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Machfer A, Tagougui S, Zghal F, Hassen HBH, Fekih N, Amor HIH, Chtourou H, Bouzid MA. Hemodynamic and neuromuscular basis of reduced exercise capacity in patients with end-stage renal disease. Eur J Appl Physiol 2024; 124:1991-2004. [PMID: 38374473 DOI: 10.1007/s00421-024-05427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 01/27/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE The present study aimed to characterize the exercise-induced neuromuscular fatigue and its possible links with cerebral and muscular oxygen supply and utilization to provide mechanistic insights into the reduced exercise capacity characterizing patients with end-stage renal disease (ESRD). METHODS Thirteen patients with ESRD and thirteen healthy males (CTR group) performed a constant-force sustained isometric contraction at 50% of their maximal voluntary isometric contraction (MVC) until exhaustion. Quadriceps muscle activation during exercise was estimated from vastus lateralis, vastus medialis, and rectus femoris EMG. Central and peripheral fatigue were quantified via changes in pre- to postexercise quadriceps voluntary activation (ΔVA) and quadriceps twitch force (ΔQtw,pot) evoked by supramaximal electrical stimulation, respectively. To assess cerebral and muscular oxygenation, throughout exercise, near-infrared spectroscopy allowed investigation of changes in oxyhemoglobin (∆O2Hb), deoxyhemoglobin (∆HHb), and total hemoglobin (∆THb) in the prefrontal cortex and in the vastus lateralis muscle. RESULTS ESRD patients demonstrated lower exercise time to exhaustion than that of CTR (88.8 ± 15.3 s and 119.9 ± 14.6 s, respectively, P < 0.01). Following the exercise, MVC, Qtw,pot, and VA reduction were similar between the groups (P > 0.05). There was no significant difference in muscle oxygenation (∆O2Hb) between the two groups (P > 0.05). Cerebral and muscular blood volume (∆THb) and oxygen extraction (∆HHb) were significantly blunted in the ESRD group (P < 0.05). A significant positive correlation was observed between time to exhaustion and cerebral blood volume (∆THb) in both groups (r2 = 0.64, P < 0.01). CONCLUSIONS These findings support cerebral hypoperfusion as a factor contributing to the reduction in exercise capacity characterizing ESRD patients.
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Affiliation(s)
- Amal Machfer
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
| | - Sémah Tagougui
- Université de Lille, Université d'Artois, Université du Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport, Santé, Société (URePSSS), Lille, France
- Montreal Clinical Research Institute (IRCM), Montreal, Canada
| | - Firas Zghal
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
- Université de La Réunion, IRISSE, Le Tampon, La Réunion, France
| | - Hayfa Ben Haj Hassen
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
| | - Nadia Fekih
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
| | | | - Hamdi Chtourou
- Activité Physique, Sport et Santé, UR18JS01, Observatoire National du Sport, 1003, Tunis, Tunisia
| | - Mohamed Amine Bouzid
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia.
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Stephens S, Jaffri A, Saliba S. Local microvascular tissue oxygenation of the intrinsic foot muscles in patients with diabetes: A cross-sectional case-comparison study. Foot (Edinb) 2023; 56:102035. [PMID: 37167703 DOI: 10.1016/j.foot.2023.102035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/03/2023] [Accepted: 05/06/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Foot-related complications including impaired peripheral circulation and lower limb ulceration are severe consequences for those with diabetes mellitus. This study aimed to assess differences in tissue oxygenation and oxygen utilization of the plantar surface intrinsic foot muscles between diabetic participants and healthy comparisons following short foot exercise and a standard walking protocol. METHODS Eighteen participants, 9 with diabetes and 9 healthy age- and sex-matched comparisons, completed two interventions in a randomized order. For the short foot exercise intervention, participants completed 5 sets of 15 intrinsic foot muscle contractions. For the walking intervention, participants completed a modified six-minute walk test. Tissue oxygenation variables including oxygenated hemoglobin, deoxygenated hemoglobin, and tissue saturation index were measured using near-infrared spectroscopy in quiet stance and during intrinsic foot muscle contraction cycles following each intervention. Means, standard deviations, 95 % confidence intervals, mean differences, and Cohen's d effect sizes were calculated for each tissue oxygenation variable. RESULTS The results of this study indicated no significant group differences in quiet standing tissue oxygenation measures at baseline and following each intervention. Participants in the diabetic group had significantly less change in tissue saturation index during intrinsic foot muscle contractions compared to healthy participants after the short foot exercise intervention (ES= 4.00, P = .0002) and walking intervention (ES= 1.33, P = .015). CONCLUSIONS By utilizing wireless NIRS and novel research methodology, this study was able to explore changes in plantar surface tissue oxygenation of the intrinsic foot muscles following a targeted short foot exercise intervention as well as a standard walking protocol in patients diagnosed with diabetes compared to age- and sex- matched individuals without diabetes. We identified that diabetic participants presented with less oxygen utilization during intrinsic foot muscle contractions performed following both exercise interventions compared to their healthy age- and sex- matched comparisons.
