Validation of near-infrared spectroscopy in humans

Skin Blood Flow Affects In Vivo Near-Infrared Spectroscopy Measurements in Human Skeletal Muscle

Skin blood flow affects NIRS. Leg skin blood flow (SkBF) was increased and decreased following local heating and intradermal epinephrine injection. Epinephrine decreased muscle saturation (StO(2)), and heating the leg increased StO(2). The results suggest that changes in SkBF can significantly affect resting StO(2) as measured by near-infrared tissue spectroscopy.

Acute compartment syndrome of the limb

In this review the aetiology, clinical signs, diagnosis and therapy of the acute compartment syndrome of the limb is discussed. It is a limb- and untreated life threatening emergency. For good results, early detection is necessary. It is important to educate those taking care of patients of risk, especially in the early symptoms and signs. In uncooperative, unconscious and sedated patients pressure monitoring is recommended. The critical level of the absolute intracompartmental pressure is unclear. It is recommended to use a delta p pressure of 30 mm Hg. Below this pressure in the presence of clinical signs a fasciotomy of all compartments is the treatment of choice.

Tissue energetics as measured by nuclear magnetic resonance spectroscopy during hemorrhagic shock

The defect in energy production in an organism during shock states may be related to the impairment of mitochondrial respiration early in shock. The aim of this study was to investigate the timing and degree of cellular energetic changes during hemorrhagic shock in real time. Instrumented, splenectomized swine were randomized to undergo hemorrhagic shock, induced by a 35% blood volume bleed, for 90 min with (n = 10) or without (n = 9) subsequent resuscitation. Resuscitated animals received shed blood in two increments followed by two normal saline boluses (20 mL/kg/bolus). Throughout experimentation, tissue phosphoenergetics of liver and skeletal muscle were monitored using 31P nuclear magnetic resonance (NMR) spectroscopy via NMR coils on the liver and hindlimb. Near-infrared spectroscopy probes were used to measure liver, stomach, and skeletal muscle oxyhemoglobin saturation (StO2). Hemorrhagic shock induced an increase in phosphomonoesters in skeletal muscle (baseline: 7.09%, 90 min: 9.94% (P < 0.05); expressed as percent total phosphorus). This increase resolved in animals receiving resuscitation (n = 10) but remained elevated in those in unresuscitated shock (n = 9). Inorganic phosphate levels increased and betaATP levels decreased significantly in the liver of animals in shock as compared with baseline. StO2 in skeletal muscle, stomach, and liver correlated with whole organism oxygen delivery (r2 = 0.356, 0.368, and 0.432, respectively). We conclude that hemorrhagic shock induces early elevation of phosphomonoesters in skeletal muscle, which correlates with the severity of shock. This implies an early transition to anaerobic glycolysis during hemorrhagic shock, which may be indicative of early mitochondrial dysfunction.

Role of tissue oxygen saturation monitoring in diagnosing necrotizing fasciitis of the lower limbs

STUDY OBJECTIVE

We determine the utility of tissue oxygen saturation monitoring in diagnosing necrotizing fasciitis of the lower extremities.

METHODS

We prospectively studied patients who met the criteria of soft tissue infection throughout the lower extremities by tissue oxygen saturation monitoring (with near-infrared spectroscopy) over the middle third of possible involved areas. Cases with evidence of chronic venous stasis, peripheral vascular disease, shock, and systemic hypoxia were excluded. Biceps and contralateral unaffected leg areas were measured as references. The tissue oxygen saturation reading for each area was compared with those finally diagnosed as necrotizing fasciitis and those with only simple soft tissue infection. The tissue oxygen saturation reading was presented as mean+/-SD. Receiver operating characteristic (ROC) curves were used to determine a cutoff value of tissue oxygen saturation reading for early diagnosis of necrotizing fasciitis.

RESULTS

Two hundred thirty-four consecutive patients were enrolled. Nineteen patients (group N) were confirmed to have necrotizing fasciitis, whereas the remaining 215 patients (group C) had only cellulitis. The tissue oxygen saturation reading measured over the biceps muscle was 86%+/-11% in group N and 85%+/-12% in group C. In group N, the leg with necrotizing fasciitis had a tissue oxygen saturation reading of 52%+/-18% throughout the involved site, whereas the tissue oxygen saturation reading measured in the comparative values found in group C was 84%+/-7% (difference 95% confidence interval [CI] 22% to 29%). After fasciotomy, the tissue oxygen saturation reading of the leg with necrotizing fasciitis returned to 82%+/-17% (95% CI 23% to 28% compared with prefasciotomy value) in group N. At the cutoff value of a tissue oxygen saturation reading less than 70% (area under the curve 0.883; 95% CI 0.817 to 0.949) defined by ROC curve, the test revealed a sensitivity of 100% (95% CI 82% to 100%), a specificity of 97% (95% CI 94% to 99%), and an accuracy of 97% (95% CI 95% to 99%).

CONCLUSION

The low tissue oxygen saturation reading values measured by near-infrared spectroscopy throughout the involved areas of the lower extremities are of value in identifying necrotizing fasciitis. This method may offer a reliable noninvasive method of assessing lower extremities at risk for necrotizing fasciitis, at least for a selected patient population.

Effects of prior heavy-intensity exercise on pulmonary O2 uptake and muscle deoxygenation kinetics in young and older adult humans

Pulmonary O2 uptake (V̇o2p) and muscle deoxygenation kinetics were examined during moderate-intensity cycling (80% lactate threshold) without warm-up and after heavy-intensity warm-up exercise in young ( n = 6; 25 ± 3 yr) and older ( n = 5; 68 ± 3 yr) adults. We hypothesized that heavy warm-up would speed V̇o2p kinetics in older adults consequent to an improved intramuscular oxygenation. Subjects performed step transitions ( n = 4; 6 min) from 20 W to moderate-intensity exercise preceded by either no warm-up or heavy-intensity warm-up (6 min). V̇o2p was measured breath by breath. Oxy-, deoxy-(HHb), and total hemoglobin and myoglobin (Hbtot) of the vastus lateralis muscle were measured continuously by near-infrared spectroscopy (NIRS). V̇o2p (phase 2; τ) and HHb data were fit with a monoexponential model. After heavy-intensity warm-up, oxyhemoglobin (older subjects: 13 ± 9 μM; young subjects: 9 ± 8 μM) and Hbtot (older subjects: 12 ± 8 μM; young subjects: 14 ± 10 μM) were elevated ( P < 0.05) relative to the no warm-up pretransition baseline. In older adults, τV̇o2p adapted at a faster rate ( P < 0.05) after heavy warm-up (30 ± 7 s) than no warm-up (38 ± 5 s), whereas in young subjects, τV̇o2p was similar in no warm-up (26 ± 7 s) and heavy warm-up (25 ± 5 s). HHb adapted at a similar rate in older and young adults after no warm-up; however, in older adults after heavy warm-up, the adaptation of HHb was slower ( P < 0.01) compared with young and no warm-up. These data suggest that, in older adults, V̇o2p kinetics may be limited by a slow adaptation of muscle blood flow and O2 delivery.

Changes in masseteric hemodynamics time-related to mental stress

Mental stress may cause a dissociation of sympathetic outflow to different regions. However, it remains unclear how the sympathetic outflow to jaw muscles is related to other sympathetic outflow under mental stress. The objective of this study was to clarify the temporal relationship between the finger sweat expulsion elicited by mental stress and the hemodynamic and electromyographic changes in the masseter muscle. Healthy adult female volunteers participated in this study. Masseteric hemodynamic changes were closely time-related to mental stress, showing a decrease in oxygen saturation of muscle blood around the onset of mental stress. In contrast, EMG activity of jaw-closing muscles was not time-related to mental stress. These results suggest that mental stress induces hemodynamic changes that are not associated with EMG activity in the masseter muscle of healthy adult females.

Monitoring Individual Erector Spinae Fatigue Responses Using Electromyography and Near Infrared Spectroscopy

This study examined the utility of electromyography and near-infrared spectroscopy (NIRS) in assessing m. erector spinae activity during the Biering-Sørensen Back Muscle Endurance (BSME) test. Six men and four women (27.0 ± 7.1 years of age) performed the BSME test (time = 131.5 ± 43.5 s). EMG was used to quantify neuromuscular activity of the right and left side at the L3 level, and root mean square was scaled for maximum value at the start of the exercise. NIRS was used to evaluate blood volume (BV) and oxygenation (OX) simultaneous with EMG bilaterally at the L3 level. There was a decrease to 49 ± 8% of initial median frequency (mean = 83 Hz) on both right and left sides when the exercise was 90% complete, and the slope of the median frequency/time relationship was significantly related to BSME time (r = 0.82). Group means for BV increased during back exercise while OX decreased and was significantly different between right and left sides of the lower back. However, large OX response differences among individuals and between right and left sides were noted. OX and median frequency were moderately related (r = 0.27-0.38). It appears that NIRS combined with EMG is a promising tool for assessing localized metabolic and neuromuscular activity during static contractions of the lower back. Key words: back endurance, back health, muscle oxygenation, blood volume

Tissue oxygenation and capacity to deliver O2 do the two go together?

