Near-infrared spectroscopy/imaging for monitoring muscle oxygenation and oxidative metabolism in healthy and diseased humans

Intestinal perfusion monitoring using photoplethysmography

In abdominal trauma patients, monitoring intestinal perfusion and oxygen consumption is essential during the resuscitation period. Photoplethysmography is an optical technique potentially capable of monitoring these changes in real time to provide the medical staff with a timely and quantitative measure of the adequacy of resuscitation. The challenges for using optical techniques in monitoring hemodynamics in intestinal tissue are discussed, and the solutions to these challenges are presented using a combination of Monte Carlo modeling and theoretical analysis of light propagation in tissue. In particular, it is shown that by using visible wavelengths (i.e., 470 and 525 nm), the perfusion signal is enhanced and the background contribution is decreased compared with using traditional near-infrared wavelengths leading to an order of magnitude enhancement in the signal-to-background ratio. It was further shown that, using the visible wavelengths, similar sensitivity to oxygenation changes could be obtained (over 50% compared with that of near-infrared wavelengths). This is mainly due to the increased contrast between tissue and blood in that spectral region and the confinement of the photons to the thickness of the small intestine. Moreover, the modeling results show that the source to detector separation should be limited to roughly 6 mm while using traditional near-infrared light, with a few centimeters source to detector separation leads to poor signal-to-background ratio. Finally, a visible wavelength system is tested in an in vivo porcine study, and the possibility of monitoring intestinal perfusion changes is showed.

Muscle oxygen consumption by NIRS and mobility in multiple sclerosis patients

BACKGROUND

The study of muscle metabolism by near-infrared spectroscopy (NIRS) has been poorly implemented in multiple sclerosis (MS). Aims of the study were to compare resting muscle oxygen consumption (rmVO2) at gastrocnemius in MS patients and in age-matched healthy controls (HC) measured using NIRS, and to evaluate its possible relationship with patients' mobility.

METHODS

Twenty-eight consecutively enrolled MS patients (male, n = 16; age = 42.7 ± 14.0 y, Relapsing-Remitting, n = 19; Primary-Progressive, n = 9) and 22 HC (male, n = 13; age = 36.0 ± 8.2 y) were studied during rest applying the NIRS probes at gastrocnemius, producing a venous occlusion at the thigh using a cuff, and analyzing the slope of the total hemoglobin to calculate rmVO2. Mobility was assessed by a 6-Minute Walking Test and 6-Minute Walking Distance (6MWD) was recorded.

RESULTS

rmVO2 was higher in MS compared to HC (0.059 ± 0.038 vs 0.039 ± 0.016 mlO2/min/100 g, P < 0.003), not different in clinical subtypes, not correlated to patients' characteristics (age, disease duration, Expanded Disability Status Scale, resting heart rate, skinfold thickness), and significantly higher in patients with lower walking ability (6MWD < 450 m, n = 12) compared to those at better performance (respectively, 0.072 ± 0.043 vs 0.049 ± 0.032 mlO2/min/100 g, P = 0.03).

CONCLUSION

rmVO2 values, significantly higher in MS patients compared to HC, and in low versus high performing patients, might represent a marker of peripheral adaptations occurred to sustain mobility, as observed in other chronic diseases.

Diffuse optical characterization of an exercising patient group with peripheral artery disease

Peripheral artery disease (PAD) is a common condition with high morbidity. While measurement of tissue oxygen saturation (S(t)O(2)) has been demonstrated, this is the first study to assess both S(t)O(2) and relative blood flow (rBF) in the extremities of PAD patients. Diffuse optics is employed to measure hemodynamic response to treadmill and pedal exercises in 31 healthy controls and 26 patients. For S(t)O(2), mild and moderate/severe PAD groups show pronounced differences compared with controls. Pre-exercise mean S(t)O(2) is lower in PAD groups by 9.3% to 10.6% compared with means of 63.5% to 66.2% in controls. For pedal, relative rate of return of S(t)O(2) to baseline is more rapid in controls (p < 0.05). Patterns of rBF also differ among groups. After both exercises, rBF tend to occur at depressed levels among severe PAD patients compared with healthy (p < 0.05); post-treadmill, rBF tend to occur at elevated levels among healthy compared with severe PAD patients (p < 0.05). Additionally, relative rate of return to baseline S(t)O(2) is more rapid among subjects with reduced levels of depression in rBF (p = 0.041), even after adjustment for ankle brachial index. This suggests a physiologic connection between rBF and oxygenation that can be measured using diffuse optics, and potentially employed as an evaluative tool in further studies.

NIRS measurements with elite speed skaters: comparison between the ice rink and the laboratory

Wearable, wireless near-infrared (NIR) spectrometers were used to compare changes in on-ice short-track skating race simulations over 1,500 m with a 3-min cycle ergometry test at constant power output (400 W). The subjects were six male elite short-track speed skaters. Both protocols elicited a rapid desaturation (∆TSI%) in the muscle during early stages (initial 20 s); however, asymmetry between right and left legs was seen in ΔTSI% for the skating protocol, but not for cycling. Individual differences between skaters were present in both protocols. Notably, one individual who showed a relatively small TSI% change (-10.7%, group mean = -26.1%) showed a similarly small change during the cycling protocol (-5.8%, group mean = -14.3%). We conclude that NIRS-detected leg asymmetry is due to the specific demands of short-track speed skating. However, heterogeneity between individuals is not specific to the mode of exercise. Whether this is a result of genuine differences in physiology or a reflection of differences in the optical properties of the leg remains to be determined.

