Nexfin noninvasive continuous hemodynamic monitoring: validation against continuous pulse contour and intermittent transpulmonary thermodilution derived cardiac output in critically ill patients

INTRODUCTION

Nexfin (Bmeye, Amsterdam, Netherlands) is a noninvasive cardiac output (CO) monitor based on finger arterial pulse contour analysis. The aim of this study was to validate Nexfin CO (NexCO) against thermodilution (TDCO) and pulse contour CO (CCO) by PiCCO (Pulsion Medical Systems, Munich, Germany).

PATIENTS AND METHODS

In a mix of critically ill patients (n = 45), NexCO and CCO were measured continuously and recorded at 2-hour intervals during the 8-hour study period. TDCO was measured at 0-4-8 hrs.

RESULTS

NexCO showed a moderate to good (significant) correlation with TDCO (R (2) 0.68, P < 0.001) and CCO (R (2) 0.71, P < 0.001). Bland and Altman analysis comparing NexCO with TDCO revealed a bias (± limits of agreement, LA) of 0.4 ± 2.32 L/min (with 36% error) while analysis comparing NexCO with CCO showed a bias (±LA) of 0.2 ± 2.32 L/min (37% error). NexCO is able to follow changes in TDCO and CCO during the same time interval (level of concordance 89.3% and 81%). Finally, polar plot analysis showed that trending capabilities were acceptable when changes in NexCO (ΔNexCO) were compared to ΔTDCO and ΔCCO (resp., 89% and 88.9% of changes were within the level of 10% limits of agreement).

CONCLUSION

we found a moderate to good correlation between CO measurements obtained with Nexfin and PiCCO.

Computerized venous strain-gauge plethysmography is a reliable method for measuring venous function

OBJECTIVES

To achieve reference values for computerized strain-gauge plethysmography (SGP), to assess reproducibility, and to evaluate the influence of different factors such as age, gender, body mass index, and symptomatic post-thrombotic disease on commonly used variables.

METHODS

Sixty-three healthy controls and 56 patients with previous deep venous thrombosis (DVT) were included. All participants underwent computerized SGP with evaluation of outflow capacity, as well as evaluation of venous reflux and muscle pump function.

RESULTS

All variables were significantly reduced in DVT limbs, both compared with contralateral limbs and with healthy controls. Only two patients had all values within normal ranges (=mean ± 2 SD in controls). Measures of outflow capacity had a coefficient of variation (CV) of 5-6% and exercise-induced volume changes a CV of 10-15%. In symptomatic post-thrombotic limbs half-refilling time was significantly related to presence of edema (R = -0.28, p < .05) and to chronic skin changes (R = -0.58, p < .001).

CONCLUSIONS

We suggest that our values in healthy controls can be used as new reference values for computerized venous strain-gauge plethysmography. The computerized design ensures high reproducibility and the results indicate that this is a very useful and sensitive test for functional quantitative assessment of patients with venous disease.

Detection of cigarette smoke inhalations from respiratory signals using reduced feature set

A combination of wearable Respiratory Inductive Plethysmograph and a hand-to-mouth Proximity Sensor (PS) can be used to monitor smoking habits and smoke exposure in cigarette smokers. In our previous work, detection of smoke inhalations was achieved by using a Support Vector Machine (SVM) classifier applied to raw sensor signals with 1503-element feature vectors. This study uses empirically-defined 27 features computed from the sensor signals to reduce the length of vectors. Further reduction in the length of the feature vectors was achieved by a forward feature selection algorithm, identifying from 2 to 16 features most critical for smoke inhalations detection. For individual detection models, the 1503-element feature vectors, 27-element feature vectors and reduced feature vectors resulted in F-scores of 90.1%, 68.7% and 94% respectively. For the group models, F-scores were 81.3%, 65% and 67% respectively. These results demonstrate feasibility of detecting smoke inhalations with a computed feature set, but suggest high individuality of breathing patterns associated with smoking.