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Affiliation(s)
- Stephanie Stephens
- University of Virginia, Department of Kinesiology, Charlottesville, VA, United States.
| | - Abbis Jaffri
- Creighton University, School of Pharmacy and Health Professions, Omaha, NE, United States
| | - Susan Saliba
- University of Virginia, Department of Kinesiology, Charlottesville, VA, United States
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Joseph S, Munshi B, Agarini R, Kwok RCH, Green DJ, Jansen S. Near infrared spectroscopy in peripheral artery disease and the diabetic foot: A systematic review. Diabetes Metab Res Rev 2022; 38:e3571. [PMID: 35939767 DOI: 10.1002/dmrr.3571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/03/2022] [Accepted: 07/01/2022] [Indexed: 11/08/2022]
Abstract
With the need for tools that assess microvascular status in diabetic foot disease (DFD) being clear, near infrared spectroscopy (NIRS) is a putative method for noninvasive testing of the diabetic foot. The use of NIRS in patients with peripheral arterial disease (PAD) has extended to its role in studying the pathophysiology of DFD. NIRS generates metrics such as recovery time, deoxygenation, oxygen consumption (VO2 ), tissue oxygen saturation (StO2 ), total haemoglobin (HbT), and oxyhaemoglobin area under the curve (O2 HbAUC ). NIRS may potentially help the multidisciplinary team stratify limbs as high-risk, especially in diabetic patients with symptoms masked by peripheral neuropathy. NIRS may be useful for assessing treatment effectiveness and preventing deterioration of patients with PAD.
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Affiliation(s)
- Simon Joseph
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Bijit Munshi
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Raden Agarini
- Physiology Department, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Western Australia, Australia
| | - Ricky Chi Ho Kwok
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Western Australia, Australia
| | - Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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Holmes M, Koutakis P, Ismaeel A. Aging alters gastrocnemius muscle hemoglobin oxygen saturation (StO 2) characteristics in healthy individuals. Eur J Appl Physiol 2022; 122:1509-1520. [PMID: 35419666 DOI: 10.1007/s00421-022-04944-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/28/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Functional limitations during exercise from alterations in the balance of oxygen supply and demand-as reported by lower tissue oxygen saturation and longer recovery time-are well documented in clinical populations. We aimed to assess changes in skeletal muscle hemoglobin oxygen saturation (StO2) characteristics during exercise as a result of aging in otherwise healthy individuals. METHODS We recruited healthy male and female participants (n = 101) from three age ranges-young (18-39 years), middle age (40-65 years), and older (> 65 years)-to complete exercise tests commonly used in clinical populations. Using near-infrared spectroscopy (NIRS) we assessed StO2 in the medial gastrocnemius during the Gardner Treadmill Protocol and 6 min walk test (6MWT). RESULTS Minimum StO2 (%) during the treadmill test was significantly lower for both middle-age (36.1 ± 20.6) and older (27.3 ± 19.4) participants compared to young (46.8 ± 14.8) (p < 0.05 and p < 0.01 respectively), and recovery time (minutes) was significantly prolonged (young = 0.22 ± 0.34; middle age = 0.66 ± 0.52; older = 1.04 ± 1.00) (p < 0.001 for both middle age and older compared to young). Similar results were shown during the 6MWT, as minimum StO2 (%) was lower in middle-age (41.7 ± 17.2) and older (40.0 ± 25.9) participants compared to young (53.6 ± 14.5) (p < 0.05), and recovery times (minutes) were prolonged (young: 0.11 ± 0.17; middle age: 0.46 ± 0.42; older: 0.93 ± 0.43) (p < 0.001 for both middle age and older compared to young). Simple linear regression analyses demonstrated that age predicted treadmill recovery and 6MWT recovery. CONCLUSION Our study provides evidence that aging, even in otherwise healthy individuals, negatively impacts muscle StO2 characteristics. In older individuals, working muscle tissue may reach lower oxygen saturation during exercise and take longer to return to baseline oxygen saturation post-exercise.
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Affiliation(s)
- Michael Holmes
- Max E, Wastl Human Performance Laboratory, Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | | | - Ahmed Ismaeel
- Department of Biology, Baylor University, Waco, TX, USA.