The utility of far-infrared illumination in oxygenation dynamics as measured with near-infrared spectroscopy

Near-infrared spectroscopy (NIRS) is a noninvasive method for measuring the oxygenation in muscle and other tissues in vivo. For quantitative NIRS measurement of oxygenation dynamics, the vessel-occlusion test was usually applied as physiological intervention. There are several drawbacks of the vessel-occlusion method that include skin contact, uncomfortable and microcirculation block of patients. Thus, we propose the far-infrared (FIR) illumination as a new physiological intervention method in this paper. Our preliminary result shows a linear correlation of oxygenation dynamic signals between FIR illumination and arterial-occlusion test (AOT) that implies the FIR illumination could be applied for hemodynamic response measurement in clinical diagnosis.

Monitoring Detrusor Oxygenation and Hemodynamics Noninvasively during Dysfunctional Voiding

The current literature indicates that lower urinary tract symptoms (LUTSs) related to benign prostatic hyperplasia (BPH) have a heterogeneous pathophysiology. Pressure flow studies (UDSs) remain the gold standard evaluation methodology for such patients. However, as the function of the detrusor muscle depends on its vasculature and perfusion, the underlying causes of LUTS likely include abnormalities of detrusor oxygenation and hemodynamics, and available treatment options include agents thought to act on the detrusor smooth muscle and/or vasculature. Hence, near infrared spectroscopy (NIRS), an established optical methodology for monitoring changes in tissue oxygenation and hemodynamics, has relevance as a means of expanding knowledge related to the pathophysiology of BPH and potential treatment options. This methodological report describes how to conduct simultaneous NIRS monitoring of detrusor oxygenation and hemodynamics during UDS, outlines the clinical implications and practical applications of NIRS, explains the principles of physiologic interpretation of NIRS voiding data, and proposes an exploratory hypothesis that the pathophysiological causes underlying LUTS include detrusor dysfunction due to an abnormal hemodynamic response or the onset of oxygen debt during voiding.

Asymmetry of quadriceps muscle oxygenation during elite short-track speed skating

PURPOSE

It has been suggested that, because of the low sitting position in short-track speed skating, muscle blood flow is restricted, leading to decreases in tissue oxygenation. Therefore, wearable wireless-enabled near-infrared spectroscopy (NIRS) technology was used to monitor changes in quadriceps muscle blood volume and oxygenation during a 500-m race simulation in short-track speed skaters.

METHODS

Six elite skaters, all of Olympic standard (age = 23 ± 1.8 yr, height = 1.8 ± 0.1 m, mass = 80.1 ± 5.7 kg, midthigh skinfold thickness = 7 ± 2 mm), were studied. Subjects completed a 500-m race simulation time trial (TT). Whole-body oxygen consumption was simultaneously measured with muscle oxygenation in right and left vastus lateralis as measured by NIRS.

RESULTS

Mean time for race completion was 44.8 ± 0.4 s. VO2 peaked 20 s into the race. In contrast, muscle tissue oxygen saturation (TSI%) decreased and plateaued after 8 s. Linear regression analysis showed that right leg TSI% remained constant throughout the rest of the TT (slope value = 0.01), whereas left leg TSI% increased steadily (slope value = 0.16), leading to a significant asymmetry (P < 0.05) in the final lap. Total muscle blood volume decreased equally in both legs at the start of the simulation. However, during subsequent laps, there was a strong asymmetry during cornering; when skaters traveled solely on the right leg, there was a decrease in its muscle blood volume, whereas an increase was seen in the left leg.

CONCLUSIONS

NIRS was shown to be a viable tool for wireless monitoring of muscle oxygenation. The asymmetry in muscle desaturation observed on the two legs in short-track speed skating has implications for training and performance.

Noninvasive evaluation of skeletal muscle mitochondrial capacity with near-infrared spectroscopy: correcting for blood volume changes

Near-infrared spectroscopy (NIRS) is a well-known method used to measure muscle oxygenation and hemodynamics in vivo. The application of arterial occlusions allows for the assessment of muscle oxygen consumption (mVo(2)) using NIRS. The aim of this study was to measure skeletal muscle mitochondrial capacity using blood volume-corrected NIRS signals that represent oxygenated hemoglobin/myoglobin (O(2)Hb) and deoxygenated hemoglobin/myoglobin (HHb). We also assessed the reliability and reproducibility of NIRS measurements of resting oxygen consumption and mitochondrial capacity. Twenty-four subjects, including four with chronic spinal cord injury, were tested using either the vastus lateralis or gastrocnemius muscles. Ten healthy, able-bodied subjects were tested on two occasions within a period of 7 days to assess the reliability and reproducibility. NIRS signals were corrected for blood volume changes using three different methods. Resting oxygen consumption had a mean coefficient of variation (CV) of 2.4% (range 1-32%). The recovery of oxygen consumption (mVo(2)) after electrical stimulation at 4 Hz was fit to an exponential curve, which represents mitochondrial capacity. The time constant for the recovery of mVo(2) was reproducible with a mean CV of 10% (range 1-22%) only when correcting for blood volume changes. We also examined the effects of adipose tissue thickness on measurements of mVo(2). We found the mVo(2) measurements using absolute units to be influenced by adipose tissue thickness (ATT), and this relationship was removed when an ischemic calibration was performed, supporting its use to compare mVo(2) between individuals of varying ATT. In conclusion, in vivo oxidative capacity can be assessed using blood volume-corrected NIRS signals with a high degree of reliability and reproducibility.

