Non-invasive measurements of O2 availability in human skeletal muscle with near-infrared spectroscopy

Sustained Compression with a Pneumatic Cuff on Skeletal Muscles Promotes Muscle Blood Flow and Relieves Muscle Stiffness

(1) Purpose: This study aimed to examine whether a pneumatic cuff could promote muscle blood flow and improve muscle stiffness by continuously compressing muscles with air pressure in healthy college students. (2) Method: Twenty-one healthy collegiate students participated in this study. The probe of the near-infrared spectrometer was attached to the upper surface of the left gastrocnemius muscle, and a cuff was wrapped around the left lower leg. The cuff was inflated to 200 mmHg. After 10 min, the cuff was deflated, and the patient rested for 10 min. Muscle stiffness and fatigue were assessed before and after the intervention. (3) Results: During 10 min of continuous compression, StO₂ continued to decrease until seven min of compression. After 10 min of continuous compression, StO₂ was 30.8 ± 10.4%, which was approximately half of 69.2 ± 6.1% at rest. After the release of the pneumatic cuff compression, the StO₂ remained higher than that at rest from 1 to 10 min. Muscle hardness was 19.0 ± 8.0 before intervention was 8.7 ± 4.8 after the intervention. Muscle fatigue was 6.6 ± 1.7 cm before the intervention and 4.0 ± 1.6 cm after the intervention. (4) Conclusions: This study suggests that sustained muscle compression using a pneumatic cuff can promote muscle blood flow and improve muscle stiffness and fatigue.

Review of early development of near-infrared spectroscopy and recent advancement of studies on muscle oxygenation and oxidative metabolism

Near-infrared spectroscopy (NIRS) has become an increasingly valuable tool to monitor tissue oxygenation (Toxy) in vivo. Observations of changes in the absorption of light with Toxy have been recognized as early as 1876, leading to a milestone NIRS paper by Jöbsis in 1977. Changes in the absorption and scatting of light in the 700-850-nm range has been successfully used to evaluate Toxy. The most practical devices use continuous-wave light providing relative values of Toxy. Phase-modulated or pulsed light can monitor both absorption and scattering providing more accurate signals. NIRS provides excellent time resolution (~ 10 Hz), and multiple source-detector pairs can be used to provide low-resolution imaging. NIRS has been applied to a wide range of populations. Continued development of NIRS devices in terms of lower cost, better detection of both absorption and scattering, and smaller size will lead to a promising future for NIRS studies.

Lumbar sympathicolysis in patients with severe peripheral artery disease: hemodynamics of the lower limbs determined by near-infrared spectroscopy, color coded duplex sonography, and temperature measurement

The objective was to investigate the effects of CT-guided lumbar sympathicolysis on somatic regional oxygen saturation, arterial flow velocity, and skin temperature of the lower limbs in patients with advanced peripheral artery disease (PAD). CT-guided lumbar sympathicolysis was additionally performed after successful revascularization therapy in 61 patients with PAD in categories 5 and 6 according to Rutherford. Somatic regional oxygen saturation in the distal lower limbs was determined semiquantitatively with a near-infrared spectroscopy (NIRS) system. Before and after intervention, peak flow and end-diastolic flow velocity in the dorsalis pedis artery were determined by means of color-coded duplex sonography, and the skin temperature of the feet was measured with an infrared thermometer. After CT-guided lumbar sympathicolysis, somatic regional oxygen saturation, peak flow, end-diastolic flow velocity, and skin temperature in the lower limbs increased significantly.

Experimental investigation of NIRS spatial sensitivity

Near infrared spectroscopy (NIRS) is regarded as a potential medical diagnostic technique for investigation of hemodynamic changes. However, uncertainties pertaining to the origin of NIRS signals have hampered its clinical interpretation. The uncertainities in NIRS measurements especially in case of living tissues are due to lack of rigorous combined theoretical-experimental studies resulting in clear understanding of the origin of NIRS signals. For their reliable interpretation it is important to understand the relationship between spatial changes in optical properties and corresponding changes in the NIRS signal. We investigated spatial sensitivity of near infrared optical measurements using an experimental approach. It uses a liquid optical phantom as tissue equivalent, which is explored under robot-control by a small, approximately point like perturbation of desired optical properties, and a NIRS instrument for trans-illumination/reflection measurements. The experimentally obtained sensitivity has been analyzed and compared with numerical simulations. In preliminary experiments we investigated the influence of various optical properties of the medium and of source/detector distances on the spatial sensitivity distribution. The acquired sensitivity maps can be used to define characteristic parameters. As an example, we used a 25% threshold to define a penetration depth measure which provides values in good accordance with published ones. To the best of our knowledge this is the first experimental study of NIRS spatial sensitivity. The presented method will allow in depth experimental investigation of the influence of various conditions pertaining to medium such as optical properties of tissue (scattering and absorption) and of the source/detector configuration.

