作者感谢意大利帕多瓦大学医学与外科科学系的Piccoli教授和Pastori教授提供BIVA软件。此外，还有路易斯·略伦特博士和德拉。来自 INCMNSZ 免疫学和风湿病学系的 Andrea Hinojosa-Azaola，用于对患者进行风湿病学评估。这项工作得到了 CONACyT 的支持，CONACyT 赞助了 CVU 奖学金，777701 Mariel Lozada Mellado 在博士课程学习期间以及通过研究项目资助000000000261652。申办者在研究设计或数据的收集、分析或解释中没有任何作用，也没有在报告的撰写和提交论文发表的决定中发挥任何作用。

本方案由国家医学科学与营养研究所萨尔瓦多·祖比兰（参考文献:1347）的人类研究和伦理委员会指南批准并遵循。在参与本研究之前，已获得人类参与者的知情同意。本研究仅纳入功能性 I 至 III 级的患者，未进行全部或部分关节置换术18,19 且不适合假体。排除标准包括患有心血管疾病、癌症、慢性肾病、妊娠或其他与RA重叠的自身免疫性疾病的患者。
1. 招募参与者
<ol><li>招募患者。 注:在本研究中，从风湿病门诊招募了 12 名患有 RA 的女性。</li>
	<li>确保患者在过去6个月内接受稳定的药物治疗;其中可能包括以下任何一种:抗疟药（例如氯喹、羟氯喹）、改善病情的抗风湿药 （DMARD）（例如甲氨蝶呤、来氟米特）和糖皮质激素（例如泼尼松）20。 注意:根据风湿病学家的评估，如有必要，可以在干预期间改变药物治疗。</li>
</ol>2. 参与者预测试
注意:预测试是在开始动态锻炼计划前 1 周进行的。使用多频生物电阻抗分析设备（见 材料表），并在患者禁食 4 至 5 小时时进行测量。
<ol><li>测试前的步骤<ol><li>确保这些测量由具有丰富经验的标准化人员进行。</li>
		<li>使用0.05%氯己定清洁设备，并确保洗手。</li>
		<li>向患者解释程序并获得体重 （kg） 和身高 （cm） 的测量值。</li>
		<li>要求患者脱掉鞋子和右袜子以及与皮肤接触的任何金属物体。</li>
		<li>将患者置于仰卧位 5 分钟，双腿和双臂伸展，并确认它们没有与身体的任何部位接触。</li>
	</ol></li>
	<li>BIA的测量<ol><li>用70%酒精清洁手背和右脚。</li>
		<li>将两个电极放在手背上:一个在第三掌指关节上，另一个在手腕中间的尺骨头水平。</li>
		<li>在右脚上放置两个电极:一个在第三跖趾关节，另一个在内踝和外踝之间。电极之间应有 5-10 厘米的间隙。</li>
		<li>连接设备的四根电缆。连接后，将红色夹子放在靠近指甲和脚趾甲的电极上;将黑色夹子放在剩余的电极上。电缆不得相互交叉。</li>
		<li>四种不同频率（5、50、100 和 200 kHz）的阻抗值 （Z） 将显示在设备屏幕上。注意 50 kHz 频率的电阻和电抗值。这些值对于恶病质患者分类是必要的。 注意:使用四极多频设备的生物电阻抗分析可在 50 kHz 的单个频率下提供准确的电阻和电抗值，以及 200 kHz 和 5 kHz 阻抗值 （200/5 kHz） 之间的比率。</li>
	</ol></li>
	<li>BIVA对恶病质的分类<ol><li>下载BIVA公差R-Xc图形软件（参见 材料表）并打开它。 注意:该软件是一个电子表格，可以在七个工作表的底部看到。</li>
		<li>转到第二个工作表， 参考人口;选择与参考人口相对应的行;复制它;并将其粘贴到第二行，标记为黄色。 注意:参考人群是根据要评估的人群的年龄范围、种族、性别和 BMI 选择的。</li>
		<li>转到第五个工作表" 受试者"，然后在第二行中插入患者的数据:在 A 列中，输入 患者的 ID;在 B 列中，输入数字 1;对于接下来的两列，可以选择是否输入患者姓名。</li>
		<li>在 E 列中，输入 患者的性别，使用 M 表示男性，使用 F 表示女性。在 F 和 G 列中，插入前面记下的 50 kHz 电阻和电抗值。在接下来的两列中输入身高 （cm） 和体重 （kg）。</li>
		<li>在 J 列中，输入与第二个工作表中选择的参考人口相对应的数字。</li>
		<li>在 K 列中插入一个介于 1 和 10 之间的数字。"点图"表需要它;在下一列中，输入患者的年龄。 注意:可以在 1 到 10 之间选择值，因为在 BIVA 公差软件中最多可以有 10 名患者同时绘制图表。</li>
		<li>选项栏位于软件顶部。找到 补码 选项并 单击 它。然后，选择将显示的 计算 选项并 单击 它。观察通过高度和相位角调整的电阻和电抗值。</li>
		<li>接下来，导航到工作表 3 点图，并根据所选的参考群体观察 BIVA 图。将显示一个对话框。选择在步骤 2.3.6 的 K 列中输入的 组代码 。选择 "确定"，BIVA 图将显示为将患者的向量绘制为几何图形。</li>