Arrhythmia discrimination using hemoglobin spectroscopy in humans

BACKGROUND

Inappropriate therapies are frequently delivered by implantable cardioverter-defibrillators (ICDs). We have investigated muscle perfusion as a means of augmenting arrhythmia discrimination by using implanted near-infrared spectroscopy.

OBJECTIVE

To evaluate hemodynamic stability by monitoring muscle perfusion from within the ICD pocket, in fresh tissue and inside the scar capsule on preexisting ICD generators, during induced cardiac arrhythmias, in humans.

METHODS

The sensor was implanted on or under the pectoral muscle, during ICD defibrillation threshold testing. A microvascular oxygenation trend indicator (O2 Index) was computed during 74 induced ventricular fibrillation and 34 normal sinus rhythm episodes in 34 patients and also during 28 atrial and 90 ventricular overdrive pacing episodes as simulations of supraventricular and ventricular tachycardias, respectively.

RESULTS

On average, the change in oxygenation, based on the O2 Index, was statistically significant (P <.003) from baseline within 3 seconds following cardiac arrest. An optimized O2 Index, used for detecting the hemodynamic trend, exhibited a decreasing trend during ventricular fibrillation (P <.0001) and was different from that during normal sinus rhythm (P <.0001). The sensitivity for the detection of ventricular fibrillation was 100%, and the specificity for the rejection of normal sinus rhythm was 82% in the presence of scar tissue on the optical sensor. For a 35-mm Hg drop in the mean arterial pressure as the threshold for hemodynamic instability, the specificity for the rejection of hemodynamically stable atrial and ventricular pacing episodes was 93% and 71%, respectively.

CONCLUSION

An implantable near-infrared spectroscopic sensor may be useful for hemodynamic monitoring during cardiac arrhythmias to prevent inappropriate therapy.

Determination of absorption changes from moments of distributions of times of flight of photons: optimization of measurement conditions for a two-layered tissue model

Time-resolved near-infrared spectroscopy allows for depth-selective determination of absorption changes in the adult human head that facilitates separation between cerebral and extra-cerebral responses to brain activation. The aim of the present work is to analyze which combinations of moments of measured distributions of times of flight (DTOF) of photons and source-detector separations are optimal for the reconstruction of absorption changes in a two-layered tissue model corresponding to extra- and intra-cerebral compartments. To this end we calculated the standard deviations of the derived absorption changes in both layers by considering photon noise and a linear relation between the absorption changes and the DTOF moments. The results show that the standard deviation of the absorption change in the deeper (superficial) layer increases (decreases) with the thickness of the superficial layer. It is confirmed that for the deeper layer the use of higher moments, in particular the variance of the DTOF, leads to an improvement. For example, when measurements at four different source-detector separations between 8 and 35 mm are available and a realistic thickness of the upper layer of 12 mm is assumed, the inclusion of the change in mean time of flight, in addition to the change in attenuation, leads to a reduction of the standard deviation of the absorption change in the deeper tissue layer by a factor of 2.5. A reduction by another 4% can be achieved by additionally including the change in variance.

Muscle force recovery in relation to muscle oxygenation

The aim of this study was to investigate the relative contribution of human muscle reoxygenation on force recovery following a maximal voluntary contraction (MVC). Ten athletes (22·9 ± 4·0 years) executed a plantar-flexion sequence including two repeated MVCs [i.e. a 30-s MVC (MVC(30)) followed by a 10-s MVC (MVC(10))] separated by 10, 30, 60, 120 or 300 s of passive recovery. A 10-min passive recovery period was allowed between each MVC sequence. This procedure was randomly repeated with two different recovery conditions: without (CON) or with (OCC) arterial occlusion of the medial gastrocnemius. During OCC, the occlusion was maintained from the end of MVC(30) to the end of MVC(10). Muscle oxygenation (Near-infrared spectroscopy, NIRS, [Hb(diff) ]) was continuously measured during all MVC sequences and expressed as a percentage of the maximal changes in optical density observed during MVC(30). Maximal Torque was analysed at the start of each contraction. Torque during each MVC(10) was expressed as a percentage of the Torque during the previous MVC(30). Torque recovery was complete within 300 s after MVC(30) during CON (MVC(10) = 101·8 ± 5·0%); 88·6 ± 8·9% of the Torque was recovered during OCC (P = 0·005). There was also a moderate correlation between absolute level of muscle oxygenation and Torque (r = 0·32 (90% CI, 0·09;0·52), P = 0·02). Present findings confirm the role of human muscle oxygenation in muscular force recovery during repeated-maximal efforts. However, the correlation between absolute muscle oxygenation and force level during recovery is only moderate, suggesting that other mechanisms are likely involved in the force recovery process.