Effects of respiratory muscle unloading on leg muscle oxygenation and blood volume during high-intensity exercise in chronic heart failure

Blood flow requirements of the respiratory muscles (RM) increase markedly during exercise in chronic heart failure (CHF). We reasoned that if the RM could subtract a fraction of the limited cardiac output (QT) from the peripheral muscles, RM unloading would improve locomotor muscle perfusion. Nine patients with CHF (left ventricle ejection fraction = 26 ± 7%) undertook constant-work rate tests (70-80% peak) receiving proportional assisted ventilation (PAV) or sham ventilation. Relative changes (Δ%) in deoxy-hemoglobyn, oxi-Hb ([O2Hb]), tissue oxygenation index, and total Hb ([HbTOT], an index of local blood volume) in the vastus lateralis were measured by near infrared spectroscopy. In addition, QT was monitored by impedance cardiography and arterial O2 saturation by pulse oximetry (SpO2). There were significant improvements in exercise tolerance (Tlim) with PAV. Blood lactate, leg effort/Tlim and dyspnea/Tlim were lower with PAV compared with sham ventilation ( P < 0.05). There were no significant effects of RM unloading on systemic O2 delivery as QT and SpO2 at submaximal exercise and at Tlim did not differ between PAV and sham ventilation ( P > 0.05). Unloaded breathing, however, was related to enhanced leg muscle oxygenation and local blood volume compared with sham, i.e., higher Δ[O2Hb]% and Δ[HbTOT]%, respectively ( P < 0.05). We conclude that RM unloading had beneficial effects on the oxygenation status and blood volume of the exercising muscles at similar systemic O2 delivery in patients with advanced CHF. These data suggest that blood flow was redistributed from respiratory to locomotor muscles during unloaded breathing.

Glycolytic activation at the onset of contractions in isolated Xenopus laevis single myofibres

Intracellular pH (pHi) was measured in isolated Xenopus laevis single myofibres at the onset of contractions, with and without glycolytic blockade, to investigate the time course of glycolytic activation. Single myofibres (n=8; CON) were incubated in 2',7'-bis(carboxyethyl)-5(6)-carboxyfluorescein acetoyxmethyl ester (10 microM; for fluorescence measurement of pHi) and stimulated for 15 s at 0.67 Hz in anoxia in the absence (control condition; CON) and presence of a glycolytic inhibitor (1 mM iodoacetic acid; IAA). Intracellular pHi and tension were continuously recorded, and the differences in pHi between conditions were used to estimate the activation time of glycolysis. An immediate and steady increase in pHi (initial alkalosis) at the onset of contractions was similar between CON and IAA trials for the first 9 s of the contractile bout. However, from six contractions (approximately 10 s) throughout the remainder of the bout, IAA demonstrated a continued rise in pHi, in contrast to a progressive decrease in pHi in CON (P<0.05). These results demonstrate, with high temporal resolution, that glycolysis is activated within six contractions (10 s at 0.67 Hz) in single Xenopus skeletal muscle fibres.

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

Near-infrared spectroscopy (NIRS) was initiated in 1977 by Jobsis as a simple, noninvasive method for measuring the presence of oxygen in muscle and other tissues in vivo. This review honoring Jobsis highlights the progress that has been made in developing and adapting NIRS and NIR imaging (NIRI) technologies for evaluating skeletal muscle O(2) dynamics and oxidative energy metabolism. Development of NIRS/NIRI technologies has included novel approaches to quantification of the signal, as well as the addition of multiple source detector pairs for imaging. Adaptation of NIRS technology has focused on the validity and reliability of NIRS measurements. NIRS measurements have been extended to resting, ischemic, localized exercise, and whole body exercise conditions. In addition, NIRS technology has been applied to the study of a number of chronic health conditions, including patients with chronic heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, varying muscle diseases, spinal cord injury, and renal failure. As NIRS technology continues to evolve, the study of skeletal muscle function with NIRS first illuminated by Jobsis continues to be bright.