		<li>观察 BIVA 图中 50%、75% 和 95% 的公差椭圆以及象限 I、II、III 和 IV。要使用BIVA对恶病质患者进行分类，载体必须位于右下象限（IV象限）和75%容差椭圆之外（图1）。 注意:载体落在 <75% 公差椭圆内的任何象限内的患者将被考虑为正常身体成分分类21。</li>
	</ol></li>
</ol>3.动态锻炼计划
注意:该程序由物理治疗师应用和监督。估计每位患者的干预持续时间为 48 次。锻炼课程在"INCMNSZ"风湿病和免疫科物理治疗区内的机械疗法健身房进行，持续时间为 90 分钟，每周两次。
<ol><li>对会议的评价<ol><li>询问患者他们感觉到的关节疼痛或不适。 注:视觉模拟量表 （VAS） 用于评估疼痛。如果他们报告任何关节的 VAS 疼痛超过 7/10，则由物理治疗部门进行更具体的评估（例如，如果只有疼痛，则使用电疗，如果存在僵硬，则使用热疗，当同时存在疼痛和炎症时使用冷冻疗法）。</li>
		<li>每次锻炼前测量生命体征。</li>
	</ol></li>
	<li>热身 注意:持续时间为 15 分钟，建立了分为几个阶段的一般动态热身。激活阶段:对所有运动弧线进行简单、轻柔和的全局运动，同时保持静止姿势，重复 10 到 15 次。设置阶段:在最后一部分中，进行了温和的动态练习，模拟了将在工作阶段实施的动作的手势，重复 10-15 次。<ol><li>激活阶段<ol><li>选择最合适的热身运动，包括上肢和下肢关节及其活动范围。<ol><li>上肢:指导患者达到一定范围的运动，每次关节运动都不会感到不适。教练必须引导患者进行正常速度的运动，并指导患者避免疼痛的运动范围。</li>
				<li>下肢:指导患者以站立姿势进行热身，双脚放在地面和稳定的表面上。当患者坐在椅子上时，指导患者在每个关节的运动范围内达到无痛的运动速度。 注意:如果有些患者可以长时间站立，则必须达到坐姿，考虑背部伸直且双脚着地的稳定椅子。必须包括髋关节、膝盖、脚踝和脚的可用活动范围。</li>
			</ol></li>
		</ol></li>
		<li>设置阶段<ol><li>指导患者执行功能性运动模式，包括每节段（下肢或上肢）两个以上的关节。</li>
			<li>在此阶段进行监督，以在运动过程中带来健康感，并在患者出现不适时调整运动范围。</li>
		</ol></li>
	</ol></li>
	<li>工作阶段 注意: 持续时间为 60 分钟，工作阶段分为三个阶段，每个阶段 20 分钟。<ol><li>有氧运动:在跑步机上进行锻炼。 注意: 选择没有默认倾斜度的跑步机。<ol><li>确保急停装置工作正常，并向患者解释安全措施。建议患者穿运动鞋。</li>
			<li>向患者提供有关跑步机启动时必须进行的调整的信息，并且必须正确执行以避免不自然的步态运动。</li>
			<li>为每位患者设定基本速度，要求在行走过程中保持正常感觉。</li>
			<li>在跑步机上调整速度 5 分钟后。使用脉搏血氧仪（参见材料表），在速度增加的同时测量心率，直到达到 HRmax 的 55% 和 75%14,31 之间的心率区。 注意: 如果患者的心率超过 75% HRmax，则必须将速度降低到理想的心率区。指导患者寻找舒适的步伐。</li>
			<li>10 分钟后，要求患者使用感知努力量表进行评估。 注:感知用力量表的改良 Borg 评分用于评估感知用力。</li>
			<li>在患者的最后 5 分钟内将跑步机速度降低到舒适的速度。达到 5 分钟时，速度必须降低到完全停止。</li>
			<li>询问患者使用跑步机后是否有任何疼痛或不适。</li>
		</ol></li>
		<li>抗阻练习 注意:定向关节活动练习与肌肉力量练习结合使用。锻炼包括每次练习 8-10 次重复。使用软（0.5-2.6 kg）和中（0.7-3.2 kg）阻力带，每2周逐渐增加阻力。运动的剂量取决于干预时患者的状态。<ol><li>上肢<ol><li>指导患者在用双手处理木棍（<1 kg）时进行上肢活动。</li>
				<li>教患者进行联合锻炼，包括两个以上关节的运动范围（例如，肩部和肘部屈曲）。</li>
				<li>指导患者在末端上方固定带子。患者必须用带子的末端卷起手以确保他们的抓地力。 注意: 如果患者的手感到不适，教练必须轻轻地将腕带固定在手腕上。</li>
				<li>指导患者将带子的一端放在地板上，然后用脚踩踏。然后，对束带的阻力进行肘部屈曲。肘关节伸展必须在离心收缩时起作用，同时返回中立位置。 注意:患者必须站立，脚底稳定，姿势良好。如果患者表现出一些不适，则必须以坐姿进行此练习。</li>
				<li>指导患者在手上卷起带子，确保不要施加过大的压力。另一端应由患者在臀部水平处紧挨身体的空手握住。然后，指导患者将肘部弯曲 90°，肘部处于中立位置。 注意:患者可以在两次运动之间休息 20 秒。</li>
			</ol></li>
