.002), and higher TDCAVG (32.7 ± 4.1 vs. 28.5 ± 5.1, p = 0.008). TDC values were not significantly impacted by H2O% or FAT%. Female TDC exhibited a significant decreasing trend from morning to night (p = 0.004); male TDC showed no trend. CONCLUSION Skin water assessed by TDC shows some intra-day variations for females and males but with quite different temporal patterns. Clinical relevance relates to the confidence level associated with skin hydration estimates when measured at different times of day during normal clinic hours which, based on the present data, is expected to be around 5% for both males and females.
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Affiliation(s)
- Harvey N. Mayrovitz
- Department of Medical Education, Dr. Kiran C. Patel College of Allopathic MedicineNova Southeastern UniversityFort LauderdaleUSA
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2
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Toro C, Markarian B, Mayrovitz HN. Breast Cancer-Related Lymphedema Assessed via Tissue Dielectric Constant Measurements. Cureus 2024; 16:e59261. [PMID: 38813316 PMCID: PMC11135004 DOI: 10.7759/cureus.59261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
This review describes the use of tissue dielectric constant (TDC) measurements mainly in the assessment of breast cancer-related lymphedema (BCRL). PubMed, Web of Science, and EMBASE databases were initially searched using criteria that included the terms "dielectric" and "lymphedema." The initial search yielded a total of 131 titles. After removing studies not focused on upper extremity lymphedema, 56 articles remained. These articles, together with relevant articles from their bibliographies, formed the basis of the review. The findings show the potential utility and applications of TDC measurements to help detect and track BCRL, whether present in limbs, breasts, or trunks. It is reported as a non-invasive, simple-to-use method, with each measurement requiring less than 10 seconds, suggesting its practicality and useability as an in-office or in-clinic screening and tracking method. Although there are various ways to quantitatively evaluate lymphedema, most, if not all, are restricted to measurements on limbs. Thus, one significant advantage of the TDC approach is that almost any local region of interest can be effectively measured and tracked, which, for BCRL, could include specific regions of arms or hands, breasts, and truncal areas.
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Affiliation(s)
- Carel Toro
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Biura Markarian
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Harvey N Mayrovitz
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
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Mayrovitz HN. Medical Applications of Skin Tissue Dielectric Constant Measurements. Cureus 2023; 15:e50531. [PMID: 38222165 PMCID: PMC10787628 DOI: 10.7759/cureus.50531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Tissue dielectric constant (TDC) values assess certain skin properties that are dependent on multiple factors but mainly on the relative amount of water content within a locally measured tissue volume. Because of the non-invasive nature of these measurements and their ease of use, the method has been widely used in various medically related applications. The goal of this paper was to review and describe the uses and findings of such TDC measurements, considering and including the wide array of medical applications. The review is in part based on information derived from an analysis of published material obtained via literature searches of four major electronic databases and, in part, based on the author's experience with the TDC measurement methods and their various applications and his professional experiences. The databases searched were PubMed, Web of Science, EMBASE, and CINAHL Complete. Based on the initial search criteria, a total of 1257 titles were identified. After removing duplicates and filtering according to relevancy, 160 remained for detailed further review. In some cases, the bibliography of these retrieved articles provided additional sources. The findings demonstrate multiple research and medical uses and applications of TDC measurements, focusing on detecting and quantifying localized edema and lymphedema in multiple target sites. These include the upper and lower extremities, breasts, and trunk as regions involved in medical conditions causing lymphedema. In addition, the findings suggest that TDC evaluations are a convenient, non-invasive method to study and evaluate other conditions impacting skin, including diabetes mellitus and skin wounds or ulcers. Its ability to detect aspects of tissue changes simply and rapidly at almost any anatomical location makes it a useful tool for investigating multiple dermatological conditions and their treatment as future applications of this method.