Oxidative phosphorylation is the most important source of energy in mammals. Oxygen capture, convective and diffusive oxygen transport as well as the final intracellular oxygen utilization within the mitochondria represent highly refined mechanisms, supervised by a variety of physiological control systems. Any disease process interfering with the delivery of oxygen to tissue will ultimately lead to an impairment of cellular energy production. Generally, cellular hypoxia may result from either reduced oxygen uptake (hypoxic hypoxia), reduced convective and diffusive oxygen transport (circulatory and anemic hypoxia), impaired oxygen consumption (histotoxic hypoxia), or a combination of these states. To effectively treat any of these conditions, it is mandatory to recognize the underlying specific alterations of oxidative metabolism. Identification of the various types of hypoxia as well as contemporary treatment surveillance strategies depend primarily on measuring oxygen partial pressure in inspiratory gas, blood (arterial, mixed-venous) and tissue (extracellular fluid), next to monitoring of various circulatory parameters. This review focuses (a) on the diagnostic value of different techniques used to monitor blood and tissue oxygenation and (b) on the effects of impaired capacity to deliver O2 on tissue oxygen delivery and consumption. The potential value of multiparametric monitoring in guiding specific treatment measures to improve oxygen delivery to tissue is highlighted.

Muscle Oxygenation Trends During Dynamic Exercise Measured by Near Infrared Spectroscopy

During the last decade, NIRS has been used extensively to evaluate the changes in muscle oxygenation and blood volume during a variety of exercise modes. The important findings from this research are as follows: (a) There is a strong correlation between the lactate (ventilatory) threshold during incremental cycle exercise and the exaggerated reduction in muscle oxygenation measured by NIRS. (b) The delay in steady-state oxygen uptake during constant work rate exercise at intensities above the lactate/ventilatory threshold is closely related to changes in muscle oxygenation measured by NIRS. (c) The degree of muscle deoxygenation at the same absolute oxygen uptake is significantly lower in older persons compared younger persons; however, these changes are negated when muscle oxygenation is expressed relative to maximal oxygen uptake values. (d) There is no significant difference between the rate of biceps brachii and vastus lateralis deoxygenation during arm cranking and leg cycling exercise, respectively, in males and females. (e) Muscle deoxygenation trends recorded during short duration, high-intensity exercise such as the Wingate test indicate that there is a substantial degree of aerobic metabolism during such exercise. Recent studies that have used NIRS at multiple sites, such as brain and muscle tissue, provide useful information pertaining to the regional changes in oxygen availability in these tissues during dynamic exercise. Key words: blood volume, noninvasive measurement

Reduced forearm blood flow in children and adolescents with type 1 diabetes (measured by near-infrared spectroscopy)

OBJECTIVE

The aim of this study was to measure forearm blood flow (FBF) to detect any possible changes that might indicate vascular disorders in children and adolescents with type 1 diabetes.

RESEARCH DESIGN AND METHODS

FBF was measured by near-infrared spectroscopy (NIRS), venous occlusion at rest, and after handgrip exercise. A total of 40 children and adolescents with type 1 diabetes and 40 healthy children and adolescents (6-18 years) were matched for age and sex for comparison.

RESULTS

In the diabetic group (age 12.79 +/- 2.9 years, duration of diabetes 51.5 +/- 36 months), FBF at rest was significantly lower (1.39 +/- 0.76 ml x 100 g muscle(-1) x min(-1)) than in control subjects (age 12.66 +/- 2.9 years, FBF at rest 1.90 +/- 1.19 ml x 100 g muscle(-1) x min(-1)). After exercise, FBF increased significantly less in the diabetic group (0.70 +/- 0.82 ml. 100 g muscle(-1) x min(-1)) compared with the control subjects (1.15 +/- 1.05 ml. 100 g muscle(-1) x min(-1)). FBF at rest decreased with increasing age in both groups. The change in FBF after exercise was independent of age in the diabetic group and increased with increasing age in control subjects. FBF is reduced with impaired hyperemic response after exercise in children and adolescents with type 1 diabetes.

CONCLUSIONS

These data suggest that vascular disorders in childhood are detectable noninvasively by NIRS.

Mapping human skeletal muscle perforator vessels using a quantum well infrared photodetector (QWIP) might explain the variability of NIRS and LDF measurements

Near-infrared spectroscopy (NIRS) and laser Doppler flowmetry (LDF) have become the techniques of choice allowing the non-invasive study of local human skeletal muscle metabolism and blood perfusion on a small tissue volume (a few cm3). However, it has been shown that both NIRS and LDF measurements may show a large spatial variability depending on the position of the optodes over the investigated muscle. This variability may be due to local morphologic and/or metabolic characteristics of the muscle and makes the data interpretation and comparison difficult. In the present work, we use a third method to investigate this problem which permits fast, non-invasive mapping of the intramuscular vessel distribution in the human vastus latelralis muscle. This method uses an advanced, passive, infrared imaging sensor called a QWIP (quantum well infrared photodetector). We demonstrate, using a recovery-enhanced infrared imaging technique, that there is a significant presence of perforator vessels in the region of interest of approximately 30 x 18 cm (the number of vessels being: 14, 9, 8, 33, 17 and 18 for each subject, respectively). The presence of these vessels makes the skeletal muscle highly inhomogeneous, and may explain the observed NIRS and LDF spatial variability. We conclude that accurate comparison of the metabolic activity of two different muscle regions is not possible without reliable maps of vascular 'singularities' such as the perforator vessels, and that the QWIP-based imaging system is one method to obtain this information.

Passive versus active recovery during high-intensity intermittent exercises

PURPOSE

To compare the effects of passive versus active recovery on muscle oxygenation and on the time to exhaustion for high-intensity intermittent exercises.

METHODS

Twelve male subjects performed a graded test and two intermittent exercises to exhaustion. The intermittent exercises (15 s) were alternated with recovery periods (15 s), which were either passive or active recovery at 40% of .VO2max. Oxyhemoglobin was evaluated by near-infrared spectroscopy during the two intermittent exercises.

RESULTS

Time to exhaustion for intermittent exercise alternated with passive recovery (962 +/- 314 s) was significantly longer (P < 0.001) than with active recovery (427 +/- 118 s). The mean metabolic power during intermittent exercise alternated with passive recovery (48.9 +/- 4.9 mL.kg-1.min-1) was significantly lower (P < 0.001) than during intermittent exercise alternated with active recovery (52.6 +/- 4.6 mL.kg-1.min-1). The mean rate of decrease in oxyhemoglobin during intermittent exercises alternated with passive recovery (2.9 +/- 2.4%.s-1) was significantly slower (P < 0.001) than during intermittent exercises alternated with active recovery (7.8 +/- 3.4%.s-1), and both were negatively correlated with the times to exhaustion (r = 0.67, P < 0.05 and r = 0.81, P < 0.05, respectively).

CONCLUSION

The longer time to exhaustion for intermittent exercise alternated with passive recovery could be linked to lower metabolic power. As intermittent exercise alternated with passive recovery is characterized by a slower decline in oxyhemoglobin than during intermittent exercise alternated with active recovery at 40% of .VO2max, it may also allow a higher reoxygenation of myoglobin and a higher phosphorylcreatine resynthesis, and thus contribute to a longer time to exhaustion.

The effect of hypoxia on pulmonary O2uptake, leg blood flow and muscle deoxygenation during single-leg knee-extension exercise

The effect of hypoxic breathing on pulmonary O(2) uptake (VO(2p)), leg blood flow (LBF) and O(2) delivery and deoxygenation of the vastus lateralis muscle was examined during constant-load single-leg knee-extension exercise. Seven subjects (24 +/- 4 years; mean +/-s.d.) performed two transitions from unloaded to moderate-intensity exercise (21 W) under normoxic and hypoxic (P(ET)O(2)= 60 mmHg) conditions. Breath-by-breath VO(2p) and beat-by-beat femoral artery mean blood velocity (MBV) were measured by mass spectrometer and volume turbine and Doppler ultrasound (VingMed, CFM 750), respectively. Deoxy-(HHb), oxy-, and total haemoglobin/myoglobin were measured continuously by near-infrared spectroscopy (NIRS; Hamamatsu NIRO-300). VO(2p) data were filtered and averaged to 5 s bins at 20, 40, 60, 120, 180 and 300 s. MBV data were filtered and averaged to 2 s bins (1 contraction cycle). LBF was calculated for each contraction cycle and averaged to 5 s bins at 20, 40, 60, 120, 180 and 300 s. VO(2p) was significantly lower in hypoxia throughout the period of 20, 40, 60 and 120 s of the exercise on-transient. LBF (l min(-1)) was approximately 35% higher (P > 0.05) in hypoxia during the on-transient and steady-state of KE exercise, resulting in a similar leg O(2) delivery in hypoxia and normoxia. Local muscle deoxygenation (HHb) was similar in hypoxia and normoxia. These results suggest that factors other than O(2) delivery, possibly the diffusion of O(2,) were responsible for the lower O(2) uptake during the exercise on-transient in hypoxia.