			<li>下肢<ol><li>指导患者坐在稳固的椅子上，髋关节和膝盖屈曲 90°，并系好阻力带的末端，形成环带。患者必须用股骨远端（膝盖上方）的橡皮筋环绕双腿。在这个位置，指导患者对每条腿进行髋关节屈曲，最多比起始位置高出 20 到 30 度。 注意: 为了正确对齐，请避免髋关节旋转和膝关节屈曲。如果患者表现出不适，请减少活动范围。</li>
				<li>指导患者坐在稳固的椅子上，髋关节和膝盖屈曲 90°，并系好阻力带的末端，形成环带。患者必须用股骨远端（膝盖上方）的橡皮筋环绕双腿。在这个位置，指导患者进行轻微的髋关节屈曲（距基本位置 10° 以上）和髋关节外展。 注意: 为了正确对齐，请避免髋关节旋转和膝盖过度屈曲。如果患者表现出不适，请减少活动范围。</li>
				<li>指导患者坐在稳固的椅子上，髋关节和膝盖屈曲 90°，并系好阻力带的末端，形成环带。患者必须用脚踝处的橡皮筋包围最近的椅腿和自己的腿。指导患者以缓慢的速度返回基本位置。 注意:为了正确对齐，患者必须保持舒适的坐姿并避免髋关节屈曲补偿。如果需要，患者可以用手握住椅子的底部，以提高稳定性。这些步骤可以一次用一条腿或通过改变侧面来执行。</li>
				<li>指导患者保持站立姿势。然后，让患者系好阻力带的末端，做一个环带，并将阻力带放在脚踝上。指导患者在坐姿和站姿之间重复改变姿势。 注意:如果患者在运动过程中感到不适，请重新评估并通过使用较高的椅子来减少膝盖屈曲或使用患者可以支撑自己并促进运动的第二把椅子来简化运动。</li>
			</ol></li>
		</ol></li>
		<li>休闲游戏 注意:包括实施涉及从足球、篮球或排球等特定运动改编的手势或动作的练习系列，整合灵活性和协调性组件，创建 4 到 7 个由多关节运动和不同练习组成的站，并进行两个系列 8 到 15 次重复（难度每 2 周增加一次）。<ol><li>根据每次疗程中患者的运动姿态选择最合适的运动，并制作一个运动站。每个工作站的设计必须考虑到患者的局限性。</li>
			<li>用两把椅子做一个足球球门，它们之间相距 1.3 m。</li>
			<li>指导患者在足球门前 3 m 处用脚击打 30 厘米的塑料球。</li>
			<li>通过增加每个站点的重复次数或组数以及向电路中添加新站点来控制难度。 注意: 示例站设计:（1） 将"Ula Ula"环连接到 1.3 m 木棍的尖端，将患者放在环前 2 m 的投掷点，并指导他们用手臂将一个 30 cm 的塑料球扔到"Ula Ula 环"上。每位患者必须至少打分 5 次，最多可以打 10 次。（2）沿着房间墙壁系上绳子，模拟排球网。绳索的最小高度必须为 1。7 m，每侧必须有两名患者就位。指导患者将 40 厘米长的气球从绳索上穿过，每次至少 10 至 15 次。（3）将两名患者放置，彼此之间相距3 m，并指导患者用手臂投掷一个30 cm的塑料球。每位患者每只手臂必须至少投掷塑料球 10 次。患者必须始终监督。</li>
		</ol></li>
	</ol></li>
	<li>冷却 注意:冷却持续时间为 15 分钟，由主动静态拉伸组成。<ol><li>在全球范围内应用，拉伸必须轻柔地进行，而不会对关节施加压力。伸展运动不应给患者带来不适。</li>
		<li>每次拉伸保持 15 到 20 秒。</li>
	</ol></li>
</ol>4. 测试后评估
注意:测试后评估必须安排在最后一次锻炼后的一周内。
<ol><li>重复测量身体成分以获得 BIVA 分类，如预测试中所述。 注:要对实施动态锻炼计划前后进行比较，需要获得电阻差除以高度的平均值（dR/H）、电抗差除以高度的平均值（dXc/H），以及差值的标准差和Pearson相关系数，公式如下:<img alt="Equation 1" src="/files/ftp_upload/65692/65692eq01.jpg" style="margin: auto;"></li>
	<li>要获得电阻和电抗的变化，请下载BIVA置信软件（参见 材料表）并打开它。 注意:该软件是一个电子表格;在底部，您可以看到五个工作表。</li>
	<li>在第四个工作表"配对数据"中，检查需要插入请求数据的十列。<ol><li>在 A 列中，放置组 ID。在 B 列中，放置已评估的患者数。</li>
		<li>在C列中，插入先前获得的d R/H的平均值。在下一列中，添加标准偏差。</li>
		<li>在 E 列中，插入 d Xc/H 的平均值，并在下一列中插入标准差。在 G 列中，插入之前获得的相关系数。 注意:在 H 列中，选择放置 1，您可以在图表上显示置信度椭圆，或者如果要显示置信度椭圆和差均值向量，请选择选项 2。</li>
		<li>在以下两列中，可以选择是否放置用于进行测量的组和设备的名称。</li>
	</ol></li>
	<li>完成所有必要的数据后，转到第 5 页"配对图"。在那里，可以看到差值均值的图，并且除了置信椭圆外，还能够定位电阻和电抗平均值的矢量。</li>
	<li>要评估更改是否具有统计显著性，请在工具栏中找到 补码 选项并 单击 它。它将打开一个带有 Hotelling 的 T2 检验统计量8 的框，允许人们找到 p 的值。</li>
</ol>