Increased variability in respiratory parameters heralds obstructive events in children with sleep disordered breathing

Sleep disordered breathing (SDB) is characterized by repeated episodes of central or obstructive apneas, disturbing respiratory patterns. The purpose of this study is to quantify respiratory variability associated with apneic/hypopneic events by computing respiratory parameters and thoraco-abdominal asynchrony (TAA) over sleep periods preceding the occurrence of obstructive events in children with SDB. One minute artifact-free epochs of ribcage (RC) and abdominal (AB) signals were extracted from the respiratory inductive plethysmograph (RIP) channel of the PSG prior to the onset of each obstruction. Breath-by-breath values of TAA were computed using a Hilbert transform based technique that measures the phase shift between the RC and AB signals. In addition, the following parameters were computed breath-by-breath from the RC signal: inspiratory time (Ti), expiratory time (Te), total time (Ttot), and the inspiratory duty cycle (DC=Ti/Ttot). Standard deviation of the parameters (SD_TAA, SD_Ti, SD_Te, SD_Ttot, SD_DC) over each 1 min epoch were calculated and averaged over each subject with respect to sleep stage. For comparison, similar measures were computed from within quiet breathing periods of each subject. We found that breaths immediately before apnea/hypopneas were associated with a high degree of variability in respiratory timing and TAA. The proposed variability analysis of RIP signals may be useful for detecting acute epochs of respiratory instability in children with SDB.

Correlation between endothelial function measured by finger plethysmography in children and HDL-mediated eNOS activation -- a preliminary study

BACKGROUND

The noninvasive measurement of endothelial function is a very powerful tool to assess cardiovascular disease. Especially in children this is not an easy task, and therefore an easy method like the Endo-Pat device is helpful. Due to the still existing uncertainties of the validity of endothelial measurement by the Endo-PAT device in children, we thought to analyze the correlation between endothelial functional measurement by Endo-PAT, and the capability of HDL to modify nitric oxide (NO) production by phosphorylation of endothelial nitric oxide synthase at the stimulatory site (Ser(1177)) and the inhibitory site (Thr(495)).

METHODS

The reactive hyperemic index (RHI) was measured in 11 school children by the Endo-PAT device. HDL was isolated by ultracentrifugation, and the capability to stimulate eNOS phosphorylation was assessed in cell culture.

RESULTS

A close correlation between the RHI and the eNOS-Ser(1177) phosphorylation (r=0.66, p=0.02) and the eNOS-Thr(495) phosphorylation (r=-0.60, p=0.04) was detected.

CONCLUSION

The results obtained in our limited study performed in healthy children supports the validity of endothelial function measurement in children using the Endo-PAT device. Nevertheless, studies measuring FMD and the RHI index need to confirm the strength of the Endo-Pat device also in children.

Effects of exercise interventions on peripheral vascular endothelial vasoreactivity in patients with heart failure with reduced ejection fraction

Changes in vascular function, such as endothelial dysfunction are linked to the progression of heart failure (HF) and poorer outcomes, such as increased hospitalisations. Exercise training may positively influence endothelial function in HF patients with reduced ejection fraction. The aim of this manuscript is to summarise HF studies evaluating the influence of exercise training on endothelial function as measured by flow mediated vasodilation as a primary outcome and to provide recommendations for future research studies designed to improve peripheral vascular function in HF. Databases were searched for studies published between 1995 and December 2011. Two reviewers determined eligibility and extracted information on study characteristics and quality, exercise interventions, and endothelial function. Eleven articles (N=318 HF participants with an ejection fraction <40%) were eligible for full review. Aerobic, resistance, or combined exercise training improved endothelium-dependent vasodilation as measured by ultrasound or plethysmography. There is less evidence supporting improvement in endothelium-independent function with exercise training. Sample sizes were small and predominantly male. Future research is needed to address the best mode and optimal dose of exercise for all patients with HF including women and subgroups with specific co-morbidities.

Venous occlusion plethysmography in patients with post-thrombotic venous claudication

OBJECTIVE

Post-thrombotic venous claudication is a serious condition that may be treated with iliac vein stenting or open surgery, and there is a need for hemodynamic tests in the preoperative evaluation. The purpose of this study was to describe the results of venous occlusion plethysmography in patients with venous claudication and to analyze the outflow curve to find variables that best describe the functional abnormality in this patient group.