Principles, techniques, and limitations of near infrared spectroscopy

In the last decade the study of the human brain and muscle energetics underwent a radical change, thanks to the progressive introduction of noninvasive techniques, including near-infrared (NIR) spectroscopy (NIRS). This review summarizes the most recent literature about the principles, techniques, advantages, limitations, and applications of NIRS in exercise physiology and neuroscience. The main NIRS instrumentations and measurable parameters will be reported. NIR light (700-1000 m) penetrates superficial layers (skin, subcutaneous fat, skull, etc.) and is either absorbed by chromophores (oxy- and deoxyhemoglobin and myoglobin) or scattered within the tissue. NIRS is a noninvasive and relatively low-cost optical technique that is becoming a widely used instrument for measuring tissue O2 saturation, changes in hemoglobin volume and, indirectly, brain/muscle blood flow and muscle O2 consumption. Tissue O2 saturation represents a dynamic balance between O2 supply and O2 consumption in the small vessels such as the capillary, arteriolar, and venular bed. The possibility of measuring the cortical activation in response to different stimuli, and the changes in the cortical cytochrome oxidase redox state upon O2 delivery changes, will also be mentioned.

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.

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.

Non-invasive quantitative assessment of oxidative metabolism in quadriceps muscles by near infrared spectroscopy

BACKGROUND

Near infrared spectroscopy can be used in non-invasive monitoring of changes in skeletal muscle oxygenation in exercising subjects.

OBJECTIVE

To evaluate whether this method can be used to assess metabolic capacity of muscles. Two distinctive variables abstracted from a curve of changes in muscle oxygenation were assessed.

METHODS

Exercise on a cycle ergometer was performed by 18 elite male athletes and eight healthy young men. A measuring probe was placed on the skin of the quadriceps muscle to measure reflected light at two wavelengths (760 and 850 nm), so that the relative index of muscle oxygenation could be calculated. Exercise intensity was increased from 50 W in 50 W increments until the subject was exhausted. During exercise, changes in muscle oxygenation and blood lactate concentration were recorded. The following two variables for assessment of muscle oxygenation were then abstracted and analysed by plotting curves of changes in muscle oxygenation: the rate of recovery of muscle oxygen saturation (R(R)) and the relative value of the effective decrease in muscle oxygenation (D(eff)).

RESULTS

Data analysis showed a correlation between muscle oxygenation and blood lactate concentration at the various exercise intensities and verified the feasibility of the experiment. Data for the athletes were compared with those for the controls using the Aspin-Welch test of significance; t = 2.3 and 2.86 for R(R) and D(eff) respectively. There were significant differences (p = 0.05) between the athletes and the control group with respect to these two variables.

CONCLUSION

R(R) and D(eff) may be distinctive variables that can be used to characterise muscle oxidative metabolism during human body movement.

Contact-free spectroscopy of leg ulcers: principle, technique, and calculation of spectroscopic wound scores

Objective wound monitoring is an essential tool for evidence-based medicine in leg ulcers and other chronic wounds. Non-invasive and contact-free optical remittance spectroscopy seems to be a useful approach as it can provide additional information with respect to more traditional techniques of wound scoring. Twenty-three patients with chronic venous, arterial, and mixed leg ulcers were enrolled in this study. The clinical state of the ulcers was documented by a clinical wound score (quantity, color, and consistency of granulation tissue). The spectroscopic readings were performed with a novel diode-array spectrometer system in the visible and near-infrared range of the spectrum (400-1600 nm) with a resolution of 5 nm. The wound spectra mainly depend on the absorption of hemoglobin and water. The maximum correlation coefficients of mean remittance spectra with the clinical wound scores did not exceed +/- 0.5. Discriminant and cluster analysis were applied for spectral classification of wound scores. By using cross-validation the percentage of correct predicted wound scores was about 69%. Our results indicate that the application of optical visible and near-infrared spectroscopy could be a valuable remedy for the clinician.

Localized oxygen use of healthy and low back pain individuals during controlled trunk movements

Individuals who have low back pain (LBP) have significantly different motion characteristics than healthy individuals. However, the cause of these differences is unknown. Oxygen use of the erector spinae muscle was examined while simultaneously monitoring motion characteristics to determine whether oxygen use differed between healthy and LBP individuals. Thirty volunteers were classified as healthy, structural, or muscular-based LBP. A near-infrared spectrometer monitored oxygen use and blood volume in the lumbar region. Results showed significant differences in oxygen use but not blood volume between healthy and LBP subjects with muscular-based disorders. Inability of the muscular group to use oxygen in a manner similar to the healthy group indicates different processes at the tissue level, indicating that differences in oxygen use may provide insight into why motion patterns differ between healthy and LBP groups.