The video discusses research on using vector impedance analysis to assess hydration changes in body cell mass in rheumatoid arthritis patients. It highlights the increased infection risk associated with low body cell mass and emphasizes the benefits of physical exercise in improving strength, quality of life, and inflammation in these patients.

为类风湿性关节炎患者制定锻炼计划

<ol>
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作者没有什么可透露的。

在类风湿性关节炎中，已经描述了该病的恶性循环，这是指由炎症机制引起的关节结构变化;这些变化，加上慢性炎症状态，导致患者经历剧烈疼痛和炎症的阶段，关节结构发生变化，从而导致功能障碍，从而增加患代谢和心血管疾病的风险，以及类风湿恶病质等身体成分改变的风险22。运动已被证明可以减轻这种疾病的症状，提高生活质量，降低患其他疾病的风险2...

类风湿性关节炎 （RA） 是一种致残性疾病，由于急性关节疼痛、肌肉力量下降和身体机能受损而影响患者的功能和独立性，所有这些都与疾病固有的炎症过程有关 1,2。在晚期，持续的炎症会导致结构改变，导致畸形、关节功能障碍和类风湿恶病质，这是这些患者的不良预后因素 3,4。
类风湿恶病质的特征是身体成分的改变，例如肌肉损失，体重稳定和脂肪量增加，这会显着影响这些患者的生活质量 3,5,6。有多种技术可用于评估身体成分，其中最广泛使用的是生物电阻抗分析（BIA）。然而，当常规 BIA 分析用于身体成分改变的受试者时，估计可能会受到限制，因为它们基于为健康或正常水合人群制定的预测方程 7,8。
另一种称为生物电阻抗矢量分析（BIVA）的方法利用基于图形RXc的阻抗矢量。它利用针对高度校正的阻抗、电阻 （R） 和电抗 （Xc） 数据，从而生成一个载体，提供有关细胞团水合状态和完整性的信息。BIVA 能够将患者分为脱水、水合过度、正常、运动员、瘦、恶病质和肥胖等类别，使其成为 RA 患者的宝贵工具 8,9,10。位于主轴上方或下方（椭圆的左半部分或右半部分）的向量分别与软组织中较高和较低的细胞质量相关。平行于长轴的矢量的向前和向后位移与脱水和液体超负荷有关。运动员被定义为细胞质量较高的个体，可能伴有脱水。瘦分类是指细胞质量较低的人，可能伴有脱水，肥胖分类适用于细胞质量较高的个体，可能伴有液体超负荷。BIVA对恶病质的分类由高电阻和低电抗值决定，由矢量向图右侧的移动表示，表明细胞质量减少，可能伴有水合状态的改变11（图1）。
RA 的常规药物治疗主要侧重于减轻疼痛、炎症和关节损伤进展，对身体成分的改变关注有限12.在该人群常用的非药物疗法中，基于运动的干预措施在改善功能、疲劳、疼痛、关节活动度、有氧能力、肌肉力量、耐力、柔韧性和心理健康方面显示出积极成果。重要的是，这些干预措施已被证明可以在不加重症状或导致关节损伤的患者中实现这些益处，而没有广泛的预先存在的损伤13,14,15,16,17。然而，关于实施和评估该人群运动干预后水合作用和体细胞质量状态变化的知识有限。这些患者经常经历疼痛、炎症和结构性关节变化，限制了他们可以从事的活动类型，并使使用传统方法的身体成分评估进一步复杂化。该协议旨在演示在为类风湿性关节炎患者实施动态锻炼计划后，如何使用生物电阻抗矢量分析评估水合作用和体细胞质量状态的变化。此外，该协议还提供了动态锻炼计划的详细信息，包括心血管能力、力量和协调成分，以及步骤、工具、限制和一般注意事项。

<table><tbody><tr><td>Alcohol 70% swabs</td><td>NA</td><td>NA</td><td>Any brand can be used</td></tr><tr><td>bicycle ergometer</td><td>NA</td><td>NA</td><td>Any brand can be used</td></tr><tr><td>BIVA&amp;nbsp; tolerance software 2002</td><td>NA</td><td>NA</td><td>Is a sofware created for academic use, can be download in http://www.renalgate.it/formule_calcolatori/bioimpedenza.htm in &quot;LE FORMULE DEL Prof. Piccoli&quot; section</td></tr><tr><td>BIVA confidence software</td><td>NA</td><td>NA</td><td>Is a sofware created for academic use, can be download in http://www.renalgate.it/formule_calcolatori/bioimpedenza.htm in &quot;LE FORMULE DEL Prof. Piccoli&quot; section</td></tr><tr><td>Chair</td><td>NA</td><td>NA</td><td>Any brand can be used</td></tr><tr><td>Chlorhexidine</td><td>NA</td><td>NA</td><td>Any brand can be used, 0.05%</td></tr><tr><td>Examination table</td><td>NA</td><td>NA</td><td>Any brand can be used</td></tr><tr><td>Leadwires square socket</td><td>BodyStat</td><td>SQ-WIRES</td><td></td></tr><tr><td>Long Bodystat 0525 electrodes</td><td>BodyStat</td><td>BS-EL4000</td><td></td></tr><tr><td>Plastic ball</td><td>NA</td><td>NA</td><td>Any brand can be used, 30 cm</td></tr><tr><td>Pulse oximeter</td><td>NA</td><td>NA</td><td>Any brand can be used</td></tr><tr><td>Quadscan 4000&amp;nbsp; equipment</td><td>BodyStat</td><td>BS-4000</td><td>Impedance measuring range: 20 - 1300 &amp;Omega; ohms&lt;br/&gt; Test Current: 620 &amp;mu;A&lt;br/&gt; Frequency: 5, 50, 100, 200 kHz&lt;br/&gt; Accuracy: Impedance 5 kHz: +/- 2 &amp;Omega;&lt;br/&gt; Impedance 50 kHz: +/- 2 &amp;Omega;&lt;br/&gt; Impedance 100 kHz: +/- 3 &amp;Omega;&lt;br/&gt; Impedance 200 kHz: +/- 3 &amp;Omega;&lt;br/&gt; Resistance 50 kHz: +/- 2 &amp;Omega;&lt;br/&gt; Reactance 50 kHz: +/- 1 &amp;Omega;&lt;br/&gt; Phase Angle 50 kHz: +/- 0.2&amp;deg;&lt;br/&gt; Calibration: A resistor is supplied for independent verification from time to time. The impedance value should read between 496 and 503 &amp;Omega;.</td></tr><tr><td>Resistence bands</td><td>NA</td><td>NA</td><td>Any brand can be used, with resistence of 0.5 kg to 3.2 kg</td></tr><tr><td>Stationary bicycle</td><td>NA</td><td>NA</td><td>Any brand can be used</td></tr><tr><td>Treadmill</td><td>NA</td><td>NA</td><td>Any brand can be used</td></tr><tr><td>Wooden stick</td><td>NA</td><td>NA</td><td>Any brand can be used, 1.5m in large and &amp;lt;1kg</td></tr></tbody></table>

evaluation of changes in hydration and body cell mass with bioelectrical impedance analysis after exercise program for rheumatoid arthritis patients