METHODS

Twenty-nine patients with previous deep venous thrombosis and with clinical evidence of venous claudication were retrospectively identified. The results of venous occlusion plethysmography in these patients were compared with results obtained in a group of 63 healthy control subjects of similar age and sex. Computerized strain-gauge plethysmography was used in a capacitance mode where the occlusion time is determined by an electronic detector allowing the maximal venous volume to be achieved in all limbs. Outflow volumes (OV1, OV4) and outflow fractions (OF1, OF4) were calculated at 1 and 4 seconds after cuff release. Outflow fraction is OV divided by maximal venous volume.

RESULTS

Both outflow volumes and outflow fractions were significantly reduced in patients compared with healthy control subjects. Outflow fractions were more sensitive than outflow volumes in identifying patients with venous claudication. The most discriminating variable was OF4 that was reduced below the normal lower limit in 69% of the patients, most severely reduced in patients with severe claudication.

CONCLUSIONS

Patients with venous claudication attributable to remaining post-thrombotic iliofemoral obstructive disease are characterized by a functional disturbance shown with venous occlusion plethysmography as a reduced venous outflow during the initial 4 seconds following cuff release in relation to their true maximal venous volume. Our results suggest that venous occlusion plethysmography can be a valuable tool in the preoperative workup for selection of patients with iliofemoral vein obstruction that may benefit from venous intervention.

Implantable acceleration plethysmography for blood pressure determination

This paper presents an implantable accelerometer which detects plethysmograms directly at an artery. The sensor provides a new method for continuous blood pressure monitoring. In vivo measurements indicate that the accelerometer is well suited for determining the Pulse Transit Time (PTT) and the Reflected Wave Transit Time (RWTT). Both parameters show a high correlation with the systolic blood pressure. By varying the blood pressure, it was seen that RWTT more closely agrees with theory than PTT. Through several blood pressure sweeps the RWTT, as detected by the accelerometer, coincided very well with the systolic blood pressure, with a correlation coefficient of 0.96 and mean deviation of 4.3% for 1800 pulses.

Local pulse wave velocity estimation using magnetic plethysmograph

Pulse Wave Velocity(PWV) is an established measure of arterial stiffness. We present a method of measuring local pulse wave velocity by the use of Magnetic Plethysmograph(MPG) sensors. The design of a Compact Single element MPG (CS-MPG) sensor is presented. The functionality of the sensor is verified by phantom experiments. The utility of this sensor for in-vivo measurements of PWV is also demonstrated. Further, a Dual-element MPG (D-MPG) for evaluation of local PWV is also presented. The error in measurement of PWV using this sensor is characterised experimentally and shown to be within acceptable limits. The ability of this dual element sensor to measure local PWV in-vivo is also demonstrated by trials on volunteers.

Biosignal-based relaxation evaluation of head-care robot

Such popular head care procedures as shampooing and scalp massages provide physical and mental relaxation. However, they place a big burden such as chapped hands on beauticians and other practitioners. Based on our robot hand technology, we have been developing a head care robot. In this paper, we quantitatively evaluated its relaxation effect using the following biosignals: accelerated plethymography (SDNN, HF/TP, LF/HF), heart rate (HR), blood pressure, salivary amylase (sAA) and peripheral skin temperature (PST). We compared the relaxation of our developed head care robot with the head care provided by nurses. In our experimental result with 54 subjects, the activity of the autonomic nerve system changed before and after head care procedures performed by both a human nurse and our proposed robot. Especially, in the proposed robot, we confirmed significant differences with the procedure performed by our proposed head care robot in five indexes: HF/TP, LF/HF, HR, sAA, and PST. The activity of the sympathetic nerve system decreased, because the values of its indexes significantly decreased: LF/HF, HR, and sAA. On the other hand, the activity of the parasympathetic nerve system increased, because of the increase of its indexes value: HF/TP and PST. Our developed head care robot provided satisfactory relaxation in just five minutes of use.

Prediction of Visceral Adipose Tissue Using Air Displacement Plethysmography in Children

OBJECTIVE

To determine the ability of air displacement plethysmography (ADP) to predict visceral adipose tissue (VAT) volume in children.

