Volumen 12 (2021): Heft 1 (January 2021)

This year, 2021, marks the “coming of age” for JoEB with its indexing in PubMed Central. It is also a century since some of the earliest studies on tissue impedance. This editorial briefly reviews the time-line of research in the field to mark this occasion.

A portable electrical impedance spectroscopy device was developed to monitor the bioimpedance resistive component of bovine meat by injecting a sinusoidal current of 1 mA at 65 kHz. Both right and left longissimus dorsi muscles were trimmed from 4 slaughtered cows. The left muscle portions were frozen to −18 °C for 7 days while the right ones were meantime maintained at 5 °C. Mean value of impedance per length (Ω/cm) of frozen and thawed left samples was 31% lower than that of right non-frozen one (P = 0.0001). It was concluded that the device is reliable for monitoring the maturation of beef meat in situ with the possibility of revealing undeclared freeze-thaw cycles.

Nonhuman primates are often used to investigate physiologic processes that occur in man during aerospace/cardiovascular orthostatic research. Few studies have compared nonhuman primates and man under identical test conditions to assess the degree of similarity between the two species. Impedance plethysmography was used to measure calf, thigh, pelvic, thoracic, upper arm, and lower arm volume changes in eight rhesus (Macacca Mulatta) monkeys and twelve human subjects during four hour exposures to −6 degree head down tilt (HDT).

The BIA primary result sheets as a rule contain one-dimensional graphical scales with a selected area of normal values. In 1994, Piccoli et al. proposed BIVA, an alternative form of BIA data presentation, where two bioimpedance parameters are considered simultaneously as tolerance ellipses: resistance and reactance normalized to height.

The purpose of this study is to develop an approach to data analysis in body composition bioimpedance research in two-dimensional representations.

The data of 1.124.668 patients aged 5 to 85 years who underwent a bioimpedance study in Russian Health Centers from 2009 to 2015 were used. Statistical programming in the R Studio environment was carried out to estimate two-dimensional distribution densities of pairs of body composition parameters for each year of life.

The non-Gaussian distribution is found in most parameters of bioimpedance analysis of body composition for most ages (Lilliefors test, p-value << 0.0001). The slices of the actual two-dimensional distribution pairs of body composition parameters had an irregular shape. The authors of the article propose using the actually observed distribution for populations where numerous bioimpedance studies have already been carried out. Such technology can be called two-dimensional bioimpedance analysis of human body composition (2DBIA). The 2DBIA approach is clearer for practitioners and their patients due to the use of body composition parameters in addition to electrical impedance parameters.

The incorporation of sensors onto the stapling platform has been investigated to overcome the disconnect in our understanding of tissue handling by surgical staplers. The goal of this study was to explore the feasibility of in vivo porcine tissue differentiation using bioimpedance data and machine learning methods. In vivo electrical impedance measurements were obtained in 7 young domestic pigs, using a logarithmic sweep of 50 points over a frequency range of 100 Hz to 1 MHz. Tissues studied included lung, liver, small bowel, colon, and stomach, which was further segmented into fundus, body, and antrum. The data was then parsed through MATLAB's classification learner to identify the best algorithm for tissue type differentiation. The most effective classification scheme was found to be cubic support vector machines with 86.96% accuracy. When fundus, body and antrum were aggregated together as stomach, the accuracy improved to 88.03%. The combination of stomach, small bowel, and colon together as GI tract improved accuracy to 99.79% using fine k nearest neighbors. The results suggest that bioimpedance data can be effectively used to differentiate tissue types in vivo. This study is one of the first that combines in vivo bioimpedance tissue data across multiple tissue types with machine learning methods.