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Affiliation(s)
- Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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Suchy JP, Glasoe WM, Koehler LA. A Tissue Dielectric Constant Evaluation of Knee Edema: A Retrospective Intra-rater Reliability and Association Study of Repeated Measures. Cureus 2023; 15:e42089. [PMID: 37602087 PMCID: PMC10435093 DOI: 10.7759/cureus.42089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND This research compared the reliability and association of tissue dielectric constant (TDC) measures of knee edema to circumferential measurements of knee girth recorded as part of a physical therapy examination. METHODS Twenty adults having observable unilateral knee edema were enrolled. A single examiner measured edematous knee swelling with a TDC device and a tape measure across two visits. The presence of edema was recorded as a positive number in reporting side-to-side differences and a positive percentage in documenting change over time. Intra-rater reliability of the measures was assessed with an intra-class correlation coefficient (ICC). Percent change in edema was evaluated independently for both methods using a paired t-test, and the association between measures was assessed by a Pearson's statistic. RESULTS Both measures were reliable (ICC ≥ 0.81), and both detected a significant percentage decrease (p < 0.05) in edema across visits. The TDC measure changed by 8.3%, an amount nearly four times larger compared to knee girth (2.4%). The subsequent follow-up comparison revealed an inverse relationship (p = 0.049; r = -0.44) between the two percent change measurements of edema. CONCLUSION The two methods capture different physical attributes of edema. The TDC records the water content of the tissue, while the use of a tape measure records circumferential limb girth. The TDC measurement was reliable and more responsive in detecting a percentage decrease in knee edema in comparison to a circumferential measure of knee girth. The TDC method may have wider use in directly measuring edema in other tissue structures and regions of the body.
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Affiliation(s)
- James P Suchy
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, USA
| | - Ward M Glasoe
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, USA
| | - Linda A Koehler
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, USA
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Camilion JV, Khanna S, Anasseri S, Laney C, Mayrovitz HN. Physiological, Pathological, and Circadian Factors Impacting Skin Hydration. Cureus 2022; 14:e27666. [PMID: 36072192 PMCID: PMC9440333 DOI: 10.7759/cureus.27666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
Thismanuscript focuses on the physiological, environmental, nutritional, circadian, and aging factors affecting skin tissue water and hydration parameters. The literature findings indicate a multiplicity of interacting processes among these parameters, ultimately impacting skin hydration in normal skin and playing a role in conditions such as atopic dermatitis and psoriasis. The maintenance of adequate skin hydration, aided by the proper functioning of the skin’s protective barrier, is facilitated by stratum corneum integrity with the presence of tight junctions and lipids such as ceramides, each of which is impacted by changes in most of the evaluated parameters. Abnormalities in aquaporin 3 (AQP3) expression and associated deficits in skin hydration appear to have a role in atopic dermatitis and psoriasis. AQP3 hydration-related aspects are influenced by circadian rhythms via modulations associated with CLOCK genes that alter AQP3 protein expression. Ultraviolet exposure, aging, and low temperatures are among those factors that affect skin ceramide composition, potentially leading to increased transepidermal water loss and negatively impacting skin hydration. Vitamin C, collagen, and probiotics may increase ceramide production and improve skin hydration. The extent to which each of the different evaluated factors affects skin hydration varies but is usually large enough to consider their potential effects when investigating skin in research and clinical settings.
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Mayrovitz HN. Circumferential and Depth Variations in Tissue Dielectric Constant Values as Indices of Lower Leg Localized Skin Water. Cureus 2022; 14:e27617. [PMID: 36059342 PMCID: PMC9433792 DOI: 10.7759/cureus.27617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/02/2022] [Indexed: 11/19/2022] Open
Abstract
The primary goal of this study was to quantify circumferential (medial, anterior, lateral) and measurement depth variations (0.5 mm, 1.5 mm, 2.5 mm) in tissue dielectric constant (TDC) values as an aid to their use to assess the presence and progression of lower extremity edema and lymphedema. Measurements were done in 30 healthy non-edematous women to provide reference data to estimate expected values and thresholds when evaluating clinical edematous or lymphedematous conditions. A second goal was to determine the extent to which TDC values evaluated at lower leg sites depend on body mass index (BMI). The study protocol (#12180901) was approved by the university’s institutional review board and subjects were evaluated after signing an approved informed consent. The study group had an age range of 19-54 years with a mean age and SD of 30.6 ± 10.1 years and had a BMI between 18.1-44.1 Kg/m2 with a mean BMI and SD of 24.5 ± 5.4 Kg/m2. The main findings show that at the three circumferential sites (medial, anterior, and lateral) located eight cm from the mid-malleolus, there are small but statistically significant differences in TDC values at every measurement depth (0.5 mm, 1.5 mm and 2.5 mm). For each depth, the maximum difference occurs between the medial and lateral locations with lateral locations having a greater TDC value at all depths. Despite the wide range of BMI values of the subjects evaluated, no significant relationship between TDC value and BMI was detected. It is concluded that TDC measurements in the lower leg reveal statistically significant differences among circumferential sites and measurement depths that should be considered when evaluating or tracking lower extremity tissue water changes associated with edema, lymphedema or other conditions related to skin water. The absolute values of these non-edematous TDC values herein determined may provide a basis for calculating TDC thresholds applicable to edematous or lymphedematous lower leg conditions.