Effect of eccentric exercise on muscle oxidative metabolism in humans

PURPOSE

The purpose of this study was to evaluate the effects of eccentric exercise on muscle oxidative function.

METHODS

Thirteen subjects performed high-intensity eccentric cycling for 30 min. Muscle oxidative function in vastus lateralis was evaluated by measurements of respiration in permeabilized muscle fibers (skinned fibers) and from the kinetics of oxyhemoglobin (oxyHb) saturation measured with near infrared spectroscopy (NIRS).

RESULTS

After eccentric cycling, all subjects reported extensive delayed onset muscle soreness (DOMS), but plasma markers of muscle damage (creatine kinase and beta-glucuronidase activity) were not significantly altered. The half time of oxyHb desaturation after circulatory occlusion (128 +/- 11 s, mean +/- SE) and oxyHb resaturation after restoration of blood flow (13.8 +/- 0.7 s) were not significantly changed after eccentric cycling (N = 7). Respiration in skinned muscle fibers measured in the absence of ADP and in the presence of a submaximal (0.1 mM) or maximal ADP concentration (1 mM) was not significantly changed after eccentric cycling (N = 6). The sensitivity of respiration to ADP was not significantly changed after eccentric cycling.

CONCLUSIONS

Muscle oxidative function (maximal respiration and respiratory control by ADP) was not compromised after high-intensity eccentric cycle exercise. Furthermore, NIRS indicates that after eccentric cycling muscle oxygen utilization and local oxygen transport at rest are unchanged. It is concluded that eccentric cycling, although causing DOMS, does not negatively affect skeletal muscle oxidative function.

Validity of NIR spectroscopy for quantitatively measuring muscle oxidative metabolic rate in exercise

The purpose of this study was to examine the validity of the quantitative measurement of muscle oxidative metabolism in exercise by near-infrared continuous-wave spectroscopy (NIRcws). Twelve male subjects performed two bouts of dynamic handgrip exercise, once for the NIRcws measurement and once for the (31)P-magnetic resonance spectroscopy (MRS) measurement as a standard measure. The resting muscle metabolic rate (RMRmus) was independently measured by (31)P-MRS during 15 min of arterial occlusion at rest. During the first exercise bout, the quantitative value of muscle oxidative metabolic rate at 30 s postexercise was evaluated from the ratio of the rate of oxyhemoglobin/myoglobin decline measured by NIRcws during arterial occlusion 30 s after exercise and the rate at rest. Therefore, the absolute values of muscle oxidative metabolic rate at 30 s after exercise [VO(2NIR(30))] was calculated from this ratio multiplied by RMRmus. During the second exercise bout, creatine phosphate (PCr) resynthesis rate was measured by (31)P-MRS at 30 s postexercise [Q((30))] under the same conditions but without arterial occlusion postexercise. To determine the validity of NIRcws, VO(2NIR(30)) was compared with Q((30)). There was a significant correlation between VO(2NIR(30)), which ranged between 0.018 and 0. 187 mM ATP/s, and Q((30)), which ranged between 0.041 and 0.209 mM ATP/s (r = 0.965, P < 0.001). This result supports the application of NIRcws to quantitatively evaluate muscle oxidative metabolic rate in exercise.

Assessment of muscle oxygenation in the horse by near infrared spectroscopy

This study examined the ability of near infrared spectroscopy (NIRS) to noninvasively determine changes to muscle oxygenation in the resting horse. Five horses had (NIRS) performed over extremity muscle while under general anaesthesia, first with 8 min limb ischaemia, then systemic hypoxaemia for 5 min. A second group of 6 awake horses had NIRS performed over extremity muscle while being administered hypoxic gas (F(I)O2 0.10) for 5 min, and after return to steady state, limb ischaemia was induced for an additional 5 min. In the anaesthetised horses' ischaemia induced marked and significant muscle deoxygenation of haemoglobin/myoglobin (P<0.01), with corresponding arterial saturation decreasing from 98.9 to 81.9%. Hypoxaemia induced small yet significant muscle deoxygenation (P<0.01) that was 3.2% of the ischaemia deoxygenation signal, with a corresponding decrease in arterial saturation from 98.6 to 90.4%. In the awake horses muscle deoxygenation was not detectable during hypoxia despite reduction of arterial saturation from 97.8 to 86.8%, whereas ischaemia induced rapid and significant deoxygenation of muscle (P<0.05), with corresponding reduction of venous saturation from 78.4 to 75.4%. In neither group of horses was there evidence of cytochrome aa3 reduction, despite complete ischaemia for up to 8 min. NIRS changes in the resting horse muscle clearly differed between ischaemia and hypoxaemia, and can readily show muscle deoxygenation in clinically relevant hypoxaemia in the horse under anaesthesia. Further, as the deoxygenation signal induced by ischaemia was clearly detectable above a background movement artefact, NIRS application to study of muscle oxygenation in the working horse should be explored.