RESEARCH METHODS AND PROCEDURES

Fifty-five (33 boys/22 girls) white children 13 to 14 years old were studied. Anthropometric measures were collected for body mass, stature, BMI, and waist-to-hip ratio (WHR), and body fat percentage was estimated from triceps and subscapular skinfolds, bioelectrical impedance analysis, and ADP. VAT volume was determined using magnetic resonance imaging, using a multiple slice protocol at levels L1 to L5.

RESULTS

Boys had significantly (p < or = 0.05) less VAT volume than girls [645.1 (360.5) cm(3) vs. 1035.8 (717.3) cm(3)]. ADP explained the greatest proportion of the variance in VAT volume compared with the other anthropometric measures. Multiple regression analysis indicated that VAT volume was best predicted by ADP body fat percentage in boys [r(2) = 0.81, SE of the estimate (SEE) = 160.1, SEE coefficient of variation = 25%] and by WHR and BMI in girls (r(2) = 0.80, SEE = 337.71, SEE coefficient of variation = 33%).

DISCUSSION

Compared with the other anthropometric measures, ADP explains the greatest proportion of the variance in VAT volume in children 13 to 14 years old. For boys, ADP is the tool of choice to predict VAT volume, yet using the more simply collected measures of BMI and WHR is recommended for girls. However, large SE of the estimates remained, suggesting that if precision is needed, there is no surrogate for direct imaging of VAT.

Body composition at 6 months of life: comparison of air displacement plethysmography and dual-energy X-ray absorptiometry

Body composition assessment during infancy is important because it is a critical period for obesity risk development, thus valid tools are needed to accurately, precisely, and quickly determine both fat and fat-free mass. The purpose of this study was to compare body composition estimates using dual-energy x-ray absorptiometry (DXA) and air displacement plethysmography (ADP) at 6 months old. We assessed the agreement between whole body composition using DXA and ADP in 84 full-term average-for-gestational-age boys and girls using DXA (Lunar iDXA v11-30.062; Infant whole body analysis enCore 2007 software, GE, Fairfield, CT) and ADP (Infant Body Composition System v3.1.0, COSMED USA, Concord, CA). Although the correlations between DXA and ADP for %fat (r = 0.925), absolute fat mass (r = 0.969), and absolute fat-free mass (r = 0.945) were all significant, body composition estimates by DXA were greater for both %fat (31.1 ± 3.6% vs. 26.7 ± 4.7%; P < 0.001) and absolute fat mass (2,284 ± 449 vs. 1,921 ± 492 g; P < 0.001), and lower for fat-free mass (5,022 ± 532 vs. 5,188 ± 508 g; P < 0.001) vs. ADP. Inter-method differences in %fat decreased with increasing adiposity and differences in fat-free mass decreased with increasing infant age. Estimates of body composition determined by DXA and ADP at 6 months of age were highly correlated, but did differ significantly. Additional work is required to identify the technical basis for these rather large inter-method differences in infant body composition.

Child-Specific Thoracic Gas Volume Prediction Equations for Air-Displacement Plethysmography

OBJECTIVE

To develop child-specific thoracic gas volume (TGV) prediction equations for use in air-displacement plethysmography in 6- to 17-year-old children.

RESEARCH METHODS AND PROCEDURES

Study 1 developed TGV prediction equations using anthropometric variables after completing a measured TGV and air-displacement plethysmography test in 224 healthy boys and girls (11.2 +/- 3.2 years, 45.3 +/- 18.7 kg, 149.9 +/- 18.5 cm). Study 2 cross-validated the prediction equations in a separate cohort of 62 healthy boys and girls (11.2 +/- 3.4 years, 44.2 +/- 15.3 kg, 149.4 +/- 19.3 cm).

RESULTS

In Study 1 (development of TGV prediction equations), the quadratic relationship using height as the independent variable and the measured TGV as the dependent variable yielded the highest adjusted R(2) and the lowest SE of estimate in both genders, thus producing the following prediction equations: TGV = 0.00056 x H(2) - 0.12422 x H + 8.15194 (boys) and TGV = 0.00044 x H(2) - 0.09220 x H + 6.00305 (girls). In Study 2 (cross-validation), no significant difference between the predicted and measured TGVs (-0.018 +/- 0.377 liters) was observed. The regression between the measured TGV and the predicted TGV yielded a slope and intercept that did not significantly differ from the line of identity. Prediction accuracy was good as indicated by a high R(2) (0.862) and low SE of estimate (0.369 liters).