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Evidence that large vessels do affect near infrared spectroscopy. Sci Rep 2022; 12:2155. [PMID: 35140261 PMCID: PMC8828816 DOI: 10.1038/s41598-022-05863-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/12/2022] [Indexed: 11/08/2022] Open
Abstract
The influence of large vessels on near infrared spectroscopy (NIRS) measurement is generally considered negligible. Aim of this study is to test the hypothesis that changes in the vessel size, by varying the amount of absorbed NIR light, could profoundly affect NIRS blood volume indexes. Changes in haemoglobin concentration (tHb) and in tissue haemoglobin index (THI) were monitored over the basilic vein (BV) and over the biceps muscle belly, in 11 subjects (7 M - 4 F; age 31 ± 8 year) with simultaneous ultrasound monitoring of BV size. The arm was subjected to venous occlusion, according to two pressure profiles: slow (from 0 to 60 mmHg in 135 s) and rapid (0 to 40 mmHg maintained for 30 s). Both tHb and THI detected a larger blood volume increase (1.7 to 4 fold; p < 0.01) and exhibited a faster increase and a greater convexity on the BV than on the muscle. In addition, NIRS signals from BV exhibited higher correlation with changes in BV size than from muscle (r = 0.91 vs 0.55, p < 0.001 for THI). A collection of individual relevant recordings is also included. These results challenge the long-standing belief that the NIRS measurement is unaffected by large vessels and support the concept that large veins may be a major determinant of blood volume changes in multiple experimental conditions.
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Theodorakopoulou MP, Dipla K, Zafeiridis A, Sarafidis P. Εndothelial and microvascular function in CKD: Evaluation methods and associations with outcomes. Eur J Clin Invest 2021; 51:e13557. [PMID: 33774823 DOI: 10.1111/eci.13557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cardiovascular disease is the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Endothelial dysfunction, the hallmark of atherosclerosis, is suggested to be involved pathogenetically in cardiovascular and renal disease progression in these patients. METHODS This is a narrative review presenting the techniques and markers used for assessment of microvascular and endothelial function in patients with CKD and discussing findings of the relevant studies on the associations of endothelial dysfunction with co-morbid conditions and outcomes in this population. RESULTS Venous Occlusion Plethysmography was the first method to evaluate microvascular function; subsequently, several relevant techniques have been developed and used in patients with CKD, including brachial Flow-Mediated Dilatation, and more recently, Near-Infrared Spectroscopy and Laser Speckle Contrast Analysis. Furthermore, several circulating biomarkers are commonly used in clinical research. Studies assessing endothelial function using the above techniques and biomarkers suggest that endothelial dysfunction occurs early in CKD and contributes to the target organ damage, cardiovascular events, death and progression towards end-stage kidney disease. CONCLUSIONS Older and newer functional methods and several biomarkers have assessed endothelial dysfunction in CKD; accumulated evidence supports an association of endothelial dysfunction with outcomes. Future research with new, non-invasive and easily applicable methods could further delineate the role of endothelial dysfunction on cardiovascular and renal disease progression in patients with CKD.
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Affiliation(s)
- Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Dipla
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Andreas Zafeiridis
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Theodorakopoulou MP, Schoina M, Sarafidis P. Assessment of Endothelial and Microvascular Function in CKD: Older and Newer Techniques, Associated Risk Factors, and Relations with Outcomes. Am J Nephrol 2020; 51:931-949. [PMID: 33311014 DOI: 10.1159/000512263] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endothelium is the inner cellular lining of the vessels that modulates multiple biological processes including vasomotor tone, permeability, inflammatory responses, hemostasis, and angiogenesis. Endothelial dysfunction, the basis of atherosclerosis, is characterized by an imbalance between endothelium-derived relaxing factors and endothelium-derived contracting factors. SUMMARY Starting from the semi-invasive venous occlusion plethysmography, several functional techniques have been developed to evaluate microvascular function and subsequently used in patients with CKD. Flow-mediated dilatation of the forearm is considered to be the "gold standard," while in the last years, novel, noninvasive methods such as laser speckle contrast imaging and near-infrared spectroscopy are scarcely used. Moreover, several circulating biomarkers of endothelial function have been used in studies in CKD patients. This review summarizes available functional methods and biochemical markers for the assessment of endothelial and microvascular function in CKD and discusses existing evidence on their associations with comorbid conditions and outcomes in this population. Key Messages: Accumulated evidence suggests that endothelial dysfunction occurs early in CKD and is associated with target organ damage, progression of renal injury, cardiovascular events, and mortality. Novel methods evaluating microvascular function can offer a detailed, real-time assessment of underlying phenomena and should be increasingly used to shed more light on the role of endothelial dysfunction on cardiovascular and renal disease progression in CKD.