Noninvasive assessment of sympathetic vasoconstriction in human and rodent skeletal muscle using near-infrared spectroscopy and Doppler ultrasound

The precise role of the sympathetic nervous system in the regulation of skeletal muscle blood flow during exercise has been challenging to define in humans, partly because of the limited techniques available for measuring blood flow in active muscle. Recent studies using near-infrared (NIR) spectroscopy to measure changes in tissue oxygenation have provided an alternative method to evaluate vasomotor responses in exercising muscle, but this approach has not been fully validated. In this study, we tested the hypothesis that sympathetic activation would evoke parallel changes in tissue oxygenation and blood flow in resting and exercising muscle. We simultaneously measured tissue oxygenation with NIR spectroscopy and blood flow with Doppler ultrasound in skeletal muscle of conscious humans ( n = 13) and anesthetized rats ( n = 9). In resting forearm of humans, reflex activation of sympathetic nerves with the use of lower body negative pressure produced graded decreases in tissue oxygenation and blood flow that were highly correlated ( r = 0.80, P < 0.0001). Similarly, in resting hindlimb of rats, electrical stimulation of sympathetic nerves produced graded decreases in tissue oxygenation and blood flow velocity that were highly correlated ( r = 0.93, P < 0.0001). During rhythmic muscle contraction, the decreases in tissue oxygenation and blood flow evoked by sympathetic activation were significantly attenuated ( P < 0.05 vs. rest) but remained highly correlated in both humans ( r = 0.80, P < 0.006) and rats ( r = 0.92, P < 0.0001). These data indicate that, during steady-state metabolic conditions, changes in tissue oxygenation can be used to reliably assess sympathetic vasoconstriction in both resting and exercising skeletal muscle.

Effect of age on O(2) uptake kinetics and the adaptation of muscle deoxygenation at the onset of moderate-intensity cycling exercise

Phase 2 pulmonary O(2) uptake (Vo(2(p))) kinetics are slowed with aging. To examine the effect of aging on the adaptation of Vo(2(p)) and deoxygenation of the vastus lateralis muscle at the onset of moderate-intensity constant-load cycling exercise, young (Y) (n = 6; 25 +/- 3 yr) and older (O) (n = 6; 68 +/- 3 yr) adults performed repeated transitions from 20 W to work rates corresponding to moderate-intensity (80% estimated lactate threshold) exercise. Breath-by-breath Vo(2(p)) was measured by mass spectrometer and volume turbine. Deoxy (HHb)-, oxy-, and total Hb and/or myoglobin were determined by near-infrared spectroscopy (Hamamatsu NIRO-300). Vo(2(p)) data were filtered, interpolated to 1 s, and averaged to 5-s bins. HHb data were filtered and averaged to 5-s bins. Vo(2(p)) data were fit with a monoexponential model for phase 2, and HHb data were analyzed to determine the time delay from exercise onset to the start of an increase in HHb and thereafter were fit with a single-component exponential model. The phase 2 time constant for Vo(2(p)) was slower (P < 0.01) in O (Y: 26 +/- 7 s; O: 42 +/- 9 s), whereas the delay before an increase in HHb (Y: 12 +/- 2 s; O: 11 +/- 1 s) and the time constant for HHb after the time delay (Y: 13 +/- 10 s; O: 9 +/- 3 s) were similar in Y and O. However, the increase in HHb for a given increase in Vo(2(p)) (Y: 7 +/- 2 microM x l(-1) x min(-1); O: 13 +/- 4 microM x l(-1) x min(-1)) was greater (P < 0.01) in O compared with Y. The slower Vo(2(p)) kinetics in O compared with Y adults was accompanied by a slower increase of local muscle blood flow and O(2) delivery discerned from a faster and greater muscle deoxygenation relative to Vo(2(p)) in O.

Near infrared spectroscopy in the diagnosis of chronic exertional compartment syndrome

BACKGROUND

Patients with chronic exertional compartment syndrome (CECS) experience pain during exercise. An abnormal increase in intracompartmental pressure (ICP) leads to impaired local tissue perfusion resulting in ischemia and pain. At cessation of exercise, pain subsides. Diagnosis is confirmed through postexercise ICP. Near infrared spectroscopy (NIRS) can measure tissue oxygen saturation (StO(2)) noninvasively.

HYPOTHESIS

NIRS can diagnose CECS by showing tissue deoxygenation.

STUDY DESIGN

Prospective, nonrandomized clinical trial.

METHOD

Volunteers completed a standardized exercise protocol. Those suspected of CECS did so preoperatively and postoperatively. StO(2) and ICP were monitored. Data were compared between volunteers and patients and prefasciotomy and postfasciotomy.

RESULTS

Significant differences between the StO(2) values of volunteers and patients with CECS were found. Average peak exercise StO(2) value for those with CECS was lower than for the healthy (27 versus 56, P <.05). Patients showed more absolute and percentage change between baseline and peak exercise StO(2) (absolute: 60 versus 35, P <.05; percentage: 67 versus 38, P <.05). StO(2) values in legs with confirmed CECS returned to normal range postfasciotomy. All changes differed significantly with preoperative values.

CONCLUSION

StO(2) can distinguish healthy from diseased legs. This study provides evidence supporting NIRS as a noninvasive, painless alternative to ICP in the diagnosis of CECS.

Phosphomonoesters Predict Early Mortality in Porcine Hemorrhagic Shock

BACKGROUND

Hemodynamic, laboratory, and tissue energetics were measured in a porcine model of hemorrhagic shock to evaluate variables as predictors of early mortality from shock. We hypothesized that elevated phosphomonoesters would predict early mortality in hemorrhagic shock.

METHODS

Pigs (n = 36) were subjected to 35% hemorrhage for 90 minutes in a 1.5-T nuclear magnetic resonance (NMR) magnet. Measurements included base deficit (BD); lactate; oxygen consumption/delivery; near-infrared spectroscopy of liver, stomach, and skeletal muscle tissue oxyhemoglobin saturation; and NMR spectroscopic measurements of high-energy phosphates of liver and skeletal muscle. Variables were compared between nonsurvivors and survivors to resuscitation after 90-minute measurements.

RESULTS

Ninety-minute mortality was 25%. Muscle phosphomonoesters (PMEs) and oxygen consumption differed significantly between survivors and nonsurvivors at baseline. Regression analysis identified baseline muscle PME levels, baseline BD, and 30-minute BD as early predictors of mortality before resuscitation (r2 = 0.304).

CONCLUSION

Baseline elevation in muscle PME levels predicts mortality in an animal model of severe hemorrhagic shock.

Investigation of TRAM Flap Oxygenation and Perfusion by Near-Infrared Reflection Spectroscopy and Color-Coded Duplex Sonography

Near-infrared reflection spectroscopy, used experimentally for investigation of tissue hemoglobin content and oxygenation in various flaps, was tested in the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, chosen as a simple clinical model because of its well-known vascular anatomy and clinical relevance. The study intended to answer the following questions: Does the near-infrared reflection spectroscopy system used in this study measure tissue hemoglobin content and oxygenation in the superficial skin layers only, as proposed by the manufacturer? Is near-infrared reflection spectroscopy able to detect differences of tissue hemoglobin content and oxygenation in distinct zones of the TRAM flap skin before, early, and late after surgery? Does tissue hemoglobin content and oxygenation correspond to blood flow in the supplying superior epigastric artery and to clinical signs of TRAM flap perfusion and viability? In 11 patients, tissue hemoglobin content and oxygenation in the lower abdomen/TRAM flap, mastectomy skin flap, and contralateral breast were measured by a new near-infrared reflection spectroscopy system preoperatively, early postoperatively, and late postoperatively. Simultaneously, systolic peak flow in the ipsilateral superior epigastric artery was obtained by color-coded duplex sonography. Routine clinical monitoring was performed throughout the early postoperative period. Tissue hemoglobin content and oxygenation in the lower abdomen, mastectomy skin flap, and contralateral breast were similar before surgery but varied considerably between different patients. There were no significant differences among preoperative, early postoperative, and late postoperative values of tissue hemoglobin content and oxygenation in the mastectomy skin flap and contralateral breast. However, near-infrared reflection spectroscopy measurements of the TRAM flap revealed significant differences between preoperative and early postoperative values of tissue hemoglobin content and oxygenation and among zones I, II, and III early after surgery. Tissue hemoglobin content in the TRAM flap skin increased and oxygenation decreased early after surgery. Near-infrared reflection spectroscopy values corresponded to clinical signs of venous congestion predominantly in zone III. Late postoperative return of hemoglobin content and oxygenation in the TRAM flap toward preoperative values can be attributed to improved venous return by reversed flow across regurgitant valves and development of collateral circulation. Finally, there was a significant increase of systolic peak flow in the ipsilateral superior epigastric artery early after surgery. This could be related to the opening of small-caliber choke arteries between the superior and deep inferior epigastric arteries following ligation of the dominant deep inferior epigastric artery and TRAM flap transfer to the chest. Systolic peak flow returned to preoperative values late after surgery. The near-infrared reflection spectroscopy system used in this study appeared to measure hemoglobin content and oxygenation in the superficial skin layers only. Near-infrared reflection spectroscopy was able to detect differences of tissue hemoglobin content and oxygenation in the TRAM flap between preoperative and postoperative measurements and between distinct zones of the TRAM flap early postoperatively. Postoperative changes in near-infrared reflection spectroscopy values corresponded to clinical observations and blood flow in the superior epigastric artery measured by color-coded duplex sonography. Further experience is needed before near-infrared reflection spectroscopy can be advocated for routine clinical flap monitoring.