类风湿性关节炎（RA）是一种使人衰弱的疾病，可导致类风湿恶病质等并发症。虽然体育锻炼已显示出对类风湿性关节炎患者的益处，但其对水合作用和身体细胞质量的影响仍不确定。疼痛、炎症和关节变化的存在通常会限制活动，并且由于水合作用水平的改变，使传统的身体成分评估变得不可靠。生物电阻抗是估计身体成分的常用方法，但它有局限性，因为它主要是为普通人群开发的，没有考虑身体成分的变化。另一方面，生物电阻抗矢量分析（BIVA）提供了一种更全面的方法。BIVA涉及以图形方式解释电阻（R）和电抗（Xc），并根据高度进行调整，以提供有关水合状态和细胞团完整性的宝贵信息。
本研究纳入了 12 名患有 RA 的女性。在研究开始时，使用 BIVA 方法获得水合作用和体细胞质量测量值。随后，患者参加了为期六个月的动态锻炼计划，包括心血管能力、力量和协调训练。为了评估水合作用和体细胞质量的变化，使用BIVA置信度软件比较了R和Xc参数的差异，并根据身高进行了调整。结果显示出明显的变化:锻炼计划后电阻降低，而电抗增加。BIVA作为一种分类方法，可以有效地将患者分为脱水、水合过度、正常、运动员、瘦、恶病质和肥胖类别。这使其成为评估 RA 患者的宝贵工具，因为它提供独立于体重或预测方程的信息。总体而言，BIVA在这项研究中的实施揭示了锻炼计划对RA患者水合作用和体细胞质量的影响。它的优势在于它能够提供全面的信息，并克服了传统身体成分评估方法的局限性。

介绍了参加 48 节动态锻炼计划的 6 名女性 RA 患者的结果。患者的平均年龄为52.7岁±13.1岁，BMI为26.8±4.6。平均病程为 15.5 ± 6.1 年，以疾病活动度评分 28 衡量的疾病活动度被归类为低活动度，平均为 1.9 ± 1。在残疾方面，健康评估问卷残疾的平均得分为0.5分±0.3分。对于没有参加锻炼计划的六名参与者，平均年龄为 55.8 ± 7，他们的 BMI 为 27.2 ± 4.8。病程为21.8±10，病害活动度与接受动态运动计划的?...

Watch this Scientific Journal Video about Implementation of BIVA for Analyzing Disease Risk Factors in Patients with Low Body Cell Mass at JoVE.com

作者聚焦:实施 BIVA 分析低体细胞质量患者的疾病风险因素 

该协议在为类风湿性关节炎患者设计的动态锻炼计划之后，使用生物电阻抗矢量分析评估水合作用和体细胞质量状态的改变。动态锻炼计划本身很详细，突出了其专注于心血管能力、力量和协调性的组成部分。该协议详细说明了步骤、仪器和限制。

类风湿性关节炎患者运动计划后通过生物电阻抗分析评估水合作用和体细胞质量的变化

Rheumatoid arthritis (RA) is a debilitating disease that can result in complications such as rheumatoid cachexia. While physical exercise has shown ...

该研究旨在证明矢量阻抗分析在评估类风湿性关节炎患者体细胞质量水合作用变化方面的效用，并调查体育锻炼对该人群的益处。最近的研究表明，使用生物电阻抗矢量分析，被归类为低体细胞质量的患者感染风险增加，并为心血管疾病提供服务预测因子。这一发现表明，通过矢量生物电阻抗分析确定的细胞质量较低的患者具有很高的感染风险。此外，我们观察到体育锻炼可以提高类风湿性关节炎患者的力量和生活质量，并减少炎症。通过生物电阻抗的矢量分析来评估身体成分，将有助于在药物治疗中做出明智的决定。此外，将体育锻炼作为治疗的一部分旨在预防或改善与身体成分变化相关的特定改变。评估类风湿性关节炎患者身体成分改变的长期影响并证明体育锻炼在增加细胞质量方面的有效性至关重要，细胞质量是代谢最活跃的人体隔室，它提供了更大的功能储备，与更好的预后相关。

evaluation-changes-hydration-body-cell-mass-with-bioelectrical

Research

JoVE Journal

Medicine

Evaluation of Changes in Hydration and Body Cell Mass with Bioelectrical Impedance Analysis after Exercise Program for Rheumatoid Arthritis Patients

1.1K 次观看.  National Autonomous University of Mexico. 该研究旨在证明矢量阻抗分析在评估类风湿性关节炎患者体细胞质量水合作用变化方面的效用，并调查体育锻炼对该人群的益处。最近的研究表明，使用生物电阻抗矢量分析，被归类为低体细胞质量的患者感染风险增加，并为心血管疾病提供服务预测因子。这一发现表明，通过矢量生物电阻抗分析确定的细胞质量较低的患者具有很高的感染风险。此外，我们观察到体育?...

视频: 作者聚焦:实施 BIVA 分析低体细胞质量患者的疾病风险因素 

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients 

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, and persistent nerve and muscle impairments after hospital discharge.1-6 Using an explicit protocol with a structured approach to training and quality assurance of research staff, manual muscle testing (MMT) is a highly reliable method for assessing strength, using a standardized clinical examination, for patients following ARDS, and can be completed with mechanically ventilated patients who can tolerate sitting upright in bed and are able to follow two-step commands. 7, 8 
This video demonstrates a protocol for MMT, which has been taught to &ge;43 research staff who have performed &gt;800 assessments on &gt;280 ARDS survivors. Modifications for the bedridden patient are included. Each muscle is tested with specific techniques for positioning, stabilization, resistance, and palpation for each score of the 6-point ordinal Medical Research Council scale.7,9-11 Three upper and three lower extremity muscles are graded in this protocol: shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion. These muscles were chosen based on the standard approach for evaluating patients for ICU-acquired weakness used in prior publications. 1,2.