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Affiliation(s)
- Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Schoina
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece,
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Scholkmann F, Scherer-Vrana A. Comparison of Two NIRS Tissue Oximeters (Moxy and Nimo) for Non-Invasive Assessment of Muscle Oxygenation and Perfusion. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1232:253-259. [PMID: 31893418 DOI: 10.1007/978-3-030-34461-0_32] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) tissue oximeters enable non-invasive measurement of muscle oxygenation and perfusion. Several NIRS oximeters are currently available, particularly for muscle measurements. AIM To evaluate the agreement of oxygenation and perfusion measurements obtained by two devices (Moxy, Fortiori Designs LLC, USA, and Nimo, Nirox, Italy) during an arterial occlusion test on the arm. SUBJECT AND METHODS Arterial occlusions were conducted at the arm of one individual for 10 min with 200 mmHg. Measurements were made twice a day on five different days. Both NIRS devices were fixed at the arm (covering the muscles extensor carpi ulnaris, extensor digitorum, and flexor carpi ulnaris). RESULTS The experiment revealed that i) both devices could detect changes in muscle oxygenation and perfusion during the occlusion, but ii) the magnitudes and dynamic changes differed between the two devices. DISCUSSION AND CONCLUSION Both devices had different performances with regard to the measurement of tissue oxygenation and perfusion. This study shows that it might be worthwhile to compare all NIRS tissue oximeters currently available for muscle measurement in a large systematic study to increase the comparability of measurements obtained with different devices.
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Affiliation(s)
- Felix Scholkmann
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland. .,Scholkmann Data Analysis Services, Scientific Consulting and Physical Engineering, Zurich, Switzerland.
| | - Andrea Scherer-Vrana
- Interdisciplinary Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland
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A Systematic Review of the Acute Effects of Hemodialysis on Skeletal Muscle Perfusion, Metabolism, and Function. Kidney Int Rep 2019; 5:307-317. [PMID: 32154452 PMCID: PMC7056853 DOI: 10.1016/j.ekir.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/05/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction The underlying mechanisms of skeletal muscle wasting in hemodialysis patients are complex. We performed a systematic review to summarize evidence on whether hemodialysis has acute effects on skeletal muscle perfusion, metabolism, and function. Methods The protocol was registered on PROSPERO (Registration number CRD42018103682). A systematic search was performed in MEDLINE, PubMed, Cochrane, Embase, Scopus, and Web of Science. Citation, reference list, and gray literature searches were also performed. Studies were selected in 2 stages: title and abstract review, then full-text review. Results A total of 65 full-text articles were reviewed, and 14 studies were eligible for inclusion. No studies were identified that assessed muscle perfusion during dialysis. Two studies used near-infrared spectroscopy to indirectly measure skeletal muscle oxygen consumption, which increased during dialysis in 1 study but only in patients with diabetes in the second. Metabolism was examined in 9 studies. A number of acute metabolic changes were reported (e.g., caspase-3 activity, polyubiquitin, and interleukin-6 protein increased in response to hemodialysis) as was a net negative protein balance over the dialysis session. Three studies examining muscle function did not produce consistent findings. Conclusion Gaps remain in understanding the acute effects of hemodialysis on skeletal muscle, particularly for changes in perfusion and function, although there does appear to be an acute effect on muscle metabolism.
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Gargani L, Bruni C, Barskova T, Hartwig V, Marinelli M, Trivella MG, Matucci-Cerinic M, L'Abbate A. Near-infrared spectroscopic imaging of the whole hand: A new tool to assess tissue perfusion and peripheral microcirculation in scleroderma. Semin Arthritis Rheum 2019; 48:867-873. [DOI: 10.1016/j.semarthrit.2018.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/16/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022]
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MacEwen C, Watkinson P, Tarassenko L, Pugh C. What lies downstream: Cellular oxygen delivery during hemodialysis. Semin Dial 2018; 32:232-236. [PMID: 30515918 DOI: 10.1111/sdi.12769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hemodialysis has been linked to structural and functional damage to vital organs such as the brain and heart, possibly via repetitive intradialytic organ ischemia. There is increasing recognition that tissue ischemia can occur without changes in standard hemodynamic parameters such as blood pressure, leading to interest in more direct assessment of the adequacy of oxygen delivery to tissues. In this article, we discuss our current understanding of what happens to cellular oxygen delivery during hemodialysis: we review the underlying physiology, potential measurement techniques, and the clinical literature to date.