Near-infrared spectroscopy assessment following exercise training in patients with intermittent claudication and in untrained healthy participants

Selected near-infrared spectroscopy (NIRS) parameters were assessed in healthy untrained participants and in peripheral arterial disease (PAD) trained patients to evaluate their usefulness in rehabilitative outcome. Forty-five PAD and 15 healthy participants were studied at entry and at 34 ± 2 weeks. Healthy participants performed their usual activities. Patients with PAD performed 2 home-based programs: structured at prescribed pace (S-pre, n = 31) and unstructured at free pace (U-free, n = 14). We measured ankle-brachial index (ABI), NIRS calf oxygen consumption at rest, NIRS dynamic muscle perfusion during an incremental test, and walking capacity. In all patients with PAD the NIRS parameters significantly increased approaching the stable values of untrained healthy participants. Among PAD, only S-pre group showed significant improvements in hemodynamic, functional, and NIRS parameters with selective adaptations in the worse legs. The assessment of NIRS parameters, that were found stable without training in healthy and modified in PAD only following structured training, might outline the local exercise-induced adaptations.

Severe hypoxia affects exercise performance independently of afferent feedback and peripheral fatigue

To test the hypothesis that hypoxia centrally affects performance independently of afferent feedback and peripheral fatigue, we conducted two experiments under complete vascular occlusion of the exercising muscle under different systemic O(2) environmental conditions. In experiment 1, 12 subjects performed repeated submaximal isometric contractions of the elbow flexor to exhaustion (RCTE) with inspired O(2) fraction fixed at 9% (severe hypoxia, SevHyp), 14% (moderate hypoxia, ModHyp), 21% (normoxia, Norm), or 30% (hyperoxia, Hyper). The number of contractions (performance), muscle (biceps brachii), and prefrontal near-infrared spectroscopy (NIRS) parameters and high-frequency paired-pulse (PS100) evoked responses to electrical muscle stimulation were monitored. In experiment 2, 10 subjects performed another RCTE in SevHyp and Norm conditions in which the number of contractions, biceps brachii electromyography responses to electrical nerve stimulation (M wave), and transcranial magnetic stimulation responses (motor-evoked potentials, MEP, and cortical silent period, CSP) were recorded. Performance during RCTE was significantly reduced by 10-15% in SevHyp (arterial O(2) saturation, SpO(2) = ∼75%) compared with ModHyp (SpO(2) = ∼90%) or Norm/Hyper (SpO(2) > 97%). Performance reduction in SevHyp occurred despite similar 1) metabolic (muscle NIRS parameters) and functional (changes in PS100 and M wave) muscle states and 2) MEP and CSP responses, suggesting comparable corticospinal excitability and spinal and cortical inhibition between SevHyp and Norm. It is concluded that, in SevHyp, performance and central drive can be altered independently of afferent feedback and peripheral fatigue. It is concluded that submaximal performance in SevHyp is partly reduced by a mechanism related directly to brain oxygenation.

Warm-up effects on muscle oxygenation, metabolism and sprint cycling performance

To investigate the effects of warm-up intensity on all-out sprint cycling performance, muscle oxygenation and metabolism, 8 trained male cyclists/triathletes undertook a 30-s sprint cycling test preceded by moderate, heavy or severe warm up and 10-min recovery. Muscle oxygenation was measured by near-infrared spectroscopy, with deoxyhaemoglobin ([HHb]) during the sprint analysed with monoexponential models with time delay. Aerobic, anaerobic-glycolytic and phosphocreatine energy provision to the sprint were estimated from oxygen uptake and lactate production. Immediately prior to the sprint, blood [lactate] was different for each warm up and higher than resting for the heavy and severe warm ups (mod. 0.94 ± 0.36, heavy 1.92 ± 0.64, severe 4.37 ± 0.93 mmol l(-1) P < 0.05), although muscle oxygenation was equally raised above rest. Mean power during the sprint was lower following severe compared to moderate warm up (mod. 672 ± 54, heavy 666 ± 56, severe 655 ± 59 W, P < 0.05). The [HHb] kinetics during the sprint were not different among conditions, although the time delay before [HHb] increased was shorter for severe versus moderate warm up (mod. 5.8 ± 0.6, heavy 5.6 ± 0.9, severe 5.2 ± 0.7 s, P < 0.05). The severe warm up was without effect on estimated aerobic metabolism, but increased estimated phosphocreatine hydrolysis, the latter unable to compensate for the reduction in estimated anaerobic-glycolytic metabolism. It appears that despite all warm ups equally increasing muscle oxygenation, and indicators of marginally faster oxygen utilisation at the start of exercise following a severe-intensity warm up, other energy sources may not be able to fully compensate for a reduced glycolytic rate in sprint exercise with potential detrimental effects on performance.

The use of muscle near-infrared spectroscopy in sport, health and medical sciences: recent developments

Near-infrared spectroscopy (NIRS) has been shown to be one of the tools that can measure oxygenation in muscle and other tissues in vivo. This review paper highlights the progress, specifically in this decade, that has been made for evaluating skeletal muscle oxygenation and oxidative energy metabolism in sport, health and clinical sciences. Development of NIRS technologies has focused on improving quantification of the signal using multiple wavelengths to solve for absorption and scattering coefficients, multiple pathlengths to correct for the influence of superficial skin and fat, and time-resolved and phase-modulated light sources to determine optical pathlengths. In addition, advances in optical imaging with multiple source and detector pairs as well as portability using small wireless detectors have expanded the usefulness of the devices. NIRS measurements have provided information on oxidative metabolism in various athletes during localized exercise and whole-body exercise, as well as training-induced adaptations. Furthermore, NIRS technology has been used in the study of a number of chronic health conditions. Future developments of NIRS technology will include enhancing signal quantification. In addition, advances in NIRS imaging and portability promise to transform how measurements of oxygen utilization are obtained in the future.

