Urinary Bladder Volume Reconstruction Based on Bioimpedance Measurements: Ex Vivo and In Vivo Validation Through Implanted Patch and Needle Electrodes

Restoring bladder sensation in patients with bladder dysfunctions by performing urinary volume monitoring is an ambitious goal. The bioimpedance technique has shown promising results in wearable solutions but long-term validation and implantable systems are not available, yet. In this work, we propose to implant commercial bioimpedance sensors on bladder walls to perform bladder volume estimation. Two commercial sensor types (Ag/AgCl patch and needle electrodes) were selected to this purpose. Injected current frequency of 1.337 MHz and electrodes pair on the same face of the bladder allowed to correlate the changes in impedance with increasing volumes. Two volume reconstruction algorithms have been proposed, based on the direct correlation between bioimpedance readings and bladder volume (Algorithm A) or bioimpedance readings and inter-electrode distance (Algorithm B, bladder shape approximated to a sphere). For both algorithms, a better fit with a second-degree fitting polynomial was obtained. Algorithm A obtained lower estimation errors with an average of 20.35% and 21.98% (volumes greater than 150 ml) for patch and needle electrodes, respectively. The variations in ions concentration led to a slight deterioration of volume estimation, however the presence of tissues surrounding the bladder did not influence the performance. Although Algorithm B was less affected by the experimental conditions and inter-subject biological variability, it featured higher estimation errors. In vivo validation on suine model showed average errors of 29.36% (volumes greater than 100 ml), demonstrating the potential of the proposed solution and paving the way towards a novel implantable volume monitoring system

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

AN INNOVATIVE SYSTEM BASED ON BIOIMPEDANCE MEASUREMENTS TO DEFINE THE BLADDER VOLUME

Objectives: Alteration of the bladder sense of fullness due to spinal cord injury or radical cystectomy leads to the inability to plan micturition timing. The development of a system for the fullness detection would be highly desirable and would enable autonomous and spontaneous management of micturition by the patient. Here the design of an innovative system of bladder volume monitoring based on bioimpedance measurements is presented. Methods: Bioimpedance measurements are performed on ex-vivo bladder tissue using traditional ECG sensors. Two couples of electrodes in different arrangements were applied on the bladder walls to detect degree of filling by 50ml step, from 0ml to 300ml. The bioimpedance values are obtained for frequencies ranging from 1 kHz to 2 MHz. Moreover, different compositions of artificial urine were tested, by varying relevant ions concentration. Results: The impedance variations were recorded around 20ohm in average from empty to full status. However, the impedance variation was dependent to ion concentration in urine. Discussion: The experiment shows the feasibility of this approach and the need to find the sensors arrangement able to normalize measurements with respect to urine composition. Conclusions: A novel system to detect the bladder filling based on bioimpedence measures is reported. This approach could be feasible both in presence of natural or artificial/reconstructed bladder. Future work will target accurate volume estimation independently on urine composition, as well as combination with other sensing strategies. Acknowledgements: The authors acknowledge INAIL (Istituto Nazionale Assicurazioni Infortuni sul Lavoro) for providing their collaboration within the BioSUP project

Verocytotoxin-producing Escherichia coli O157 in minced beef and dairy products in Italy

A total of 3879 samples of foodstuffs were examined for the presence of Verocytotoxin-producing Escherichia coli O157 (VTEC O157). The survey was conducted by 9 of the 10 Italian Veterinary Public Health Laboratories. Samples were collected between May 2000 and September 2001 in 14 regions and comprised 931 minced beef specimens and 2948 dairy products (DP) with less than 60 days of ripening. The DP included 657 pasteurised and 811 unpasteurised bovine DP, 477 pasteurised and 502 unpasteurised ovine DP, and 501 water-buffalo’s milk mozzarella cheese. Samples were collected at retail level, from plants processing minced beef and dairy plants and from farms directly manufacturing cheeses. All the samples were tested using a sensitive procedure based on ISO/DIS 16654:1999 (later ISO 16654:2001), which includes an immunomagnetic separation step. A preliminary inter-laboratory trial was organised with artificially contaminated samples to assess the ability of all the participating laboratories to isolate E. coli O157 by the established procedure. VTEC O157 was isolated from four (0.43%) of the minced beef samples, collected in four different regions and during different months, but was not detected in any of the dairy products. E. coli O157 VT_eae+ was isolated from one raw cow’s milk cheese. This survey provided national data on the presence of VTEC O157 in foodstuffs, demonstrating a low prevalence of the organism. The survey also encouraged updating of knowledge and procedures on VTEC O157 in laboratories with official responsibility for microbiological testing of foods of animal origin