Non-P(i) buffer capacity and initial phosphocreatine breakdown and resynthesis kinetics of human gastrocnemius/soleus muscle groups using 0.5 s time-resolved (31)P MRS at 4.1 T

High-time-resolution (0.5 s) (31)P MRS has been used to evaluate the initial phosphoreatine (PCr) breakdown and resynthesis kinetics, to calculate the non-P(i)(/non-bicarbonate) buffer capacity (betanon-P(i)(/non-bicarb)), and to calculate the constant relating the change in intracellular pH to the muscle's H(+) efflux rate (lambda). The slope of PCr vs time demonstrates that a slope calculated using the first 10 s of recovery underestimates initial PCr recovery rates by up to 56%. A 1-2 s time window is needed to produce a slope that is statistically equivalent to the slope measured using a 0.5 s time window (p = 0.008, one-way RM-ANOVA, Student-Newman-Keuls multiple comparison test). In addition, there was no delay or acceleration in PCr recovery after a 90 s maximum voluntary contraction (MVC) in normal subjects. This demonstrates that oxidative metabolism is occurring at the end of a 90-s MVC in normal individuals. Fitting recovery data has determined that betanon-P(i)(/non-bicarb) = 24.3 +/- 5.4 slyke (mmol/L/pH unit) and that lambda = 0.129 +/- 0.077 mM/(ph s) for human gastrocnemius/soleus muscle. betanon-P(i)(/non-bicarb) is in agreement with measurements in cat biceps, cat soleus and rat gastrocnemius muscles.

Non-invasive optical monitoring of the newborn piglet brain using continuous-wave and frequency-domain spectroscopy

We have used continuous-wave (CW) and frequency-domain spectroscopy to investigate the optical properties of the newborn piglet brain in vivo and non-invasively. Three anaesthetized, intubated, ventilated and instrumented newborn piglets were placed into a stereotaxic instrument for optimal experimental stability, reproducible probe-to-scalp optical contact and 3D adjustment of the optical probe. By measuring the absolute values of the brain absorption and reduced scattering coefficients at two wavelengths (758 and 830 nm), frequency-domain spectroscopy provided absolute readings (in contrast to the relative readings of CW spectroscopy) of cerebral haemoglobin concentration and saturation during experimentally induced perturbations in cerebral haemodynamics and oxygenation. Such perturbations included a modulation of the inspired oxygen concentration, transient brain asphyxia, carotid artery occlusion and terminal brain asphyxia. The baseline cerebral haemoglobin saturation and concentration, measured with frequency-domain spectroscopy, were about 60% and 42 microM respectively. The cerebral saturation values ranged from a minimum of 17% (during transient brain asphyxia) to a maximum of 80% (during recovery from transient brain asphyxia). To analyse the CW optical data, we have (a) derived a mathematical relationship between the cerebral optical properties and the differential pathlength factor and (b) introduced a method based on the spatial dependence of the detected intensity (dc slope method). The analysis of the cerebral optical signals associated with the arterial pulse and with respiration demonstrates that motion artefacts can significantly affect the intensity recorded from a single optode pair. Motion artefacts can be strongly reduced by combining data from multiple optodes to provide relative readings in the dc slope method. We also report significant biphasic changes (initial decrease and successive increase) in the reduced scattering coefficient measured in the brain after the piglet had been sacrificed.