Haemoglobin oxygen saturation as a biomarker: the problem and a solution

Near-infrared spectroscopy measures of haemoglobin oxygen saturation are often used as an indicator of sufficient oxygen delivery to assess injury susceptibility and tissue damage. They have also often been used as a surrogate measure of oxygen metabolism. Unfortunately, these measures have generally failed to provide robust indicators of injury and metabolism. In this paper, we first review when haemoglobin oxygen saturation does work as a robust indicator, and then detail when and why it fails for assessing brain injury and breast cancer. Finally, we discuss the solution to obtain more robust measures of tissue injury and cancer by combining oxygen saturation measurements with measures of blood flow and volume to more accurately estimate oxygen metabolism.

The use of near-infrared spectroscopy in understanding skeletal muscle physiology: recent developments

This article provides a snapshot of muscle near-infrared spectroscopy (NIRS) at the end of 2010 summarizing the recent literature, offering the present status and perspectives of the NIRS instrumentation and methods, describing the main NIRS studies on skeletal muscle physiology, posing open questions and outlining future directions. So far, different NIRS techniques (e.g. continuous-wave (CW) and spatially, time- and frequency-resolved spectroscopy) have been used for measuring muscle oxygenation during exercise. In the last four years, approximately 160 muscle NIRS articles have been published on different physiological aspects (primarily muscle oxygenation and haemodynamics) of several upper- and lower-limb muscle groups investigated by using mainly two-channel CW and spatially resolved spectroscopy commercial instruments. Unfortunately, in only 15 of these studies were the advantages of using multi-channel instruments exploited. There are still several open questions in the application of NIRS in muscle studies: (i) whether NIRS can be used in subjects with a large fat layer; (ii) the contribution of myoglobin desaturation to the NIRS signal during exercise; (iii) the effect of scattering changes during exercise; and (iv) the effect of changes in skin perfusion, particularly during prolonged exercise. Recommendations for instrumentation advancements and future muscle NIRS studies are provided.

Light diffusion in a radially N-layered cylinder

Analytical solutions of the diffusion equation for a radially N-layered cylinder were derived in the steady-state, frequency, and time domains. Solutions for axially infinite and finite cylinders are presented. The derived formulas were compared to a known solution of the diffusion equation for a layered semi-infinite geometry and to Monte Carlo simulations, showing excellent and good agreement, respectively. The analytical solutions were applied to calculate the light propagation in models of the forearm and the finger, demonstrating the improvement in analysis of hemodynamics measurements compared to the formulas used so far.

The association of near-infrared spectroscopy-derived tissue oxygenation measurements with sepsis syndromes, organ dysfunction and mortality in emergency department patients with sepsis

Introduction

Near-infrared spectroscopy (NIRS) noninvasively measures peripheral tissue oxygen saturation (StO₂). NIRS may be utilized along with a vascular occlusion test, in which limb blood flow is temporarily occluded and released, to quantify a tissue bed's rate of oxygen exchange during ischemia and recovery. The objective of this study was to test the hypothesis that NIRS-derived StO₂ measures (StO₂ initial, StO₂ occlusion and StO₂ recovery) identify patients who are in shock and at increased risk of organ dysfunction (Sequential Organ Failure Assessment (SOFA) score ≥ 2 at 24 hours) and dying in the hospital.

Methods

This prospective, observational study comprised a convenience sample of three cohorts of adult patients (age > 17 years) at three urban university emergency departments: (1) a septic shock cohort (systolic blood pressure < 90 after fluid challenge; the "SHOCK" cohort, n = 58), (2) a sepsis without shock cohort (the "SEPSIS" cohort, n = 60) and emergency department patients without infection (n = 50). We measured the StO₂ initial, StO₂ occlusion and StO₂ recovery slopes for all patients. Outcomes were sepsis syndrome severity, organ dysfunction (SOFA score at 24 hours) and in-hospital mortality.

Results

Among the 168 patients enrolled, mean initial StO₂ was lower in the SHOCK cohort than in the SEPSIS cohort (76% vs 81%), with an impaired occlusion slope (-10.2 and 5.2%/minute vs -13.1 and 4.4%/minute) and an impaired recovery slope (2.4 and 1.6%/second vs 3.9 and 1.7%/second) (P < 0.001 for all). The recovery slope was well-correlated with SOFA score at 24 hours (-0.35; P < 0.001), with a promising area under the curve (AUC) for mortality of 0.81. The occlusion slope correlation with SOFA score at 24 hours was 0.21 (P < 0.02), with a fair mortality AUC of 0.70. The initial StO₂ was significantly but less strongly correlated with SOFA score at 24 hours (-0.18; P < 0.04), with a poor mortality AUC of 0.56.

Conclusions

NIRS measurements for the StO₂ initial, StO₂ occlusion and StO₂ recovery slope were abnormal in patients with septic shock compared to sepsis patients. The recovery slope was most strongly associated with organ dysfunction and mortality. Further validation is warranted.