Kinetics of Oxygenation in Inactive Forearm Muscle during Ramp Leg Cycling

This study was carried out to determine whether hemodynamics in inactive forearm muscle during ramp leg cycling is affected from the ventilatory threshold (VT) and respiratory compensation point (RCP), at which the rate of increase in ventilation (VE) against power output begins to increase abruptly. Change in hemodynamics was evaluated by change in oxygenation index (difference between concentrations of oxygenated hemoglobin and deoxygenated hemoglobin, HbD) measured using near-infrared spectrometry (NIRS). Each subject (n=9) performed 4-min constant-work-rate leg cycling and subsequent ramp leg cycling at an increasing rate of 10 watts.min(-1) in power output. The work rates at VT, RCP and peak oxygen uptake (VO(2 peak)) were 107 +/- 11, 172 +/- 21 and 206 +/- 20 watts, respectively. The rates of increase in VE between 10-watt leg cycling, VT, RCP and VO(2 peak) were 0.19 +/- 0.03, 0.44 +/- 0.07 and 1.32 +/- 0.47 l.min(-1).watts(-1), respectively. In one subject, HbD started to decrease during ramp exercise from the VT, and the rate of decrease increased at a high intensity of exercise. In eight subjects, although no decrease in HbD from the VT was observed, HbD showed a sudden drop at a high intensity of exercise. The work rate at which HbD began to decrease at a high intensity of exercise was 174 +/- 23 watts. This work rate was not significantly different from that at the RCP and was significantly correlated with that at the RCP (r=0.72, P<0.05). The results suggest that the abrupt increase in VE from the RCP affects hemodynamics, resulting in a decrease in HbD in inactive forearm muscle.

Arterial desaturation during exercise in man: implication for O2 uptake and work capacity

Exercise-induced arterial hypoxaemia is defined as a reduction in the arterial O2 pressure (PaO2) by more than 1 kPa and/or a haemoglobin O2 saturation (SaO2) below 95%. With blood gas analyses ideally reported at the actual body temperature, desaturation is a consistent finding during maximal ergometer rowing. Arterial desaturation is most pronounced at the end of a maximal exercise bout, whereas the reduction in PaO2 is established from the onset of exercise. Exercise-induced arterial hypoxaemia is multifactorial. The ability to maintain a high alveolar O2 pressure (PAO2) is critical for blood oxygenation and this appears to be difficult in large individuals. A large lung capacity and, in turn, diffusion capacity seem to protect PaO2. A widening of the PAO2-PaO2 difference does indicate that a diffusion limitation, a ventilation-perfusion mismatch and/or a shunt influence the transport of O2 from alveoli to the pulmonary capillaries. An inspired O2 fraction of 0.30 reduces the widened PAO2-PaO2 difference by 75% and prevents a reduction of PaO2 and SaO2. With a marked increase in cardiac output, diffusion limitation combined with a fast transit time dominates the O2 transport problem. Furthermore, a postexercise reduction in pulmonary diffusion capacity suggests that the alveolo-capillary membrane is affected. An antioxidant attenuates oxidative burst by neutrophilic granulocytes, but it does not affect PaO2, SaO2 or O2 uptake (VO2), and the ventilatory response to maximal exercise also remains the same. It is proposed, though, that increased concentration of certain cytokines correlates to exercise-induced hypoxaemia as cytokines stimulate mast cells and basophilic granulocytes to degranulate histamine. The basophil count increases during maximal rowing. Equally, histamine release is associated with hypoxaemia and when the release of histamine is prevented, the reduction in PaO2 is attenuated. During maximal exercise, an extreme lactate spill-over to blood allows pH decrease to below 7.1 and according to the O2 dissociation curve this is critical for SaO2. When infusion of sodium bicarbonate maintains a stable blood buffer capacity, acidosis is attenuated and SaO2 increases from 89% to 95%. This enables exercise capacity to increase, an effect also seen when O2 supplementation to inspired air restores arterial oxygenation. In that case, exercise capacity increases less than can be explained by VO2 and CaO2. Furthermore, the change in muscle oxygenation during maximal exercise is not affected when hyperoxia and sodium bicarbonate attenuate desaturation. It is proposed that other organs benefit from enhanced O2 availability, and especially the brain appears to increase its oxygenation during maximal exercise with hyperoxia.

Effect of Muscle Oxygenation during Resistance Exercise on Anabolic Hormone Response

PURPOSE

The mechanisms that underlie the affect of acute program variables on muscle growth and strength development for strength/power athletes have been of great interest. This investigation examined the affects of two different resistance exercise protocols on muscle oxygenation, and the anabolic hormonal response to such exercise.

METHODS

Eleven experienced resistance-trained male athletes performed four sets of the squat exercise using either a low-intensity, high-volume (LI; 15 repetitions at 60% one-repetition maximum [1-RM]) or high-intensity, low-volume (HI; 4 repetitions at 90% 1-RM) load. Venous blood samples were obtained before (Pre), immediate (IP), 20- (20P), and 40-min (40P) postexercise. Continuous-wave near-infrared spectroscopy was used to measure oxygen desaturation during exercise.

RESULTS

No differences in muscle deoxygenation were seen between LI and HI. However, time-dependent postexercise reoxygenation was significantly different between the two exercise sessions (35.3 +/- 17.4 s vs 24.5 +/- 14.3 s in LI and HI, respectively). Testosterone and growth hormone (GH) concentrations were significantly elevated from Pre at IP, 20P, and 40P in both LI and HI. GH concentrations were higher (P<0.05) for LI than at HI at 20P and 40P.

CONCLUSION

Muscle oxygen recovery kinetics appeared to be influenced by differences in the intensity and volume of exercise, and delayed reoxygenation appears to affect the GH response to exercise.

Tissue (muscle) oxygen saturation (StO2): A new measure of symptomatic lower-extremity arterial disease

OBJECTIVES

Near-infrared spectroscopy provides a noninvasive method of measuring tissue oxygen saturation and has been used to monitor extremity compartment syndrome. Tissue O(2) saturation (StO(2)) is potentially useful in assessing patients with peripheral arterial disease (PAD). The purposes of this feasibility study are to (1) explore the diagnostic sensitivity of StO(2) in subjects with PAD and symptoms of intermittent claudication (IC) compared with normal subjects, and (2) correlate the change in StO(2) during and after exercise with the ankle brachial index (ABI) in patients with IC. Material and methods Forty-nine subjects, 35 normal and 14 PAD, from two centers were evaluated in a prospective cross-sectional analysis comparing StO(2) by using the InSpectra tissue spectrometer and ABI at rest (baseline) and after treadmill exercise. Measurements were obtained at baseline and peak exercise (normal subjects) and at baseline, initial claudication distance (ICD) and absolute claudication distance (ACD) in PAD subjects. Endpoint values were the mean of 15 data points. Times to 50% of StO(2) recovery to baseline (T(50)) and complete recovery to baseline (T(100)) were measured. Receiver-operator characteristic curves were constructed to assess the sensitivity/specificity values associated with various StO(2) cut-points.

RESULTS

The PAD patients were older (P =.0002) and 57% were male, compared with 37% males in the normal group. The ABI was 0.68 +/- 0.14 in PAD patients versus 1.14 +/- 0.08 in normal subjects (P <.0001). The baseline StO(2) was 65% in both groups. The peak exercise StO(2) was significantly lower and the absolute change in StO(2) and the percent change in StO(2) were significantly greater in PAD patients (P < 0.45). The T(50) and T(100) were longer in the PAD patients compared to normal subjects (P =.0001 and.002, respectively). A T(50) of >70 seconds yielded a sensitivity of 89% and a specificity of 85% for PAD.

CONCLUSIONS

StO(2) is a new and potentially useful technique to evaluate patients with PAD. Resting StO(2) was similar in PAD-IC subjects and normals. There was a significantly greater drop in StO(2) and longer recovery times in PAD-IC subjects. Interestingly, StO(2) at the ICD and ACD was similar. StO(2) offers a different and perhaps more appropriate end point for diagnosis and monitoring of the management of patients with PAD, and may offer additional insight into the pathophysiology of exercise-induced muscle ischemia and its recovery.

Intramyocellular lipid, adiposity, and muscle oxygen supply in prepubertal type 1 diabetes

BACKGROUND

In the non-diabetic population, intramyocellular lipid (IMCL) accumulation is associated with obesity and poor muscle oxygen supply. IMCL levels are increased in type 1 diabetes, but their significance is less clear.

METHODS

We studied a group of 16 prepubertal boys (age 6.4-9.9 yr) with type 1 diabetes and a range of glycemic control [hemoglobin A1c (HbA1c) 6.4-10.2%]. Children's adiposity was assessed by anthropometry, muscle oxygen supply by near-infrared spectroscopy (NIRS), abdominal and IMCL content by magnetic resonance imaging (MRI), and magnetic resonance spectroscopy (MRS).

RESULTS

IMCL content did not associate with muscle reoxygenation rate, abdominal adiposity, duration of diabetes, or recent glycemic control. Muscle reoxygenation rate correlated with percentage body fatness (r2 = 0.46, p = 0.004), visceral (r2 = 0.45, p = 0.007) and abdominal subcutaneous fat volume (r2 = 0.63, p = 0.0004), and dietary fat intake (r2 = 0.27, p = 0.03) but not with the duration of diabetes nor HbA1c. HbA1c was significantly related to dietary fat intake only (r2 = 0.28, p = 0.03).