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Affiliation(s)
- Clare MacEwen
- Oxford Kidney Unit, Oxford University Hospitals NHS Trust, Oxford, UK.,Adult Intensive Care Unit, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Peter Watkinson
- Adult Intensive Care Unit, Oxford University Hospitals NHS Trust, Oxford, UK.,Kadoorie Centre for Critical Care Research and Education, Kadoorie Centre for Critical Care Research and Education, Oxford University, Oxford, UK
| | - Lionel Tarassenko
- Department of Engineering Science, Institute of Biomedical Engineering, Oxford University, Oxford, UK
| | - Christopher Pugh
- Oxford Kidney Unit, Oxford University Hospitals NHS Trust, Oxford, UK.,Nuffield Department of Medicine, Oxford University, Oxford, UK
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Characterising skeletal muscle haemoglobin saturation during exercise using near-infrared spectroscopy in chronic kidney disease. Clin Exp Nephrol 2018; 23:32-42. [PMID: 29961156 PMCID: PMC6344386 DOI: 10.1007/s10157-018-1612-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022]
Abstract
Background Chronic kidney disease (CKD) patients have reduced exercise capacity. Possible contributing factors may include impaired muscle O2 utilisation through reduced mitochondria number and/or function slowing the restoration of muscle ATP concentrations via oxidative phosphorylation. Using near-infrared spectroscopy (NIRS), we explored changes in skeletal muscle haemoglobin/myoglobin O2 saturation (SMO2%) during exercise. Methods 24 CKD patients [58.3 (± 16.5) years, eGFR 56.4 (± 22.3) ml/min/1.73 m2] completed the incremental shuttle walk test (ISWT) as a marker of exercise capacity. Using NIRS, SMO2% was measured continuously before, during, and after (recovery) exercise. Exploratory differences were investigated between exercise capacity tertiles in CKD, and compared with six healthy controls. Results We identified two discrete phases; a decline in SMO2% during incremental exercise, followed by rapid increase upon cessation (recovery). Compared to patients with low exercise capacity [distance walked during ISWT, 269.0 (± 35.9) m], patients with a higher exercise capacity [727.1 (± 38.1) m] took 45% longer to reach their minimum SMO2% (P = .038) and recovered (half-time recovery) 79% faster (P = .046). Compared to controls, CKD patients took significantly 56% longer to recover (i.e., restore SMO2% to baseline, full recovery) (P = .014). Conclusions Using NIRS, we have determined for the first time in CKD, that favourable SMO2% kinetics (slower deoxygenation rate, quicker recovery) are associated with greater exercise capacity. These dysfunctional kinetics may indicate reduced mitochondria capacity to perform oxidative phosphorylation—a process essential for carrying out even simple activities of daily living. Accordingly, NIRS may provide a simple, low cost, and non-invasive means to evaluate muscle O2 kinetics in CKD.
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Evaluation of Skeletal Muscle Function and Effects of Early Rehabilitation during Acute Heart Failure: Rationale and Study Design. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6982897. [PMID: 29721510 PMCID: PMC5867689 DOI: 10.1155/2018/6982897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/07/2018] [Accepted: 02/11/2018] [Indexed: 12/17/2022]
Abstract
Background Acute heart failure (AHF) is associated with disturbances of the peripheral perfusion leading to the dysfunction of many organs. Consequently, an episode of AHF constitutes a “multiple organ failure” which may also affect the skeletal muscles. However, the abnormalities within skeletal muscles during AHF have not been investigated so far. The aim of this project is to comprehensively evaluate skeletal muscles (at a functional and tissue level) during AHF. Methods The study will include ≥63 consecutive AHF patients who will be randomized into 2 groups: ≥42 with cardiac rehabilitation group versus ≥21 with standard pharmacotherapy alone. The following tests will be conducted on the first and last day of hospitalization, at rest and after exercise, and 30 days following the discharge: clinical evaluation, medical interview, routine physical examination, echocardiography, and laboratory tests (including the assessment of NT-proBNP, inflammatory markers, and parameters reflecting the status of the kidneys and the liver); hemodynamic evaluation, noninvasive determination of cardiac output and systemic vascular resistance using the impedance cardiography; evaluation of biomarkers reflecting myocyte damage, immunochemical measurements of tissue-specific enzymatic isoforms; evaluation of skeletal muscle function, using surface electromyography (sEMG) (maximum tonus of the muscles will be determined along with the level of muscular fatigability); evaluation of muscle tissue perfusion, assessed on the basis of the oxygenation level, with noninvasive direct continuous recording of perfusion in peripheral tissues by local tissue oximetry, measured by near-infrared spectroscopy (NIRS). Results and Conclusions Our findings will demonstrate that the muscle tissue is another area of the body which should be taken into consideration in the course of treatment of AHF, requiring a development of targeted therapeutic strategies, such as a properly conducted rehabilitation.
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Miyazawa H, Ookawara S, Ito K, Yanai K, Ishii H, Kitano T, Shindo M, Ueda Y, Kaku Y, Hirai K, Hoshino T, Tabei K, Morishita Y. Factors associating with oxygenation of lower-limb muscle tissue in hemodialysis patients. World J Nephrol 2016; 5:524-530. [PMID: 27872834 PMCID: PMC5099598 DOI: 10.5527/wjn.v5.i6.524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/18/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the lower-limb muscle oxygenation in hemodialysis (HD) patients and identify the factors associating with muscle oxygenation.
METHODS Sixty-seven HD patients (53 men and 14 women; mean age, 67.1 ± 1.2 years; mean HD duration, 5.6 ± 0.9 years) were recruited. In addition, 15 healthy individuals (nine men and six women; mean age, 38.2 ± 4.6 years) were recruited as the control group. Lower-limb muscle regional saturation of oxygen (rSO2) was monitored on the lateral side of the gastrocnemius muscle before HD using an INVOS 5100C (Covidien Japan, Tokyo, Japan), which utilizes near-infrared spectroscopy. Here, we evaluated the association between lower-limb muscle rSO2 and clinical parameters.