Comparison of femoral blood gases and muscle near-infrared spectroscopy at exercise onset in humans

We hypothesized that near-infrared spectroscopy (NIRS) measures of hemoglobin and/or myoglobin O2 saturation (IR-SO2) in the vascular bed of exercising muscle would parallel changes in femoral venous O2 saturation (SfvO2) at the onset of leg-kicking exercise in humans. Six healthy subjects performed transitions from rest to 48 +/- 3 (SE)-W two-legged kicking exercise while breathing 14, 21, or 70% inspired O2. IR-SO2 was measured over the vastus lateralis muscle continuously during all tests, and femoral venous and radial artery blood samples were drawn simultaneously during rest and during 5 min of exercise. In all gas-breathing conditions, there was a rapid decrease in both IR-SO2 and SfvO2 at the onset of moderate-intensity leg-kicking exercise. Although SfvO2 remained at low levels throughout exercise, IR-SO2 increased significantly after the first minute of exercise in both normoxia and hyperoxia. Contrary to the hypothesis, these data show that NIRS does not provide a reliable estimate of hemoglobin and/or O2 saturation as reflected by direct femoral vein sampling.

Neutrophil activation and severity of tissue hypoxia during tourniquet-induced forearm ischemia in man

Neutrophil activation and adhesion to the endothelium are thought to be central in the inflammatory response to reperfusion after ischemia. This study explores whether the severity of tissue hypoxia can be related to a biochemical measure. Venous blood was sampled from 20 volunteers undergoing tourniquet-induced forearm ischemia for 10 min and subsequent reperfusion. Samples were analyzed for neutrophil count, neutrophil hydrogen peroxide generation measured by flow cytometry, plasma thromboxane (a marker of platelet activation), the endogenous antioxidant glutathione peroxidase, and thrombomodulin, a marker of endothelial cell damage. Forearm oxygen saturation by near-infrared spectroscopy was monitored throughout the experiment. Neutrophil hydrogen peroxide generation fell from an initial mean fluorescent intensity (MFI) of 0.91 +/- 0.07 to 0.77 +/- 0.09 (mean +/- SE) during ischemia (P < 0.05) and this reduction correlated with severity of hypoxia (r = 0.56, P < 0.01). Plasma levels of glutathione peroxidase were also reduced during ischemia (P < 0.05) whereas plasma thromboxane levels rose (P < 0.05). There were no significant changes in plasma levels of thrombomodulin or circulating neutrophil count. In conclusion, alterations in a measurement of neutrophil function reflect the changes in tissue oxygenation and may act as a biochemical predictor of the severity of an ischemic injury.

Muscle oxygenation trends during constant work rate cycle exercise in men and women

PURPOSE

To examine the relationship between muscle oxygenation and arteriovenous oxygen difference [(a - v)O2diff)] at four constant rate workloads in healthy men and women and to compare these responses between the genders.

METHODS

Nineteen men and 14 women consented to perform an incremental test to identify the lactic acidosis threshold (LAT) and maximal aerobic power (VO2max) and an intermittent constant work rate test at an oxygen uptake corresponding to 40% LAT, 80% LAT, 25% LAT-VO2max, and 50% LAT-VO2max. Each exercise interval was 5 min long followed by 2 min of recovery. Cardiac output was measured by CO2 rebreathing at each workload from which (a - v)O2diff was computed. Tissue absorbency was measured from the vastus lateralis in both the test sessions using near infrared spectroscopy (NIRS). Muscle oxygenation during constant work rate exercise and recovery was expressed as a percentage (%Mox) of the maximum range observed during incremental exercise and recovery.

RESULTS

A systematic decrease was observed in %Mox with increasing intensity, followed by a proportional increase during recovery from each exercise bout. Significant inverse relationships were observed between %Mox and (a - v)O2diff in men (r = -0.34) and women (r = -0.31) across the four intensities. Mean %Mox was significantly higher (P < 0.05) in women compared with men, suggesting lesser deoxygenation at the same relative exercise intensity.

CONCLUSIONS

%Mox was not an accurate predictor of mixed (a - v)O2diff during exercise because of the low common variance between these two variables, and it is unclear whether the gender difference in %Mox is a true physiological phenomenon or whether it is an artifact of the NIRS technique.

Evidence of muscle BOLD effect revealed by simultaneous interleaved gradient-echo NMRI and myoglobin NMRS during leg ischemia

The purpose of this work was to investigate the temporal relationship between intensity changes in T2*-weighted NMR images and tissue oxygen content, measured by myoglobin proton NMR spectroscopy, in the skeletal muscle. During an ischemic stress test, the calf muscles of five healthy volunteers were studied at 3 Tesla. An interleaved NMRI-NMRS sequence was used, which made it possible to record T2*-weighted images and myoglobin spectra simultaneously. During ischemia, rapid changes in muscle signal intensity were observed on T2*-weighted images, which immediately preceded myoglobin desaturation. Bearing in mind the respective P50 of hemoglobin and myoglobin, this observation clearly favored the hypothesis that hemoglobin desaturation was responsible for the changes in T2*. This interpretation was further supported by the temporal coincidence between the experimental NMR data and a model of hemoglobin desaturation solely derived from physiological considerations.