CONCLUSION

While causality cannot be inferred, interventions aimed at improving muscle oxygen supply, or preventing its deterioration, might reduce the development of adiposity in children with type 1 diabetes.

Discrepancy between cardiorespiratory system and skeletal muscle in elite cyclists after hypoxic training

Background

The purpose of this study was to determine the effects of hypoxic training on the cardiorespiratory system and skeletal muscle among well-trained endurance athletes in a randomized cross-over design.

Methods

Eight junior national level competitive cyclists were separated into two groups; Group A trained under normoxic condition (21% O₂) for 2 hours/day, 3 days/week for 3 weeks while Group B used the same training protocol under hypoxic condition (15% O₂). After 3 weeks of each initial training condition, five weeks of self-training under usual field conditions intervened before the training condition was switched from NT to HT in Group A, from HT to NT in Group B. The subjects were tested at sea level before and after each training period. O₂ uptake (O₂), blood samples, and muscle deoxygenation were measured during bicycle exercise test.

Results and Discussion

No changes in maximal workload, arterial O₂ content, O₂ at lactate threshold and O_2max were observed before or after each training period. In contrast, deoxygenation change during submaximal exercise in the vastus lateralis was significantly higher at HT than NT (p < 0.01). In addition, half time of oxygenation recovery was significantly faster after HT (13.2 ± 2.6 sec) than NT (18.8 ± 2.7 sec) (p < 0.001).

Conclusions

Three weeks of HT may not give an additional performance benefit at sea level for elite competitive cyclists, even though HT may induce some physiological adaptations on muscle tissue level.

Muscle oxygenation and pulmonary gas exchange kinetics during cycling exercise on-transitions in humans

Near-infrared spectroscopy (NIRS) was utilized to gain insights into the kinetics of oxidative metabolism during exercise transitions. Ten untrained young men were tested on a cycle ergometer during transitions from unloaded pedaling to 5 min of constant-load exercise below (<VT) or above (>VT) the ventilatory threshold. Vastus lateralis oxygenation was determined by NIRS, and pulmonary O2 uptake (Vo --> Vo2) was determined breath-by-breath. Changes in deoxygenated hemoglobin + myoglobin concentration Delta[deoxy(Hb + Mb)] were taken as a muscle oxygenation index. At the transition, [Delta[deoxy(Hb + Mb)]] was unmodified [time delay (TD)] for 8.9 +/- 0.5 s at <VT or 6.4 +/- 0.9 s at >VT (both significantly different from 0) and then increased, following a monoexponential function [time constant (tau) = 8.5 +/- 0.9 s for <VT and 7.2 +/- 0.7 s for >VT]. For >VT a slow component of Delta[deoxy(Hb + Mb)] on-kinetics was observed in 9 of 10 subjects after 75.0 +/- 14.0 s of exercise. A significant correlation was described between the mean response time (MRT = TD + tau) of the primary component of Delta[deoxy(Hb + Mb)] on-kinetics and the tau of the primary component of the pulmonary Vo2 on-kinetics. The constant muscle oxygenation during the initial phase of the on-transition indicates a tight coupling between increases in O2 delivery and O2 utilization. The lack of a drop in muscle oxygenation at the transition suggests adequacy of O2 availability in relation to needs.

Relationship between pulmonary O2 uptake kinetics and muscle deoxygenation during moderate-intensity exercise

The temporal relationship between the kinetics of phase 2 pulmonary O2 uptake (Vo -->Vo2p) and deoxygenation of the vastus lateralis muscle was examined during moderate-intensity leg-cycling exercise. Young adults (5 men, 6 women; 23 +/- 3 yr; mean +/- SD) performed repeated transitions on 3 separate days from 20 W to a constant work rate corresponding to 80% of lactate threshold. Breath-by-breath Vo2p was measured by mass spectrometer and volume turbine. Deoxyhemoglobin (HHb), oxyhemoglobin, and total hemoglobin and myoglobin were sampled each second by near-infrared spectroscopy (Hamamatsu NIRO-300). Vo2p data were filtered, interpolated to 1 s, and averaged to 5-s bins; HHb data were averaged to 5-s bins. Phase 2 Vo2p data were fit with a monoexponential model. For HHb, a time delay (TDHHb) from exercise onset to an increase in HHb was determined, and thereafter data were fit with a monoexponential model. The time constant for Vo2p (30 +/- 8 s) was slower (P < 0.01) than that for HHb (10 +/- 3 s). The TDHHb before an increase in HHb was 13 +/- 2 s. The possible mechanisms of the TDHHb are discussed with reference to metabolic activation and matching of local muscle O2 delivery and O2 utilization. After this initial TDHHb, the kinetics of local muscle deoxygenation were faster than those of phase 2 Vo2p (and presumably muscle O2 consumption), reflecting increased O2 extraction and a mismatch between local muscle O2 consumption and perfusion.

Local blood circulation among knee extensor synergists in relation to alternate muscle activity during low-level sustained contraction

The relation between local circulation and alternate muscle activity among knee extensor synergists was determined during low-level sustained knee extension at 2.5% of maximal voluntary contraction for 60 min in seven subjects. Blood volume of rectus femoris (RF) and vastus lateralis (VL) was assessed by using near-infrared spectroscopy. Surface electromyogram (EMG) was recorded from RF, VL, and vastus medialis (VM). Alternate muscle activity was observed between RF and either VL or VM. Cross-correlation analysis was used to investigate the relation between blood volume and integrated EMG (iEMG) sequences throughout the task. One negative peak in the cross-correlation function was seen between the iEMG and blood volume with time lag of 30-60 s, indicating that muscle activity increases (or decreases) with the decrease (or increase) in local circulation with the corresponding time lag. Two cases in the emergence of alternate muscle activities, i.e., an increase in the EMG of RF accompanied by a decline of EMG in VL (case I) and vice versa (case II) were further analyzed. The time lag between iEMG and blood volume was longer in case I than that in case II. These results were statistically significant in the RF but not in the VL. It is concluded that even during low-level sustained contraction, local circulation is modulated by the alternate muscle activity of knee extensor synergists, and a negative correlation between the muscle activity and blood volume sequences was found in only RF but not in VL.

The light still shines, but not that brightly? The current status of perinatal near infrared spectroscopy

Efforts have been made to find new, non-invasive methods for assessing tissue oxygenation and haemodynamics, particularly in the brain of the fetus and the newborn infant. Near infrared spectroscopy (NIRS) is a developmental technique that provides just such a method, allowing calculation of variables such as cerebral blood flow and cerebral blood volume. It can also measure peripheral oxygen consumption. This review is based on our long experience of using NIRS. Basic principles, techniques, validation, and clinical applications are highlighted. Although more than two decades have passed since its introduction, NIRS remains very much a developmental technique, despite technical progression. A great deal more research is required for NIRS to become a routine clinical tool.

Exploratory multivariate spectroscopic study on human skin

BACKGROUND/AIMS

Spectroscopy on human skin is a field that is being adopted increasingly because of its rapidity and high reproducibility. Infrared reflectance (IR), near-infrared reflectance (NIR), and fluorescence spectroscopy have previously been applied to human skin in vivo to compare healthy and sick skin, including skin cancer, atopy, and leprosy. Exploratory data analysis/chemometrics is a tool for evaluating multivariate data such as spectroscopic measurements. The objective of this study was to explore the spectral variance spanned by people with normal integument, and to demonstrate the advantages of multivariate analysis to skin research.

METHODS

IR, NIR and fluorescence spectroscopy have been carried out in vivo on 216 volunteers' forearms before and after four tape strippings. The subjects were asked to fill in a questionnaire regarding factors suspected to influence the measurement results. Principal Component Analysis (PCA) was used to investigate whether the population can be divided into groups on the basis of their skin chemistry. Unless otherwise stated, the results are from the measurements prior to stripping.

RESULTS

In contrast to IR and fluorescence spectra, NIR spectra proved able to detect gender differences. By use of PCA, classifications on male and female subjects were observed from the IR and NIR measurements, and as an indication from the fluorescence measurements. The NIR and fluorescence measurements varied between elderly and young subjects. The largest variance in the fluorescence landscapes was seen between pigmented and non-pigmented skin. No connection was found between the spectroscopic measurements and smoking or drinking habits.

CONCLUSIONS

Future spectroscopic skin investigations should be balanced as regards to gender and age, as these can possibly affect the measurement results. Chemometrics proved to be superior to traditional attempts of interpreting the spectra.

Cerebral oxygenation determined by near-infrared spectrophotometry in patients with fulminant hepatic failure

BACKGROUND/AIMS

In severe cases of acute liver failure (ALF), cerebral hyperperfusion may result in high intracranial pressure and brain damage. The aim of this study was to determine if near-infrared spectrophotometry (NIRS) could detect a raise in cerebral blood flow and oxygenation induced by noradrenaline (NA) infusion.

METHODS

In seven ALF patients (five females and two males; median age 49 years (range 20-70)) changes in cerebral concentration of oxy-(deltaHbO(2)) and total-haemoglobin (deltaHbT) were compared to the jugular bulb saturation (SvjO(2)) and cerebral blood flow velocity (Vmean) during NA infusion.

