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    "textoCompleto" => "<p class="elsevierStylePara">Bioelectrical impedance analysis provides information relating to the human body&#39;s state of nutrition and hydration&#46; It is not surprising that bioimpedance monitors are now widely used in chronic renal disease patients&#46; Two excellent editorials recently published in <span class="elsevierStyleItalic">Nefrolog&#237;a</span><span class="elsevierStyleItalic"> </span>reviewed available bioimpedance systems and the clinical information that we can obtain from them&#46;<span class="elsevierStyleSup">1&#44;2</span> However&#44; gaining a basic understanding of bioimpedance may be difficult for a doctor whose notions about electricity are limited to high school courses taken many years before&#46; This editorial provides a review of the electrical principles needed in order to understand how a bioimpedance monitor works&#46;</p><p class="elsevierStylePara">Alternating current electrical circuits are defined by four parameters&#58; current&#44; voltage&#44; impedance and oscillation frequency&#46; Impedance refers to the opposition that a circuit presents to the passage of a current&#44; measured in Ohm&#46; The unit for measuring electric current is the Amp&#232;re&#59; voltage is measured in Volt and frequency in Hertz &#40;cycles per second&#41;&#46; The fundamental law of electricity relating impedance with current and voltage is Ohm&#39;s law&#58; impedance&#61;voltage&#47;current&#46;</p><p class="elsevierStylePara">When alternating current circulates through a medium&#44; impedance depends partially on the medium&#39;s ability to conduct current&#44; and it is proportional to the electrical resistivity or poor conductivity of that medium&#46; If an electrical circuit also contains capacitors &#40;systems made up of metal foils separated by insulating film where energy is stored&#44; and which discharge energy when the system becomes saturated&#41;&#44; impedance will also depend on the number of capacitors through which the current must pass&#44; and on their charging and discharging capacity&#46; The impedance component &#40;Z&#41; resulting from poor conductivity of the medium is called resistance &#40;R&#41; and the component resulting from the action of the capacitors is known as capacitive reactance &#40;Xc&#41;&#44; or simply reactance for purposes of this paper&#46; The equation relating these concepts is&#58;</p><p class="elsevierStylePara">&#40;Z&#41;&#178; &#61;&#160;&#40;R&#41;&#178; &#43; &#40;Xc&#41;&#178; &#40;equation 1&#41;</p><p class="elsevierStylePara">The behaviour of an alternating current circuit is defined by 2 waves having different amplitudes&#44; but the same frequency&#58; the current wave and the voltage wave&#46; If the peaks of both waves coincide&#44; we say that the current is in phase with the voltage&#46; When the circuit contains capacitors&#44; their charging and discharging processes slow the voltage wave with respect to the current wave&#44; and the current is said to be out of phase&#46; This phase difference is given as an angle&#44; called the phase angle &#40;&#966;&#41; &#40;Figure 1&#41;&#46; The tangent of &#966; is Xc&#47;R &#40;equation 2&#41;&#46;</p><p class="elsevierStylePara">Bioimpedance represents the resistance offered by a biological medium to the flow of alternating current&#44; and it contains the components of resistance and reactance mentioned previously&#46; Resistance depends on the resistivity of different tissues to conducting electrical current&#58; bone and fatty tissues are poor conductors&#44; and current flows better through intra- and extracellular fluids&#44; which are electrolytic solutions&#46; Reactance is produced due to the insulating effect of cell membranes&#44; which act as capacitors to store energy and discharge as the current passes through them&#46;</p><p class="elsevierStylePara">The most common bioimpedance system is the whole body analysis &#40;4 electrode method&#41;&#58; two electrodes are placed on a lower limb &#40;top of the foot and ankle&#41; and the other two on an upper limb &#40;back of the hand and wrist&#41;&#46; Stable&#44; very low alternating current flows between the distal electrodes &#40;measuring a few tens or hundreds of microamperes&#41;&#46; The monitor reads the voltage between the proximal electrodes &#40;Figure 2&#41;&#46; It reads the voltage and the current&#44; and is able to detect the difference &#40;phase angle&#41; between both values&#46;&#160; Using Ohm&#8217;s law&#44; it calculates impedance from the voltage and the current&#46; Using equations 1 and 2&#44; the monitor calculates resistance and reactance from impedance and the phase angle&#46;<span class="elsevierStyleSup">3&#44;4</span></p><p class="elsevierStylePara">Resistance&#44; reactance and phase angle values all depend on the alternating current frequency&#46; Resistance is inversely proportional to frequency&#44; since the electrical conductivity of most tissues increases along with frequency&#46; The relationship between reactance and the phase angle is a parabolic curve&#58; the maximum values are obtained at frequencies approaching 50kHz and decrease as the frequency departs from that value&#44; regardless of whether it increases or decreases&#46;<span class="elsevierStyleSup">5</span> The frequency of alternating current is a key factor for interpreting the bioelectrical