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Sasaki K, Porter E, Rashed EA, Farrugia L, Schmid G. Measurement and image-based estimation of dielectric properties of biological tissues —past, present, and future—. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac7b64] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/22/2022] [Indexed: 12/23/2022]
Abstract
Abstract
The dielectric properties of biological tissues are fundamental pararmeters that are essential for electromagnetic modeling of the human body. The primary database of dielectric properties compiled in 1996 on the basis of dielectric measurements at frequencies from 10 Hz to 20 GHz has attracted considerable attention in the research field of human protection from non-ionizing radiation. This review summarizes findings on the dielectric properties of biological tissues at frequencies up to 1 THz since the database was developed. Although the 1996 database covered general (normal) tissues, this review also covers malignant tissues that are of interest in the research field of medical applications. An intercomparison of dielectric properties based on reported data is presented for several tissue types. Dielectric properties derived from image-based estimation techniques developed as a result of recent advances in dielectric measurement are also included. Finally, research essential for future advances in human body modeling is discussed.
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Mayrovitz HN, Somarriba C, Weingrad DN. Breast Tissue Dielectric Constant as a Potential Breast Edema Assessment Parameter. Lymphat Res Biol 2022; 20:33-38. [PMID: 33761280 DOI: 10.1089/lrb.2020.0137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Many methods can quantitatively assess limb lymphedema, but methods to assess breast edema/lymphedema are quite limited. Thus, there is a need for a convenient and accurate way to quantify and track changes in this condition. Herein, breast tissue dielectric constant (TDC) values that depend on tissue water were used to obtain reference TDC values and interbreast TDC ratios. Methods and Results: TDC was measured in both breasts of 61 women who were about to undergo an ultrasound-guided diagnostic biopsy of a single mass (tumor) in 1 breast. Patient age and body mass index were (mean ± SD) 65.1 ± 11.6 (41-87 years) and 28.9 ± 5.1 (19.1-43.7 kg/m2). TDC was measured at a standardized site (12 o'clock position) with the TDC probe placed with its outer edge at the periphery of the subareolar region. TDC values of healthy breasts versus tumor breasts showed tumor breasts 3% greater (30.4 ± 4.6 vs. 29.5 ± 4.6, p = 0.02). Patients with benign tumors (N = 33) showed no difference between breasts (30.5 ± 4.4 vs. 30.8 ± 4.6 p = 0.434) and had an interbreast TDC ratio (tumor breast/healthy breast) of 1.013 ± 0.077. Patients with malignant tumors (N = 28) had tumor breast values 5% greater (29.8 ± 4.8 vs. 28.4 ± 4.6, p = 0.018) and an interbreast ratio of 1.056 ± 0.117. The overall interbreast ratio (N = 61) was 1.033 ± 0.099. Conclusion: Breast TDC values from nonedematous breasts provide the basis for calculating potential edematous/lymphedematous threshold values based on the measured means +2.5 standard deviation (SD). Accordingly, a TDC threshold value of 41 and an interbreast ratio of 1.28 were determined. These parameters have potential applicability for early detection in at-risk patients and those suspected of having breast edema/lymphedema.