RESULTS

Mean arterial pressure increased from 68 (64-86) to 103 (87-118) mmHg and the cerebral perfusion pressure from 61 (53-79) to 95 (74-110) mmHg (P<0.05), while the intracranial pressure (7 (6-15) mmHg) was not significantly changed. In six patients cerebral deltaHbO(2) and deltaHbT increased 2.7 (0.3-9.6) and 2.0 (0.3-14.8) micromol l(-1), respectively, but cerebral oxygenation decreased in one patient. SvjO(2) increased from 68 (55-76) to 74 (64-78) % (P<0.05) concomitant with an increase in Vmean from 47 (34-65) to 68 (50-86) cm s(-1) (P<0.05). deltaHbO(2) covariated with changes in SvjO(2) during NA in all but one patient.

CONCLUSIONS

In ALF patients, a change in cerebral perfusion was detected by NIRS. The combination of NIRS and transcranial Doppler sonography may be valuable non-invasive techniques to detect cerebral hyperperfusion before intracranial hypertension becomes manifest.

Effects of short-term endurance training on muscle deoxygenation trends using NIRS

PURPOSE

This study examined changes in cardiorespiratory responses and muscle deoxygenation trends to test the hypothesis that both central and peripheral adaptations would contribute to the improvements in VO(2max) and simulated cycling performance after short-term high-intensity training.

METHODS

Eight male cyclists performed an incremental cycle ergometer test to voluntary exhaustion, and a simulated 20-km time trial (20TT) on wind-loaded rollers before and after training (60 min x 5 d x wk(-1) x 3 wk at 85-90% VO(2max). Near-infrared spectroscopy (NIRS) was used to evaluate the trend in vastus medialis hemoglobin/myoglobin deoxygenation (Hb/Mb-O(2) during both tests pre- and post-training.

RESULTS

Training induced significant increases (P </= 0.05) in maximal power output (367 +/- 63 to 383 +/- 60 W), VO(2max) (4.39 +/- 0.66 to 4.65 +/- 0.57 L x min(-1)), and maximal O(2) pulse (22.7 +/- 3.2 to 24.6 +/- 2.8 mL O(2) x beat(-1)) during the incremental test, but maximal muscle deoxygenation was unchanged. 20TT performance was significantly faster (27:32 +/- 1:43 to 25:46 +/- 1:44 min:s; P </= 0.05) after training without a significant increase (P > 0.05) in the VO(2) (4.02 +/- 0.52 to 4.04 +/- 0.51), heart rate (176 +/- 9 to 173 +/- 8 beats x min ) or O pulse (22.4 +/- 3.2 to 23.5 +/- 2.8 mL O(2) x beat(-1)). However, mean muscle deoxygenation during the 20TT was significantly lower after training (-550 +/- 292 to -707 +/- 227 mV, P </= 0.05), and maximal deoxygenation showed a trend toward significance (-807 +/- 344 to -1,009 +/- 331 mV, P = 0.08), suggesting a greater release of oxygen from Hb/Mb-O(2) via the Bohr effect.

CONCLUSION

The significant improvement in VO(max) induced by short-term endurance training in well-trained cyclists was due primarily to central adaptations, whereas the simulated 20TT performance was enhanced due to localized changes in muscle oxygenation.

Muscle deoxygenation as related to work rate

PURPOSE

The kinetics of the decrease in venous O(2) content in response to constant work rate exercise below the lactic acidosis threshold (LAT) is very rapid, reaching a constant value by approximately 1 min. However, for work rates above the LAT, a slow further decrease in venous O(2) content takes place that is attributable to the Bohr effect rather than further decrease in end capillary PO. We hypothesized that similar differences, with respect to the LAT, will be observed in muscle deoxygenation kinetics when studied with near-infrared spectroscopy (NIRS).

METHODS

Twelve normal subjects performed three constant work rate tests from unloaded cycling at 60% of LAT, 80% LAT, each with four repetitions, and above LAT (LAT + 35% between LAT and VO(2max) three times, on a cycle ergometer for 6 min. We measured tissue deoxygenation with NIRS, with the probe over the vastus lateralis muscle, time-averaging the repetitions. Gas exchange and heart rate (HR) were measured breath-by-breath and beat-by-beat.

RESULTS

Tissue deoxygenation kinetics were significantly faster than VO(2) and HR at 60%- and 80%-LAT work rates. By 1 min of exercise, deoxygenation was constant for the work rate below the LAT. At 30 s, tissue deoxygenation was 70-95% complete, whereas VO(2) and HR were only 30-60% complete. For the work rate above the LAT, a steady state for muscle deoxygenation was not reached during the 6 min of exercise. After 1 min of above-LAT exercise, either one of two patterns of slow change in tissue oxygenation developed, deoxygenation or reoxygenation. It is postulated that these different responses might be due to effects of the exercise lactic acidosis. H accompanying lactate increase might cause further deoxygenation due to the Bohr effect, and acidosis-induced vasodilatation might cause reoxygenation after the initial deoxygenation.

CONCLUSION

1) The kinetics of tissue deoxygenation are significantly more rapid than VO(2) and HR kinetics at all work rates studied, and 2) steady-state in tissue deoxygenation is seen by 1 min of constant work rate exercise below the LAT, but this is much delayed for work rates above the LAT.

Bicarbonate attenuates arterial desaturation during maximal exercise in humans

The contribution of pH to exercise-induced arterial O2 desaturation was evaluated by intravenous infusion of sodium bicarbonate (Bic, 1 M; 200-350 ml) or an equal volume of saline (Sal; 1 M) at a constant infusion rate during a "2,000-m" maximal ergometer row in five male oarsmen. Blood-gas variables were corrected to the increase in blood temperature from 36.5 +/- 0.3 to 38.9 +/- 0.1 degrees C (P < 0.05; means +/- SE), which was established in a pilot study. During Sal exercise, pH decreased from 7.42 +/- 0.01 at rest to 7.07 +/- 0.02 but only to 7.34 +/- 0.02 (P < 0.05) during the Bic trial. Arterial PO2 was reduced from 103.1 +/- 0.7 to 88.2 +/- 1.3 Torr during exercise with Sal, and this reduction was not significantly affected by Bic. Arterial O2 saturation was 97.5 +/- 0.2% at rest and decreased to 89.0 +/- 0.7% during Sal exercise but only to 94.1 +/- 1% with Bic (P < 0.05). Arterial PCO2 was not significantly changed from resting values in the last minute of Sal exercise, but in the Bic trial it increased from 40.5 +/- 0.5 to 45.9 +/- 2.0 Torr (P < 0.05). Pulmonary ventilation was lowered during exercise with Bic (155 +/- 14 vs. 142 +/- 13 l/min; P < 0.05), but the exercise-induced increase in the difference between the end-tidal O2 pressure and arterial PO2 was similar in the two trials. Also, pulmonary O2 uptake and changes in muscle oxygenation as determined by near-infrared spectrophotometry during exercise were similar. The enlarged blood-buffering capacity after infusion of Bic attenuated acidosis and in turn arterial desaturation during maximal exercise.

Reperfusion response changes induced by repeated, sustained contractions in normal human masseter muscle

The purpose was to evaluate the intramuscular reperfusion response characteristics associated with repeated isometric contractions in normal human masseter. Intramuscular blood volume was quantified with a near-infrared spectroscopic device that measured the total haemoglobin (Hb) concentration in the muscle. Electromyographic (EMG) activity from the masseter and total bite forces were also recorded. Sixteen healthy volunteers, eight females and eight males, without masticatory muscle pain participated. They were asked first to clench their teeth for as long as possible at 50% of their maximum voluntary contraction (MVC). This was followed by a 60s rest and then immediately by a standard clenching task (50% MVC for 30s) and a 60s recovery period, immediately after which they were asked to repeat exactly the same procedure, with a final 5 min recovery period after the second 30s contraction. Bite force, EMG and Hb concentration were measured continuously and the duration of the two endurance tasks and the amplitudes of all recorded signals were compared (first trial versus second trial). Specifically, the difference between the lowest Hb (trough) seen during the standardised 30s contractions and the highest (peak) seen just after them was assessed. The trough-to-peak difference in Hb concentration of the second standard contraction task was significantly smaller than that of the first standard task (P<0.05, paired t-test). These data show that with sustained effort the post-contraction vasodilatory reperfusion responses of the human masseter are diminished, suggesting a progressive desensitisation of the vasodilatory system.

In vivo quantitative near-infrared spectroscopy in skeletal muscle during incremental isometric handgrip exercise

The aim of this study was to investigate the performance of in vivo quantitative near-infrared spectroscopy (NIRS) in skeletal muscle at various workloads. NIRS was used for the quantitative measurement of O2 consumption (mVO2) in the human flexor digitorum superficialis muscle at rest and during rhythmic isometric handgrip exercise in a broad range of work intensities (10-90% MVC=maximum voluntary contraction force). Six subjects were tested on three separate days. No significant differences were found in mVO2 measured over different days with the exception of the highest workload. The within-subject variability for each workload measured over the three measurements days ranged from 15.7 to 25.6% and did not increase at the high workloads. The mVO2 was 0.14 +/- 0.01 mlO2 min-1 100 g-1 at rest and increased roughly 19 times to 2.68 +/- 0.58 mlO2 min-1 100 g-1 at 72% MVC. These results show that local muscle oxygen consumption at rest as well as during exercise at a broad range of work intensities can be measured reliably by NIRS, applied to a uniform selected subject population. This is of great importance as direct local measurement of mVO2 during exercise is not possible with the conventional techniques. The method is robust enough to measure over separate days and at various workloads and can therefore contribute to a better understanding of human physiology in both the normal and pathological state of the muscle.