values that are given&#46; Some bioimpedance monitors use 50kHz as their sole frequency&#44; while other monitors read and calculate bioelectrical parameters using multiple frequencies&#46;</p><p class="elsevierStylePara">The monitor&#8217;s computer system uses a set of equations to calculate values for body volume and mass based on the electrical data&#46; These predictive equations include other variables&#44; such as weight&#44; height&#44; age and sex&#59; most do not include the reactance component&#46;<span class="elsevierStyleSup">3&#44;6-10</span> These equations have been validated against the methods of reference for measuring different components of the human body&#46;<span class="elsevierStyleSup">7&#44;9-11</span> Each monitor uses different equations depending on the bioimpedance system&#44; the theoretical analysis models and the method of reference chosen to validate measurements&#46; These equations are often hard to obtain&#46; Presenting bioimpedance results as body volumes and masses is called conventional bioimpedance analysis&#46; Another way of expressing bioelectrical data is to construct an impedance vector using the resistance and reactance obtained at a frequency of 50kHz &#40;vector bioimpedance&#41;&#46; By comparing this vector with that of a healthy population&#44; we obtain information about the individual&#8217;s state of hydration and nutrition&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">In conclusion&#44; we can state that current&#44; voltage and phase angle are the three main electrical parameters with which the monitor works&#46; Using these parameters&#44; the monitor calculates impedance and its two components&#44; resistance and reactance&#46; Different body volume and mass values are calculated with predictive equations&#44; based on the electrical parameters and other patient data&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11310&#95;16025&#95;28456&#95;en&#95;f1&#95;11310&#46;jpg" class="elsevierStyleCrossRefs"><img src="11310_16025_28456_en_f1_11310.jpg" alt="Voltage and current in alternating current circuits"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Voltage and current in alternating current circuits</p><p class="elsevierStylePara"><a href="grande&#47;11310&#95;16025&#95;28457&#95;en&#95;f2&#95;113102&#46;jpg" class="elsevierStyleCrossRefs"><img src="11310_16025_28457_en_f2_113102.jpg" alt="Diagram of a 4 electrode bioimpedance model"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Diagram of a 4 electrode bioimpedance model</p>"
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The electrical basis of bioimpedance
Fundamentos eléctricos de la bioimpedancia
Andrés Sánchez-Iglesiasa, Milagros Fernández-Lucasb, José L. Teruelb
a Profesor de Física. Colegio Valdeluz, Madrid,
b Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid,
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    "textoCompleto" => "<p class="elsevierStylePara">Bioelectrical impedance analysis provides information relating to the human body&#39;s state of nutrition and hydration&#46; It is not surprising that bioimpedance monitors are now widely used in chronic renal disease patients&#46; Two excellent editorials recently published in <span class="elsevierStyleItalic">Nefrolog&#237;a</span><span class="elsevierStyleItalic"> </span>reviewed available bioimpedance systems and the clinical information that we can obtain from them&#46;<span class="elsevierStyleSup">1&#44;2</span> However&#44; gaining a basic understanding of bioimpedance may be difficult for a doctor whose notions about electricity are limited to high school courses taken many years before&#46; This editorial provides a review of the electrical principles needed in order to understand how a bioimpedance monitor works&#46;</p><p class="elsevierStylePara">Alternating current electrical circuits are defined by four parameters&#58; current&#44; voltage&#44; impedance and oscillation frequency&#46; Impedance refers to the opposition that a circuit presents to the passage of a current&#44; measured in Ohm&#46; The unit for measuring electric current is the Amp&#232;re&#59; voltage is measured in Volt and frequency in Hertz &#40;cycles per second&#41;&#46; The fundamental law of electricity relating impedance with current and voltage is Ohm&#39;s law&#58; impedance&#61;voltage&#47;current&#46;</p><p class="elsevierStylePara">When alternating current circulates through a medium&#44; impedance depends partially on the medium&#39;s ability to conduct current&#44; and it is proportional to the electrical resistivity or poor conductivity of that medium&#46; If an electrical circuit also contains capacitors &#40;systems made up of metal foils separated by insulating film where energy is stored&#44; and which discharge energy when the system becomes saturated&#41;&#44; impedance will also depend on the number of capacitors through which the current must pass&#44; and on their charging and discharging capacity&#46; The impedance component &#40;Z&#41; resulting from poor conductivity of the medium is called resistance &#40;R&#41; and the component resulting from the action of the capacitors is known as capacitive reactance &#40;Xc&#41;&#44; or simply reactance for purposes of this paper&#46; The equation relating these concepts is&#58;</p><p class="elsevierStylePara">&#40;Z&#41;&#178; &#61;&#160;&#40;R&#41;&#178; &#43; &#40;Xc&#41;&#178; &#40;equation 1&#41;</p><p