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Affiliation(s)
- Harvey N Mayrovitz
- Division of Physiology, Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
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Jayabal H, Bates-Jensen BM, Abiakam NS, Worsley PR, Bader DL. Anatomical variability of sub-epidermal moisture and its clinical implications. J Tissue Viability 2021; 30:434-438. [PMID: 33893014 DOI: 10.1016/j.jtv.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/02/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Technologies have been developed to monitor changes in dermal oedema, indicative of the early signs of pressure ulcers. However, there is limited information on the effects of regional differences in tissue morphology on these sub-epidermal moisture (SEM) parameters. This study was designed to investigate the absolute SEM readings across different anatomical sites using a commercial device. METHODS Twenty-four healthy participants were recruited to evaluate basal SEM values at different bony prominences, sampled by an experienced operator. RESULTS Distinct differences were observed in unloaded SEM values across different anatomical sites, notably between the upper and lower extremities. A high degree of variability was observed in particular sites, such as the heels. Moreover, SEM values at certain locations revealed significant relationships with age, BMI and gender (p < 0.05). CONCLUSION The study revealed a high level of variability between and within anatomical sites in a healthy cohort of participants. Determining the changes in local skin and sub-dermal tissue status using SEM may require consideration of both site specific and individual demographic factors, with further research needed in cohorts at risk of pressure ulcers.
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Affiliation(s)
- Hemalatha Jayabal
- School of Health Sciences, University of Southampton, Southampton, UK.
| | - Barbara M Bates-Jensen
- School of Nursing and David Geffen School of Medicine, University of California at Los Angeles (UCLA), USA
| | | | - Peter R Worsley
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Dan L Bader
- School of Health Sciences, University of Southampton, Southampton, UK
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10
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Mayrovitz HN, Forbes J, Vemuri A, Krolick K, Rubin S. Skin tissue dielectric constant in women with high body fat content. Skin Res Technol 2019; 26:226-233. [DOI: 10.1111/srt.12784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/02/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Harvey N. Mayrovitz
- College of Medical Sciences Nova Southeastern University Ft. Lauderdale Florida
| | - Jessica Forbes
- KCP College of Osteopathic Medicine Nova Southeastern University Ft. Lauderdale Florida
| | - Adithi Vemuri
- KCP College of Osteopathic Medicine Nova Southeastern University Ft. Lauderdale Florida
| | - Katelyn Krolick
- KCP College of Osteopathic Medicine Nova Southeastern University Ft. Lauderdale Florida
| | - Samantha Rubin
- KCP College of Osteopathic Medicine Nova Southeastern University Ft. Lauderdale Florida
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Mayrovitz HN. Assessing Lower Extremity Lymphedema Using Upper and Lower Extremity Tissue Dielectric Constant Ratios: Method and Normal Reference Values. Lymphat Res Biol 2019; 17:457-464. [DOI: 10.1089/lrb.2018.0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Harvey N. Mayrovitz
- Department of Physiology, College of Medical Sciences, Nova Southeastern University, Fort Lauderdale, Florida
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12
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Mayrovitz HN. Assessing Upper and Lower Extremities Via Tissue Dielectric Constant: Suitability of Single Versus Multiple Measurements Averaged. Lymphat Res Biol 2019; 17:316-321. [DOI: 10.1089/lrb.2018.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Harvey N. Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Fort Lauderdale, Florida
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13
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Mayrovitz HN, Mikulka A, Woody D. Minimum Detectable Changes Associated with Tissue Dielectric Constant Measurements as Applicable to Assessing Lymphedema Status. Lymphat Res Biol 2018; 17:322-328. [PMID: 30526306 DOI: 10.1089/lrb.2018.0052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Tissue dielectric constant (TDC) measurements are increasingly being used as a tool to help characterize lymphedema features, detect its presence, and assess treatment related changes. Although the underlying physics of this technology has been well described in the literature, there has been little systematic study of in vivo reliability aspects. A central unanswered question is the minimal detectable change (MDC) that, with a given level of confidence, may be ascribed to this technology. Our goal was to address this issue using test-retest measurements from which intraclass correlations coefficients (ICC) and MDC could be estimated. Methods and Results: Forty volunteers (20 females) aged 19-61 years with body mass indices of 14.7-47 kg/m2 and body fat percentages of 12.0%-48.9% were evaluated. Two measurers (M1 and M2) used two different TDC measuring devices (multiprobe and compact) to measure TDC in triplicate sequentially and bilaterally at three locations; anterior forearm, hand palmar mid-thenar eminence, and dorsum mid-web. These measurements were made by each measurer twice constituting test-retest values (T1 and T2). From these measurements ICC2,1 and MDC at 95% confidence were determined for each site and probe for absolute TDC values and for inter-side ratios. MDC values for absolute TDC ranged from 2 to 9 TDC units, and for inter-side ratios ranged from 5.3% to 8.0% depending on site and probe. ICC2,1 values ranged from 0.765 to 0.982. Conclusions: The MDC values herein documented may be used to provide guidance to aid interpretation of measured TDC changes or differences in a clinical environment.