Nitric oxide-dependent modulation of sympathetic neural control of oxygenation in exercising human skeletal muscle

Nitric oxide (NO) attenuates alpha-adrenergic vasoconstriction in contracting rodent skeletal muscle, but it is unclear if NO plays a similar role in human muscle. We therefore hypothesized that in humans, NO produced in exercising skeletal muscle blunts the vasoconstrictor response to sympathetic activation. We assessed vasoconstrictor responses in the microcirculation of human forearm muscle using near-infrared spectroscopy to measure decreases in muscle oxygenation during reflex sympathetic activation evoked by lower body negative pressure (LBNP). Experiments were performed before and after NO synthase inhibition produced by systemic infusion of N(G)-nitro-L-arginine methyl ester (L-NAME). Before L-NAME, LBNP at -20 mmHg decreased muscle oxygenation by 20 +/- 2 % in resting forearm and by 2 +/- 3 % in exercising forearm (n = 20), demonstrating metabolic modulation of sympathetic vasoconstriction. As expected, L-NAME increased mean arterial pressure by 17 +/- 3 mmHg, leading to baroreflex-mediated suppression of baseline muscle sympathetic nerve activity (SNA). The increment in muscle SNA in response to LBNP at -20 mmHg also was attenuated after L-NAME (before, +14 +/- 2; after, +8 +/- 1 bursts min(-1); n = 6), but this effect of L-NAME was counteracted by increasing LBNP to -40 mmHg (+19 +/- 2 bursts min(-1)). After L-NAME, LBNP at -20 mmHg decreased muscle oxygenation similarly in resting (-11 +/- 3 %) and exercising (-10 +/- 2 %) forearm (n = 12). Likewise, LBNP at -40 mmHg decreased muscle oxygenation both in resting (-19 +/- 4 %) and exercising (-21 +/- 5 %) forearm (n = 8). These data advance the hypothesis that NO plays an important role in modulating sympathetic vasoconstriction in the microcirculation of exercising muscle, because such modulation is abrogated by NO synthase inhibition with L-NAME.

Changes in blood volume and oxygenation level in a working muscle during a crank cycle

PURPOSE

This study examined circulatory and metabolic changes in a working muscle during a crank cycle in a pedaling exercise with near-infrared spectroscopy (NIRS).

METHODS

NIRS measurements sampled under stable metabolic and cadence conditions during incremental pedaling exercise were reordered according to the crank angles whose signals were obtained in eight male subjects.

RESULTS

The reordered changes in muscle blood volume during a crank cycle demonstrated a pattern change that corresponded to changes in pedal force and electrical muscle activity for pedal thrust. The top and bottom peaks for muscle blood volume change at work intensities of 180 W and 220 W always preceded (88 +/- 32 and 92 +/- 23 ms, respectively) those for muscle oxygenation changes. Significant differences in the level of NIRS parameters (muscle blood volume and oxygenation level) among work intensities were noted with a common shape in curve changes related to pedal force. In addition, a temporary increase in muscle blood volume following a pedal thrust was detected at work intensities higher than moderate. This temporary increase in muscle blood volume might reflect muscle blood flow restriction caused by pedal thrusts.

CONCLUSION

The results suggest that circulatory and metabolic conditions of a working muscle can be easily affected during pedaling exercise by work intensity. The present method, reordering of NIRS parameters against crank angle, serves as a useful measure in providing additional findings of circulatory dynamics and metabolic changes in a working muscle during pedaling exercise.

Effects of acetazolamide and furosemide on ventilation and cerebral blood volume in normocapnic and hypercapnic patients with COPD

STUDY OBJECTIVES

Effects of chronic metabolic alkalosis and acidosis and their relation to central chemoregulation may differ between normocapnic and chronic hypercapnic patients with COPD. The relationship between responses of inspired ventilation (VI), mouth occlusion pressure (P(0.1)), and cerebral blood volume (CBV), to short-term changes in arterial PCO(2) was measured.

PATIENTS AND METHODS

Seventeen patients with chronic hypercapnia and COPD (PaCO(2) > 6.0 kPa) and 16 normocapnic patients with COPD (PaCO(2) < or = 6.0 kPa) [FEV(1) 27% predicted] were studied under baseline metabolic conditions and after 1 week of treatment with oral furosemide, 40 mg/d, or acetazolamide, 500 mg/d. Hypercapnia (change in end-tidal carbon dioxide > 1 kPa) was induced by administering adequate amounts of carbon dioxide in the inspired air. CBV was measured using near-infrared spectroscopy.

RESULTS

Compared with baseline metabolic condition, chronic metabolic acidosis and alkalosis did not change ventilatory (Delta VI/Delta PaCO(2)) and cerebrovascular (Delta CBV/Delta PaCO(2)) reactivity. Base excess (BE) decreased by 6.8 +/- 1.1 mEq/L and 6.9 +/- 1.6 mEq/L, respectively, in the normocapnic and chronic hypercapnic COPD groups during metabolic acidosis, resulting in a not-quite-significant leftward shift of both the ventilatory and cerebrovascular carbon dioxide response curve. BE increased by 2.3 +/- 1.2 mEq/L and 1.2 +/- 1.3 mEq/L, respectively, during chronic metabolic alkalosis in both COPD groups, without concomitant shift. Poor correlations between ventilatory and cerebrovascular carbon dioxide responsiveness (Delta CBV/Delta PaCO(2) and Delta VI/Delta PaCO(2), Delta CBV/Delta PaCO(2) and Delta P(0.1)/Delta PaCO(2), respectively) were found irrespective of baseline, respiratory condition, and induced metabolic state.

CONCLUSIONS

Normocapnic and chronic hypercapnic COPD patients have the same ventilatory and cerebrovascular carbon dioxide responsiveness irrespective of induced metabolic state.

Noninvasive monitoring of hemodynamic stress using quantitative near-infrared frequency-domain photon migration spectroscopy

Hemorrhagic hypovolemia and inotropic agent administration were used to manipulate cardiac output (CO) and oxygen delivery in rabbits to investigate the correlation between noninvasive frequency domain photon migration (FDPM) spectroscopy and invasive hemodynamic monitoring parameters. Frequency-domain photon migration provides quantitative measurements of light absorption and reduced scattering (mu(a) and mu(s)(prime prime or minute), respectively) in tissue. Wavelength dependent mu(a) values were used to calculate in vivo tissue concentration of deoxyhemoglobin [Hb], oxyhemoglobin [HbO(2)], total hemoglobin [TotHb], and water [H(2)O] as well as mixed arterial-venous oxygen saturation (S(t)O(2)) in tissue. FDPM-derived physiologic properties were correlated with invasive measurements of CO and mean pulmonary artery pressure (mPAP), FDPM-derived [TotHb] and S(t) O(2) correlated significantly with hemorrhaged volume (HV), mPAP, and CO. Correlation coefficients for [TotHb] vs HV, mPAP, and CO were -0.77, 0.86, and 0.70, respectively. Correlation coefficients of S(t)O( 2) vs HV, mPAP, and CO were -0.71, 0.55, and 0.61, respectively. Dobutamine induced changes resulted in correlation coefficients between FDPM-derived and invasively measured physiologic parameters that are comparable to those induced by hypovolemia. FDPM spectroscopy is sensitive to changes in mPAP and CO of as little as 15%. These results suggest that FDPM spectroscopy may be used in clinical settings to noninvasively monitor central hemodynamic parameters and to directly assess oxygenation of tissues.

Regional difference of muscle oxygen saturation and blood volume during exercise determined by near infrared imaging device

Using a near infrared (NIR) imaging device, we tested the hypothesis that regional differences in oxygen status could be detected in the gastrocnemius muscle during exercise and recovery. Six healthy subjects performed the standing plantar flexion exercises for 2 min; the frequency was one contraction per second. The NIR imaging device was placed over the medial head of the right gastrocnemius muscle and the signals from two optical sensors situated on the middle proximal and middle distal portions were used. The NIR-O(2) saturation (difference between deoxygenated and oxygenated Hb signals) and NIR-blood volume (sum of the oxygenated and deoxygenated Hb signals) were calculated in optical density units. Plantar flexion resulted in more deoxygenation during exercise and more reoxygenation during recovery in the distal portion compared with the proximal portion. The changes in NIR-O(2) between rest and a 2 min exercise, and between a 2 min exercise and a 3 min recovery were 0.11 and -0.23, respectively, in the distal portion, which were significantly larger than proximal values (0.05 and -0.10, p < 0.05). Plantar flexion resulted in lower NIR-blood volumes during exercise and greater recovery of blood after exercise in the distal portion compared with the proximal portion. The changes in NIR blood volume between rest and a 2 min exercise and between a 2 min exercise and a 3 min recovery were -0.19 and 0.31, respectively, in the distal portion, significantly larger than proximal values (-0.07 and 0.12, p < 0.05 for all comparisons). These findings indicate that the distal portion of the medial gastrocnemius had larger changes in NIR-O(2) saturation and NIR-blood volume than the proximal portion had. This is consistent with the distal portion having a greater impairment of blood flow possibly because of the higher intramuscular pressure during exercise.