Manual Muscle Testing:  A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Survivors of acute respiratory distress syndrome (ARDS) and critical illness frequently develop long-lasting muscle weakness. Manual muscle testing (MMT) is a standardized clinical examination commonly used to measure strength of peripheral skeletal muscle groups. This video demonstrates MMT using the 6-point Medical Research Council scale.

危重病人中的应用手册肌力测试：下肢肌力测量方法

Survivors of acute respiratory distress syndrome (ARDS) and other causes of critical illness often have generalized weakness, reduced exercise tolerance, ...

科研

医学

Evaluation of Cancer Stem Cell Migration Using Compartmentalizing Microfluidic Devices and Live Cell Imaging

In the last 40 years, the United States invested over 200 billion dollars on cancer research, resulting in only a 5% decrease in death rate. A major obstacle for improving patient outcomes is the poor understanding of mechanisms underlying cellular migration associated with aggressive cancer cell invasion, metastasis and therapeutic resistance1. Glioblastoma Multiforme (GBM), the most prevalent primary malignant adult brain tumor2, exemplifies this difficulty. Despite standard surgery, radiation and chemotherapies, patient median survival is only fifteen months, due to aggressive GBM infiltration into adjacent brain and rapid cancer recurrence2. The interactions of aberrant cell migratory mechanisms and the tumor microenvironment likely differentiate cancer from normal cells3. Therefore, improving therapeutic approaches for GBM require a better understanding of cancer cell migration mechanisms. Recent work suggests that a small subpopulation of cells within GBM, the brain tumor stem cell (BTSC), may be responsible for therapeutic resistance and recurrence. Mechanisms underlying BTSC migratory capacity are only starting to be characterized1,4.
Due to a limitation in visual inspection and geometrical manipulation, conventional migration assays5 are restricted to quantifying overall cell populations. In contrast, microfluidic devices permit single cell analysis because of compatibility with modern microscopy and control over micro-environment6-9.
We present a method for detailed characterization of BTSC migration using compartmentalizing microfluidic devices. These PDMS-made devices cast the tissue culture environment into three connected compartments: seeding chamber, receiving chamber and bridging microchannels. We tailored the device such that both chambers hold sufficient media to support viable BTSC for 4-5 days without media exchange. Highly mobile BTSCs initially introduced into the seeding chamber are isolated after migration though bridging microchannels to the parallel receiving chamber. This migration simulates cancer cellular spread through the interstitial spaces of the brain. The phase live images of cell morphology during migration are recorded over several days. Highly migratory BTSC can therefore be isolated, recultured, and analyzed further. 
Compartmentalizing microfluidics can be a versatile platform to study the migratory behavior of BTSCs and other cancer stem cells. By combining gradient generators, fluid handling, micro-electrodes and other microfluidic modules, these devices can also be used for drug screening and disease diagnosis6. Isolation of an aggressive subpopulation of migratory cells will enable studies of underlying molecular mechanisms.

A compartmentalizing microfluidic device for investigating cancer stem cell migration is described. This novel platform creates a viable cellular microenvironment and enables microscopic visualization of live cell locomotion. Highly motile cancer cells are isolated to study molecular mechanisms of aggressive infiltration, potentially leading to more effective future therapies.

癌症干细胞迁移的使用进行划分的微流控芯片和活细胞成像的评价

In the last 40 years, the United States invested over 200 billion dollars on cancer research, resulting in only a 5% decrease in death rate. A major ...

Assessing Teratogenic Changes in a Zebrafish Model of Fetal Alcohol Exposure

Fetal alcohol syndrome (FAS) is a severe manifestation of embryonic exposure to ethanol. It presents with characteristic defects to the face and organs, including mental retardation due to disordered and damaged brain development. Fetal alcohol spectrum disorder (FASD) is a term used to cover a continuum of birth defects that occur due to maternal alcohol consumption, and occurs in approximately 4% of children born in the United States. With 50% of child-bearing age women reporting consumption of alcohol, and half of all pregnancies being unplanned, unintentional exposure is a continuing issue2. In order to best understand the damage produced by ethanol, plus produce a model with which to test potential interventions, we developed a model of developmental ethanol exposure using the zebrafish embryo. Zebrafish are ideal for this kind of teratogen study3-8. Each pair lays hundreds of eggs, which can then be collected without harming the adult fish. The zebrafish embryo is transparent and can be readily imaged with any number of stains. Analysis of these embryos after exposure to ethanol at different doses and times of duration and application shows that the gross developmental defects produced by ethanol are consistent with the human birth defect. Described here are the basic techniques used to study and manipulate the zebrafish FAS model.

In order to understand the molecular mechanisms of the ethanol-induced developmental damage, we have developed a zebrafish model of ethanol exposure and are exploring the physical, cellular, and genetic alterations that occur after ethanol exposure1. We then seek to find potential interventions and rapidly test them in this animal model.

在斑马鱼模型的胎儿酒精暴露评估致畸的变化

Fetal alcohol syndrome (FAS) is a severe manifestation of embryonic exposure to ethanol. It presents with characteristic defects to the face and organs, ...