DISCUSSION

The new child-specific TGV prediction equations accurately, precisely, and without bias estimated the actual TGV of 6- to 17-year-old children.

Air-displacement plethysmography pediatric option in 2-6 years old using the four-compartment model as a criterion method

The objective of this study was to determine the accuracy, precision, bias, and reliability of percent fat (%fat) determined by air-displacement plethysmography (ADP) with the pediatric option against the four-compartment model in 31 children (4.1 ± 1.2 years, 103.3 ± 10.2 cm, 17.5 ± 3.4 kg). %Fat was determined by (BOD POD Body Composition System; COSMED USA, Concord, CA) with the pediatric option. Total body water (TBW) was determined by isotope dilution ((2)H(2)O; 0.2 g/kg) while bone mineral was determined by dual-energy X-ray absorptiometry (DXA) (Lunar iDXA v13.31; GE, Fairfield, CT and analyzed using enCore 2010 software). The four-compartment model by Lohman was used as the criterion measure of %fat. The regression for %fat by ADP vs. %fat by the four-compartment model did not deviate from the line of identity where: y = 0.849(x) + 4.291. ADP explained 75.2% of the variance in %fat by the four-compartment model while the standard error of the estimate (SEE) was 2.09 %fat. The Bland-Altman analysis showed %fat by ADP did not exhibit any bias across the range of fatness (r = 0.04; P = 0.81). The reliability of ADP was assessed by the coefficient of variation (CV), within-subject SD, and Cronbach's α. The CV was 3.5%, within-subject SD was 0.9%, and Cronbach's α was 0.95. In conclusion, ADP with the pediatric option is accurate, precise, reliable, and without bias in estimating %fat in children 2-6 years old.

Subject positioning in the BOD POD® only marginally affects measurement of body volume and estimation of percent body fat in young adult men

INTRODUCTION

The aim of the study was to evaluate whether subject positioning would affect the measurement of raw body volume, thoracic gas volume, corrected body volume and the resulting percent body fat as assessed by air displacement plethysmography (ADP).

METHODS

Twenty-five young adult men (20.7±1.1 y, BMI = 22.5±1.4 kg/m(2)) were measured using the BOD POD® system using a measured thoracic gas volume sitting in a 'forward bent' position and sitting up in a straight position in random order.

RESULTS

Raw body volume was 58±124 ml (p<0.05) higher in the 'straight' position compared to the 'bent' position. The mean difference in measured thoracic gas volume (bent-straight = -71±211 ml) was not statistically significant. Corrected body volume and percent body fat in the bent position consequently were on average 86±122 ml (p<0.05) and 0.5±0.7% (p<0.05) lower than in the straight position respectively.

CONCLUSION

Although the differences reached statistical significance, absolute differences are rather small. Subject positioning should be viewed as a factor that may contribute to between-test variability and hence contribute to (in)precision in detecting small individual changes in body composition, rather than a potential source of systematic bias. It therefore may be advisable to pay attention to standardizing subject positioning when tracking small changes in PF are of interest. The cause of the differences is shown not to be related to changes in the volume of isothermal air in the lungs. It is hypothesized and calculated that the observed direction and magnitude of these differences may arise from the surface area artifact which does not take into account that a subject in the bent position exposes more skin to the air in the device therefore potentially creating a larger underestimation of the actual body volume due to the isothermal effect of air close to the skin.

Pulse-plethysmographic variables in hemodynamic assessment during mannitol infusion