IN CONCLUSION

(1) regional differences in oxygen status in the gastrocnemius muscle were detected with exercise, with the distal portion having greater NIR-O(2) saturation and NIR-blood volume changes, and (2) the NIR imaging device might be a useful method to detect the regional differences of oxygen status in the muscle.

Influence of training on NIRS muscle oxygen saturation during submaximal exercise

PURPOSE

Endurance training improves the oxygen delivery and muscle metabolism. Muscle oxygen saturation measured by near infrared spectroscopy (IR-SO(2)), which is primarily influenced by the local delivery/demand balance, should thus be modified by training. We examined this effect by determining the influence of change in blood lactate and muscle capillary density with training on IR-SO(2) in seven healthy young subjects.

METHODS

Two submaximal exercise tests at 50% (Ex1) and 80% pretraining VO(2max) (Ex2) were performed before and after a 4-wk endurance-training program.

RESULTS

VO(2max) increased only slightly (+8%, NS) with training but the training effect was confirmed by the increased capillary density (+31%, P < 0.01) and citrate synthase activity (50%, P < 0.01), determined from muscle biopsy samples. Before training, blood lactate increased during the first 5 min of Ex1 and then remained constant (3.8 +/- 0.5 mmol x L(-1), P < 0.01), whereas it increased continuously during Ex2 (8.9 +/- 1.8 mmol x L(-1), P < 0.001). After training, lactate decreased significantly and remained constant during the two bouts of exercise (2.0 +/- 0.4 and 3.7 +/- 1.2 at the end of Ex1 and Ex2, respectively, both P < 0.001). During Ex1, IR-SO(2) dropped initially at the onset of exercise and recovered progressively without reaching the resting level. Training did not change this pattern of IR-SO(2). During Ex2, IR-SO(2) decreased progressively during the 15 min of exercise (P < 0.05); IR-SO2 kept constant after the initial drop after training. We found a significant relationship (r = 0.42, P = 0.03) between blood lactate and IR-SO(2) at the end of both bouts of exercise; this relationship was closer before training. By contrast, IR-SO(2) or IR-BV was not related to the capillary density.

CONCLUSION

The training-induced adaptation in blood lactate influences IR-SO(2) during mild- to hard-intensity exercise. Thus, NIRS could be used as a noninvasive monitoring of training-induced adaptations.

Quantitative (1)H magnetic resonance spectroscopy of myoglobin de- and reoxygenation in skeletal muscle: reproducibility and effects of location and disease

1H-magnetic resonance spectroscopy ((1)H-MRS) of deoxymyoglobin (DMb) provides a means to noninvasively monitor the oxygenation state of human skeletal muscle in work and disease. As shown in this work, it also offers the opportunity to measure the absolute tissue content of DMb, the basic oxygen consumption of resting muscle, and the reperfusion characteristics after release of a pressure cuff. The methodology to determine these tissue properties simultaneously at two positions along the calf is presented. The obtained values are in agreement with invasive determinations. The reproducibility of the (1)H-MRS measurements is established for healthy controls and patients with peripheral arterial disease (PAD). A location dependence in axial direction, as well as differences between controls and patients are demonstrated for all parameters. The reoxygenation time in particular is expected to provide a means to quantitatively monitor therapies aimed at improving muscular perfusion in these patients.

Correlation of the near-infrared spectroscopy signals with signal intensity in T(2)-weighted magnetic resonance imaging of the human masseter muscle

The purpose of this study was to compare and contrast blood volume changes transcutaneously measured using near-infrared (NIR) spectroscopy against water signal intensity changes taken from a transverse T(2)-weighted MR image of the masseter muscle in healthy human subjects before, during and after contraction. Eight healthy non-smoking males with no history of chronic muscle pain or vascular headaches participated (mean age: 23.9+/-0.6 years). The MRI data were gathered using a turbo spin echo sequence (TR: 2300 ms; TE: 90 ms; FOV: 188x300 mm; scanning time: 30 s; slice thickness: 10 mm) and the slice level was set at the mid-point between the origin and insertion of the masseter. Intramuscular haemoglobin (Hb) levels and water content of the right masseter muscle were continuously monitored for 2 min before, 30 s during and 15 min after a maximum voluntary clenching (MVC) task. Both the near-infrared and MRI data were baseline-corrected and normalized and mean levels were established and plotted. Plots of the data showed that both near-infrared-based total Hb and T(2)-weighted MRI-based signal-intensity levels clearly decreased during contraction and a clear post-contraction rebound response was evident after the contraction. The near-infrared data were found to be highly correlated with MRI-based signal-intensity data (Pearson's r=0.909, P<0.0001). In conclusion, these data provide powerful evidence that near-infrared data (total Hb), transcutaneously taken from the masseter muscle in humans, will reflect the intramuscular water signal intensity changes seen using a T(2)-weighted MRI imaging method.

Near-infrared spectroscopy determined brain and muscle oxygenation during exercise with normal and resistive breathing

To elevate effects of carbon dioxide (CO2) retention by way of an increased respiratory load during submaximal exercise (150 W), the concentration changes of oxy- (DeltaHbO2) and deoxy-haemoglobin (DeltaHb) of active muscles and the brain were determined by near-infrared spectroscopy (NIRS) in eight healthy males. During exercise, pulmonary ventilation increased to 33 (28-40) L min-1 (median with range) with no effect of a moderate breathing resistance (reduction of the pneumotach diameter from 30 to 14 and 10 mm). The end-tidal CO2 pressure (PETCO2) increased from 45 (42-48) to 48 (46-58) mmHg with a reduction of only 1% in the arterial haemoglobin O2 saturation (SaO2). During control exercise (normal breathing resistance), muscle and brain DeltaHbO2 were not different from the resting levels, and only the leg muscle DeltaHb increased (4 (-2-10) microM, P < 0.05). Moderate resistive breathing increased DeltaHbO2 of the intercostal and vastus lateralis muscles to 6 +/- (-5-14) and 1 (-7-9) microM(P < 0.05), respectively, while muscle DeltaHb was not affected. Cerebral DeltaHbO2 and DeltaHb became elevated to 6 (1-15) and 1 (-1-6) microM by resistive breathing (P < 0.05). Resistive breathing caused an increased concentration of oxygenated haemoglobin in active muscles and in the brain. The results indicate that CO2 influences blood flow to active skeletal muscle although its effect appears to be smaller than for the brain.

Intramuscular haemodynamic responses to different durations of sustained extension in normal human masseter

Ten healthy non-smoking males (mean age 24.3+/-0.8 years) with no history of chronic muscle pain or migraine participated in this study. Intramuscular total haemoglobin (Hb), an indicator of blood volume in the illuminated area, was measured with a non-invasive, near-infrared spectroscopic device. Each participant was told to maintain maximal mouth opening to extend the masseter muscle for 30, 60 or 120 s in random order. Data were continuously recorded from the right masseter 1 min before, at set times during and for 5 min after sustained muscle extension in each trial. Each trial was separated by a 10-min interval. Heart rate (HR) and blood pressure (BP) were also recorded. The mean normalized Hb decreased during muscle extension and rebound hyperaemia was observed after it in each trial (P=0.0001). Hb returned to baseline within 60 s. The magnitude of the decremental change during extension and of the incremental change in the rebound hyperaemia was not significantly different among the three trials (P=0.9071); neither were mean normalized HR and BP. These data suggest that sustained extension of the masseter produces a reduction in total intramuscular Hb during extension and a secondary increase in Hb following a return to the resting muscle's normal length.

Ventilatory and cerebrovascular responses in normocapnic and hypercapnic COPD patients

This study investigated the hypothesis that hypercapnia in some chronic obstructive pulmonary disease (COPD) patients may be related to a high cerebrovascular response to carbon dioxide (CO2). The relationship between responses of ventilation and of cerebral blood volume (CBV) to acute changes in carbon dioxide tension in arterial blood (Pa,CO2) was measured in 17 chronic hypercapnic (Pa,CO2 >6.0 kPa) and 16 normocapnic (Pa,CO2 < or = 6.0 kPa) COPD patients, who were matched for degree of airway obstruction (forced expiratory volume in one second 27% predicted). Results were compared with 15 age-matched healthy subjects. CBV was measured using near infrared spectroscopy during normo- and hypercapnia and related to inspired minute ventilation (V'I) and mouth occlusion pressure (P0.1). Hypercapnia (end-tidal pressure of carbon dioxide (deltaPET,CO2) > 1 kPa) was induced by giving adequate amounts of CO2 in the inspired air. During normocapnia, CBV (mL x 100 g(-1)) was 2.41+/- 0.66 and 2.90 +/- 0.60 (mean +/- SD) in the normocapnic and chronic hypercapnic patients, respectively, which was significantly lower compared to healthy subjects (3.53 +/- 0.77). All slopes of CO2 responsiveness (deltaCBV/deltaPa,CO2, deltaV'I/deltaPa,CO2, deltaP0.1/deltaPa,CO2) were significantly lower in both COPD groups relative to healthy subjects, but were not significantly different between the COPD groups. A poor but positive correlation between ventilatory and cerebrovascular CO2 responsiveness (deltaCBV/deltaPa,CO2 and deltaV'I/deltaPa,CO2) was found in COPD patients and healthy subjects. The findings do not support the hypothesis of abnormal cerebrovascular responses to carbon dioxide in hypercapnic chronic obstructive pulmonary disease patients.