Trial registration

NCT01062685

Transcutaneous neuromuscular electrical stimulation: influence of electrode positioning and stimulus amplitude settings on muscle response

The aim of the study was to investigate the influence of two different transcutaneous neuromuscular electrical stimulation procedures on evoked muscle torque and local tissue oxygenation. In the first one (MP mode), the cathode was facing the muscle main motor point and stimulus amplitude was set to the level eliciting the maximal myoelectrical activation according to the amplitude of the evoked electromyogram (EMG); in the second one (RC mode), the electrodes were positioned following common reference charts for electrode placement while stimulus amplitude was set according to subject tolerance. Tibialis Anterior (TA) and Vastus Lateralis (VL) muscles of 10 subjects (28.4 ± 8.2 years) were tested in specific dynamometers to measure the evoked isometric torque. The EMG and near-infrared spectroscopy probes were placed on muscle belly to detect the electrical activity and local metabolic modifications of the stimulated muscle, respectively. The stimulation protocol consisted of a gradually increasing frequency ramp from 2 to 50 Hz in 7.5 s. Compared to RC mode, in MP mode the contractile parameters (peak twitch, tetanic torque, area under the torque build-up) and the metabolic solicitation (oxygen consumption and hyperemia due to metabolites accumulation) resulted significantly higher for both TA and VL muscles. MP mode resulted also to be more comfortable for the subjects. Based on the assumption that proper mechanical and metabolic stimuli are necessary to induce muscle strengthening, our results witness the importance of an optimized, i.e., comfortable and effective, stimulation to promote the aforementioned muscle adaptive modifications.

Performance and physiological responses during a sprint interval training session: relationships with muscle oxygenation and pulmonary oxygen uptake kinetics

The purpose of this study was to examine the cardiorespiratory and muscle oxygenation responses to a sprint interval training (SIT) session, and to assess their relationships with maximal pulmonary O(2) uptake [Formula: see text], on- and off- [Formula: see text] kinetics and muscle reoxygenation rate (Reoxy rate). Ten male cyclists performed two 6-min moderate-intensity exercises (≈90-95% of lactate threshold power output, Mod), followed 10 min later by a SIT session consisting of 6 × 30-s all out cycling sprints interspersed with 2 min of passive recovery. [Formula: see text] kinetics at Mod onset ([Formula: see text]) and cessation ([Formula: see text]) were calculated. Cardiorespiratory variables, blood lactate ([La](b)) and muscle oxygenation level of the vastus lateralis (tissue oxygenation index, TOI) were recorded during SIT. Percentage of the decline in power output (%Dec), time spent above 90% of [Formula: see text] (t > 90% [Formula: see text]) and Reoxy rate after each sprint were also recorded. Despite a low mean [Formula: see text] (48.0 ± 4.1% of [Formula: see text]), SIT performance was associated with high peak [Formula: see text] (90.4 ± 2.8% of [Formula: see text]), muscle deoxygenation (sprint ΔTOI = -27%) and [La](b) (15.3 ± 0.7 mmol l(-1)) levels. Muscle deoxygenation and Reoxy rate increased throughout sprint repetitions (P < 0.001 for both). Except for t > 90% [Formula: see text] versus [Formula: see text] [r = 0.68 (90% CL, 0.20; 0.90); P = 0.03], there were no significant correlations between any index of aerobic function and either SIT performance or physiological responses [e.g., %Dec vs. [Formula: see text]: r = -0.41 (-0.78; 0.18); P = 0.24]. Present results show that SIT elicits a greater muscle O(2) extraction with successive sprint repetitions, despite the decrease in external power production (%Dec = 21%). Further, our findings obtained in a small and homogenous group indicate that performance and physiological responses to SIT are only slightly influenced by aerobic fitness level in this population.

Comparisons of local and systemic aerobic fitness parameters between finswimmers with different athlete grade levels

To study the relationship between the local and systemic aerobic fitness parameters, and between the muscle oxygenation and aerobic performance, 16 female finswimmers were recruited and divided into high-level (HL) group and low-level group. Cardiorespiratory function, blood lactate concentration and near infrared spectroscopy muscle oxygenation in the vastus lateralis (VL) were monitored simultaneously during a maximal incremental exercise. We found that the break point (Bp) of the oxygenation index (OI) in the VL (BpVL) had significant correlations with lactate threshold (LT) and gas exchange threshold (GET), and the appearance sequence of the three thresholds was BpVL ≈ LT ≤ GET. When considering different levels, the [Formula: see text] at BpVL, LT and GET were higher in the HL group. During intensive exercise, there were significantly faster [Formula: see text] increase and evidently slower OI decrease in the HL group, suggesting that faster [Formula: see text] increase in the HL group slowed down the muscle deoxygenation and facilitated subjects to cycle to higher workloads. In conclusion, multi-modality approaches combining local and systemic physiological monitoring technologies might provide better explanations of the relationship between local and systemic aerobic fitness parameters, and might be a novel way to analyze the difference between groups of different levels.

Multi-modality optical neural imaging using coherence control of VCSELs

Neural optical imaging can evaluate cortical hemodynamic fluctuations which reflect neural activity and disease state. We evaluate the use of vertical-cavity surface-emitting lasers (VCSELs) as illumination source for simultaneous imaging of blood flow and tissue oxygenation dynamics ex vivo and in vivo and demonstrate optical imaging of blood flow changes and oxygenation changes in response to induced ischemia. Using VCSELs we show a rapid switching from a single-mode to a special multi-mode rapid current sweep operation and noise values reduced to within a factor of 40% compared to non-coherent LED illumination. These VCSELs are promising for long-term portable continuous monitoring of brain dynamics in freely moving animals.