Simultaneous measurement of perfusion and oxygenation changes using a multiple gradient-echo sequence: application to human muscle study

We have developed a magnetic resonance imaging (MRI) technique based on a multiple gradient-echo sequence designed to probe perfusion and oxygenation simultaneously within skeletal muscle. Processing of the images acquired at successive echo times (TEs) generates two functional maps: one of the signal intensity (SI) extrapolated to zero echo time, which is sensitive to perfusion; and a second one of R2*, which reflects oxygenation. An advantage of the processing procedure lies in the selection of tissue of interest through the profile of T2* decay, leading to automatic rejection of pixels containing small vessels. This allows a more specific assessment of tissue perfusion and oxygenation. This technique was demonstrated successfully during post-ischemic reactive hyperemia in human calf. A perfusion peak of 123 mL x 100 g(-)1 x min(-1) was measured immediately after ischemia, whereas R2* value showed an 11.5% decrease at the same time, essentially reflecting blood oxygenation changes. Differences in the time courses of reperfusion and re-oxygenation were observed, oxygenation presenting a slower recovery. The mechanisms responsible for such a differential dynamic response are discussed.

Near infrared spectroscopy for non-invasive assessment of intracranial haemoglobin oxygenation in an in vitro model of the calf head

An in vitro model of the calf head was used to examine the ability of near infrared spectroscopy (NIRS) to non-invasively determine oxygenation events within the calf head. The brains were removed from 16 calf skulls and replaced with oxygenated dilutions of calf blood that had the oxygen progressively decreased from PO2 > 110 mmHg to < 10 mmHg. Appropriate placement of the lighting source and sensor (optodes) was examined, as were the influences of skull thickness and overlying skin of the skull (including colour). The changes in haemaglobin oxygenation in the model calf head, as observed by NIRS, were highly correlated to PO2 changes in all 16 calf skulls examined (mean r2=0.91, range 0.71 to 0.99). There was a trend for optode positioning to achieve optimal NIRS signals over the middle of the frontal bone in a longitudinal axis and with optodes spaced 4 cm apart, but with the large variation between calf heads this was not shown to be significantly different from other sites tested. The presence of skin over the skull had a significant damping effect on the NIRS signal when compared with the bare skull (P<0.01) but it was not possible to detect a difference in this damping effect between black and white coloured skin. All but the two thickest skulls (13 and 14 mm frontal bone thickness) appeared to allow sufficiently strong NIRS signals of changes in haemoglobin oxygenation. This study showed that NIRS can be used for non-invasive study of oxygenation events within the cranial cavity of calves, and established some guidelines and limitations for its use in this species.

Detection of ventilatory threshold using near infrared spectroscopy in men and women

The onset of anaerobic (lactate) metabolism during incremental exercise, which may be a result of an imbalance between tissue oxygen supply and demand, has been associated with the gas exchange ventilatory threshold (VT). This study was designed to examine whether near infrared spectroscopy (NIRS) could be used to detect the VT in healthy subjects. Twenty-one men and 19 women completed incremental cycle ergometry during which NIRS measurements were obtained from the right vastus lateralis and gas exchange measurements were monitored simultaneously using a metabolic cart. The VT was identified from the metabolic data by the V-slope method and from NIRS data as the intensity at which tissue absorbency crossed the resting baseline value observed immediately prior to the initiation of exercise. Pearson correlations for the relative oxygen uptake and power output observed for the two methods of detecting VT were 0.90 and 0.88, respectively, in men and 0.89 and 0.86, respectively, in women (P < 0.01). No significant differences were observed between the two methods of detecting VT for any of the physiological responses (P > 0.05). No significant (P > 0.05) gender differences were observed in muscle oxygenation values at the VT, 32% in men and 38% in women. These results validate the use of NIRS as an alternate noninvasive method for detecting VT during cycle exercise in healthy subjects.