Plethysmographic signal using pulse oximetry may be used to assess fluid status of patients during surgery as it resembles arterial pressure waveform. This will avoid placement of invasive arterial lines. This study was designed to find out whether intravascular volume changes induced by mannitol bolus in neurosurgical patients are detected by variations in arterial pressure and plethysmographic waveforms and also to assess the strength of correlation between different variables derived from these two waveforms. The time difference between the onset of arterial and plethysmographic waveforms as means of significant hemodynamic changes was also evaluated. Forty one adult ASA I and II neurosurgical patients requiring mannitol infusion were recruited. Arterial line and plethysmographic probe were placed in the same limb. Digitized waveforms were collected before, at the end, and 15, 30 and 60 min after mannitol infusion. Using MATLAB, the following parameters were collected for three consecutive respiratory cycles,-systolic pressure variation (SPV), pulse pressure variation (PPV), plethysmographic peak variation (Pl-PV), plethysmographic amplitude variation (Pl-AV) and blood pressure-plethysmographic time lag (BP-Pleth time lag). Changes in above parameters over the study period were studied using repeated measure analysis of variance. Correlation between the parameters was analysed. SPV and Pl-PV showed significant increase at 15, 30 and 60 min compared to end of mannitol infusion (P < 0.01 for SPV; P < 0.05 for Pl-PV). PPV and Pl-AV showed significant increase only at 30 min (P < 0.05). The correlation between ∆SPV-∆Pl-PV, ∆PPV-∆Pl-AV and ∆SPV-∆BP-Pleth time lag were significant (r = 0.3; P < 0.01). SPV and time lag had no significant interaction. Pl-PV correlates well with SPV following mannitol infusion and can be used as an alternative to SPV. (BP-Pleth) time-lag promises to be an important parameter in assessing the state of peripheral vascular resistance and deserves further investigation.

[Value of eye haemodynamics examination in surgery of traumatic retinal detachment]

Literature on eye microhaemodynamics in patients with traumatic retinal detachment is reviewed. The main noninvasive methods of eye microhaemodynamics examination and potentials of their use in traumatic retinal detachment are analyzed

Optoelectronic plethysmography demonstrates abrogation of regional chest wall motion dysfunction in patients with pectus excavatum after Nuss repair

PURPOSE

We previously demonstrated that patients with pectus excavatum (PE) have significantly decreased chest wall motion at the pectus defect compared with the rest of the chest vs unaffected individuals and use abdominal respiratory contributions to compensate for decreased upper chest wall motion. We hypothesize that PE repair will reverse chest wall motion dysfunction.

METHODS

A prospective, institutional review board-approved study compared patients with PE before and after Nuss repair. Informed consent was obtained before motion analysis. Sixty-four patients with uncorrected PE ages 10 to 21 years underwent optoelectronic plethysmography analysis. Repeat analysis was performed in 42 patients 6 months postoperative (PO).

RESULTS

Volume of the chest wall and its subdivisions were calculated. Total chest wall volume at rest was significantly increased after repair and in each thoracic compartment. PO patients developed increased midline marker excursion at the pectus defect and significantly decreased excursion at the level of the umbilicus.

CONCLUSIONS

Optoelectronic plethysmography kinematic analysis demonstrates that chest wall remodeling during Nuss repair results in increased thoracic volume. Chest wall motion dysfunction at the pectus defect is reversed after Nuss repair. Abdominal respiratory contributions are also markedly decreased. These findings may help to explain why patients with PE report an improvement in endurance after the Nuss procedure.

Empirical mode decomposition of respiratory inductive plethysmographic signals for stroke volume variations monitoring: respiratory protocol and comparison with impedance cardiography

We investigate Respiratory Inductive Plethysmography (RIP) to estimate cardiac activity from thoracic volume variations and study cardio-respiratory interactions. The objective of the present study is to evaluate the ability of RIP to monitor stroke volume (SV) variations, with reference to impedance cardiography (IMP). Five healthy volunteers in seated and supine positions were asked to blow into a manometer in order to induce significant SV decreases. Time-scale analysis was applied on calibrated RIP signals to extract cardiac volume signals. Averaged SV values, in quasi-stationary states at rest and during the respiratory maneuvers, were then estimated from these cardiac signals and from IMP signals simultaneously acquired. SV variations between rest and maneuvers were finally evaluated for both techniques. We show that SV values as well as SV variations are correlated between RIP and IMP estimations, suggesting that RIP could be used for SV variations monitoring.