The repeated-bout effect: influence on biceps brachii oxygenation and myoelectrical activity

This study investigated biceps brachii oxygenation and myoelectrical activity during and following maximal eccentric exercise to better understand the repeated-bout effect. Ten men performed two bouts of eccentric exercise (ECC1, ECC2), consisting of 10 sets of 6 maximal lengthening contractions of the elbow flexors separated by 4 wk. Tissue oxygenation index minimum amplitude (TOImin), mean and maximum total hemoglobin volume by near-infrared spectroscopy, torque, and surface electromyography root mean square (EMGRMS) during exercise were compared between ECC1 and ECC2. Changes in maximal voluntary isometric contraction (MVC) torque, range of motion, plasma creatine kinase activity, muscle soreness, TOImin, and EMGRMS during sustained (10-s) and 30-repeated isometric contraction tasks at 30% (same absolute force) and 100% MVC (same relative force) for 4 days postexercise were compared between ECC1 and ECC2. No significant differences between ECC1 and ECC2 were evident for changes in torque, TOImin, mean total hemoglobin volume, maximum total hemoglobin volume, and EMGRMS during exercise. Smaller ( P < 0.05) changes and faster recovery of muscle damage markers were evident following ECC2 than ECC1. During 30% MVC tasks, TOImin did not change, but EMGRMS increased 1–4 days following ECC1 and ECC2. During 100% MVC tasks, EMGRMS did not change, but torque and TOImin decreased 1–4 days following ECC1 and ECC2. TOImin during 100% MVC tasks and EMGRMS during 30% MVC tasks recovered faster ( P < 0.05) following ECC2 than ECC1. We conclude that the repeated-bout effect cannot be explained by altered muscle activation or metabolic/hemodynamic changes, and the faster recovery in muscle oxygenation and activation was mainly due to faster recovery of force.

Diffuse optical multipatch technique for tissue oxygenation monitoring: clinical study in intensive care unit

Diffuse optical multipatch technique is used to assess spatial variations in absorption and scattering in biological tissue, by monitoring changes in the concentration of oxyhemoglobin and deoxyhemoglobin. In our preliminary study, the temporal tracings of tissue oxygenation are measured using diffuse optical multipatch measurement and a venous occlusion test, employing normal subjects and ICU patients suffering from sepsis and heart failure. In experiments, obvious differences in tissue oxygenation signals were observed among all three groups. This paper discusses the physiological relevance of tissue oxygenation with respect to disease.

Correlation between tissue oxygenation and erythrocytes elasticity

In this paper, near-infrared spectroscopy (NIRS) and jumping optical tweezers were used to measure the tissue oxygenation and the elasticity of erythrocytes, respectively. The correlation between tissue oxygenation induced by arterial occlusion test (AOT) and the mechanical properties of individual erythrocytes from a blood sample obtained after AOT was studied. The experimental results show a linear correlation between the oxygenation signal caused by AOT and the elasticity of erythrocytes.

Reproducibility and sensitivity of muscle reoxygenation and oxygen uptake recovery kinetics following running exercise in the field

The purpose of this study was to assess the reliability of postexercise near-infrared spectroscopy (NIRS)-derived measurements and their sensitivity to different exercise intensities in the field. Seventeen athletes (24·1 ± 5·6 year) repeated, on three occasions, two 2-min submaximal shuttle-runs at 40% and 60% of V(IFT) (final speed of the 30-15 intermittent fitness test) and a 50-m shuttle-run sprint (Sprint), with (OCC) or without (CON) repeated transient arterial occlusions of the medial gastrocnemius during the postexercise period. NIRS variables (i.e. oxyhaemoglobin [HbO(2)], deoxyhaemoglobin [HHb] and their difference [Hb(diff)]) were measured continuously for 3 min after each exercise. Half-recovery (½Rec) and mean response (MRT; monoexponential curve fitting) times of muscle reoxygenation and muscle oxygen uptake (mVO(2)) recovery were calculated. Reliability was assessed using the typical error of measurement, expressed as a coefficient of variation (CV). Postexercise recovery of muscle reoxygenation revealed CVs ranging from 16·8% to 37·3%; CV for mVO(2) recovery ranged from 6·2% to 20·9%, with no substantial differences shown between NIRS variables and exercise intensities. While running, intensity did not affect MRT or ½Rec for muscle reoxygenation, and differences were found for mVO(2) recovery (e.g. [Hb(diff)]-mVO(2) MRT = 28·7 ± 5·2, 34·2 ± 5·1 and 37·3 ± 6·2 s for 40%, 60% and Sprint, respectively, P<0·01). To conclude, the kinetics of postexercise NIRS measurements showed CV values ranging from 6% to 37%, with no substantial differences between exercise intensities or NIRS-derived variables. However, exercise intensity did influence mVO(2) recovery kinetics, but not that of muscle reoxygenation in an occlusion-free condition.

A compact time-resolved system for near infrared spectroscopy based on wavelength space multiplexing

We designed and developed a compact dual-wavelength and dual-channel time-resolved system for near-infrared spectroscopy studies of muscle and brain. The system employs pulsed diode lasers as sources, compact photomultipliers, and time-correlated single photon counting boards for detection. To exploit the full temporal and dynamic range of the acquisition technique, we implemented an approach based on wavelength space multiplexing: laser pulses at the two wavelengths are alternatively injected into the two channels by means of an optical 2×2 switch. In each detection line (i.e., in each temporal window), the distribution of photon time-of-flights at one wavelength is acquired. The proposed approach increases the signal-to-noise ratio and avoids wavelength cross-talk with respect to the typical approach based on time multiplexing. The instrument was characterized on tissue phantoms to assess its properties in terms of linearity, stability, noise, and reproducibility. Finally, it was successfully tested in preliminary in vivo measurements on muscle during standard cuff occlusion and on the brain during a motor cortex response due to hand movements.