The increase of duration of isometric contraction may not relate to change of relative oxygenation of forearm muscle

The aim of this study is to ascertain, how an increase in duration of isometric contraction influences tissue oxygenation of forearm muscles, undergoing physical training. Four subjects underwent 6 weeks of training of the left forearm muscles by performing isometric contractions. Subjects repeated 10 s contractions, 10-15 times in the first, and 20 s contractions in the second 3 week period. Relative oxygenation of forearm muscles was measured by using. Near Infrared Spectroscopy (CWS2000, NIM Incorporated, Philadelphia). The training increased the duration of isometric contraction at 20 kp of experimental forearm muscles by 41 +/- 25 s, which was more (P < 0.05) than in control forearm (8 +/- 4 s). This increase was not reflected in changes of maximum relative deoxygenation of experimental muscles, which decreased by only -6.9 +/- 14.4%. The results show that an increase in duration of isometric contraction may not depend on the oxygenation of muscle tissue at fixed force of 20 kp.

Glycolytic ATP production estimated from 31P magnetic resonance spectroscopy measurements during ischemic exercise in vivo

In an oxygen-depleted muscle, glycolytically produced ATP is inversely related to the ([ATP]+ creatine phosphate [PCr]) decrease because ATP, PCr, and glycolysis are virtually the only energy sources under these conditions. In particular, the onset of glycolysis or any appreciable increase in the rate of glycolytic ATP production will lead to a slower rate of ([ATP]+ [PCr]) breakdown at a given energy consumption. To quantify this relationship, endurance athletes performed isometric foot plantar flexion (20% of a test force [TF], n = 10; 50% TF, n = 5) during local arterial occlusion. Parameters of energy metabolism were measured with 31P magnetic resonance spectroscopy (31P-MRS). During exercise, [PCr] decreased to 80 +/- 10 (20% TF) and 11 +/- 4% (50% TF) of its resting concentration, and pH dropped from 7.04 +/- 0.01 to 6.98 +/- 0.10 (20% TF) and from 7.03 +/- 0.02 to 6.70 +/- 0.10 (50% TF). In both experiments, two phases of ([ATP]+ [PCr]) decrease were observed: an initial faster decrease was followed by a slower decline. The latter phase started at about the time when the pH began to drop. The difference between a line extrapolated from the slope of the initial phase and the measured ([ATP]+[PCr]) decrease was used as an estimate for glycolytically produced ATP. This estimate and pH were significantly correlated with r = -0.97 (20% TF) and r = -0.99 (50% TF). These results indicate that glycolytically produced ATP can be estimated from the ([ATP]+ [PCr]) decrease during exercise.

Determination of oxygen consumption in muscle during exercise using near infrared spectroscopy

The aim of this study was to determine oxygen consumption (VO2) during isometric exercise in human muscles using near infrared spectroscopy (NIRS). The technique was used to study the relationship between VO2 in the soleus muscle and the level of isometric exercise expressed as percentages of the maximum voluntary contraction (MVC). For the study 11 healthy male volunteers were recruited. Reproducibility was studied in 6 subjects. The subjects were seated in a chair with the knee joint at an angle of 90 degrees. The optodes of the NIRS instrument were attached to the lateral aspect of the soleus muscle. A horizontal bar above the knee was connected to a dynamometer. Subjects applied isometric force to the bar by producing a torque at the ankle joint. Firstly the MVC was determined. Secondly the VO2 at rest and at 5 levels of isometric exercise, ranging from 5% to 25% of MVC and increasing by 5% each stage, was measured. In all cases the VO2 at rest or during isometric contraction was determined from the decrease of the oxyhaemoglobin (O2Hb) signal immediately after arterial occlusion of the thigh. Repeated measurements showed no significant difference between trials, indicating that the measurements were reproducible. At rest a VO2 of 6.7 +/- 1.1 microMO2Hb.min-1 (mean +/- S.E.M.) was found, a result comparable with other studies. In all subjects a linear relationship was found between the VO2 and the level of exercise. The average slope of the regression lines of all individuals was 0.85 +/- 0.22 microMO2Hb.min-1.%MVC-1 (mean +/- S.E.M.). Inter-individual variation of the slopes was high and ranged from 0.28 to 2.29 microMO.Hb.min-1.%MVC-1, which can be explained by differences in fat percentage and in the measuring volume of the NIRS instrument. NIRS appeared to be a reproducible and reliable method for the non-invasive measurement of VO2 in human muscles. The method could be used to investigate regional differences as well as changes in time between muscle groups as a function of training.