class="elsevierStylePara">The behaviour of an alternating current circuit is defined by 2 waves having different amplitudes&#44; but the same frequency&#58; the current wave and the voltage wave&#46; If the peaks of both waves coincide&#44; we say that the current is in phase with the voltage&#46; When the circuit contains capacitors&#44; their charging and discharging processes slow the voltage wave with respect to the current wave&#44; and the current is said to be out of phase&#46; This phase difference is given as an angle&#44; called the phase angle &#40;&#966;&#41; &#40;Figure 1&#41;&#46; The tangent of &#966; is Xc&#47;R &#40;equation 2&#41;&#46;</p><p class="elsevierStylePara">Bioimpedance represents the resistance offered by a biological medium to the flow of alternating current&#44; and it contains the components of resistance and reactance mentioned previously&#46; Resistance depends on the resistivity of different tissues to conducting electrical current&#58; bone and fatty tissues are poor conductors&#44; and current flows better through intra- and extracellular fluids&#44; which are electrolytic solutions&#46; Reactance is produced due to the insulating effect of cell membranes&#44; which act as capacitors to store energy and discharge as the current passes through them&#46;</p><p class="elsevierStylePara">The most common bioimpedance system is the whole body analysis &#40;4 electrode method&#41;&#58; two electrodes are placed on a lower limb &#40;top of the foot and ankle&#41; and the other two on an upper limb &#40;back of the hand and wrist&#41;&#46; Stable&#44; very low alternating current flows between the distal electrodes &#40;measuring a few tens or hundreds of microamperes&#41;&#46; The monitor reads the voltage between the proximal electrodes &#40;Figure 2&#41;&#46; It reads the voltage and the current&#44; and is able to detect the difference &#40;phase angle&#41; between both values&#46;&#160; Using Ohm&#8217;s law&#44; it calculates impedance from the voltage and the current&#46; Using equations 1 and 2&#44; the monitor calculates resistance and reactance from impedance and the phase angle&#46;<span class="elsevierStyleSup">3&#44;4</span></p><p class="elsevierStylePara">Resistance&#44; reactance and phase angle values all depend on the alternating current frequency&#46; Resistance is inversely proportional to frequency&#44; since the electrical conductivity of most tissues increases along with frequency&#46; The relationship between reactance and the phase angle is a parabolic curve&#58; the maximum values are obtained at frequencies approaching 50kHz and decrease as the frequency departs from that value&#44; regardless of whether it increases or decreases&#46;<span class="elsevierStyleSup">5</span> The frequency of alternating current is a key factor for interpreting the bioelectrical values that are given&#46; Some bioimpedance monitors use 50kHz as their sole frequency&#44; while other monitors read and calculate bioelectrical parameters using multiple frequencies&#46;</p><p class="elsevierStylePara">The monitor&#8217;s computer system uses a set of equations to calculate values for body volume and mass based on the electrical data&#46; These predictive equations include other variables&#44; such as weight&#44; height&#44; age and sex&#59; most do not include the reactance component&#46;<span class="elsevierStyleSup">3&#44;6-10</span> These equations have been validated against the methods of reference for measuring different components of the human body&#46;<span class="elsevierStyleSup">7&#44;9-11</span> Each monitor uses different equations depending on the bioimpedance system&#44; the theoretical analysis models and the method of reference chosen to validate measurements&#46; These equations are often hard to obtain&#46; Presenting bioimpedance results as body volumes and masses is called conventional bioimpedance analysis&#46; Another way of expressing bioelectrical data is to construct an impedance vector using the resistance and reactance obtained at a frequency of 50kHz &#40;vector bioimpedance&#41;&#46; By comparing this vector with that of a healthy population&#44; we obtain information about the individual&#8217;s state of hydration and nutrition&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">In conclusion&#44; we can state that current&#44; voltage and phase angle are the three main electrical parameters with which the monitor works&#46; Using these parameters&#44; the monitor calculates impedance and its two components&#44; resistance and reactance&#46; Different body volume and mass values are calculated with predictive equations&#44; based on the electrical parameters and other patient data&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11310&#95;16025&#95;28456&#95;en&#95;f1&#95;11310&#46;jpg" class="elsevierStyleCrossRefs"><img src="11310_16025_28456_en_f1_11310.jpg" alt="Voltage and current in alternating current circuits"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Voltage and current in alternating current circuits</p><p class="elsevierStylePara"><a href="grande&#47;11310&#95;16025&#95;28457&#95;en&#95;f2&#95;113102&#46;jpg" class="elsevierStyleCrossRefs"><img src="11310_16025_28457_en_f2_113102.jpg" alt="Diagram of a 4 electrode bioimpedance model"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Diagram of a 4 electrode bioimpedance model</p>"
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