We present here the first impedance-based characterization of the differentiation process of two human mesencephalic fetal neural stem lines. The two dopaminergic neural stem cell lines used in this study, Lund human mesencephalic (LUHMES) and human ventral mesencephalic (hVM1 Bcl-X_L), have been developed for the study of Parkinsonian pathogenesis and its treatment using cell replacement therapy. We show that if only relying on impedance magnitude analysis, which is by far the most usual approach in, e.g., cytotoxicity evaluation and drug screening applications, one may not be able to distinguish whether the neural stem cells in a population are proliferating or differentiating. However, the presented results highlight that equivalent circuit analysis can provide detailed information on cellular behavior, e.g. simultaneous changes in cell morphology, cell-cell contacts, and cell adhesion during formation of neural projections, which are the fundamental behavioral differences between proliferating and differentiating neural stem cells. Moreover, our work also demonstrates the sensitivity of impedance-based monitoring with capability to provide information on changes in cellular behavior in relation to proliferation and differentiation. For both of the studied cell lines, in already two days (one day after induction of differentiation) equivalent circuit analysis was able to show distinction between proliferation and differentiation conditions, which is significantly earlier than by microscopic imaging. This study demonstrates the potential of impedance-based monitoring as a technique of choice in the study of stem cell behavior, laying the foundation for screening assays to characterize stem cell lines and testing the efficacy epigenetic control.

Electrical impedance tomography (EIT) is a low-cost noninvasive imaging method. The main purpose of this paper is to highlight the main aspects of the EIT method and to review the recent advances and developments. The advances in instrumentation and in the different image reconstruction methods and systems are demonstrated in this review. The main applications of the EIT are presented and a special attention made to the papers published during the last years (from 2015 until 2020). The advantages and limitations of EIT are also presented. In conclusion, EIT is a promising imaging approach with a strong potential that has a large margin of progression before reaching the maturity phase.

Ultrasonography (US) and Electrical Impedance Tomography (EIT) can be used to detect breast cancer. Ultrasonography is based on non-ionizing radiations without adverse biological effects. A set of electrodes was placed around the torso and a small alternating current (AC) was injected via two of the electrodes into the object. This study aimed to acquire preliminary data to evaluate the EIT method for differentiation of artificial solid and cystic tumors in comparison to standard US.

This study used a phantom made from chicken meat. In order to obtain the image of the solid tumor, an olive with carrot insertion was done, and the cystic tumor was created by filling a small balloon with water. GE Logic C5 ultrasound was performed with a 12 MHz linear transducer. For EIT measurement, 16 ECG electrodes and 32 ECG electrodes were placed. Data processing was done using the Graz consensus Reconstruction algorithm for EIT (GREIT) and Newton's One Step Error Reconstructor (NOSER) methods.

The artificial solid tumor produced an ultrasound image of an oval, inhomogeneous lesions. The GREIT method with 16 electrodes of artificial solid tumor did not show a match between the reconstructed image and the original object containing 2 anomalies, but a match was found with 32 electrodes. In the NOSER method, both 16 and 32 electrodes showed a match. Ultrasound of the artificial cystic tumor showed an oval, circumscribed, anechoic with posterior enhancement. Both the GREIT and NOSER methods using the artificial cystic tumor showed a match between the reconstructed image and the original object containing two anomalies.

EIT has a lower imaging resolution in comparison to ultrasonography, but is progressively maturing as a tool for monitoring and imaging. The solid and cystic anomalies on the phantoms were visualized by the GREIT and NOSER methods except for the solid anomaly with the GREIT 16 electrodes.

Karate, a millennial martial art, was recently inserted among traditional Olympic combat sports for the Olympic Games in Japan. The aim of the present study is to determine, through bioimpedance analysis, the body composition of high-performance athletes participating in the São Paulo Olympic Karate Project. Participants were 22 athletes of both sexes, average age of 23.6 (6.0) years old, body mass of 66.6 (13.5) kg and fat percentage of 16.6 (5.5)%. Bioimpedance test indicated significant differences between sexes related to sexual dysmorphia, which had an impact on bioelectrical variables. Through comparative evaluation between male and female athletes, this study contributes to body composition analysis, indicating that, in the future, related bioimpedance tests should be used beyond their classical application, including phase angle, muscle function and other attributes.

Human skin has been classified as a non-volatile memristor and it is shown that information can be stored within for at least three minutes. Here we investigate whether it is possible to store information up to 20 minutes. Furthermore, we investigate whether the information can be based on four different states, not just two (binary). We stored the information into the skin of the forehead of the test subjects under three different electrodes, which allows in principle for 64 different combinations (3 electrodes, 4 states) and one can think of numbers on the base of four. For this experiment, we decided on the numbers 123₄ and 302₄ (that correspond to numbers 27 and 50 in the decimal system). Writing of the different states was done by the application of DC voltage pulses that cause electro-osmosis in the sweat ducts (nonlinear electrical measurements). Based on our results, we were not able to distinguish between four different states. However, we can show that binary information storage in human skin is possible for up to 20 minutes.