In vivo Macrophage Imaging Using MR Targeted Contrast Agent for Longitudinal Evaluation of Septic Arthritis

Macrophages are key-cells in the initiation, the development and the regulation of the inflammatory response to bacterial infection. Macrophages are intensively and increasingly recruited in septic joints from the early phases of infection and the infiltration is supposed to regress once efficient removal of the pathogens is obtained. The ability to identify in vivo macrophage activity in an infected joint can therefore provide two main applications: early detection of acute synovitis and monitoring of therapy.
In vivo noninvasive detection of macrophages can be performed with magnetic resonance imaging using iron nanoparticles such as ultrasmall superparamagnetic iron oxide (USPIO). After intravascular or intraarticular administration, USPIO are specifically phagocytized by activated macrophages, and, due to their magnetic properties, induce signal changes in tissues presenting macrophage infiltration. A quantitative evaluation of the infiltrate is feasible, as the area with signal loss (number of dark pixels) observed on gradient echo MR images after particles injection is correlated with the amount of iron within the tissue and therefore reflects the number of USPIO-loaded cells.
We present here a protocol to perform macrophage imaging using USPIO-enhanced MR imaging in an animal model of septic arthritis, allowing an initial and longitudinal in vivo noninvasive evaluation of macrophages infiltration and an assessment of therapy action.

In vivo Macrophage Imaging Using MR Targeted Contrast Agent for Longitudinal Evaluation of Septic Arthritis

We demonstrate how to perform macrophage MR imaging using ultrasmall superparamagnetic contrast agent (USPIO) in septic arthritis, allowing an initial and longitudinal in vivo non-invasive evaluation of macrophages infiltration and an assessment of therapy efficacy.

在体内的巨噬细胞成像采用MR靶向造影剂化脓性关节炎的纵向评价

Macrophages are key-cells in the initiation, the development and the regulation of the inflammatory response to bacterial infection. Macrophages are ...

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic conditions. As part of a diagnostic assessment, the early detection of postural deficits is important so that appropriate and targeted interventions can be prescribed. The Sensory Organization Test (SOT) on the EquiTest determines an individual&#39;s use of the sensory systems (somatosensory, visual, and vestibular) that are responsible for postural control. Somatosensory and visual input are altered by the calibrated sway-referenced support surface and visual surround, which move in the anterior-posterior direction in response to the individual&#39;s postural sway. This creates a conflicting sensory experience. The Motor Control Test (MCT) challenges postural control by creating unexpected postural disturbances in the form of backwards and forwards translations. The translations are graded in magnitude and the time to recover from the perturbation is computed.
Intermittent claudication, the most common symptom of peripheral arterial disease, is characterized by a cramping pain in the lower limbs and caused by muscle ischemia secondary to reduced blood flow to working muscles during physical exertion. Claudicants often display poor balance, making them susceptible to falls and activity avoidance. The Ankle Brachial Pressure Index (ABPI) is a noninvasive method for indicating the presence of peripheral arterial disease and intermittent claudication, a common symptom in the lower extremities. ABPI is measured as the highest systolic pressure from either the dorsalis pedis or posterior tibial artery divided by the highest brachial artery systolic pressure from either arm. This paper will focus on the use of computerized dynamic posturography in the assessment of balance in claudicants.

Individuals with intermittent claudication exhibit poor balance compared to healthy controls. Computerized dynamic posturography is an objective method for measuring an individual's postural responses to balance disturbances. This provides an objective reflection of the person&#x2019;s ability to respond to situations under which sensory stimuli are altered and unexpected perturbations occur.

Computerized dynamic posturography with the EquiTest is an objective technique for measuring postural strategies under challenging static and dynamic ...

Carotid Artery Infusions for Pharmacokinetic and Pharmacodynamic Analysis of Taxanes in Mice

When proposing the use of a drug, drug combination, or drug delivery into a novel system, one must assess the pharmacokinetics of the drug in the study model. As the use of mouse models are often a vital step in preclinical drug discovery and drug development1-8, it is necessary to design a system to introduce drugs into mice in a uniform, reproducible manner. Ideally, the system should permit the collection of blood samples at regular intervals over a set time course. The ability to measure drug concentrations by mass-spectrometry, has allowed investigators to follow the changes in plasma drug levels over time in individual mice1, 9, 10. In this study, paclitaxel was introduced into transgenic mice as a continuous arterial infusion over three hours, while blood samples were simultaneously taken by retro-orbital bleeds at set time points. Carotid artery infusions are a potential alternative to jugular vein infusions, when factors such as mammary tumors or other obstructions make jugular infusions impractical. Using this technique, paclitaxel concentrations in plasma and tissue achieved similar levels as compared to jugular infusion. In this tutorial, we will demonstrate how to successfully catheterize the carotid artery by preparing an optimized catheter for the individual mouse model, then show how to insert and secure the catheter into the mouse carotid artery, thread the end of the catheter out through the back of the mouse&#8217;s neck, and hook the mouse to a pump to deliver a controlled rate of drug influx. Multiple low volume retro-orbital bleeds allow for analysis of plasma drug concentrations over time.

This method was developed with the goal of delivering a steady drug solution via the carotid artery, to assess the pharmacokinetics of novel drugs in mouse models.

颈动脉输液的紫杉烷类化合物在小鼠体内的药代动力学和药效学分析

When proposing the use of a drug, drug combination, or drug delivery into a novel system, one must assess the pharmacokinetics of the drug in the study ...

A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology

The endothelium is the innermost lining of the vasculature and is involved in the maintenance of vascular homeostasis. Damage to the endothelium may predispose the vessel to atherosclerosis and increase the risk for cardiovascular disease. Assessments of peripheral endothelial function are good indicators of early abnormalities in the vascular wall and correlate well with assessments of coronary endothelial function. The present manuscript details the important methodological steps necessary for the assessment of microvascular endothelial function using laser Doppler imaging with iontophoresis, large vessel endothelial function using flow-mediated dilatation, and carotid atherosclerosis using carotid artery ultrasound. A discussion on the methodological considerations for each of the techniques is also presented, and recommendations are made for future research.