RESULTS The rSO2 values were significantly lower in patients undergoing HD than in healthy individuals (50.0% ± 1.7% vs 76.8% ± 2.5%, P < 0.001). Lower-limb muscle rSO2 showed significant positive correlations with diastolic blood pressure, blood urea nitrogen concentration, serum creatinine concentration, serum potassium concentration, serum inorganic phosphate concentration, and serum albumin concentration as well as negative correlation with HD duration. We conducted a multiple linear regression analysis using parameters that were significantly correlated with the lower-limb muscle rSO2 in a simple linear regression analysis. Multiple regression analysis demonstrated that lower-limb muscle rSO2 was independently associated with serum inorganic phosphate (standardized coefficient: 0.27) and serum albumin concentrations (standardized coefficient: 0.24). In addition, there were no differences in lower-limb muscle rSO2 between diabetic and non-diabetic HD patients. This study has several limitations. Firstly, its sample size was relatively small. Secondly, we could not evaluate the association between lower-limb muscle rSO2 and calculated nutritional markers, including normalized protein catabolic rate and body mass index, anthropometric measurements representing nutritional status, and the severity of protein-energy wasting. Finally, we did not routinely examine the arterial vascular status of HD patients without symptoms of peripheral artery disease. As such, it is possible that some HD patients with subclinical peripheral artery disease may have been included in this study.
CONCLUSION In HD patients, the oxygenation of lower-limb muscle tissue was associated with serum inorganic phosphate and albumin concentrations, both of which represent nutritional status.
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Nugent WH, Song BK, Pittman RN, Golub AS. Simultaneous sampling of tissue oxygenation and oxygen consumption in skeletal muscle. Microvasc Res 2015; 105:15-22. [PMID: 26683232 DOI: 10.1016/j.mvr.2015.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 12/08/2015] [Accepted: 12/08/2015] [Indexed: 01/07/2023]
Abstract
Under physiologic conditions, microvascular oxygen delivery appears to be well matched to oxygen consumption in respiring tissues. We present a technique to measure interstitial oxygen tension (PISFO2) and oxygen consumption (VO2) under steady-state conditions, as well as during the transitions from rest to activity and back. Phosphorescence Quenching Microscopy (PQM) was employed with pneumatic compression cycling to achieve 1 to 10 Hz sampling rates of interstitial PO2 and simultaneous recurrent sampling of VO2 (3/min) in the exteriorized rat spinotrapezius muscle. The compression pressure was optimized to 120-130 mmHg without adverse effect on the tissue preparation. A cycle of 5s compression followed by 15s recovery yielded a resting VO2 of 0.98 ± 0.03 ml O2/100 cm(3)min while preserving microvascular oxygen delivery. The measurement system was then used to assess VO2 dependence on PISFO2 at rest and further tested under conditions of isometric muscle contraction to demonstrate a robust ability to monitor the on-kinetics of tissue respiration and the compensatory changes in PISFO2 during contraction and recovery. The temporal and spatial resolution of this approach is well suited to studies seeking to characterize microvascular oxygen supply and demand in thin tissues.
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Affiliation(s)
- William H Nugent
- Department of Physiology and Biophysics, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Bjorn K Song
- Department of Physiology and Biophysics, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Roland N Pittman
- Department of Physiology and Biophysics, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA 23298, USA.
| | - Aleksander S Golub
- Department of Physiology and Biophysics, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA 23298, USA
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16
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Meinders AJ, Nieuwenhuis L, Ince C, Bos WJ, Elbers PW. Haemodialysis Impairs the Human Microcirculation Independent from Macrohemodynamic Parameters. Blood Purif 2015; 40:38-44. [DOI: 10.1159/000380902] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 02/12/2015] [Indexed: 11/19/2022]
Abstract
Hemodynamic changes during haemodialysis are common. Often these changes are associated with symptoms that are thought to be the result of reduced microcirculatory blood flow and oxygen delivery. The microcirculatory effect of hemodialysis is scarcely researched, though of possible influence on patient outcome. New techniques have become available to visualise and analyse microvascular blood flow. We performed an observational study using Sidestream Dark Field imaging, a microscopic technique using polarised light to visualise erythrocytes passing through sublingual capillaries, to analyse the effect of haemodyalisis on central microvascular blood flow. We showed that there is a substantial impairment of microvascular blood flow and a discrepancy between micro- and macro-vascular parameters.