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.

Due to the possibilities in miniaturization and wearability, photoplethysmography (PPG) has recently gained a large interest not only for heart rate measurement, but also for estimating heart rate variability, which is derived from ECG by convention. The agreement between PPG and ECG-based HRV has been assessed in several studies, but the feasibility of PPG-based HRV estimation is still largely unknown for many conditions. In this study, we assess the feasibility of HRV estimation based on finger PPG during rest, mild physical exercise and mild mental stress. In addition, we compare different variants of signal processing methods including selection of fiducial point and outlier correction. Based on five minutes synchronous recordings of PPG and ECG from 15 healthy participants during each of these three conditions, the PPG-based HRV estimation was assessed for the SDNN and RMSSD parameters, calculated based on two different fiducial points (foot point and maximum slope), with and without outlier correction. The results show that HRV estimation based on finger PPG is feasible during rest and mild mental stress, but can give large errors during mild physical exercise. A good estimation is very dependent on outlier correction and fiducial point selection, and SDNN seems to be a more robust parameter compared to RMSSD for PPG-based HRV estimation.

Positive end-expiratory pressure (PEEP) is a respiratory/ventilation procedure that is used to maintain or improve breathing in clinical and experimental cases that exhibit impaired lung function. Body fluid shift movement is not monitored during PEEP application in intensive care units (ICU), which would be interesting specifically in hypotensive patients. Brain injured and hypotensive patients are known to have compromised cerebral blood flow (CBF) autoregulation (AR) but currently, there is no non-invasive way to assess the risk of implementing a hypotensive resuscitation strategy and PEEP use in these patients.

The advantage of electrical bioimpedance measurement is that it is noninvasive, continuous, and convenient. Since it has good time resolution, it is ideal for monitoring in intensive care units (ICU). The basis of its future use is to establish physiological correlates. In this study, we demonstrate the use of electrical bioimpedance measurement during bleeding and the use of PEEP in pig measurement.

In an anesthetized pig, we performed multimodal recording on the torso and head involving electrical bioimpedance spectroscopy (EIS), fixed frequency impedance plethysmography (IPG), and bipolar (rheoencephalography – REG) measurements and processed data offline. Challenges (n=16) were PEEP, bleeding, change of SAP, and CO₂ inhalation. The total measurement time was 4.12 hours.

Systemic circulatory results: Bleeding caused a continuous decrease of SAP, cardiac output (CO), and increase of heart rate, temperature, shock index (SI), vegetative - Kerdo index (KI). Pulse pressure (PP) decreased only after second bleeding which coincided with loss of CBF AR. Pulmonary arterial pressure (PAP) increased during PEEP challenges as a function of time and bleeding.

EIS/IPG results: Body fluid shift change was characterized by EIS-related variables. Electrical Impedance Spectroscopy was used to quantify the intravascular, interstitial, and intracellular volume changes during the application of PEEP and simulated hemorrhage. The intravascular fluid compartment was the primary source of blood during hemorrhage. PEEP produced a large fluid shift out of the intravascular compartment during the first bleeding period and continued to lose more blood following the second and third bleeding. Fixed frequency IPG was used to quantify the circulatory responses of the calf during PEEP and simulated hemorrhage. PEEP reduced the arterial blood flow into the calf and venous outflow from the calf.

Head results: CBF AR was evaluated as a function of SAP change. Before bleeding, and after moderate bleeding, intracranial pressure (ICP), REG, and carotid flow pulse amplitudes (CFa) increased. This change reflected vasodilatation and active CBF AR. After additional hemorrhaging during PEEP, SAP, ICP, REG, CFa signal amplitudes decreased, indicating passive CBF AR. 1) The indicators of active AR status by modalities was the following: REG (n=9, 56 %), CFa (n=7, 44 %), and ICP (n=6, 38 %); 2) CBF reactivity was better for REG than ICP; 3) REG and ICP correlation coefficient were high (R² = 0.81) during CBF AR active status; 4) PRx and REGx reflected active CBF AR status. CBF AR monitoring with REG offers safety for patients by preventing decreased CBF and secondary brain injury.