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Affiliation(s)
- Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida
| | - Alexander Mikulka
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida
| | - Don Woody
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida
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Mayrovitz HN, Gildenberg SR, Spagna P, Killpack L, Altman DA. Characterizing the tissue dielectric constant of skin basal cell cancer lesions. Skin Res Technol 2018; 24:686-691. [DOI: 10.1111/srt.12585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2018] [Indexed: 02/04/2023]
Affiliation(s)
- H. N. Mayrovitz
- College of Medical Sciences; Nova Southeastern University; Fort Lauderdale Florida
| | - S. R. Gildenberg
- St. Joseph Mercy Livingston Dermatology Residency Program; Detroit Michigan
| | - P. Spagna
- College of Osteopathic Medicine; Nova Southeastern University; Fort Lauderdale Florida
| | - L. Killpack
- St. Joseph Mercy Livingston Dermatology Residency Program; Detroit Michigan
| | - D. A. Altman
- St. Joseph Mercy Livingston Dermatology Residency Program; Detroit Michigan
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Wang H, Li D, Liuya J, Dylke ES, Ward LC, Jia J, Kilbreath SL. Reference Ranges Using Bioimpedance for Detection of Lymphedema in Chinese Women. Lymphat Res Biol 2017; 15:268-273. [PMID: 28880731 DOI: 10.1089/lrb.2017.0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bioimpedance is a commonly used technique for detection of early lymphedema. The thresholds used for detection are based on impedance measurements obtained in Western populations. It is unknown whether these thresholds are applicable to a Chinese population. METHODS AND RESULTS Impedance measurements were obtained for both arms in 391 women, ranging in age from 20 to 84 years, using a standardized protocol. Frequency distributions of interlimb impedance arm ratios for both dominant:non-dominant and non-dominant:dominant were used to determine thresholds at two and three standard deviations (SDs) above the mean. Absolute impedance was significantly higher in the youngest group (20-39 years) compared to other age groups. However, there was no significant effect of age on impedance ratios. Similarly, there was no significant difference between impedance ratios determined in this study and those from recent studies in the Australia and the United States, which used similar protocols. New two and three SDs above the mean thresholds, using a weighted average from the pooled data of these studies are 1.108 and 1.153 for use when the dominant limb is at-risk and 1.072 and 1.116 when the non-dominant limb is at-risk. CONCLUSION There was no effect of ethnicity on impedance ratios. Consequently, the proposed pooled thresholds can be used, irrespective of ethnicity.
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Affiliation(s)
- Hewei Wang
- 1 Rehabilitation Department, Huanshan Hospital, Fudan University , Shanghai, China
| | - Ding Li
- 1 Rehabilitation Department, Huanshan Hospital, Fudan University , Shanghai, China
| | - Jiang Liuya
- 2 Rehabilitation Department, Jing' An District Centre Hospital of Shanghai , Shanghai, China
| | - Elizabeth S Dylke
- 3 Faculty of Health Sciences, University of Sydney , Sydney, Australia
| | - Leigh C Ward
- 3 Faculty of Health Sciences, University of Sydney , Sydney, Australia .,4 School of Chemistry and Molecular Biosciences, The University of Queensland , Brisbane, Australia
| | - Jie Jia
- 1 Rehabilitation Department, Huanshan Hospital, Fudan University , Shanghai, China
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