Noninvasive assessment of endothelial function in clinical practice

In the fight against cardiovascular diseases, preventive strategies are becoming the focus of attention. One of these strategies proposes to identify individuals who are at a high risk of developing cardiovascular disease. Endothelial dysfunction could improve patient risk stratification and the implementation of preventive strategies. In this review we focus on noninvasive techniques that have recently become available to assess endothelial function: flow-mediated vasodilation as measured by ultrasound of the brachial artery, pulse wave analysis, and finger plethysmography during postischemic hyperemia. We describe the basic principles, the main protocols to perform these techniques, and their clinical value based on the scientific evidence.

Validity of weight loss to estimate improvement in body composition in individuals attending a wellness center

The accuracy of weight loss in estimating successful changes in body composition (BC), namely fat mass (FM) loss, is not known and was addressed in our study. To assess the correlation between change in body weight and change in FM, fat% and fat-free mass (FFM), 465 participants (41% male; 41 ± 13 years), who met the criteria for weight change assessment at a wellness center, underwent air-displacement plethysmography (ADP). Body weight and BC were measured at the same time. We categorized the change in body weight, FM and FFM as an increase if there was >1 kg gain, a decrease if there was >1 kg loss and no change if the difference was ≤1 kg. We estimated the diagnostic performance of weight change to identify improvement in BC. After a median time of 132 days, there was a mean weight change was 2.4 kg. From the 255 people who lost >1 kg of weight, 216 (84.7%) had lost >1 kg of FM, but 69 (27.1%) had lost >1 kg of FFM. Of the 143 people with no weight change, 42 (29.4%) had actually lost >1 kg of FM. Of the 67 who gained >1 kg of weight at follow-up, in 23 (34.3%) this was due to an increase in FFM but not in FM. Weight change had a NPV of 73%. Our results indicate that favorable improvements in BC may go undetected in almost one-third of people whose weight remains the same and in one-third of people who gain weight after attending a wellness center. These results underscore the potential role of BC measurements in people attempting lifestyle changes.

Quantitative nuclear magnetic resonance to measure fat mass in infants and children

Quantitative nuclear magnetic resonance (QMR) is being used in human adults to obtain measures of total body fat mass (FM) with high precision. The current study assessed a device specially designed to accommodate infants and children between 3 and 50 kg (EchoMRI-AH). Body composition of 113 infants and children (3.3-49.9 kg) was assessed using dual-energy X-ray absorptiometry (DXA), air displacement plethysmography (ADP, PeaPod for infants ≤ 8 kg and BodPod for children ≥ 6 years) and QMR. Results were compared with the deuterium oxide dilution technique (D(2)O) and a four-compartment model (4-C). The percentages of compliance were: 98% QMR; 75% DXA; 94% BodPod; and 95% PeaPod. Although QMR precision was high (coefficient of variation = 1.42%), it overestimated FM ~10% compared to the 4-C model and underestimated FM by ~4% compared to the deuterium method in children ≥ 6 years. QMR was less concordant with 4-C or D(2)O models for infants ≤ 8 kg. Thus, a piece-wise defined model for mathematically fitting the QMR data to the D(2)O data was employed and this adjustment improved the accuracy relative to D(2)O and 4-C for infants. Our results suggest that the pediatric QMR with appropriate mathematical adjustment provides a fast and precise method for assessing FM longitudinally in infants and in children weighing up to 50 kg.

Respiratory and sniffing behaviors throughout adulthood and aging in mice

Orienting responses are physiological and active behavioral reactions evoked by novel stimulus perception and are critical for survival. We explored whether odor orienting responses are impacted throughout both adulthood and normal and pathological aging in mice. Novel odor investigation (including duration and bout numbers) and its subsequent habituation as assayed in the odor habituation task were preserved in adult C57BL/6J mice up to 12 mo of age with <6% variability between age groups in investigation time. Separately, using whole-body plethysmography we found that both spontaneous respiration and odor-evoked sniffing behaviors were strikingly preserved in wildtype (WT) mice up to 26 mo of age. In contrast, mice accumulating amyloid-β protein in the brain by means of overexpressing mutations in the human amyloid precursor protein gene (APP) showed preserved spontaneous respiration up to 12 mo, but starting at 14 mo showed significant differences from WT. Similar to WTs, odor-evoked sniffing was not impacted in APP mice up to 26 mo. These results show that odor-orienting responses are minimally impacted throughout aging in mice, and suggest that the olfactomotor network is mostly spared of insults due to aging.