We used different types of bioimpedance instrumentation to identify physiologic responses in the different parts of the body (that have not been discussed before) and how the peripheral responses ultimately lead to decreased cardiac output and changes in the head. These bioimpedance methods can improve ICU monitoring, increase the adequacy of therapy, and decrease mortality and morbidity.

Human body communication (HBC) uses the human body as the channel to transfer data. Extensive work has been done to characterize the human body channel for different HBC techniques and scenarios. However, statistical channel bioimpedance characterisation of human body channels, particularly under dynamic conditions, remains relatively understudied. This paper develops a stochastic fading bioimpedance model for the human body channel using Monte Carlo simulations. Differential body segments were modelled as 2-port networks using ABCD parameters which are functions of bioimpedance based body parameters modelled as random variables. The channel was then modelled as the cascade of these random 2-port networks for different combinations of probability distribution functions (PDFs) assumed for the bioimpedance-based body parameters. The resultant distribution of the cascaded body segments varied for the different assumed bioimpedance based body parameter distributions and differential body segment sizes. However, considering the distribution names that demonstrated a best fit (in the top 3 PDF rankings) with highest frequency under the varying conditions, this paper recommends the distribution names: Generalized Pareto for phase distributions and Log-normal for magnitude distributions for each element in the overall cascaded random variable ABCD matrix.

Volume measurement is beneficial in left ventricular assist device (LVAD) therapy to quantify patient demand. In principle, an LVAD could provide a platform that allows bioimpedance measurements inside the ventricle without requiring additional implants. Conductance measured by the LVAD can then be used to estimate the ventricular radius, which can be applied to calculate ventricular volume. However, established methods that estimate radius from conductance require elaborate individual calibration or show low accuracy.

This study presents two analytical calculation methods to estimate left ventricular radius from conductance using electric field theory. These methods build on the established method of Wei, now considering the dielectric properties of muscle and background tissue, the refraction of the electric field at the blood-muscle boundary, and the changes of the electric field caused by the measurements.

The methods are validated in five glass containers of different radius. Additional bioimpedance measurements are performed in in-vitro models that replicate the left ventricle’s shape and conductive properties. The proposed analytical calculation methods estimate the radii of the containers and the in-vitro models with higher accuracy and precision than Wei’s method. The lead method performs excellently in glass cylinders over a wide range of radii (bias: 1.66%–2.48%, limits of agreement < 16.33%) without calibration to specific geometries.

Bioimpedance measurements use current or voltage sources to inject an excitation signal into the body. These sources require a high bandwidth, typically from 1 kHz to 1 MHz. Besides a low common mode, current limitation is necessary for patient safety. In this paper, we compare a symmetric enhanced Howland current source (EHCS) and a symmetric voltage source (VS) based on a non-inverting amplifier between 1 kHz and 1 MHz. A common mode reduction circuit has been implemented in both sources. The bandwidth of each source was optimized in simulations and achieved a stable output impedance over the whole frequency range. In laboratory measurements, the output impedance of the EHCS had its -3 dB point at 400 kHz. In contrast, the VS reached the +3 dB point at 600 kHz. On average over the observed frequency range, the active common mode compensation achieved a common mode rejection of -57.7 dB and -71.8 dB for the EHCS and VS, respectively. Our modifications to classical EHCS and VS circuits achieved a low common mode signal between 1 kHz and 1 MHz without the addition of complex circuitry, like general impedance converters. As a conclusion we found VSs to be superior to EHCSs for bioimpedance spectroscopy due to the higher bandwidth performance. However, this only applies if the injected current of the VS can be measured.

Kramers-Kronig (KK) equations allow us to obtain the real or imaginary part of linear, causal and time constant functions, starting from the imaginary or real part respectively. They are normally applied on different practical applications as a control method. A common problem in measurements is the lack of data in a wide-range frequency, due to some of the inherent limitations of experiments or practical limitations of the used technology. Different solutions to this problem were proved, such as several methods for extrapolation, some of which based on piecewise polynomial fit or the approach based on the expected asymptotical behavior. In this work, we propose an approach based on the symmetric extrapolation method to generate data in missing frequency ranges, to minimize the estimated error of the KK equations. The results show that with data from impedance measurements of an electrode-electrolyte interface, the adjustment error of the transformed functions can be drastically reduced to below 1%.