The present article describes the methodological considerations for several non-invasive assessments of vascular function and morphology that are commonly used in medical research to assess different stages of atherosclerosis.

方法论方法血管功能和形态的非侵入性评估

The endothelium is the innermost lining of the vasculature and is involved in the maintenance of vascular homeostasis.  Damage to the endothelium may ...

Treating SCA1 Mice with Water-Soluble Compounds to Non-Specifically Boost Mitochondrial Function

Mitochondrial dysfunction plays a significant role in the aging process and in neurodegenerative diseases including several hereditary spinocerebellar ataxias and other movement disorders marked by progressive degeneration of the cerebellum. The goal of this protocol is to assess mitochondrial dysfunction in Spinocerebellar ataxia type 1 (SCA1) and assess the efficacy of pharmacological targeting of metabolic respiration via the water-soluble compound succinic acid to slow disease progression. This approach is applicable to other cerebellar diseases and can be adapted to a host of water-soluble therapies.
Ex vivo analysis of mitochondrial respiration is used to detect and quantify disease-related changes in mitochondrial function. With genetic evidence (unpublished data) and proteomic evidence of mitochondrial dysfunction in the SCA1 mouse model, we evaluate the efficacy of treatment with the water-soluble metabolic booster succinic acid by dissolving this compound directly into the home cage drinking water. The ability of the drug to pass the blood brain barrier can be deduced using high performance liquid chromatography (HPLC). The efficacy of these compounds can then be tested using multiple behavioral paradigms including the accelerating rotarod, balance beam test and footprint analysis. Cytoarchitectural integrity of the cerebellum can be assessed using immunofluorescence assays that detect Purkinje cell nuclei and Purkinje cell dendrites and soma. These methods are robust techniques for determining mitochondrial dysfunction and the efficacy of treatment with water-soluble compounds in cerebellar neurodegenerative disease.

We present a biochemical and behavioral protocol to evaluate the efficacy of mitochondria-targeted water-soluble compounds for the treatment of Spinocerebellar ataxia type 1 (SCA1) and other cerebellar neurodegenerative diseases.

治疗SCA1小鼠水溶性化合物，以非特异性升压线粒体功能

Mitochondrial dysfunction plays a significant role in the aging process and in neurodegenerative diseases including several hereditary spinocerebellar ...

Evaluation of Fluid Overload by Bioelectrical Impedance Vectorial Analysis

Early detection and management of fluid overload are critically important in acute illness, as the impact of therapeutic intervention can result in decreased or increased mortality rates. Accurate fluid status assessment entails appropriate therapy. Unfortunately, as the gold standard method of radioisotopic fluid measurement is costly, time-consuming, and lacks sensitivity in the acute care clinical setting, other less-accurate methods are typically used, such as clinical examination or 24 h output. Bioelectrical impedance vectorial analysis (BIVA) is an alternative impedance-based approach, where the raw parameter resistance and reactance of a subject are plotted to produce a vector, the position of which can be evaluated relative to tolerance intervals in an R-Xc graph. The fluid status is then interpreted as normal or abnormal, based on the distance from the mean vector derived from a healthy reference population. The objective of the present study is to demonstrate how to evaluate the presence of fluid overload through bioelectrical impedance vectorial analysis and the impedance ratio measured with tetrapolar multi-frequency equipment in patients admitted to the emergency department.

In this study, we demonstrate how to evaluate the presence of fluid overload through bioelectrical impedance vectorial analysis (BIVA) and the impedance ratio measured using tetrapolar multi-frequency equipment in patients admitted to the emergency department. BIVA and impedance ratio are reliable and useful tools to predict poor outcomes.

通过生物电阻抗矢量分析评估流体过载

Early detection and management of fluid overload are critically important in acute illness, as the impact of therapeutic intervention can result in ...

Evaluation of Hydration Status by Bioelectrical Impedance Vector Analysis in Patients with Ischemic Heart Disease Undergoing Exercise Stress Test

Ischemic heart disease (IHD) represents a group of clinical syndromes characterized by myocardial ischemia, leading to an impairment in the myocardial blood supply and compromised perfusion. Several clinical variables assessed through a stress test, such as oxygen uptake (VO2) and heart rate oxygen pulse (HR/O2), have been attributed as cardiopulmonary prognostic factors in patients with IHD. However, other factors like hydration status (HS), potentially affecting the cardiopulmonary response, have been barely addressed. Unbalanced HS has a short-term effect on plasma volume and the sympathetic nervous system, which impacts blood volume, and lowers VO2 and HR/O2. Recently, bioelectrical impedance analysis (BIA), a method based on the opposition of body tissues (including fluid volume) to a low electrical current, has been widely used to assess HS by obtaining two components: resistance (R) and reactance (Xc) and using prediction formulas. However, several limitations as chronic illness or abnormal fluid status, may affect the results. In this sense, alternative BIA methods, such as bioelectrical impedance vector analysis (BIVA), have become relevant. R and Xc (adjusted by height) result in a vector plotted on the R/Xc graph, which allows interpreting the HS as normal or abnormal according to the distance of the mean vector. This study aims to describe how to determine HS by BIVA using a single-frequency device and compare the results with the cardiopulmonary response in patients with IHD.

Hydration status imbalances can have a short-term effect on direct and indirect determinants of oxygen uptake and pulse, and morbidity and mortality prognostic factors in ischemic heart disease. This protocol describes the technique for assessment of hydration status through bioelectrical impedance vector analysis and cardiopulmonary response during exercise stress test.

通过生物电阻抗矢量分析评估缺血性心脏病患者接受运动负荷试验的水合状态

Ischemic heart disease (IHD) represents a group of clinical syndromes characterized by myocardial ischemia, leading to an impairment in the myocardial ...

类风湿性关节炎患者运动计划后通过生物电阻抗分析评估水合作用和体细胞质量的变化

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