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17
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Pipili C, Grapsa E, Tripodaki ES, Ioannidou S, Manetos C, Parisi M, Nanas S. Changes in skeletal muscle microcirculation after a hemodialysis session correlates with adequacy of dialysis. Int J Nephrol Renovasc Dis 2015; 8:59-64. [PMID: 26089698 PMCID: PMC4467734 DOI: 10.2147/ijnrd.s68639] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Monitoring of the microcirculation may add additional information in terms of improving the adequacy of hemodialysis (HD) for patients. Withdrawal of liquid and complement activation during a HD session reduces the external pressure on the microcirculation and leads to an increased dilatation of the peripheral capillaries. The purposes of this study were to assess the effect of a single HD or hemodiafiltration session on the thenar microcirculation in patients with end-stage renal disease (ESRD) with or without diabetes, investigate the possible relationship between changes in the microcirculation and adequacy of dialysis (including Kt/V and parameters indicating secondary hyperparathyroidism), and compare microcirculation measurements obtained from patients with ESRD and those from healthy controls. Methods This pilot prospective observational study including eleven patients with ESRD on maintenance HD (nine men of mean age 73±10.5 years, ten [91%] with hypertension), nine patients with ESRD on maintenance hemodiafiltration (six men of mean age 65.5±13.2 years, five [55.5%] with diabetes and four [44.5%] with hypertension), and eight healthy volunteers. Two paired microcirculation assessments were recorded for each HD patient before and after a dialysis session. Near infrared spectroscopy and the vascular occlusion test were used to assess the microcirculation, and blood work samples were collected before and after dialysis when the pump slowed down. Results Patients with ESRD showed an increase in thenar cell metabolism at rest after a 4-hour HD session, and changes in cell metabolism correlated with the Kt/V of the session. Pre-dialysis tissue oxygen saturation over the 4-hour HD session correlated with pre-dialysis serum calcium and parathyroid hormones. Vascular reactivity was lower in ESRD patients receiving HD or hemodiafiltration than in healthy controls. Conclusion Improvement in skeletal muscle microcirculation noted after a HD session was related to adequacy of dialysis. Evaluation of the microcirculation may provide additional information for management of patients on HD and identify novel targets for treatment. These preliminary findings need to be tested using a larger data set.
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Affiliation(s)
- Chrysoula Pipili
- First Critical Care Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini Grapsa
- First Critical Care Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Elli-Sophia Tripodaki
- First Critical Care Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Ioannidou
- Laboratory of Biochemistry, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Manetos
- First Critical Care Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Parisi
- First Critical Care Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Serafim Nanas
- First Critical Care Department, National and Kapodistrian University of Athens, Athens, Greece
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18
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Pierro ML, Kainerstorfer JM, Civiletto A, Weiner DE, Sassaroli A, Hallacoglu B, Fantini S. Reduced speed of microvascular blood flow in hemodialysis patients versus healthy controls: a coherent hemodynamics spectroscopy study. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:026005. [PMID: 24522805 PMCID: PMC3922146 DOI: 10.1117/1.jbo.19.2.026005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 01/08/2014] [Accepted: 01/10/2014] [Indexed: 05/19/2023]
Abstract
We present a pilot clinical application of coherent hemodynamics spectroscopy (CHS), a technique to investigate cerebral hemodynamics at the microcirculatory level. CHS relies on frequency-resolved measurements of induced cerebral hemodynamic oscillations that are measured with near-infrared spectroscopy (NIRS) and analyzed with a hemodynamic model. We have used cyclic inflation (200 mmHg) and deflation of a pneumatic cuff placed around the subject's thigh at seven frequencies in the range of 0.03 to 0.17 Hz to generate CHS spectra and to obtain a set of physiological parameters that include the blood transit times in the cerebral microcirculation, the cutoff frequency for cerebral autoregulation, and blood volume ratios across the three different compartments. We have investigated five hemodialysis patients, during the hemodialysis procedure, and six healthy subjects. We have found that the blood transit time in the cerebral microcirculation is significantly longer in hemodialysis patients with respect to healthy subjects. No significant differences were observed between the two groups in terms of autoregulation efficiency and blood volume ratios. The demonstration of the applicability of CHS in a clinical setting and its sensitivity to the highly important cerebral microcirculation may open up new opportunities for NIRS applications in research and in medical diagnostics and monitoring.