Electrical impedance spectroscopy (EIS) has been used as an adjunct to colposcopy for cervical cancer diagnosis for many years, Currently, the template match method is employed for EIS measurements analysis, where the measured EIS spectra are compared with the templates generated from three-dimensional finite element (FE) models of cancerous and non-cancerous cervical tissue, and the matches between the measured EIS spectra and the templates are then used to derive a score that indicates the association strength of the measured EIS to the High-Grade Cervical Intraepithelial Neoplasia (HG CIN). These FE models can be viewed as the computational versions of the associated physical tissue models. In this paper, the problem is revisited with an objective to develop a new method for EIS data analysis that might reveal the relationship between the change in the tissue structure due to disease and the change in the measured spectrum. This could provide us with important information to understand the histopathological mechanism that underpins the EIS-based HG CIN diagnostic decision making and the prognostic value of EIS for cervical cancer diagnosis. A further objective is to develop an alternative EIS data processing method for HG CIN detection that does not rely on physical models of tissues so as to facilitate extending the EIS technique to new medical diagnostic applications where the template spectra are not available.

An EIS data-driven method was developed in this paper to achieve the above objectives, where the EIS data analysis for cervical cancer diagnosis and prognosis were formulated as the classification problems and a Cole model-based spectrum curve fitting approach was proposed to extract features from EIS readings for classification. Machine learning techniques were then used to build classification models with the selected features for cervical cancer diagnosis and evaluation of the prognostic value of the measured EIS. The interpretable classification models were developed with real EIS data sets, which enable us to associate the changes in the observed EIS and the risk of being HG CIN or developing HG CIN with the changes in tissue structure due to disease. The developed classification models were used for HG CIN detection and evaluation of the prognostic value of EIS and the results demonstrated the effectiveness of the developed method. The method developed is of long-term benefit for EIS–based cervical cancer diagnosis and, in conjunction with standard colposcopy, there is the potential for the developed method to provide a more effective and efficient patient management strategy for clinic practice.

In this paper, the possibility of using cell culture impedance measurements to assess the biocompatibility of a material in contact with cells was analyzed. For this purpose, the Electric Cell-substrate Impedance Sensing (ECIS) method and a commercial measuring device were used. The test substrates with thin-film electrodes made of various metals were prepared using the magnetron sputtering method. The choice of metals was dictated by their varying degrees of biocompatibility. Cultures of mouse fibroblasts were cultured on the prepared substrates. The experiment showed that the complete cycle of culture from attachment and reproduction to apoptosis occurred. The results obtained indicate that it is possible to use the ECIS method to study the influence of metal on cell culture activity.

The leading cause of health loss and deaths worldwide are cardiovascular diseases. A predictor of cardiovascular diseases and events is the arterial stiffness. The pulse wave velocity (PWV) can be used to estimate arterial stiffness non-invasively. The tonometer is considered as the gold standard for measuring PWV. This approach requires manual probe fixation above the artery and depends on the skills of the operator. Electrical impedance plethysmography (IPG) is an interesting alternative using skin surface sensing electrodes, that is miniaturizable, cost-effective and allows measurement of deeper arteries. The aim of this pilot study was to explore if IPG can be a suitable technique to measure pulse wave velocity in legs as an alternative for the tonometer technique. The PWV was estimated by differences in the ECG-gated pulse arrival times (PAT) at the a. femoralis, a. popliteal, a. tibialis dorsalis and a. dorsalis pedis in nine healthy young adults using IPG and the SphygmoCor tonometer as a reference. The estimated PWV results from bioimpedance and the tonometer were fairly in agreement, and the beat-to-beat variability in PAT was similar. This pilot study indicates that the use of IPG may be a good alternative for estimating PWV in the legs.

This paper describes the development, execution and results of an experiment assessing emotions with electrodermal response measurements and machine learning. With ten participants, the study was carried out by eliciting emotions through film clips. The data was gathered with the Sudologger 3 and processed with continuous wavelet transformation. A machine learning algorithm was used to classify the data with the use of transfer learning and random forest classification. The results showed that the experiment lays a foundation for further exploration in the field. The addition of augmented data strengthened the classification and proved that more data would benefit the machine learning algorithm. The pilot study brought to light several areas to help with the expansion of the study for larger scale assessment of emotions with electrodermal response measurements and machine learning for the benefit of fields like psychology.