Muscle oxygenation of vastus lateralis and medialis muscles during alternating and pulsed current electrical stimulation

This study compared between alternating and pulsed current electrical muscle stimulation (EMS) for muscle oxygenation and blood volume during isometric contractions. Nine healthy men (23-48 years) received alternating current EMS (2500 Hz) modulated at 75 Hz on the knee extensors of one leg, and pulsed current EMS (75 Hz) for the other leg separated by 2 weeks in a randomised, counter-balanced order. Pulse duration (400 μs), on-off ratio (5-15 s) and other stimulation parameters were matched between conditions and 30 isometric contractions were induced at the knee joint angle of 100° (0° full extension). Changes in tissue oxygenation index (∆TOI) and total hemoglobin volume (∆tHb) of vastus lateralis and medialis muscles over 30 contractions were assessed by a near-infrared spectroscopy, and were compared between conditions by a two-way repeated measures ANOVA. Peak torque produced during EMS increased over 30 contractions in response to the increase in the stimulation intensity for pulsed current, but not for the alternating current EMS. The torque during each isometric contraction was less stable in alternating than pulsed current EMS. The changes in ∆TOI amplitude during relaxation phases and ∆tHb amplitude were not significantly different between conditions. However, the decreases in ∆TOI amplitude during contraction phases from baseline were significantly (P < 0.05) greater for the pulsed current than alternating current from the 18th contraction (-15.6 ± 2.3 vs. -8.9 ± 1.8%) to 30th contraction (-10.7 ± 1.8 vs. -4.8 ± 1.5%). These results suggest that the muscles were less activated in the alternating current EMS when compared with the pulsed current EMS.

Comparison between maximal lengthening and shortening contractions for biceps brachii muscle oxygenation and hemodynamics

Eccentric contractions (ECC) require lower systemic oxygen (O2) and induce greater symptoms of muscle damage than concentric contractions (CON); however, it is not known if local muscle oxygenation is lower in ECC than CON during and following exercise. This study compared between ECC and CON for changes in biceps brachii muscle oxygenation [tissue oxygenation index (TOI)] and hemodynamics [total hemoglobin volume (tHb) = oxygenated-Hb + deoxygenated-Hb], determined by near-infrared spectroscopy over 10 sets of 6 maximal contractions of the elbow flexors of 10 healthy subjects. This study also compared between ECC and CON for changes in TOI and tHb during a 10-s sustained and 30-repeated maximal isometric contraction (MVC) task measured immediately before and after and 1–3 days following exercise. The torque integral during ECC was greater ( P < 0.05) than that during CON by ∼30%, and the decrease in TOI was smaller ( P < 0.05) by ∼50% during ECC than CON. Increases in tHb during the relaxation phases were smaller ( P < 0.05) by ∼100% for ECC than CON; however, the decreases in tHb during the contraction phases were not significantly different between sessions. These results suggest that ECC utilizes a lower muscle O2 relative to O2 supply compared with CON. Following exercise, greater ( P < 0.05) decreases in MVC strength and increases in plasma creatine kinase activity and muscle soreness were evident 1–3 days after ECC than CON. Torque integral, TOI, and tHb during the sustained and repeated MVC tasks decreased ( P < 0.01) only after ECC, suggesting that muscle O2 demand relative to O2 supply during the isometric tasks was decreased after ECC. This could mainly be due to a lower maximal muscle mass activated as a consequence of muscle damage; however, an increase in O2 supply due to microcirculation dysfunction and/or inflammatory vasodilatory responses after ECC is recognized.

Biceps brachii muscle oxygenation in electrical muscle stimulation

The purpose of this study was to compare between electrical muscle stimulation (EMS) and maximal voluntary (VOL) isometric contractions of the elbow flexors for changes in biceps brachii muscle oxygenation (tissue oxygenation index, TOI) and haemodynamics (total haemoglobin volume, tHb = oxygenated-Hb + deoxygenated-Hb) determined by near-infrared spectroscopy (NIRS). The biceps brachii muscle of 10 healthy men (23-39 years) was electrically stimulated at high frequency (75 Hz) via surface electrodes to evoke 50 intermittent (4-s contraction, 15-s relaxation) isometric contractions at maximum tolerated current level (EMS session). The contralateral arm performed 50 intermittent (4-s contraction, 15-s relaxation) maximal voluntary isometric contractions (VOL session) in a counterbalanced order separated by 2-3 weeks. Results indicated that although the torque produced during EMS was approximately 50% of VOL (P<0.05), there was no significant difference in the changes in TOI amplitude or TOI slope between EMS and VOL over the 50 contractions. However, the TOI amplitude divided by peak torque was approximately 50% lower for EMS than VOL (P<0.05), which indicates EMS was less efficient than VOL. This seems likely because of the difference in the muscles involved in the force production between conditions. Mean decrease in tHb amplitude during the contraction phases was significantly (P<0.05) greater for EMS than VOL from the 10th contraction onwards, suggesting that the muscle blood volume was lower in EMS than VOL. It is concluded that local oxygen demand of the biceps brachii sampled by NIRS is similar between VOL and EMS.