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Affiliation(s)
- Michele L. Pierro
- Tufts University, Department of Biomedical Engineering, 4 Colby Street, Medford, Massachusetts 02155
| | - Jana M. Kainerstorfer
- Tufts University, Department of Biomedical Engineering, 4 Colby Street, Medford, Massachusetts 02155
- Address all correspondence to: Jana M. Kainerstorfer, E-mail:
| | - Amanda Civiletto
- Tufts Medical Center, 800 Washington Street, Boston, Massachusetts 02111
| | - Daniel E. Weiner
- Tufts Medical Center, 800 Washington Street, Boston, Massachusetts 02111
| | - Angelo Sassaroli
- Tufts University, Department of Biomedical Engineering, 4 Colby Street, Medford, Massachusetts 02155
| | - Bertan Hallacoglu
- Tufts University, Department of Biomedical Engineering, 4 Colby Street, Medford, Massachusetts 02155
| | - Sergio Fantini
- Tufts University, Department of Biomedical Engineering, 4 Colby Street, Medford, Massachusetts 02155
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19
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Molinari F, Acharya UR, Martis RJ, De Luca R, Petraroli G, Liboni W. Entropy analysis of muscular near-infrared spectroscopy (NIRS) signals during exercise programme of type 2 diabetic patients: quantitative assessment of muscle metabolic pattern. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2013; 112:518-528. [PMID: 24075080 DOI: 10.1016/j.cmpb.2013.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 06/02/2023]
Abstract
Diabetes mellitus (DM) is a metabolic disorder that is widely rampant throughout the world population these days. The uncontrolled DM may lead to complications of eye, heart, kidney and nerves. The most common type of diabetes is the type 2 diabetes or insulin-resistant DM. Near-infrared spectroscopy (NIRS) technology is widely used in non-invasive monitoring of physiological signals. Three types of NIRS signals are used in this work: (i) variation in the oxygenated haemoglobin (O2Hb) concentration, (ii) deoxygenated haemoglobin (HHb), and (iii) ratio of oxygenated over the sum of the oxygenated and deoxygenated haemoglobin which is defined as: tissue oxygenation index (TOI) to analyze the effect of exercise on diabetes subjects. The NIRS signal has the characteristics of non-linearity and non-stationarity. Hence, the very small changes in this time series can be efficiently extracted using higher order statistics (HOS) method. Hence, in this work, we have used sample and HOS entropies to analyze these NIRS signals. These computer aided techniques will assist the clinicians to diagnose and monitor the health accurately and easily without any inter or intra observer variability. Results showed that after a one-year of physical exercise programme, all diabetic subjects increased the sample entropy of the NIRS signals, thus revealing a better muscle performance and an improved recruitment by the central nervous system. Moreover, after one year of physical therapy, diabetic subjects showed a NIRS muscular metabolic pattern that was not distinguished from that of controls. We believe that sample and bispectral entropy analysis is need when the aim is to compare the inner structure of the NIRS signals during muscle contraction, particularly when dealing with neuromuscular impairments.
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Affiliation(s)
- Filippo Molinari
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy.
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20
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Romagnoli S. Circulatory failure: Exploring macro- and micro-circulation. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2013.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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ROSATI SAMANTA, BALESTRA GABRIELLA, MOLINARI FILIPPO. FEATURE SELECTION APPLIED TO THE TIME-FREQUENCY REPRESENTATION OF MUSCLE NEAR-INFRARED SPECTROSCOPY (NIRS) SIGNALS: CHARACTERIZATION OF DIABETIC OXYGENATION PATTERNS. J MECH MED BIOL 2012. [DOI: 10.1142/s0219519412400131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diabetic patients might present peripheral microcirculation impairment and might benefit from physical training. Thirty-nine diabetic patients underwent the monitoring of the tibialis anterior muscle oxygenation during a series of voluntary ankle flexo-extensions by near-infrared spectroscopy (NIRS). NIRS signals were acquired before and after training protocols. Sixteen control subjects were tested with the same protocol. Time-frequency distributions of the Cohen's class were used to process the NIRS signals relative to the concentration changes of oxygenated and reduced hemoglobin. A total of 24 variables were measured for each subject and the most discriminative were selected by using four feature selection algorithms: QuickReduct, Genetic Rough-Set Attribute Reduction, Ant Rough-Set Attribute Reduction, and traditional ANOVA. Artificial neural networks were used to validate the discriminative power of the selected features. Results showed that different algorithms extracted different sets of variables, but all the combinations were discriminative. The best classification accuracy was about 70%. The oxygenation variables were selected when comparing controls to diabetic patients or diabetic patients before and after training. This preliminary study showed the importance of feature selection techniques in NIRS assessment of diabetic peripheral vascular impairment.
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Affiliation(s)
- SAMANTA ROSATI
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, 10129, Italy
| | - GABRIELLA BALESTRA
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, 10129, Italy
| | - FILIPPO MOLINARI
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, 10129, Italy
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De Blasi RA, Tonelli E, Arcioni R, Mercieri M, Cigognetti L, Romano R, Pinto G. In vivo effects on human skeletal muscle oxygen delivery and metabolism of cardiopulmonary bypass and perioperative hemodilution. Intensive Care Med 2011; 38:413-21. [DOI: 10.1007/s00134-011-2404-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 10/14/2011] [Indexed: 11/28/2022]
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23
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Kastrouni M, Sarantopoulou E, Aperis G, Alivanis P. QUALITY OF LIFE OF GREEK PATIENTS WITH END STAGE RENAL DISEASE UNDERGOING HAEMODIALYSIS. J Ren Care 2010; 36:126-32. [DOI: 10.1111/j.1755-6686.2010.00187.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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